Tuesday Apr 02, 2019
EAT-Lancet Recommendations Have Value, but Are They Feasible?
For a long time, I've wondered what the physician's role in combating climate change looks like. After all, climate change is predicted to bring horrific consequences for population health, including food insecurity; water insecurity; resource-based conflicts; forced migration; spread of infectious diseases and worsening air quality that impacts respiratory, cardiovascular and mental health. As a result, I view environmental advocacy as an extension of my work as a physician.
The AAFP does its part by setting policy on this topic and as a member of the Medical Society Consortium on Climate and Health.(medsocietiesforclimatehealth.org) But those are big-picture, organizational efforts. As an individual doctor, how thrilling would it be to advocate for sustainability from inside the exam room by recommending a diet that not only improves the health of my patients, but also the health of the planet?
The Lancet, in conjunction with EAT, a nongovernmental advocacy group based in Norway, put together a commission(eatforum.org) boasting "more than 30 world-leading scientists from across the globe" who share the goal of developing recommendations for a sustainable, healthy diet supported by a sustainable food system.
The EAT-Lancet report asks us to fundamentally shift how we view food and the system in which it is produced, consumed and disposed. The report delineates recommendations at the global policy level, such as getting international and governmental support to increase free trade, remove farming subsidies, decrease livestock production, reclaim unused pasture land, improve governance of land and water, decrease food waste,(www.washingtonpost.com) and promote healthy plant-based diets. Canada's new food guide(nationalpost.com) offers one example of this last topic; it encourages a diet composed of 50 percent fruits and vegetables, 25 percent protein (with an emphasis on plant-based proteins) and 25 percent whole grains.
A considerable portion of the 46-page EAT-Lancet report describes its "planetary health diet," which is high in plants and whole grains and low in animal products and processed foods. Each macronutrient is painstakingly broken down to the gram in a targeted "reference diet."
Reference ranges for each food group in the report's diet are aggregated on an international level and compared with current regional food consumption. Overall, the report promotes a significant increase in consumption of vegetables, fruits, whole grains, legumes and nuts, and a 60 percent decrease in red meat and starchy vegetable consumption worldwide.
Predictably, the report has been criticized by animal agriculture lobbyists. But for me, the emphasis on decreasing meat isn't the drawback. After all, there is consensus within the scientific community that decreased red meat production and consumption could help mitigate the effects of climate change. And it's not just about the methane.(www.nytimes.com) Livestock production is energy-intensive and requires high volumes of water, as well as large swaths of land for pasture and feed production (beautifully depicted in this infographic(www.bloomberg.com)) that could be used to produce nutritious human food instead.
Even then, the report is fairly balanced when it comes to meat consumption. After all, it acknowledges that animal protein, such as red meat, is a crucial source of nutrition in resource-scarce areas and among more vulnerable populations, including pregnant and breastfeeding women, children, and individuals with dietary restrictions due to chronic medical conditions.
The greatest weakness of the planetary health diet is its prescriptive nature, seemingly devoid of underrepresented voices. The report itself is peppered with caveats acknowledging local food cultures and individual dietary needs. However, neither the report nor the star-studded launch at the UN felt inclusive of all backgrounds, cultures and socioeconomic statuses. For example, a primer on the planetary health diet for health professionals(eatforum.org) published on the EAT-Lancet Commission website provides facts and data about why this diet would theoretically be beneficial, but gives no thought to the barriers people face in implementing these dietary changes.
EAT's Instagram account(www.instagram.com) displays a series of gorgeous, well-lit photos of mostly vegan, vegetarian and pescatarian dishes from prominent food bloggers. In addition to these recipe ideas, I'd love to see photos of cooks around the world at home serving authentic or slightly modified traditional meals to fit the planetary health diet, as well as of people who live normal lives but still eat healthy while decreasing their carbon footprint.
I admire the EAT-Lancet Commission's push to simultaneously adopt nutritious plant-based diets and sustainable food systems with the goal of minimizing the effects of climate change. But my ability to recommend a diet depends on my patients' day-to-day experiences, and patients vary widely in their ability to access affordable, nutrient-rich foods.
Despite knowing this, I still advise most of my patients to avoid prepackaged, processed foods; adhere to portion control; eat a variety of vegetables and fruits; drink plenty of water; choose complex whole grains instead of simple carbohydrates or sugar; and get sufficient protein through plant or animal sources.
However, to support the EAT-Lancet report fully, I need to know that EAT and the EAT-Lancet Commission are thoughtful in their approach to implementing these recommendations globally. We need to meet people where they are, whether they are avid meat eaters, have no time to prep healthy meals, or just can't afford or can't access nutrient-rich food. Essentially, all my patients need to find these recommendations both relatable and feasible to incorporate them in small, albeit meaningful, ways. After all, regardless of background, culture or socioeconomic status, we all need to be on board to improve not only our own health, but the health of the planet, as well.
Lalita Abhyankar, M.D., M.H.S., is a family physician practicing in New York City. You can follow her on Twitter @L_Abhyankar.(twitter.com)
Posted at 01:14PM Apr 02, 2019 by Lalita Abhyankar, MD, MHS