Sustainable Diets: Food for
Healthy People and a Healthy Planet

WORKSHOP SUMMARY

Leslie Pray, Rapporteur

Food Forum

Food and Nutrition Board

Roundtable on Environmental Health Sciences, Research, and Medicine

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE
     OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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Leslie Pray, Rapporteur Food Forum Food and Nutrition Board Roundtable on Environmental Health Sciences, Research, and Medicine Board on Population Health and Public Health Practice

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THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was ap- proved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by Contract Nos. HHSP233201200333P (Office of the Assistant Secretary of Health), HHSN26300002 (National Institutes of Health), and 59-1235-2-114, CNPP-IOM-FY2012-01, FS-IOM-FY2012-01, and AG-3A94- P-12-0088 (U.S. Department of Agriculture) and with the National Academy of Sciences. Additional support came from Abbott Laboratories, Cargill, Inc., ConAgra Foods, General Mills, Inc., Kellogg Company, Kraft Foods, Mars, Inc., McDonald’s, Mead Johnson and Company, Monsanto Company, Nestlé Nutrition, PepsiCo, and The Coca-Cola Company. The views presented in this publication do not necessar- ily reflect the views of the organizations or agencies that provided support for the activity. International Standard Book Number-13:  978-0-309-29667-0 International Standard Book Number-10:  0-309-29667-6 Additional copies of this workshop summary are available for sale from the Na- tional Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent ad- opted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Cover credit: Design by Casey Weeks. Suggested citation: IOM (Institute of Medicine). 2014. Sustainable diets: Food for healthy people and a healthy planet: Workshop summary. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE ON A WORKSHOP ON SUSTAINABLE DIETS: FOOD FOR HEALTHY PEOPLE AND A HEALTHY PLANET1 ERIK D. OLSON (Chair), Natural Resources Defense Council, Washington, DC KATHERINE L. CLANCY, University of Minnesota, St. Paul, and Johns Hopkins University, Baltimore, MD RICHARD A. FENSKE, University of Washington, Seattle ROBERT C. POST, FoodMinds, LLC, Washington, DC PAMELA STARKE-REED, National Institutes of Health, Bethesda, MD ANNE M. SWEENEY, Texas A&M University, College Station G. DAVID TILMAN, University of Minnesota, St. Paul PARKE E. WILDE, Tufts University, Boston, MA DEREK YACH, The Vitality Group, New York City, NY IOM Staff HEATHER COOK, Co–Study Director LESLIE J. SIM, Co–Study Director ANDRÉS GAVIRIA, Research Associate GERALDINE KENNEDO, Administrative Assistant 1  Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. v

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FOOD FORUM1 FRANCIS F. BUSTA (Chair), University of Minnesota, St. Paul NELSON ALMEIDA, Kellogg Company, Battle Creek, MI MARK ANDON, ConAgra Foods, Omaha, NE ARTI ARORA, The Coca-Cola Company, Atlanta, GA PAUL M. COATES, National Institutes of Health, Bethesda, MD DAVID B. COCKRAM, Abbott Laboratories, Columbus, OH RICHARD F. D’ALOISIO, Mondelēz International, East Hanover, NJ ERIC A. DECKER, University of Massachusetts, Amherst CAROLINE SMITH DEWAAL, Center for Science in the Public Interest, Washington, DC SAMUEL GODEFROY, Health Canada, Ottawa, ON DAVID GOLDMAN, U.S. Department of Agriculture, Washington, DC CINDY GOODY, McDonald’s USA, LLC, Oak Brook, IL DANIELLE GREENBERG, PepsiCo, Purchase, NY SONYA GRIER, American University, Washington, DC BRENDA HALBROOK, U.S. Department of Agriculture, Alexandria, VA JACKIE HAVEN, U.S. Department of Agriculture, Alexandria, VA JERRY HJELLE, Monsanto Company, St. Louis, MO KATE J. HOUSTON, Cargill, Inc., Washington, DC VAN S. HUBBARD, National Institutes of Health, Bethesda, MD LEE-ANN JAYKUS, North Carolina State University, Raleigh GORDON L. JENSEN, Pennsylvania State University, University Park RENÉE JOHNSON, Congressional Research Service, Washington, DC WENDY JOHNSON-ASKEW, Nestlé Nutrition, Florham Park, NJ MICHAEL M. LANDA, Food and Drug Administration, College Park, MD JOHN A. MILNER, U.S. Department of Agriculture, Beltsville, MD S. SUZANNE NIELSEN, Purdue University, West Lafayette, IN ERIK D. OLSON, Natural Resources Defense Council, Washington, DC RICHARD OLSON, U.S. Department of Health and Human Services, Rockville, MD STEVEN W. RIZK, Mars, Inc., Hackettstown, NJ SARAH ROLLER, Kelley Drye & Warren LLP, Washington, DC SHARON ROSS, National Institutes of Health, Rockville, MD SYLVIA ROWE, SR Strategy, LLC, Washington, DC KARI HECKER RYAN, Kraft Foods, Glenview, IL PRISCILLA SAMUEL, Tate & Lyle, Hoffman Estates, IL MAHA TAHIRI, General Mills, Inc., Minneapolis, MN 1  Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. vii

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Forum Staff HEATHER COOK, Co–Study Director LESLIE J. SIM, Co–Study Director GERALDINE KENNEDO, Administrative Assistant ANN YAKTINE, Interim Director, Food and Nutrition Board viii

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ROUNDTABLE ON ENVIRONMENTAL HEALTH SCIENCES, RESEARCH, AND MEDICINE1 FRANK LOY (Chair), Washington, DC LYNN R. GOLDMAN (Vice Chair), George Washington University, Washington, DC HENRY A. ANDERSON, Wisonsin Division of Public Health, Madison JOHN M. BALBUS, National Institute of Environmental Health Sciences, Bethesda, MD JAMES K. BARTRAM, University of North Carolina, Chapel Hill LINDA S. BIRNBAUM, National Institute of Environmental Health Sciences, Research Triangle Park, NC LUZ CLAUDIO, Mount Sinai School of Medicine, New York, NY DENNIS J. DELVIN, Exxon Mobil Corporation, Irving, TX RICHARD A. FENSKE, University of Washington, Seattle ALISTAIR FRASER, Royal Dutch Shell, The Hague, Netherlands LUIZ A. GALVÃO, Pan American Health Organization, Washington, DC BERNARD D. GOLDSTEIN, University of Pittsburgh, PA RICHARD J. JACKSON, University of California, Los Angeles SUZETTE M. KIMBALL, U.S. Geological Survey, Reston, VA JAY LEMERY, University of Colorado, Denver ANDREW MAGUIRE, Environmental Defense Fund, Washington, DC LINDA A. McCAULEY, Emory University, Atlanta, GA AL McGARTLAND, U.S. Environmental Protection Agency, Washington, DC DAVID M. MICHAELS, Occupational Safety and Health Administration, Washington, DC CANICE NOLAN, European Commission, Brussels, Belgium MARTIN A. PHILBERT, University of Michigan, Ann Arbor CHRISTOPHER J. PORTIER, Centers for Disease Control and Prevention, Atlanta, GA PAUL SANDIFER, National Oceanic and Atmospheric Administration, Charleston, SC JOHN D. SPENGLER, Harvard School of Public Health, Boston, MA LOUIS W. SULLIVAN, Morehouse School of Medicine, Atlanta, GA ANNE M. SWEENEY, Texas A&M University, College Station G. DAVID TILMAN, University of Minnesota, St. Paul PATRICIA VERDUIN, Colgate-Palmolive Company, Piscataway, NJ 1  Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. ix

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NSEDU OBOT WITHERSPOON, Children’s Environmental Health Network, Washington, DC HAROLD ZENICK, U.S. Environmental Protection Agency, Research Triangle Park, NC Roundtable Staff CHRISTINE COUSSENS, Roundtable Director (until August 2013) ERIN RUSCH, Associate Program Officer ANDRÉS GAVIRIA, Research Associate (until August 2013) HOPE HARE, Administrative Assistant ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice x

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Reviewers T his workshop summary has been reviewed in draft form by indi- viduals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent re- view is to provide candid and critical comments that will assist the institu- tion in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: Mark Bomford, Yale University Richard A. Fenske, University of Washington Jillian Fry, Johns Hopkins University Michael W. Hamm, Michigan State University Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Georges C. Benjamin, American Public Health Association. Ap- pointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review com- ments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteur and the institution. xi

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Contents 1 INTRODUCTION 1 Roadmap for This Report, 2 Keynote Presentation, 3 References, 8 2 DEFINING RELATIONSHIPS: SYNERGIES AND TRADE-OFFS BETWEEN HEALTH AND ENVIRONMENTAL IMPACTS 11 Priority Agriculture–Environmental–Nutrition Linkages for Sustainable Diets, 13 Fish, Fisheries, and Food Security, 22 Environmental Impact of Meat: Greenhouse Gas Emissions, 26 Panel Discussion with the Audience, 29 References, 32 3 QUANTIFYING SYNERGIES AND TRADE-OFFS: MOVING FORWARD FROM CONCEPTUAL LINKS TO EMPIRICAL DATA 35 Quantifying Environmental Impacts of Diets, 37 Land Use Effects of Various Diet Patterns, 44 Life-Cycle Assessment of Dietary Patterns, 49 Panel Discussion with the Audience, 55 References, 58 xiii

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xiv CONTENTS 4 THE FOOD PRICE ENVIRONMENT 61 Projected Food Prices: The Impact of Environmental Constraints, 63 The Effect of Natural Resource Scarcity on Commodity Sourcing, 67 Can Economic Incentives Drive Environmental Sustainability and Healthier Diets?, 70 Panel Discussion with the Audience, 74 References, 78 5 OPTIONS AND APPROACHES TO ENABLE SUSTAINABLE FOOD CHOICES 81 Lessons from Across the Atlantic: Policy Faultiness and Policy Possibilities on Sustainable Diets, 83 Policy Implications, 91 Options and Approaches to Enable Sustainable Food Choices: Research Priorities, 95 Panel Discussion with the Audience, 101 References, 104 6 MOVING FORWARD 107 Behavioral Economics: Implications for the Food Environment and Choices, 108 Reflections of Derek Yach, 116 Reflections of Erik Olson, 119 Lisa Eakman’s Take-Home Messages, 121 References, 125 APPENDIXES A ABBREVIATIONS AND ACRONYMS 127 B WORKSHOP AGENDA 129 C SPEAKER BIOGRAPHICAL SKETCHES 133