Integrating sustainability competences in nutrition education^{(53–Reference Michel, Brundiers and Barth57)}

Nutrition education can be understood as ‘that provided by institutions of higher education based on state-of-the-art research’^{(Reference Perez-Cueto, Brennan and Laitinen58)}.

Sustainability competences are defined as ‘the interlinked set of knowledge, skills, attitudes and values that enable effective, embodied action in the world with respect to real-world sustainability problems, challenges and opportunities, according to the context’^{(Reference Bianchi54)}. Given the complexity of the food system and its impact on the environment^{(Reference Godfray, Aveyard and Garnett59–Reference Springmann, Clark and Mason-D’Croz61)}, it is crucial that nutrition students and practitioners develop competences that equip them for a changing world and empower them to be agents of change and supporters of populations through transitions to sustainable healthy diets.

Consensus has been growing around five key sustainability competences in higher education^{(Reference Bianchi54–Reference Brundiers, Barth and Cebrián56)}, which are the framework for this review and together provide critical thinking: strategic (or strategic action-oriented) thinking⁽⁵³⁾, systems thinking, values thinking, futures thinking and interpersonal competences.

Sustainability competence in nutrition education involves integrating systems thinking in order to understand the interconnectedness of food systems^{(Reference Crippa, Solazzo and Guizzardi7)}, recognising financial conflicts of interest that affect research, education, practice and policy around food^{(Reference Ludwig, Kushi and Heymsfield49)} and addressing such complexity through evidence-based solutions^{(Reference Obbagy, Raghavan and English62,Reference Johnston, Seivenpiper and Vernooij63)} .

Strategic thinking emphasises acknowledging the historical roots of the current food system, including the enduring influence of colonialist principles^{(Reference Earle64–Reference Oyoo, Shilabukha and Otieno66)}. It also requires a respectful understanding that many so-called ‘new approaches to resilience’^{(Reference Shwaikh67)}, or ideas of rediscovering the value of natural resources, are in fact based on the long-standing traditions and modes of knowing of indigenous peoples^{(Reference Guinto and Holley28,Reference Willows, Blanchet and Wasonti:io Delormier68,Reference Engebretsen and Baker69)} . Planning innovative strategies for sustainable diet transitions can no longer involve following a top-to-down approach; instead, it must emerge from inclusive societal conversations held between equals^{(Reference Kaljonen, Kortetmäki and Tribaldos26,Reference Guinto and Holley28,Reference Aschemann-Witzel, Mulders and Janssen70)} .

Values thinking involves evaluating actions based on ethical principles and personal beliefs^{(Reference de Gavelle, Davidenko and Fouillet71)}, along with the long-term consequences of these^{(Reference Plechatá, Morton and Perez-Cueto72–Reference Syropoulos, Law and Young74)}, in order to empower individuals to drive change. It aims to do this in spite of any potential misalignments between private, for-profit interests and public-health ones^{(Reference Coyle, Little and Williamson75)}. Futures thinking anticipates climate-driven food scenarios, blending traditional knowledge with technology in order to facilitate proactive decision-making^{(Reference Biesbroek, Kok and Tufford38,Reference Swinburn, Kraak and Allender76)} . Interpersonal competences foster collaboration^{(Reference Kanter and León Villagra77)}, moving from a paternalist concept of inclusion to a praxis of decolonising the food system^{(Reference Guinto and Holley28)}. They help individuals to show empathy to both human and non-human^{(Reference Bryant, Prosser and Barnett78)} victims of oppression and inequality^{(Reference Northrope, Howell and Kashima79)}, to address challenges such as cognitive dissonance^{(Reference Makransky and Petersen80–Reference Bentler, Kadi and Maier82)} and climate anxiety^{(Reference Hickman, Marks and Pihkala83)} and to co-create solutions to food insecurity and dietary transitions^{(Reference Rosegrant, Sulser and Dunston84–Reference Sandström, Valin and Krisztin86)}.

Some of these competences are not easily measurable and may be considered ‘soft’ or to relate to values thinking or interpersonal competences. Such competences may be ‘practiced’ in group work and collaboration. Ultimately, it is the task of the nutritionist to integrate them in their day-to-day activities, as an empowered agent of change.

Climate change affects health both directly and indirectly. The former effects include floods, fires, heatwaves and droughts^{(Reference Grant, Vanderkelen and Gudmundsson87)}, and the latter crop failures^{(Reference Meza, Darbyshire and Farrell88)}, declining marine food supply chains^{(Reference Kasihmuddin, Cob and Noor89)}, and disease-vector expansion^{(Reference Di Napoli, McGushin and Romanello90)}. Food availability is expected to become uncertain and unreliable over the next decades due to the aforementioned direct and indirect effects of climate change^{(Reference Nelson, Cheung and Bezner Kerr91)}. In some places foods such as legumes are expected to lose their nutritional content, while in others they may improve, albeit for a short while; similarly, cereals are likely to be impoverished of their nutritional value^{(Reference Swinburn, Kraak and Allender76,Reference Macdiarmid and Whybrow92)} . Therefore, future nutritionists must be able to navigate food security in a manner that goes beyond ‘business as usual’^{(Reference Macdiarmid and Whybrow92)}.

The coming challenge for nutrition education is to teach and mentor students in practical ways, so that they are able to meaningfully engage in mitigation actions: first, by practicing and promoting healthy, sustainable dietary behaviours that are proven to be effective^{(Reference Kim, Caulfield and Rebholz19,Reference Kim and Rebholz93–Reference Nagra, Tsam and Ward97)} ; second, by equipping them with sustainability competences so that they can be agents of change within their spheres of influence, e.g., providing advice to families or individuals seeking to change their eating habits^{(Reference Koeder and Perez-Cueto43,Reference Agnoli, Baroni and Bertini98,Reference Barbour, Bicknell and Brimblecombe99)} , or evidence to policy-makers^{(Reference Obbagy, Raghavan and English62,Reference Johnston, Seivenpiper and Vernooij63,Reference Abrahamse100)} ; and third, by cultivating a set of competences beyond those acquired through factual knowledge and scientific evidence^{(Reference Friedman101)}, acknowledging and integrating other modes of knowing and being human that go beyond the limits imposed by capitalism and adjacent ideologies^{(Reference Wiek, Withycombe and Redman55,Reference Redman and Wiek102)} .

Examples of integrating sustainability into dietary guidelines

Worldwide, health eating is generally considered to involve a high intake of foods of plant origin, such as fruits, vegetables, pulses, nuts and cereals, along with a low or limited intake of animal-sourced foods (ASF)^{(Reference Hu103–Reference Franchi, Orsini and Cantelli106)}. Such diets are also encouraged on the basis of their relatively low environmental footprint^{(Reference Chai, van der Voort and Grofelnik5,Reference Fresán, Craig and Martínez-González107)} . Three examples of the integration of sustainability into dietary guidelines are the EAT-Lancet Commission’s Planetary Health Diet (PHD), the Nordic Nutrition Recommendations 2023 (NNR2023) and the Mediterranean diet (MD).

The use of sustainability competences addresses the criticism of sustainable diet shifts

Similar strategies as those employed by the tobacco^{(Reference Reed, Hendlin and Desikan131)} and fossil fuel industries^{(Reference Gertrudix, Carbonell-Alcocer and Arcos132,Reference Goldberg and Vandenberg133)} are being used in the domains of food, nutrition and the diet shift to undermine public-health interests^{(Reference Moodie134–Reference Rogers, Wilkinson and Downie136)}. In this context, a non-exhaustive list of the tactics used to discredit or counteract public-health research and priorities has been presented, with the items grouped into seven categories^{(Reference Moodie134)}. These tactics are systematically applied by the opponents of sustainable healthy diet recommendations, as is discussed below.

Describing individual cases of the use of disinformation playbooks^{(Reference Gertrudix, Carbonell-Alcocer and Arcos132)} or manuals^{(Reference Reed, Hendlin and Desikan131)} in the field of nutrition provides a framework to empower public-health nutrition practitioners with systems and strategic-thinking competences. Further, it facilitates the identification of discourses that apply these tactics – whether intentionally or not – which can be further utilised by interested stakeholders. This requires a strong understanding of the complex, interlinked processes throughout the food chain and the policies that facilitate sustainable food and nutrition⁽¹³⁷⁾ and awareness of the financial conflicts of interest^{(Reference Tani, Fujiwara and Anzai44,Reference Choffnes, Relman and Olsen45,Reference Kraak and Aschemann-Witzel129)} and financial interests at stake around food recommendations^{(139–Reference Mosley141)}. Ultimately, critical thinking and understanding of how various actors along the food chain implement their playbooks are key to navigating the current, rapidly changing area of nutrition and public health^{(Reference Feigin, Wiebers and Blumstein142)}.

Furthermore, nutritionists need to be familiar with so-called ‘wicked problems’^{(Reference Lönngren and van Poeck143)}, which are typically characterised by a diversity of opinions and generate a cacophony of contradictory messages^{(Reference Willett, Rockström and Loken17,Reference Beal, Ortenzi and Fanzo144–Reference Klapp, Wyma and Alessandrini146)} . Being critical of such messages, which today are often spread on social media^{(Reference Rogers, Wilkinson and Downie136,Reference Fleming-Milici and Harris147)} , requires applying strong systems and values thinking, as much of the chaos of messaging results from (dis)information produced by interested actors^{(Reference Carter148–Reference Muhammed and Mathew150)}.

Analysis of the criticism of the EAT-Lancet Commission’s PHD

Before, during and after its launch, the PHD faced criticism, primarily online. Days prior to its release, a strong communication campaign called yes2meat was frequently tweeted about and peaked in popularity shortly after the publication of the PHD. This resulted in a strong sentiment against the PHD online^{(Reference Garcia, Galaz and Daume151)}. All of these online actions against the PHD can be considered to be the result of the application of the ‘fund industry disinformation campaigns’ tactic. Although it was broadly accepted by the scientific community and used as a standard for local improvements^{(Reference Lassen, Christensen and Trolle110,Reference Sharma, Kishore and Roy111)} , soon after its publication the PHD faced an array of responses that exemplified disinformation tactics^{(Reference Moodie134,Reference Carter148)} .

Later, some criticism came from the scientific community^{(Reference Beal, Ortenzi and Fanzo144,Reference Magkos, Tetens and Bügel152,Reference Brønnum, Jensen and Schmidt153)} : despite the PHD being significantly associated with reduced odds of chronic diseases such as type 2 diabetes^{(Reference López, Batis and González154)}, CVD and cancer, along with a general reduced mortality^{(Reference Di Napoli, McGushin and Romanello90,Reference Stubbendorff, Stern and Ericson112,Reference Liu, Shen and Wang155)} , a central element in discourses against the PHD – and any other dietary lifestyle that entails a reduction in ASF – was a focus on nutrients and potential risk of nutrient deficiencies^{(Reference Beal, Ortenzi and Fanzo144,Reference Magkos, Tetens and Bügel152)} . This reductive approach can be classified as ‘manufacturing false debate’, in that attention was redirected towards nutrient density and downplaying the environmental effects of ASF reduction. This move is often the first that is made and is most likely to be well received by well-intentioned nutritionists and dietitians who care for vulnerable populations and fight against malnutrition in their day-to-day practice^{(Reference Koeder and Perez-Cueto43,Reference Agnoli, Baroni and Bertini98,Reference Barbour, Bicknell and Brimblecombe99)} . The next element is ‘framing key issues in creative ways’, e.g suggesting that the dietary shift is too expensive^{(Reference Hirvonen, Bai and Headey109)}, difficult to implement practically^{(Reference Micheelsen, Havn and Poulsen156–Reference Lea, Crawford and Worsley159)} or unattainable or elitist^{(Reference Micheelsen, Holm and O’Doherty Jensen160)}. Another common framing is to focus on the level of processing, as many plant-based foods can be categorised as ultra-processed^{(Reference Nagra, Tsam and Ward97,Reference Ohlau, Spiller and Risius161)} ; however, such argument cannot be used to discourage the consumption of plant-based foods based on processing level, as the available evidence only supports its healthier role when compared to the ASF that they replace^{(Reference Ohlau, Spiller and Risius161–Reference Cordova, Viallon and Fontvieille163)}.

Of course, preventing malnutrition in all its forms is of undeniable importance, particularly as regards disadvantaged groups^{(Reference Willits-Smith, Aranda and Heller164)}. However, in the context of the global food system, where food overproduction has led to a two-thirds increase in available energy for consumption as compared to the 1960s^{(12,Reference Bentham, Singh and Danaei165)} , the risk of nutrient deficiencies due to a transition to a plant-rich diet is unlikely, with the exception of Vitamin B12^{(Reference Koeder and Perez-Cueto43)}, which is relevant across dietary lifestyles. Preventing malnutrition in all its forms can be achieved through a plant-rich diet, which has the capacity to be both more environmentally friendly and less expensive than the typical diet^{(Reference Kim, Caulfield and Rebholz19,Reference Broeks, Biesbroek and Over166,Reference Springmann, Dinivitzer and Freund167)} .

Analysis of the criticism of the NNR2023

The implementation of the NNR2023 in multiple Scandinavian countries is an example of how private-sector interests override those of the public. By applying textbook practices to undermine public-health policy^{(Reference Moodie134,Reference Carter148,Reference Wood, Swan and Masino168,Reference Clare, Maani and Milner169)} , the food sectors that were the more affected by the NNR2023 developed a large set of discourses to water down the recommendations and cast doubt on them and require more ‘evidence’ regarding the potential impact of such reduction on nutrient availability, social sustainability, preparedness and the economic impacts to the food industry of reducing meat in the countries^{(135,Reference Wood, Swan and Masino168)} .

Similar to how it was framed in the UK^{(Reference Clare, Maani and Milner169)}, in the Nordics four main themes were dominant. First, the ‘still open for debate’ principle, which closely follows the tactic ‘attack on legitimate science’ by insisting on or exaggerating the uncertainty within or questioning the quality of current knowledge. Second, the ‘most people must not worry’ principle, and third, ‘keep eating meat to be healthy’; here, while admitting that there are some problems with the traditional approach, a focus is placed on minimising the dangers to health and the environment of ASF consumption as part of the overarching tactic of ‘framing key issues in highly creative ways’. This framing included concentrating on the nutrients provided by meat^{(Reference Rochell Wood, Swan and Masino170)}, downplaying the negative health implications of meat consumption^{(Reference Bouvard, Loomis and Guyton171–Reference Dominguez, Bes-Rastrollo and Basterra-Gortari174)}, vilifying plant-based foods as nutritionally insufficient despite their positive impacts on health^{(Reference Satija and Hu175–Reference Hemler and Hu177)} and neglecting the positive impact of plant-based foods on the environment^{(Reference Chai, van der Voort and Grofelnik5,Reference Biesbroek, Kok and Tufford38,Reference Kraak and Aschemann-Witzel129)} .

As a result of the pressure by different actors^{(Reference Wood, Swan and Masino168)} implementing the tactic of ‘influencing the political agenda’, Norway’s implementation of the NNR2023 will only focus on health⁽¹⁷⁸⁾, despite efforts to align its guidelines to environmental goals^{(Reference Lengle, Lengle and Zhang179)}. This weakens the message of reducing red-meat consumption far below the upper limit of 350 g/week for environmental reasons. At the end of 2024, the Swedish government issued a request to the Livsmidelverket (the National Food Agency) to ‘re-evaluate’ the health, nutritional and economic aspects of reduction in red-meat consumption at a population level^{(Reference Wood, Swan and Masino168)}, based on the arguments outlined above^{(Reference Wood, Swan and Masino168,Reference Rochell Wood, Swan and Masino170)} . A final recommendation was issued in spring 2025 where the upper limit of 350 g/week of red meat and meat products is retained, albeit with the explanation that it corresponds to 400–500 g/week before cooking, and to consume a small portion of charcuterie⁽¹⁸⁰⁾.

Analysis of the criticism of the Mediterranean diet’s sustainability

Criticism of the MD is generally an example of the anticipatory-thinking or future-thinking competence, as most focuses on food safety. Due to its richness in foods of plant origin, the potential exposure to residues of pesticides and herbicides is high^{(Reference Baudry, Neves and Lairon181)}. Similar assessments have been made for other predominantly plant-based dietary lifestyles^{(Reference Kesse-Guyot, Allès and Brunin182)}, although such exposure is lower among vegetarians as they are more likely to consume organic produce^{(Reference Baudry, Rebouillat and Allès183)}. Nevertheless, it is foreseeable that arguments against transitioning to predominantly plant-rich dietary lifestyles, including vegetarianism and veganism, would involve discussion of health risks due to exposure to residuals of pesticides and herbicides.

Considerations for future dietary guidelines

It has been suggested that the next generation of guidelines should consider ecological, economic, human-health and socio-political dimensions with a plant-forward perspective^{(Reference Klapp, Wyma and Alessandrini146)}. This review suggests that, if future dietary guidelines are to be formulated by nutritionists applying sustainability competences, three additional aspects should be taken into account: freedom from financial conflicts of interest, a decolonised approach and participatory processes.

Freedom from financial conflicts of interest

The question ‘who funds nutrition research?’ seems almost impossible to answer. Most notably, it is hard to trace the funding to nutrition-related fields through public schemes like Horizon Europe, as most of the calls require multi-actor approaches and multi-disciplinarity. Consequently, nutrition-related research is embedded in larger projects that constitute a context for interaction between private and public-sector actors^{(Reference Cullerton, Adams and White50)}. Furthermore, most countries have their own national research councils, with different agendas that may or may not include food or nutrition^{(Reference Perez-Cueto, Brennan and Laitinen58)}.

Yet, private companies, usually very large ones, also fund nutrition research^{(Reference Ludwig, Kushi and Heymsfield49)}. In many cases such research is focused on the benefits that a given product or substance has on human health and is conducted in order to subsequently use those benefits within a marketing strategy^{(Reference Nestle184)}. Private funding, however, generates conflicts of interest^{(Reference Moore, Straus and Lexchin138,Reference Luce185,Reference Webb, Menard and Hofmann186)} , and these can permeate dietary guidelines^{(Reference Mialon, Serodio and Crosbie187)}. Conflicts of interest^{(Reference Cullerton, Adams and White50,Reference Cullerton, Adams and Forouhi51)} can be dealt with in different ways, including by compulsory declarations^{(Reference Harris, Carriedo and Freire188)}, codes of conduct^{(Reference Saririan, Bhamidipati and Dey189)} and value-based statements, as proposed recently^{(Reference Penders, Bordoni and Daniel190)}.

A decolonised approach

As a result of the present reflection, a step further is proposed: decolonisation. Decolonising nutrition and dietary guidelines is inscribed within the broader calls to decolonise academic research^{(Reference Guinto and Holley28,Reference Willows, Blanchet and Wasonti:io Delormier68)} and public health^{(Reference Engebretsen and Baker69,Reference Forsberg and Sundewall191)} . Applying strategic thinking’s understanding of the historical roots of the food system^{(Reference Choffnes, Relman and Olsen45)}, it is possible to infer that nutrition and diet have been and are used as tools for imperialism and settler colonialism^{(Reference Earle64,Reference Mamani Huallco65)} .

Parallels can be drawn between colonialist discourses and some current food guidelines. By stigmatising indigenous foods and praising those of colonisers, the rhetoric of superior vs. inferior has been applied to systematically denigrate indigenous foods and cultures, while replacing them with the dietary patterns of the settlers. Examples include quinoa and llama meat in South America^{(Reference Mamani Huallco65)}, vegetables and amaranth in Africa^{(Reference Oyoo, Shilabukha and Otieno66)} and reindeer and foraged herbs and vegetables in Northern Europe^{(Reference Nilsson192)}.

ASFs, which are common in the Western diet, have been presented as aspirational and linked to high socioeconomic status, and their industrial production means that they are cheaply available^{(Reference Wills, Backett-Milburn and Roberts193,Reference Morris, Kaljonen and Aavik194)} . Moreover, for many people ASFs are associated with the concepts of masculinity, power and strength, which are also colonialist concepts^{(Reference Rothgerber195)}.

Economic interests shape food availability through food aid, which in reality is often a dumping practice that eventually destroys local production^{(Reference Prudencio and Franqueville196)} and creates unjust dependencies. Moreover, in both industrialised and developing countries, edible crops have been given to animals as feed instead of to humans, an inefficient method of food production. This practice exacerbates global food insecurity, as it reduces the amount of food available for people even though, in theory, there is enough food to feed everyone^{(Reference Crippa, Solazzo and Guizzardi7,Reference Nelson, Cheung and Bezner Kerr91,Reference Klapp, Wyma and Alessandrini146,Reference Klapp, Feil and Risius197)} . Consequently, the number of hungry people in the world has not diminished, highlighting the systemic inefficiencies and inequities in the global food system^{(Reference Klapp, Wyma and Alessandrini146)}.

Dietary guidelines reflect the economic priorities of the industrialised West; hence, ‘comparable’ food groups have been created and guidelines issued containing globalised items^{(Reference Klapp, Feil and Risius197)}. The nutrition transition, wherein Western diets were adopted to the massive detriment of both traditional diets^{(Reference Hawkes198–Reference Tapia, Gandarillas and Alandia201)} and human health, was one of the results of this.

Future dietary guidelines must move away from advocating for changes ‘within the neo-liberal capitalist framework we live in’^{(Reference Willows, Blanchet and Wasonti:io Delormier68,Reference Engebretsen and Baker69,Reference Figueroa-Helland, Thomas and Aguilera140)} , into a transformational framework that recognises the historical roots of the food system^{(Reference Earle64,Reference Mamani Huallco65,Reference Montford202,Reference Carson203)} , where the cruelty of the slaughterhouse^{(Reference McKeown and Dunn204)} and the violence of erasing food cultures and ancestral food knowledge^{(Reference Guinto and Holley28,Reference Mosley141,Reference Hawkes199,Reference Nilsson, Dahlgren and Johansson205)} are no longer hidden behind a technical discourse about nutrient availability^{(Reference Beal, Ortenzi and Fanzo144)}. Decolonised future dietary guidelines should incorporate the nutritional needs of different population groups and provide knowledge regarding how to eat healthily^{(Reference Koeder and Perez-Cueto43,Reference Agnoli, Baroni and Bertini98,Reference Barbour, Bicknell and Brimblecombe99)} and nourish children^{(Reference Weder, Hoffmann and Becker206)}, adults^{(Reference Springmann145,Reference Raj, Guest and Landry207)} and older people^{(Reference Grasso, Hung and Olthof208)} in a healthy and sustainable manner.

Co-created and participatory

Healthy eating has previously been approached either from a ‘top-down’ perspective, through public-sector guidelines and recommendations^{(Reference Mukamel, Haeder and Weimer209)}, or unilaterally by the industry sector, e.g. through reformulation of products⁽²¹⁰⁾. Both approaches have resulted in very little success^{(Reference Canuto, Garcez and Souza211)}, exhibited an absence of comprehensive and systems thinking^{(Reference Kugelberg, Bartolini and Kanter212)} and demonstrated limited active involvement of lay citizens, citizen-group representatives and advocates in decision-making processes^{(Reference Brown, Hermoso and Timotijevic213)}.

The investments of EU countries in promoting healthy eating have returned poor results. Only a small fraction of Europeans complies with healthy-eating guidelines^{(Reference Bechtold, Spahic and Sommer214)}; everyday social life and practicalities, established norms and conventions, lay beliefs about the nutritional and satiating capacity of plant-based foods^{(Reference Onwezen, Bouwman and Reinders33)} and gendered beliefs that men should eat meat^{(Reference Klapp, Wyma and Alessandrini146)} may be reasons behind the relative lack of societal change^{(Reference Micheelsen, Havn and Poulsen156)}.

Decolonising the field of nutrition will require that dietary guidelines be issued following proper consultation and that these consultations have a participatory approach^{(Reference Guinto and Holley28,Reference Willows, Blanchet and Wasonti:io Delormier68)} . The transparency and rigour with which the NNR2023 was developed^{(Reference Christensen, Arnesen and Andersen114)} show that it is possible to produce evidence-based guidelines after consultation with different stakeholders and to maintain the integrity of scientists. However, if the field of nutrition is to decolonise itself, ‘connected to anti-colonial, anti-capitalist and anti-imperial action’ ^{(Reference Engebretsen and Baker69)}, our praxis should be more than an academic exercise of inclusion and instead be a constant practice of partnering on equal grounds with communities and citizens to define nutrition-related solutions, in the form of guidelines.