Doctors need to get behind the great food transformation

How do we reduce diet related disease, improve health and feed a global population of 10 billion by 2050 without damaging our planet?

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How do we reduce diet related disease, improve health and feed a global population of 10 billion by 2050 without damaging our planet?   

The Lancet-EAT commission’s recent launch of “Food in the Anthropocene” sets scientific targets to address this challenging question. It concludes that food could be “the single strongest lever to optimise human health and environmental sustainability on Earth”.

However, to achieve this, “a radical transformation of the global food system is urgently required”.

The report outlines the close connections between what we eat, our health, and the health of our planet. Past studies covered similar ground*, but this one points out that we will not meet UN Sustainable Development Goals, or the Paris Agreement to ensure greenhouse gas emissions peak by 2020, under today’s farming and food practices.   

The result of a three-year study, involving 37 experts from 16 countries, the report details the ways our ecosystems are being strained and ruptured by the vast extent of human agriculture across the globe.

Taking up 40% of our land surface, dominated by ruminant livestock, and generating 30% of human greenhouse gases emissions, farming is the major cause of land clearing and species extinction, and is rapidly consuming soil and water.

Food is abundant, but its distribution is so skewed, that of the eight billion people alive today, over two billion are overweight or obese, while two billion are malnourished. There is a diabetes epidemic, yet 200 million children in poorer countries are stunted or wasted, and almost half the world’s grain harvests are fed to cattle. Diet-related lifestyle illnesses are now the major cause of death in wealthy nations.

The report lists five key strategies to achieve a “great food transformation”:

1) Shift towards primarily plant-based diets, and away from meat and sugar; make healthy food cheaper and more available than less healthy alternatives.

2) Repurpose agriculture towards producing diverse, healthy food, not just calories.

3) A new agricultural revolution, based on research and innovation, wiser resource use, species diversity, carbon sequestration, reduced fossil fuel use, and so on.

4) Strong and coordinated governance of land and ocean at all levels, beyond political interference, to ensure there is no further land clearing, that 50% of the Earth is preserved as an intact ecosystem, and that marine life is safeguarded from overfishing. 

5) Reducing overall global food wastage from its current 30%, down to 15%.

The first strategy is simple, powerful and should involve the medical profession; commit to a shift towards healthy diets. The report presents a “planetary diet” that is primarily plant-based, has adequate calories and micronutrients for health, is endlessly adaptable to local geographies and cultures, and eases environmental pressures by reducing animal protein, especially red meat, to 10% of a total daily 2500 kcal for an adult male.

This means the weekly equivalent of one beef burger, a couple of eggs, and two serves of fish, with a daily serve of dairy. The rest of the plate, 90%, is made up of vegetables, fruits, tubers, whole grains, legumes, nuts and seeds.

The biggest meat reductions would be in “protein rich” nations, including Australia, which has some of the world’s heaviest meat consumers at 250gm a day, or 90kg a year; quadruple the amount recommended by conventional nutritional guidelines.

For an average Australian, yearly meat consumption would fall about 80%, from 90kg to around 18kg, with a parallel six-fold increase in beans and lentils.

For those in poorer nations, the 2500kcal/day diet represents a huge improvement in nutrition, reminiscent of the best of local traditional menus. Attention is given to special groups such as children, pregnant women, and those in marginal lands such as sub-Saharan Africa.

Globally there would be a greater than 50% fall in meat and sugar production, and a greater than 50% increase in plant crops for human consumption. As well as being easier on the environment, such a diet is predicted to be healthier at a population level. The report states, “replacing protein from animal sources, with protein from plant sources, was associated with substantially reduced overall mortality”.

The report predicts that following the planetary diet should result in around 20% fewer adult deaths, or around 11 million per year worldwide, from diet-related conditions such as diabetes and IHD. These figures alone make the Lancet-EAT diet worthy of strong public health support.

Generating such changes in the way we grow and consume food is urgent and daunting, but achievable, and doctors have a strong role to play.

In Australia, 60% of adults are overweight or obese, and very few eat the recommended greens, plant fibre and micronutrients.

As doctors, we deal daily with the results of these poor choices; we write a lot of scripts, but are less sure about the diet changes we should be suggesting.

Our study of food and nutrition has languished for too long; it is a major determinant of health, so let’s encourage it back into the medical curriculum, along with training that gives us the skills to assess nutrition from a “planetary” perspective.

We can talk to our colleagues, colleges, unions and dieticians, participate in community education, support local sustainable food growers, and play a part in reducing food wastage, particularly in our hospitals and practices.

Food is life; we can’t do without it, and its infinite variety, attraction and complexity can create confusion around what is best for us. Crowds of celebrity chefs, food gurus and diet advocates, tend to provide contradictory and often unsound advice, while powerful industry groups work through advertising and political lobbying to further their own financial interests.

The Lancet report avoids ideology, brings science to the table, and provides a road map to health and a sustainable future. Despite some accusations, it is not vegan or religious, and it does support meat, just not to the extent that it has dominated our food systems to date.

Already there has been pushback from some sectors, but the science is sound, and in the end the medical profession, public, policy setters and the agriculture and food industry can get behind this transformation.

Recent record-breaking heatwaves, fish kills and ongoing land clearing in Australia show that business as usual is not an option.

Healthy, well fed people on a thriving, sustainable green and blue planet by 2050? Now that is a goal doctors can work towards, starting now.                                                                     

Dr Michael Schien is a Newcastle based procedural GP, a member of Doctors for the Environment Australia, and has a farm on the NSW Mid North Coast