A few weeks ago an older patient looked over my shoulder at the tupperware box on the filing cabinet behind me, which held a rainbow quinoa salad. ‘Did you make that?’ she cooed delightedly. ‘Must be why you’re so thin!’ My product placement was unintentional, and though I was delighted to see that someone had finally noticed my rather puritanical eating habits, unfortunately the patient was one of the most vibrant octogenarians I’ve ever clapped eyes on. Not unfortunate for her of course, but my efforts did seem rather wasted. Who am I kidding? We live our lives surrounded by adverts for ultraprocessed junk food on giant billboards and by the products themselves in corner shops, stations, and supermarkets. Expecting to change someone’s habit by showing them a tasty salad would be like having a stand to promote drinking in moderation at freshers week.
Fixing the pendulum
It is beyond silly that the health service isn’t doing more to buck this trend. It’s all very well having the Eatwell Guide, but the food offered on NHS grounds speaks far louder than pretty illustrations on a website. Just walk around any hospital. You’ll see chocolates, crisps, and cakes beckoning your gaze (and your stomach) at vending machines and hospital shops, but will you see any fresh fruit? Patient food isn’t much better. In some hospitals even children are routinely served white bread, concentrated fruit juice, and ice cream/cakes/jelly as if they are, and should be, dietary staples. Maybe that’s just a reflection of patient choice, and of course sick people need to eat — but should the health service really be so passively led by culture?
And then there’s the cow in the room. Red meat. Sure it tastes great, and British farmers are doing a lot more for animal welfare than most countries, but the sheer volume of red meat eaten is a massive problem. Raising livestock for dairy and meat uses 80% of global agricultural land, despite providing just 17% of its calories, and 37% of its protein. Livestock weigh 10 times more than all the wild mammals and birds put together. Hugely polluting herbivores live in vast biodiversity deserts when there should be climate regulating temperate rainforest covering much of the land. I’m not even vegan and can see that the dietary pendulum has swung way too far in favour of meat. For the good of our atmosphere, air, biodiversity, reservoirs, antibiotics, and pandemic prevention plans, it needs to swing back.
This is why 11 hospitals in New York are offering patients delicious whole-food plant-based meals, like Moroccan root vegetable tagine with tricolor couscous, before they offer any meat and dairy dishes. It’s a simple example of ‘choice architecture’ and as a result they have saved USD 500 000 and reduced their food-related carbon emissions by one-third. In addition, they discourage excessive meat consumption, which is a driver of antibiotic resistance. Hopefully it will also seep into wider culture, as New York’s biggest health institutions practice what we all preach: eat more fruit, vegetables, beans, and grains, less meat and dairy, and much less junk food.
Nudges like this are needed because despite regular reports about improving the diet of the population, little has changed. Eight years ago less than a third of people ate five portions of fruit and vegetables per day, and that figure hasn’t budged since. In 2021, the National Food Strategy suggested that we should aim as a nation to increase consumption of fruits and vegetables by 30%, reduce consumption of meat by 30%, and increase consumption of fibre by 50%, all by 2032.
How to help turn the tide
There is considerable appetite for UK hospitals to replicate the successes in New York. On 15 October, World Food Day, over 1000 health professionals and 24 health institutions — including the Faculty of Public Health and the British Society for Haematology — supported the Plants First Healthcare Campaign. It went out to all hospital CEOs, lead dietitians, and sustainability officers to say look, this works, and it saves money! Why don’t you copy it?
But what can we do as GPs, apart from support these changes to hospital meals? Educating ourselves on the harms of ultraprocessed food and excessive meat and dairy would be a start. Chris van Tulleken’s book, Ultra-processed People, is an excellent read, and chapter 8 of the National Food Strategy, titled The Complexities of Meat (just 4 pages long!), is a great and unbiased starter to understand why excessive meat consumption is a problem. Next, we could look at our staff rooms. Wouldn’t it be nice for a change to see a fruit bowl in addition to the piles of cookies and cakes (or dare I say it, in place of)? And for patients we can put posters up promoting a whole-food plant-predominant diet, such as those on the Greener Practice website (https://www.greenerpractice.co.uk), and have suggestions at our fingertips when the topic of food comes up, such as batch-cooking budget meal planners.
And for those of use with puritanical eating habits like myself, yes, maybe if you place your lunch in eye-line, it might spark up a conversation now and again. It just probably won’t be with the patients you want.
Footnotes
Competing interests
Chris Newman is the Director of Earth Medic and co-organiser of the Plants First Healthcare Campaign.
This article (with references) was first posted on BJGP Life on 7 Nov 2024; https://bjgplife.com/turningtide
- © British Journal of General Practice 2024
