Sustainability: Irish Dietitians Perceptions and Experiences

Abstract

Sustainability is an important aspect of all areas of life, including nutrition and dietetic practice. The Sustainability Development Goals are 17 goals set by the United Nations as a guideline on how the global population can be more sustainable moving into the future. Opportunities are available for nutrition and dietetic professionals to be involved in making changes and supporting the SDGs. Yet, there are limited studies exploring Irish dietitians’ perceptions and experiences of sustainability. An online survey consisting of 16 questions exploring familiarity with, as well as personal and professional perceptions of, sustainability was circulated to Irish dietitians by the Irish Nutrition and Dietetic Institute and promoted online through social media platforms (Twitter and Facebook). The survey was open for four weeks (18 October–16 November 2021) and was housed in Qualtrics and analysed using SPSS. A total of 102 Irish dietitians completed the survey (n = 100, 98% female). Most (96.1%) reported that sustainability is very important or important and 81.4% felt that it was very important or important in dietetic practice. Overall, participants were more familiar with environmental sustainability, e.g., widespread availability (79.4%), climate change (89.2%) and some concepts under economic, social, and general sustainability. They were most unfamiliar with agricultural sustainability concepts, e.g., use of food and agricultural policies (36.2% were familiar). This study illustrates the importance that Irish dietitians place on sustainability, aspects they feel confident in and areas for future education and support.

1. Introduction

Sustainability can be defined as the ability to maintain systems over a long term by meeting the needs of the present without jeopardizing the capability of meeting the needs of future generations [1]. Sustainability is a multi-dimensional matter and the United Nations Sustainable Development Goals (SDGs) consider three pillars: environmental, economic, and social sustainability [2].

Sustainability in nutrition is crucial due to its profound impact on environmental health, food security, and public health [3]. Nutrition is integral to many of the SDG goals including no poverty, zero hunger, good health and well-being, clean water and sanitation, sustainable cities and communities, responsible consumption, and production [2]. The ‘EAT-Lancet Commission on healthy diets from sustainable food systems’ recognised that a transformation to a sustainable food system is necessary to achieve the Sustainable Development Goals [4].

Agricultural practices, particularly those associated with animal farming, are significant contributors to greenhouse gas emissions, deforestation, and water usage [5,6]. Promoting diets that minimise environmental impact, such as plant-based diets, which have been shown to significantly reduce carbon emissions and resource depletion, could therefore be important [5,7]. Dietitians play an important support role with this transition and ensuring the nutritional adequacy of what is being consumed [8].

Another critical aspect of sustainability in nutrition is food security [9]. With the global population expected to reach nearly 10 billion by 2050, ensuring a stable and sufficient food supply is essential [10]. Sustainable practices in agriculture, such as crop diversification, organic farming, and regenerative agriculture, can improve soil health, enhance biodiversity, and increase resilience against climate change, ultimately supporting long-term food security [11,12]. These practices help create a more stable and sustainable food system that can meet the nutritional needs of the growing population without depleting natural resources.

Economic sustainability is an important aspect which can impact the nutrition of individuals and has affected most individuals to some degree in their lifetime [13]. Aspects such as income, shifts in the population and conflict among countries [1] can have an effect on individuals’ nutrition status and should be taken into consideration by dietitians. Populations in countries that have high levels of malnutrition often face economic pressure and may not have access to safe, healthy, and affordable food [13]. Upward of 820 million people go to bed hungry every night; in 2018, around 1.3 billion people experienced moderate levels of food insecurity [14].

Social sustainability and nutrition are intricately linked, playing crucial roles in the overall well-being and development of communities. Social sustainability encompasses factors such as equity, inclusivity, and community engagement, all of which are essential for promoting access to nutritious food [15]. Ensuring that everyone has access to adequate and nutritious food not only fosters physical health but also strengthens social cohesion and reduces disparities. By prioritising social sustainability in food systems, we can address issues of food insecurity, promote healthy lifestyles, and build resilient communities capable of thriving in the face of challenges [15]. Ultimately, integrating social sustainability principles into nutrition initiatives is vital for creating a more equitable and prosperous society for all [15].

Public health also benefits significantly from sustainable nutrition [3]. Diets that emphasise whole, minimally processed foods, such as fruits, vegetables, whole grains, and legumes, are not only better for the environment but also promote better health outcomes [16]. These diets are associated with a lower risk of chronic diseases such as obesity, diabetes, cardiovascular disease, and certain cancers [4]. By aligning dietary patterns with sustainability principles, it is possible to achieve a synergy between environmental health and human health, leading to healthier communities and ecosystems [17].

Dietitians are able to act as leaders and advocates for food system practice to facilitate a healthier planet and healthy humans [18] and to encourage populations to be more sustainable. Factors such as minimising the consumption of animal products, incorporating more plant-based foods in the diet [19], using seasonal foods, buying local produce, and minimising food waste [20] can all contribute towards environmental sustainability. Increasing knowledge on budgeting, reducing food costs, and working with all communities can ensure that economic and social sustainability are also prioritised.

Perceptions of the concepts of sustainability and their use in practice has previously been explored in dietitians in Sweden and Europe [21,22] and with nutrition and dietetics students in Australia [18]. Dietitians were interested in gaining more knowledge about sustainable food practices but were unsure of their role in promoting this [21,22]. Dietitians were also unsure on how to approach sustainability in practice as well as concerned as to how it would work along with other nutritional practices [21,22]. This topic has not currently been explored among Irish dietitians.

The aim of this study was therefore to investigate Irish dietitians self-reported familiarity with and their perceptions of sustainability under three concepts: namely, environmental, economic, and social sustainability. A secondary aim was to explore this cohort’s views on sustainability and the dietetics profession.

2. Materials and Methods

2.1. Study Design and Participants

A cross-sectional survey was designed to determine the perception of sustainability by Irish dietitians and their experiences with the application into practice. Registered dietitians working in the Republic of Ireland were eligible to take part. Ethical approval was granted by the Institute Ethics Committee in the Institute of Technology Sligo (Ref: 2020056) (now Atlantic Technological University Sligo).

2.2. Questionnaire and Data Collection

A questionnaire previously used in Australia [18] was used with permission from the authors. The demographic questions around course and study year were adapted to reflect a working population and focused on area of work and years of experience. The questionnaire consisted of 16 questions. Four questions focused on personal information about the participants such as sex, age, years qualified, and area of practice. Two questions focused on participants indicating which of four and six options best reflected their own attitudes to sustainability and their personal views on society, respectively. An open question asked participants for up to four key words/phrases that express their personal understanding of sustainability.

The following were then measured using a five-point Likert scale: (i) familiarity (from not at all familiar to very familiar) with a number of environmental sustainability (n = 17), economic sustainability (n = 9), social sustainability (n = 15) and general sustainability concepts (n = 4); (ii) degree to which sustainability, cost, and convenience influence food choices (strongly agree to strongly disagree); (iii) degree to which sustainability influences their own daily lives and that of their dietetic practice (not at all to all the time); (iv) degree to which they believe that sustainability is an important issue in general, in dietetic practice and for the future of dietetic practice (very unimportant to very important).

The questionnaire was hosted in Qualtrics, an online platform for conducting surveys and was open for four weeks (18 October–16 November 2021). The questionnaire was promoted through the Irish Nutrition and Dietetic Institute and through social media (Twitter and Facebook).

2.3. Statistical Analysis

Descriptive analysis was carried out on the collected data using IBM Statistical Package for the Social Sciences (SPSS) version 26. A word cloud/tag cloud was generated using wordart.com to display the responses to the question asking for 4 phrases which participants used to express their personal understanding of sustainability. The larger the word within the word cloud, the greater the number of participants who mentioned it.

3. Results

3.1. Participant Characteristics

A total of 145 Irish dietitians agreed to participate in the study (10.1% of all registered dietitians in the Republic of Ireland (n = 1440) [23] with 102 participants fully completing the survey and included in the analysis (completion rate of 70.3%). The majority identified as female (n = 100, 98.0%), aged between 40 and 49 years (n = 29, 28.4%), were more than 10 years qualified (n = 66, 64.7%), and the main area of practice was in a hospital-based setting (n = 48, 47.1%) (

Table 1. Participant characteristics.

Characteristic	n	%
Sex
Male	2	2
Female	100	98.0
Age
21–29	24	23.5
30–39	27	26.5
40–49	29	28.4
50–59	17	16.7
60+	5	5.0
Years qualified
<5 years	21	20.6
5–10 years	15	14.7
>10 years	66	64.7
Area of practice
Hospital-based	48	47.1
Community-based	24	23.4
Public health nutrition	3	2.9
Academia	10	9.8
Industry	3	2.9
Other	14	13.7

).

3.2. Attitudes towards Sustainability

When asked to describe their attitude towards sustainability, 76.5% of the participants reported “I think it is a good thing” (n = 78). 18.8% reported that they were a “passionate advocate” of sustainability (n = 18), 4.9% of participants (n = 5) reported “It is OK if others want to do it” and 1% of the participants (n = 1) reported that they were “not really bothered” about sustainability.

Figure 1 represents dietitians personal views on the future of sustainability in society. Participants were asked to choose which of the statements was closest to representing their personal view on the future of society Many of the participants chose the statement “improvement in government policies in relation to the environment, trade and social services linked with a better education of these to our youth will ensure a safe, healthy, and sustainable society living with ecological limits” (35.6%). Another statement also proved popular: “through strong government interventions is the only way we will be able to establish justice and equality which will guarantee a safe, healthy, and sustainable society living in ecological limits” (31.7%). Both statements refer to government action or intervention as a plan to improve societies attitude towards sustainability.

3.3. Understanding of Sustainability

Participants were asked to “write four keywords or phrases which express your personal understanding of sustainability”. This contained a lot of feedback and showed that in relation to food and nutrition the participants were aware of how those topics link with sustainability. Forty-one percent of the responses focused on environmental impact with words such as climate change, agriculture, avoid waste, and biodiversity, and a further 22% of words and phrases related to food and diet, such as plant based, vegetarian, and nutritious. A word cloud outlining the frequency of words and phrases can be found in Figure 2.

3.4. Familiarity with Sustainability Concepts

Overall, environmental sustainability (Figure 3) was the concept participants were most familiar with. Concepts such as widespread availability (31.3%), climate change (43.1%), water quality (35.3%), need for environmentally responsible farming practices (33.3%), depletion of fish stocks (33.3%), food miles (34.3%), biodiversity (32.4%), and contamination of fish (34.3%) were the concepts which had the most participants report familiarity. The results also showed concepts which participants had no familiarity with, for example, soil quality, farmland protection, and use of synthetic fertilisers.

In relation to economic sustainability (Figure 4), many participants were only somewhat familiar with concepts of sustainability, for example, economic viability (31.4%), preservation of rural communities (32.4%), monopoly in food production (30.4%), and the relationship between food choices and the local economy (32.4%). The concepts with which the participants were most unfamiliar were resilience to economic risk (38.2%) and social capital (46.1%).

In terms of social sustainability (Figure 5), the participants were quite familiar with access to education and knowledge (32.4%), non-discrimination and equity (31.4%), unequal distribution of wealth and ownership of food production (31.4%), and access to nutritious foods by vulnerable groups (32.4%). Examples of concepts with which participants were most unfamiliar include the right to resource use (41.2%), living conditions of farm labourers (31.4%), and labour rights (29.4%).

When asked to respond to some general sustainability concepts (Figure 6), participants responded somewhat familiar with issues with food additives and genetically modified foods (32.4%), food security at a national and global level (33.3%), and the use of food and agricultural policies (38.2%). There was also one concept which participants were unfamiliar with under this topic, the use of food and agricultural policies (25.5%).

3.5. Influence on Personal and Professional Practice

Despite 56.9% of participants somewhat agreeing with the statement, “I consider sustainability/the environment when I make personal food choices”, when asked how sustainability influences their own daily decision making, 37.3% of the participants responded that it only sometimes impacts their daily decision making. When considering dietetic practice, 53.9% of participants responded rarely to sustainability having an influence in their dietetic practice. When asked to what degree they believe that sustainability is an important issue for their future dietetic practice, 75.7% of participants agreed that it was either very important or important.

3.6. Importance of Sustainability

A total of 96.1% of Irish dietitians (n = 98) reported that sustainability in general is either very important or important, while 81.4% (n = 83) of participants agreed that sustainability was either important or very important in dietetic practice (

Table 2. Importance of sustainability.

	n	%
Sustainability in general
Very unimportant	0	0
Unimportant	0	0
Neither important nor unimportant	4	3.9
Important	22	21.6
Very important	76	74.5
Sustainability in dietetic practice
Very unimportant	0	0
Unimportant	0	0
Neither important nor unimportant	19	18.6
Important	45	44.1
Very important	38	37.3

).

4. Discussion

The main aim of this study was to investigate the perceptions and experiences of Irish dietitians towards sustainability under the headings of environmental, economic, and social sustainability and their use in dietetic practice. The main findings from this study show that Irish dietitians have a positive attitude towards sustainability and recognise its importance in both personal and professional life, however, this has not yet translated into influencing personal and professional choices/decisions. Participants were more familiar with environmental sustainability than other aspects of sustainability, which is maybe not surprising given that the reporting of sustainability in media, as well as in dietetic curriculums, tends to focus on environmental aspects such as food production, food waste, food quality, climate change, food systems, etc. A large percentage of participants (68.7%) felt that improvements in government policies and having stronger government interventions regarding the environment, trade, and social policy would make living a sustainable lifestyle more achievable for the population of Ireland. Overall, our findings mirror that of Longvall and Muñoz-Martínez et al. on European and Swedish dietitians [21,22] as well as Burkhart et al.’s work on Australian undergraduate nutrition and dietetic students [18], indicating similar responses, feelings, and awareness at all levels of education and practice.

Dietitians within this study recognised the importance of sustainability within society more generally but also specifically within dietetic practice. A survey conducted by the Academy of Nutrition and Dietetics in the United States reported that a significant proportion of dietitians believe that sustainable nutrition is essential for addressing the global challenges of food security and climate change [23]. This is further supported by professional bodies around the world. In Europe, the European Federation of the Associations of Dietitians (EFAD) has highlighted the necessity of integrating sustainability into nutrition policies. Similarly, in Australia, the Dietitians Association of Australia (DAA) [24] has stressed the role of dietitians in promoting sustainable food systems. In the United States, the Academy of Nutrition and Dietetics has published position papers that strongly advocate for sustainable diets [25]. Globally, the EAT-Lancet Commission [3] has provided a comprehensive framework for sustainable diets, advocating for a planetary health diet that balances human health and environmental sustainability. These global perspectives illustrate a consensus among dietitians and nutritionists on the importance of sustainable nutrition. By promoting dietary patterns that are both health-promoting and environmentally friendly, dietitians are at the forefront of efforts to address global challenges such as climate change, food security, and public health.

However, despite this interest and awareness, there were still many topics which participants felt unfamiliar with, particularly those relating to economic and social aspects. Resilience to economic risk and social capital were two concepts which a large percentage of participants were not familiar with. Economic risk, such as income instability or poverty, can severely limit individuals’ access to nutritious foods, leading to inadequate diets and adverse health outcomes [26]. By understanding the economic challenges faced by their clients, dietitians can tailor interventions that address affordability, thereby ensuring access to nutritious foods for all socioeconomic groups [27]. Additionally, social capital, characterised by social networks, trust, and reciprocity within communities, enhances access to resources and support systems [28]. Dietitians can leverage social capital to facilitate behaviour change, disseminate nutrition education, and establish community initiatives promoting healthier food environments [27]. By integrating considerations of economic resilience and social capital into their practice, dietitians can effectively address disparities in nutrition and contribute to building healthier, more resilient communities [27].

From a social perspective, the right to resource use (41.2%), living conditions of farm labourers (31.4%), and labour rights (29.4%) where the main concepts with which participants were unfamiliar. The right to resource use, living conditions of farm labourers, and labour rights are paramount considerations for dietitians due to their direct impact on food systems and nutrition outcomes [28,29]. The sustainability challenges that relate to food systems span many countries and therefore an international collaboration and consensus among many stakeholders, including dietitians is necessary moving forward [30].

When asked what words or phrases best demonstrate their understanding of sustainability, the most common words/phrases were ‘reducing waste’ and ‘plant-based’. Food waste is a significant issue globally, with approximately one-third of all food produced globally wasted, which has severe environmental, economic, and social implications [31]. The environmental impact includes unnecessary greenhouse gas emissions from decomposing food in landfills and wasted resources used in food production, such as water, land, and energy [32]. According to one study [33], reducing food waste by 50% could significantly decrease the environmental footprint of the food system and improve food security by making more food available without increasing production. The shift towards plant-based diets is another critical aspect of sustainable nutrition. Plant-based diets generally have a lower environmental impact than diets high in animal products. They require fewer natural resources, produce fewer greenhouse gas emissions, and have a lesser impact on biodiversity [34]. Additionally, plant-based diets are associated with numerous health benefits, including lower risks of heart disease, hypertension, diabetes, and certain cancers [35].

Dietitians are uniquely positioned to lead initiatives in both reducing food waste and promoting plant-based diets due to their expertise in nutrition science and public health. Dietitians can influence food waste reduction by educating individuals and communities about proper food storage, portion control, meal planning, and using leftovers creatively. They can also advocate for systemic changes, such as improved supply chain efficiencies and policies that encourage food donation and composting [36]. Dietitians play a vital role in promoting plant-based diets by providing evidence-based nutritional guidance and developing culturally appropriate, balanced meal plans that meet nutritional needs. They can dispel myths about plant-based diets, ensuring that individuals understand how to obtain essential nutrients, such as protein, iron, calcium, and vitamin B12 when not consuming or reducing animal sources. Moreover, dietitians can advocate for and support public health policies that promote plant-based diets, such as dietary guidelines and educational campaigns [25].

While our study highlights an awareness of and interest in the importance of sustainability in dietetic practice, it also highlighted a lack of knowledge in some specific dimensions of sustainability. This interest could be leveraged to provide continuing professional development opportunities in specific facets of sustainability for dietitians as well as integrating more aspects of sustainability throughout undergraduate and postgraduate training programmes in dietetics. A recently published study from the United States reinforces this need [37]. The study of 1161 registered dietitians, found that the majority of dietitians support the involvement of their profession in advocating for sustainable food systems. However, a significant proportion express a lack of confidence in offering guidance, primarily citing insufficient education and resources. Additionally, the survey highlighted that dietitians see opportunities for furthering their understanding in the sociocultural and planetary health dimensions of sustainability, identifying these as priority areas for professional development.

Like any study, there are strengths and limitations associated with this work. This is the first research to look at these concepts among Irish dietitians. Dietitians directly influence dietary behaviours through their recommendations and practice. Their perceptions of sustainability can shape how they advise individuals on food choices, meal planning, and lifestyle modifications, and it is therefore important to explore their perceptions on this topic. If dietitians are well-informed and positively perceive the importance of sustainability, they are more likely to integrate sustainable practices into their professional guidance, thereby influencing a broad audience to adopt environmentally friendly and health-promoting dietary habits [38]. Dietitians can also influence educational curricula and professional training programmes. By understanding these perceptions, educators can ensure that sustainability is adequately covered in dietetic training programmes, equipping future dietitians with the knowledge and skills needed to promote sustainable diets [39]. This is essential for preparing dietitians to address contemporary challenges related to nutrition, health, and environmental sustainability.

Some of the questions (multicomponent) were quite long, which could have impacted recruitment. Also, recruitment accounted for just 10% of registered dietitians in Ireland and therefore the views collected may not be reflective of all Irish dietitians. Moving forward, qualitative work would allow for a greater understanding of this area and the nuances within it and help to further inform training needs and preferred methods of delivery.

5. Conclusions

This study reveals a significant and promising interest in sustainability among dietitians, highlighting their readiness to embrace environmentally responsible practices in nutrition and dietetics. However, the findings also expose critical gaps in their familiarity with the economic and social dimensions of sustainability, and a notable deficiency in the integration of these principles into their professional practice. These gaps suggest that while dietitians recognise the importance of sustainability, their current educational frameworks and professional development opportunities may not sufficiently cover the comprehensive aspects required to implement sustainable practices effectively.

Dietitians, given their pivotal role in influencing dietary behaviours and public health policies, are uniquely positioned to champion sustainable nutrition practices. Addressing the knowledge to practice gaps identified in this study is imperative. Educational curricula for dietitians must be expanded to include a thorough understanding of the economic and social pillars of sustainability. This includes training on topics such as the socio-economic impacts of food choices, food equity, and the economic viability of sustainable food systems. Empowering dietitians with this knowledge will facilitate more effective collaboration with other stakeholders in the food system, fostering interdisciplinary solutions to complex global challenges such as food security, climate change, and health disparities.

Moreover, professional development programmes should be designed to provide current practitioners with the tools and knowledge necessary to implement sustainability in a practical and meaningful way. This could involve interdisciplinary training, collaboration with experts in economics and social sciences, and the development of practical guidelines for integrating sustainability into dietetic practice.

In conclusion, while dietitians demonstrate a commendable interest in sustainability, addressing their educational and experiential gaps in the economic and social domains is essential. By doing so, we can harness their full potential as advocates for a sustainable food system, ultimately contributing to a healthier planet and population. Future research should focus on developing targeted educational interventions and exploring the impact of enhanced sustainability training on dietetic practice and outcomes.