An Exploration of U.S. Nutritional Diet Policies: A Narrative Review for Transformation Toward Sustainable Food Systems

Abstract

Background: Current food systems contribute significantly to poor public health and environmental degradation. With increasing rates of chronic disease and undernutrition globally and in the United States of America (U.S.), transforming food systems toward sustainability is a critical public health priority. Objectives: This narrative review aimed to summarize U.S. policies from the past decade relevant to sustainable food systems, focusing on four domains—availability, accessibility, affordability, and desirability—proposed by the 22nd Annual Harvard Nutrition Obesity Symposium. Methods: Systematic searches were conducted using MEDLINE (PubMed), Scopus, U.S. Congress websites, and Google searches. Studies and policies published between 2013 and 2023 that addressed at least one of the four domains were included. Policies were reviewed according to their alignment with the policy lifecycle framework, encompassing formulation through implementation. Results: A review of the final 632 articles explained that, despite growing interest in sustainable food systems, there is a lack of comprehensive U.S. policies that address the four domains in an integrated manner. Most initiatives were limited in scope, often school-based, and not explicitly sustainability-focused. Food availability and accessibility policies exist but remain fragmented, while affordability and desirability domains are severely underrepresented. Few laws or bills have been enacted or evaluated for population-level or environmental outcomes. Conclusions: Transforming U.S. food systems requires more robust evidence-based policy development and evaluation. There is an urgent need for integrated multisectoral policy frameworks to ensure health, equity, and sustainability across all food system domains.

1. Introduction

Food systems impact diet, nutrition, and population health outcomes [1]. Around the world, more than two billion people are micronutrient-deficient, 151 million children are stunted, 51 million children are wasted, and over 820 million people worldwide continue to be undernourished [2]. At the same time, in the last 30 years, many countries have undergone the nutrition transition [3]. This means that, as the countries have become more urbanized and industrialized, their traditional eating patterns have changed to diets high in sugars, fats, sodium, and ultra-processed meats, accompanied by decreased physical activity [3]. This transition has led to approximately two billion adults becoming overweight or obese, and the prevalence of non-communicable diseases such as diabetes, cardiovascular diseases, and cancer has more than doubled in the last 30 years [2]. Chronic diseases account for more than 70% of the deaths worldwide [4]. According to the Centers for Disease Control and Prevention (CDC), 41.9% of American adults are overweight or obese [5]. Moreover, 60% of adults have one or more chronic diseases, which are the leading causes of death and disability in the United States [6]. In addition to the human health emergency, traditional food production practices, characterized by intensive farming methods and reliance on fossil fuels, have imposed significant strains on natural resources, including land, water, and biodiversity [7,8]. Moreover, these practices contribute substantially to more than 30% of greenhouse gas emissions, exacerbating climate change and threatening the stability of ecosystems worldwide [7,8].

Most researchers agree that the current food systems must be drastically changed to ensure food security and nutrition for the world’s growing population [2,9], which is expected to reach over 10 billion people by the year 2050 [10]. Food systems are defined as all elements and activities that intervene in the production, processing, distribution, preparation, and consumption of food [2]. Thus, the interconnectedness of food systems with the health of the planet and people’s health necessitates a paradigm shift towards more sustainable approaches to food production, distribution, and consumption. However, another element that needs to be considered is the price of healthy diets. The cost of obtaining a nutrient-rich diet exceeds the available income of three billion people worldwide [3]. Healthier diets are more expensive because they are more arduous to cultivate, store, and transport [3]. The high prices of healthier diets are associated with food insecurity and an increase in the burden of non-communicable diseases [3]. In 2022, more than 12% of households in the United States were food insecure, making it more challenging to have access to healthy food [11]. Additionally, the economic burden, physical access, and availability of fresh produce affect the capability of healthy eating [3].

Sustainable Healthy Diets are defined as dietary patterns that promote all dimensions of people’s health and well-being [12]. Food systems need to be changed to provide everyone with a sufficient, nutritious, desirable, and safe diet. They also need to reach the right levels of availability, accessibility, and affordability [2,3,7]. Simultaneously, these diets ought to come from resilient and sustainable food systems that support just and equal livelihoods and have a positive impact on the environment [2,3,7]. Promoting sustainable and healthy eating habits is a significant task for policymakers [7,9]. Sustainable nutrition policies serve as a crucial framework to address these multifaceted challenges, offering pathways to safeguard both the planet and human health for present and future generations. Sustainable nutrition policies advocate holistic approaches that prioritize environmental stewardship, promote regenerative agricultural practices, reduce food waste, and preserve biodiversity [13]. By embracing sustainable agriculture and resource-efficient food production systems, these policies aim to mitigate environmental degradation and build resilience to the impacts of climate change [14]. By fostering food environments that encourage the consumption of plant-based foods, whole grains, fruits, and vegetables, these policies have the potential to improve public health outcomes while simultaneously reducing the environmental footprint of food production and consumption [2,3]. This narrative review aimed to provide a comprehensive overview and summarize the existing United States evidence on policy initiatives related to sustainable diets and nutrition. This objective encompasses at least one aspect of the four domains of transformation necessary across food systems proposed by the 22nd Annual Harvard Nutrition Obesity Symposium.

2. Materials and Methods

2.1. Study Design

A narrative review was conducted for this study. A narrative review provides an overview of the facts and previously published works related to a particular subject. They are typically instructive, thematic, non-quantitative, and, when appropriate, opinionated [15]. The narrative approach is useful because it summarizes the history and development of the phenomenon under study [16]. The advantages of a narrative review include compiling earlier research, summarizing, pointing out gaps or omissions, and producing new ideas by discovering connections that were previously undiscovered and obscure [17]. A narrative review of literature and policy documents from 2013 to 2023 was conducted using PubMed, Scopus, the U.S. Congress website, and Google searches. The inclusion criteria focused on U.S.-based policies relevant to sustainable food systems across four domains: availability, accessibility, affordability, and desirability.

Aim and Research Questions

The objective of this narrative review is to explore and synthesize policy initiatives related to sustainable diets in the United States through the lens of four key domains. Specifically, this review seeks to answer the following questions.

(1)

What federal policies currently exist in the U.S. that address sustainable food availability, accessibility, affordability, and desirability?

(2)

To what extent have these policies incorporated both public health and environmental sustainability?

(3)

What are the gaps in existing policy efforts and what recommendations have been proposed in the literature?

2.2. Definitions of Key Food Security Dimensions

2.2.1. Food Availability

Food availability refers to the physical presence of food in a region or area through its production, distribution, and exchange. This includes food supplied through domestic production, imports, food aid, and market access. The Food and Agriculture Organization of the United Nations (FAO) defines food availability as “the availability of sufficient quantities of food of appropriate quality, supplied through domestic production or imports (including food aid)” [18].

2.2.2. Food Accessibility

Food accessibility is the ability of individuals and households to obtain appropriate foods for a nutritious diet through means such as purchasing, bartering, or home production. This reflects both physical and economic access to food. According to the FAO, food accessibility “is ensured when all individuals have access to adequate resources for acquiring appropriate foods for a nutritious diet” [18].

2.2.3. Food Affordability

Food affordability refers to the economic capacity of individuals or households to purchase nutritious food without compromising other basic needs. They are often influenced by food prices, income levels, and economic policies. The United States Department of Agriculture (USDA) considers affordability as “the ability of consumers to purchase healthy food without undue financial burden.” [19,20].

2.2.4. Food Desirability

Food desirability encompasses individual and cultural preferences for food, including taste, familiarity, cultural significance, and the perception of quality. It affects whether available and accessible food is actually chosen and consumed depending on consumers’ food preferences and purchasing power. This is the least studied domain of food environments [21].

2.3. Search Strategy

An electronic search of the PubMed^® and Scopus^® databases was conducted to identify research studies published between January 2013 and December 2023. Research years were chosen based on the relatively new rising interest in creating sustainable food systems to guarantee sufficient nutrition and tackle the prevalence of malnourishment, non-communicable diseases, climate change, and social inequities [3]. There were two main searches in these databases. The first one included the following search terms in different combinations: for the food availability search, food availability, food accessibility, food affordability, and food desirability a combination of keywords including, “Food production”, “Agriculture”, “Policy”, “Policies”, “Intervention”, “Nutrition” “Legislation” “Food Packaging”, “Food Preservation”, “Food distribution”, “Food handling” “United States”, “Price”, “Tax”, “Trade”, “Marketing”, “Promotion”, and “Commercial” were utilized for the searches in four domains. For the four searches, the filters applied were full-text, congress, meta-analysis, observational study, randomized controlled trial, review, systematic review, and English, from 2013 to 2023.

The second main search was conducted using the same word combinations but included the word “sustainable” at the end. This was the search used to conduct this narrative review, shown for the time period in Figure 1. The reason for this decision was that the original search was too broad and did not align with the focus of this paper. The authors examined the search results, including titles and abstracts, and conducted a detailed analysis of relevant articles. In addition, relevant reference citations obtained in the reviewed articles were assessed to ensure that all significant information was retrieved. A comprehensive search strategy is provided in the Supplementary Material.

Due to the limited relevant results found, another search was conducted on the United States Congress website. The words used to look for current policies, bills, or laws related to food-sustainable systems and diets were as follows: “sustainable foods”, “sustainable food systems”, “food availability”, “food affordability”, “food marketing”, “food desirability”, and “food desirability.” Additionally, with the limited results found for food affordability and food desirability, a broader Google search was conducted to find the gray literature or other information related to the topics. The search terms included were “sustainable and affordable food policies in the United States” and “sustainable food marketing policies United States.”.

The articles had to be published in English and implemented in the United States. Moreover, they had to address at least one aspect of the four domains of transformation necessary across food systems proposed by the 22nd Annual Harvard Nutrition Obesity Symposium [3]. The four domains are availability, accessibility, affordability, and desirability. Studies describing policies or policy initiatives related to sustainable diets and nutrition implemented outside the United States were excluded.

2.4. Policy Analysis Review

This review takes into consideration the policies and initiatives related to sustainable diets and nutrition implemented in the United States. The evidence was divided and analyzed based on the four transformation domains across sustainable food systems. The first area of transformation is food availability, which must guarantee that nutrient-rich food is available to everyone and produced sustainably. The second area that needs to be improved is the accessibility of healthy foods to everyone. The third area is affordability. Previous evidence suggests that healthy diets are unaffordable for approximately half of the world. Making healthy diets affordable to everyone should be a priority. The fourth area is desirability. It is important to empower consumers to make informed choices regarding healthy and sustainable diets [3].

The health policy research goal is to comprehend the potential effects of laws, policies, and practices on population health. Improving population health, addressing health inequities, and transforming towards sustainable food systems require converting research into evidence-based policy [2,3,22,23]. We used the policy lifecycle framework to guide our narrative review. Before being implemented, policies go through several development phases. These phases are known as the policy life cycle and consist of five stages: policy formulation, policy adoption, policy implementation, policy implementation evaluation, and policy maintenance [23]. This narrative review aims to evaluate the policies at any stage of the life cycle related to healthy and sustainable diets in the United States.

3. Results

A total of 632 articles were identified: 611 from PubMed and 21 from Scopus. Even though there are several policies created by the United States government and research institutions, most of them were implemented in school settings between 2013 and 2016 [22] and do not address the sustainability problems that have been identified in recent years, nor do they target the transformation of food systems that improve health and have environmental benefits. A comprehensive article screening and criteria are shown in Figure 2, which illustrates the methodology used in the narrative review, including identification, screening, eligibility, and inclusion of sources, with categorization under the four policy domains: availability, accessibility, affordability, and desirability.

Additionally, the search for policies, laws, or bills on the Congress website showed 991 entries when the word “sustainable food” was used. However, only 334 were from the last ten years, and the majority were discussing committee meetings, reports, and amendments. Of the 334 entries found, only 1 was a law, 16 were resolutions, and 26 were bills related to sustainable food. The words “food availability” only reflected four results. In contrast, the word “food access”, showed 560 entries. The repeated search process for “food affordability” generated 35 entries. Lastly, to identify food desirability, the combinations of the words “food acceptability”, “food desirability”, and “food marketing” resulted in a total of 5 entries, 0 entries, and 1992 entries, respectively. In the case of the broader Google search for affordable and sustainable food domains, the results showed several policies and initiatives implemented in different governmental agencies, but there was no mention of a peer-reviewed process before these publications.

3.1. Food Availability

After screening and reviewing the 22 articles related to food availability, only one briefly discussed current policies about sustainable seafood [24]. Most studies have focused on discussing recommendations to enhance food availability and make it more sustainable. During the last few years, there has been a shift in the policies to support less healthy food environments and less sustainable diets [25]. For example, agricultural subsidies to support commodity production have been associated with this unhealthy trend [25]. Therefore, the availability of less healthy foods has increased. Americans consume more meat than recommended, but the main problem lies in how meat is produced. Antibiotics and synthetic growth hormones are commonly used to produce livestock. In addition, animals raised on grains yield food products with higher levels of cholesterol and saturated fats and lower levels of healthy fatty acids [25]. Although excessive meat consumption is often cited as a dietary concern, the broader problem of unhealthy food availability extends beyond that of meat. A significant increase in ultra-processed foods, sugary beverages, and refined grain products has saturated the food environment, especially in underserved communities. These products are frequently high in added sugars, sodium, and unhealthy fats, and their proliferation has been linked to an increasing burden of diet-related chronic diseases [26,27,28]. In addition, societal preferences for convenience-driven eating can overshadow the availability of whole grains and other nutrient-dense food choices, ultimately affecting overall food security and nutrition [29].

To date, policy interventions have inadequately addressed the systemic drivers behind the widespread availability and affordability of unhealthy food items. In contrast, the concept of sustainable food availability emphasizes whether there is sufficient food to regularly supply the population’s need for energy and nutrients [30]. Policies must encourage more ecological models of production that combine measures intended to maintain the essential resources that are currently depleted or degraded to continue providing food for expanding populations [2,3,30].

3.1.1. Sustainable Food Availability Policies in the United States

Increasing sustainable food availability is critical for strengthening human capital and is a requirement for human development and food systems transformation [31]. However, the results from this narrative review showed that few policies currently address sustainable food availability in the United States. One of the papers included in this narrative review discussed the importance of associating fisheries with public health policies to achieve food security [24]. Federal agencies such as the Food and Drug Administration (FDA), National Oceanic and Atmospheric Administration (NOAA), and the US Department of Agriculture (USDA) inspect a small percentage of local and international seafood and sea processing facilities [24]. Nonetheless, they barely discussed any current sustainable policy related to sustainable seafood availability, which means that there is a gap in current policies to address this issue. Among the recommendations highlighted by the authors is an urgent shift toward a national food policy that acknowledges the benefits that agriculture and fisheries policies may have for the environment and public health [24]. The Environmental Protection Agency (EPA) has implemented policies to regulate certain pollutants, such as the Clean Water Act and the Clean Air Act. However, many policies do not accomplish their goals because of lobbying or particular financial interests [32].

Among the results found on the U.S. Congress website was the “Enabling Farmer, Food Worker, Environmental, and Climate Targets through Innovative, Values-aligned, and Equitable Food Procurement Act” or the “EFFECTIVE Food Procurement Act.” The EFFECTIVE Food Procurement Act, S. 3390, was introduced by the Senate in December 2023 to improve the purchasing of food by the Department of Agriculture and for other purposes [33]. Parallel to this Act, the House of Representatives introduced the H.R.6569—EFFECTIVE Food Procurement Act in January 2024 [34]. Among the Act requirements is a section focused on how the Department of Agriculture should purchase foods that mitigate the impact of climate change and that are produced using agricultural practices that measurably reduce greenhouse gas emissions and increase on-farm diversification and resilience to climate impacts [34]. However, there is no mention of how this will benefit the population’s health.

3.1.2. Recommendations for Sustainable Food Availability Policies

The current policies or the absence of policies directly or indirectly affect the existing food production model and processing, which facilitates the high intake of less healthy foods and the lack of sustainable and biodiverse agricultural systems. For that reason, several investigators and sustainable food systems advocates have come up with recommendations to develop, adopt, implement, and evaluate food policies to improve healthy food availability that, at the same time, is healthy for the environment. Among some recommendations, we can find the elimination of agricultural market distortions that discourage the production of fruits and vegetables, prohibit the use of antibiotics in food animals unless a confirmed disease or exposure to one exists, and increase the reporting of antimicrobial usage in food animal production and veterinary oversight. Tax exemptions, assistance in obtaining land, and additional incentives to farmers who employ agroecological practices should be offered (

Table 1. Comparative overview: International vs. U.S. food policy models.

Policy Feature	International Models (e.g., EU, Brazil, Canada)	U.S. Policies
Policy Framework	Comprehensive national strategies (e.g., EU Farm to Fork)	Fragmented programs across USDA, FDA, and state/local agencies
Primary Objectives	Improve health, reduce environmental footprint, ensure food sovereignty	Improve access and affordability, limited focus on sustainability
Implementation Strategy	Top-down plus community-led pilots	Program-specific interventions (e.g., SNAP, school meals)
Governance Level	National and regional coordination	Federal, with state variation
Monitoring and Evaluation	Structured metrics, annual reports, SDG alignment	Inconsistent or absent outcome tracking
Integration of Environmental Goals	Strong integration with climate and biodiversity goals	Often limited or indirect integration
Stakeholder Engagement	Multi-stakeholder forums, civil society involvement	Primarily agency-driven with limited community input

) [30,35,36,37,38,39,40,41,42]. In addition to these recommendations, the scientific community has been advocating for a reform in the Farm Bill to lessen climate change while decreasing the rates of chronic diseases and food insecurity [43]. All the recommendations highlight the necessity of strengthening existing policies, implementing new policies, and changing the focus to make healthier food more available and friendly to the planet. There is still a lot of work ahead to improve the domain of food availability to help transform the food systems.

3.2. Food Accessibility

Food access refers to having sufficient resources and the capacity to obtain the right food for a balanced and nutritious diet without compromising other basic needs [30]. From the database search, 602 articles were identified (598 from PubMed and four from Scopus). After reviewing all articles, only 20 were relevant for this narrative review. From the Congress website, the search reflected 560 entries in total. Only 436 entries were from the last ten years, and more than 40 were bills related to food access. In addition, two laws and six resolutions were identified.

3.2.1. Sustainable Food Accessibility Policies in the United States

After reading the selected articles, it was evident that, even though there are many recommendations on how to make food systems more accessible and sustainable for people’s and the planet’s health, there is a lack of policies that have been implemented in the United States (

Table 2. Summary of U.S. Policies related to sustainable food systems.

Policy Name	Year of Enactment	Target Population	Policy Goals	Level of Implementation
Agricultural Act (Farm Bill)	2014, 2018	Farmers, low-income families	Support agriculture, conservation, nutrition assistance	Federal
Supplemental Nutrition Assistance Program (SNAP)	Ongoing	Low-income individuals and families	Improve food access through financial assistance	Federal
Healthy, Hunger-Free Kids Act	2010	School-aged children	Improve school meal nutrition standards	Federal with local implementation
EFFECTIVE Food Procurement Act (proposed)	2023 (Senate), 2024 (House)	Federal food procurement programs	Promote climate-resilient procurement and sustainability	Federal (proposed)
Senior Hunger Prevention Act (proposed)	2023	Older adults and disabled individuals	Streamline nutrition access and reduce senior hunger	Federal (proposed)

). None of the articles discussed the impact of any implemented policies related to this domain. Nonetheless, the articles discussed possible interventions that have shown that, if they are scaled up, they could benefit the nutritional status of the people while decreasing food waste and improving access to healthy foods [30,44,45,46,47].

Among the results found on the Congress website, we can mention the H.R.4060—Food Access and Stability Act of 2023, introduced by the House of Representatives in July of 2023. The bill aimed to “repeal the sunset of the work requirement exemption applicable to homeless individuals, veterans, and foster care individuals to determine eligibility to receive supplemental nutrition assistance program benefits under the Food and Nutrition Act of 2008” [48]. Another bill introduced to amend the Food and Nutrition Act of 2008 to streamline nutrition access for older adults and adults with disabilities was S. 1036 Senior Hunger Prevention Act of 2023, introduced by the Senate in March 2023 [49]. Several more bills have been introduced in recent years by the Senate and the House of Representatives to address the food access issue [50,51,52,53,54,55]. However, little is known about their impact on transforming the food systems and improving access to healthy food, especially to marginalized populations. The evolution of bills after being referred to different committees is unknown. Only two laws were reflected in the search: the H.R.2642 Agricultural Act of 2014 and the H.R.2 Agriculture Improvement Act of 2018. Both aimed to address commodity support, conservation, nutrition assistance, farm credit, rural development, and other agricultural practices to improve food access and availability [56,57].

3.2.2. Recommendations for Sustainable Food Accessibility Policies

In recent years, sustainability has become a common topic. Research has shown a lack of policies to improve all the processes involved in improving food access. Food access is related to how food is handled, stored, and transported until everyone has independent access to food unconditional of where they live [3,30]. Owing to the crucial importance of making food accessible while making the process sustainable for the planet, several recommendations have been made. Among some recommendations provided by the scientific community, the allocation of appropriate funds to support Farmer’s Market Nutrition Programs in all states is imperative. In addition, nutrition programs such as SNAP should meet the nutritional standards for all ages who have access to the program. Moreover, it is necessary to prioritize and invest in the regional, local, and sustainable food production, storage, packing, and transportation of nutrient-rich foods (

Table 3. Summary of policy recommendations to promote food system transformation domains.

Food System Transformation Domains	Summary of Policy Recommendations Found in the Literature
Food availability [30,35,36,38,43]	Elimination of agricultural market distortions that discourage the production of fruits and vegetables. Prohibit the use of antibiotics in food animals unless a confirmed disease or exposure to one exists. Increase the reporting of antimicrobial usage in food animal production and veterinary oversight. Offer tax exemptions, assistance in obtaining land, and additional incentives to farmers who employ agroecological practices. Reform in the Farm Bill to lessen climate change while decreasing the rates of chronic diseases and food insecurity
Food accessibility [30,38,39]	Allocation of appropriate funds to support Farmer’s Market Nutrition Programs in all states. Nutrition programs like SNAP should meet the nutritional standards for all ages of people who have access to the program. Prioritize and invest in regional, local, and sustainable food production, storage, packing, and transportation of nutrient-dense foods.
Food affordability [30,39,42]	Provide tax credits to businesses that employ alternative energy sources for food processing, transportation, and retail to make sustainable food more affordable. Encourage producers to use more sustainable methods to grow their food. Include healthier foods among the benefits of SNAP. Support farmers’ markets. Leverage USDA grant programs to build local food systems.
Food desirability [30,58]	Prohibit food marketing with low nutritional value targeted to children. Regulate the health claims in advertisements and food packages. Mandate contributions to a nutritional campaign according to the amount of money spent on marketing foods high in calories and low in nutrients. Pass legislation to shield kids from online and other harmful food promotions. Design educational campaigns using nudges to promote healthy eating habits.

) [30]. If the minimum recommendations are met, strong policies could be implemented that are beneficial for both the planet and the people within the domains of comprehensive policy models.

3.3. Food Affordability

Sustainable food affordability refers to the ability of people to purchase or grow the food they need to meet their daily nutritional requirements [39]. Although programs such as the Supplemental Nutrition Assistance Program (SNAP) have been created to help people afford food, previous evidence has shown that SNAP participants have lower diet quality than non-SNAP participants [39]. Thus, they have a higher likelihood of developing noncommunicable diseases and, therefore, a lower quality of life. These results highlight the necessity of implementing or reinforcing policies that promote affordable and healthy foods. The results from the sustainable and affordable food policies showed only four articles relevant to the topic. In addition, none of the articles discussed policies created or implemented related to sustainable food affordability. On the other hand, the results from the Google search showed a USDA 2022 sustainable plan. However, there is no mention of how this will help with the equitable purchase of healthy food.

3.3.1. Sustainable Food Affordability Policies in the United States

There is a lack of scientific evidence that shows the current policies to make healthy food more sustainable and affordable, especially for low-income communities and minority populations. The Congress website did not reflect any specific law or bill proposed to address this issue. Furthermore, none of the articles found in the literature search discussed policies to improve this matter in the United States. This is a problem that needs to be prioritized by federal, state, and local governments.

3.3.2. Recommendations for Sustainable Food Affordability Policies

Scientists have made several recommendations to improve food systems and make healthy foods more affordable. Among those recommendations, we can mention providing tax credits to businesses that employ alternative energy sources for food processing, transportation, and retail to make sustainable food more affordable and encourage producers to use more sustainable methods to grow their food. Additionally, SNAP benefits include healthier foods, support farmers’ markets, and leverage USDA grant programs to build local food systems (Table 1) [30,39].

3.4. Food Desirability

The ability to find food that meets the social and cultural norms of specific groups is defined as food desirability or food acceptability [3,30]. Food marketing plays an important role in this domain. Food marketing and advertisements influence communities’ acculturation to unhealthy diets [30]. Public health should be a guiding perspective for policy development in this area. It can use the interdependence of the rights to food, health, and education to justify attempts to alter cultural acceptability through health education and pushing for legislative changes to improve diets and food availability [30]. The literature search results are similar to those for sustainable food affordability policies. When the term “sustainable” was added to the database search, only four articles were found. The articles are the same as those that appeared in the sustainable and affordable food domain. In addition, neither of these articles discusses any current policy that targets the food marketing of unhealthy foods. The search on the Congress website showed 1992 results, but only 365 were from the last ten years. However, only a few were relevant to this topic. Several studies have focused on the Affordable Care Act, tax relief for low- and middle-income families, and tax reforms. Only 11 bills addressed food marketing, with a focus on children. In addition, only one law has been established. This was the Agriculture Improvement Act of 2018 [57]. The broader Google search showed that, even though many websites discuss the importance of implementing food marketing policies that limit exposure to ultra-processed foods, little is achieved at the policy level.

3.4.1. Sustainable Food Desirability Policies in the United States

As previously mentioned, no relevant policies were found in the database search. However, the Congress website showed that a few bills have been introduced to address the food marketing issue. The S. 2342 Bill was introduced in the Senate in May of 2014. This bill aimed to deny a tax deduction for any business that advertised food with poor nutrition directly to children. Unfortunately, there is no further discussion of what happened with this bill [59]. Similar cases are presented in the H.R.5232—Stop Subsidizing Childhood Obesity Act, S.2936—Stop Subsidizing Childhood Obesity Act, H.R.9299—Stop Subsidizing Childhood Obesity Act, S.5086—Stop Subsidizing Childhood Obesity Act of 2022, and the H.R.7342—Stop Subsidizing Childhood Obesity Act [60,61,62,63,64]. All of them were introduced to Congress but were referred to different committees, and, from that point, there was no information about their resolution. Additionally, some nutrition education acts required that school wellness policies indicate that students must receive 50 h of school nutrition education per school year [65,66,67,68]. Lastly, the H.R.2—Agriculture Improvement Act of 2018 reauthorizes the USDA to modify programs that address commodity support, conservation, trade and international food aid, nutrition assistance, farm credit, horticulture, agriculture and food defense, and historically underserved producers, but there is no mention of how to shift food desirability towards healthier and sustainable food systems [57]. Google search did not reveal any policy implemented in the United States that regulates food desirability, food marketing, and food acceptability to create more sustainable food systems.

3.4.2. Recommendations for Sustainable Food Desirability Policies

A few studies have provided strategies for designing and implementing policies to target sustainable food desirability. For example, these strategies include the following: prohibit marketing of foods with low nutritional value to children, regulate healthy claims in advertisements and food packages, mandate contributions to a nutritional campaign according to the amount of money spent in marketing foods high in calories and low in nutrients, pass legislation to shield kids from online and other harmful food promotion, and design educational campaigns using nudges to promote healthy eating habits (Table 3) [30,58].

4. Discussion

Our review has explained that effective development and implementation of policies for sustainable food systems are essential for addressing global challenges, such as food security, environmental degradation, and public health. Sustainable food policies encompass various approaches aimed at enhancing food production, distribution, and consumption while preserving ecological integrity and promoting social equity. Our findings also reveal specific weaknesses in the U.S. policy landscape. For example, although accessibility and availability have been partially addressed through existing programs, affordability and desirability remain concepts that are underrepresented in both legislative and programmatic action. Furthermore, even where policies exist, such as in SNAP or the Farm Bill, integration of environmental sustainability principles is often absent or secondary.

One significant aspect of sustainable food policy is the integration of food sovereignty and environmental sustainability. It has been emphasized that food sovereignty underpins the concept of sustainable food policies, particularly in regions like Indonesia, where rice is central to food security [69]. This perspective emphasizes the need for policies that enable local communities to control their food systems while ensuring environmental sustainability, which aligns with the basic principles of environmental science that advocate for balanced natural systems. Such policies are crucial for creating resilient food systems that can withstand external shocks, such as climate change and economic fluctuations.

Moreover, the development of sustainable food systems in Europe underscores the importance of public policy measures to facilitate local food procurement and establish sustainable markets. There is a need for advocacy for policies that reduce barriers to accessing sustainable food and promote the affordability of such foods compared to unsustainable options, potentially through tax incentives [70]. These recommendations align with other relevant findings, deeming the necessity of holistic policy approaches that integrate production and trade policies aimed at sustainable consumption [71]. This integrated viewpoint is vital for creating a supportive policy framework that addresses the interconnected challenges within food systems.

Social policies play a crucial role in enhancing food sustainability by addressing agrobiodiversity and local community factors. It is also suggested that policies embedding social considerations alongside environmental ones are more effective than isolated sectoral policies [72]. This concept is echoed in the previous research, which also emphasized the need for systemic approaches to food consumption and production that promote healthy diets within the public healthcare sector [73]. Policies should synergize dietary education programs with sustainable procurement practices to foster demand for healthy foods, thereby shifting consumption patterns towards sustainability.

Various local government initiatives have demonstrated how targeted food policies can address public health and environmental goals. The success of local policies in promoting organic and fair-trade food systems is emphasized, thus encouraging public health and sustainability [74]. Similarly, the integration of food policies in local Australian governments also shows the potential of such policies to enhance food security and equity [75]. Effective local governance can serve as a model for broader applications, positioning communities as active participants in sustainability dialogue.

Additionally, international trade policies play a central role in achieving sustainability in food systems. There is also an argument for the design of fair agri-food trade policies within the European Union to bolster environmental protection while ensuring global food security [76]. These policies can provide a framework for local and international food systems to operate sustainably, significantly influencing socioeconomic improvement, especially in developing nations. Addressing the interplay between these factors requires careful consideration of the socioeconomic contexts and food environments that dictate access to nutritious food. Interventions aimed at improving food security must address these complex dynamics to encourage healthier eating practices and to improve public health.

Finally, collaboration between various stakeholders, including the government, private sectors, and civil societies, is vital for cohesive food policies. This integration must address challenges in food waste, urban food access, and nutrition security, which is pivotal for coordinated governance in fostering sustainable food ecosystems [77]. By actively engaging multiple stakeholders in policy formation and implementation, the goal of a sustainable food system that meets the needs of current and future generations can be achieved. The formulation and execution of policies related to sustainable food systems are critical for ensuring food security, enhancing community resilience, and promoting environmental sustainability [78]. Through an integrated approach that encompasses local and global perspectives, effective policies can create systems capable of thriving amidst the challenges posed by climate change, socioeconomic disparities, and public health crises. Operationalizing stakeholder collaboration in the U.S. requires multi-tiered mechanisms. At the federal level, Congress and the USDA can establish permanent policy advisory councils, including representatives from farming cooperatives, nutrition advocacy groups, climate scientists, and consumer organizations. Public–private partnerships should incentivize corporations to reformulate products with improved nutrition profiles and sustainable sourcing, potentially tied to federal procurement contracts. Civil society organizations can be integrated more directly through mandated public comment processes and community impact reviews prior to policy implementation.

4.1. Implications

The findings from our review indicate that transforming food systems is essential to ensure human health, environmental sustainability, food security, and equitable livelihoods by making nutritious food accessible, reducing environmental harm, and promoting social justice. In the face of climate change, population growth, and resource limitations, sustainable food systems offer resilient solutions to meet current and future global challenges. This review highlights several actionable implications for U.S. policy development. First, food affordability policies should be expanded to integrate climate-conscious procurement and equitable access across states. Second, there is a pressing need for federal oversight mechanisms to regulate food marketing—particularly for children—where several bills have been stalled in Congress. Lastly, policy development should prioritize evaluating the sustainability outcomes of current programs, such as the Farm Bill and SNAP, which remain inadequately assessed in terms of both health and environmental metrics.

Therefore, it is important to transform food systems for the following reasons:

• Guaranteeing human health: Transforming food systems is necessary to ensure that everyone has access to sufficiently nutritious and safe diets. By promoting sustainable, healthy diets, food systems can contribute to improving people’s health and well-being.
• Ensuring environmental health: Current food systems, including deforestation, greenhouse gas emissions, and water pollution, have significant impacts on the environment. The transformation of food systems can help mitigate these negative environmental impacts and promote sustainability.
• Addressing food security: With the world’s population expected to reach over 10 billion people by 2050, it is crucial to transform food systems to ensure food security for everyone. By improving food availability, accessibility, and affordability, sustainable food systems can help meet the growing demand for food.
• Supporting just and equal livelihoods: Transforming food systems involves creating policies that prioritize equitable access to food and support fair livelihoods for those involved in the food production and distribution chain. This can help reduce inequalities and promote social justice within the food system.
• Meeting future challenges: As the world faces challenges such as climate change, resource scarcity, and population growth, transforming food systems has become essential for adapting to these challenges and building resilience. Sustainable food systems can contribute to mitigating the impacts of climate change, conserving resources, and ensuring long-term food security.

The transformation of food systems is important for the well-being of both humans and the environment, addressing food security, promoting social justice, and preparing for future challenges.

4.2. Strengths and Limitations

To the best of our knowledge, this is the first narrative review to provide a comprehensive overview and summary of the existing evidence of United States policies related to sustainable diets and nutrition using the four domains of food system transformations proposed by the 22nd Annual Harvard Nutrition Obesity Symposium. This review followed the life cycle of the policy framework to look for all the policies created, implemented, and evaluated in the United States relevant to this topic. In addition, the data search was conducted in two databases: the U.S. Congress website and, in some cases, a Google search to try to include all the information available to date. Nonetheless, this study had some limitations. First, the inclusion criteria used could be perceived as subjective because there is no official framework that can be applied to sustainable food systems, which could have limited the available publications related to policies and sustainable diets. Additionally, publication bias was not accounted for in the selection due to the nature of this narrative review. The timeline restriction could have limited the results, and the limited articles could have impacted the results of this narrative review.

In addition, some policies related to education or finance could have been limited during the search because they did not include the words “sustainable”, “food availability”, “food accessibility”, “food affordability”, or “food desirability”. Furthermore, we did not include or explore social and environmental policies that did not incorporate the word “food” in the title or the abstract.

5. Conclusions

The present narrative review summarizes the available policies related to sustainable diets using the framework proposed during the 22nd Annual Harvard Nutrition Obesity Symposium to transform food systems and make them healthier for people and the environment. The conclusion that can be drawn is that the United States still has a long way to go to improve its food policies. There is limited evidence of what has been accomplished in the U.S. to improve population and environmental health. There is a lack of evidence of policies created, implemented, or evaluated to address the transformation of food systems. In addition, there is a need to generate evidence of the current effectiveness of policies. The policy domains explored were as follows: (1) sustainable food availability, (2) sustainable food accessibility, (3) sustainable food affordability, and (4) sustainable food desirability. More research is needed on existing policies in the United States and their implications for sustainable diets and people’s and environmental health.