Turning the tide on healthy eating

Chris Newman is a flexitarian southeast coast GP with a passion for tennis, cycling, mens work and greener practice.

A few weeks ago an elderly 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 ultra-processed junk food on giant billboards and by the products themselves in corner shops, stations, 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.

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.¹ 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 ten 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 New York Hospitals offer patients delicious wholefood 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 managed to save $500,000, reduce food emissions by over a third as well, reduce the use of ‘last resort’ antibiotics in farmed animals.² Hopefully it will also seep into 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,³ and that figure hasn’t budged since.⁴  In 2021 the National Food Strategy⁵ suggested that we should aim as a nation to increase fruits and vegetables 30%, reduce meat 30% and increase fibre by 50% all by 2032.

There is considerable appetite for UK hospitals to replicate the successes in New York. On October 15th, World Food Day,⁶ over 1000 health professionals and 24 health institutions – including the Faculty of Public Health and the British Society of Haematology – supported the ‘Plants First Healthcare Campaign’. It went out to all hospital CEOs, lead dieticians and sustainability officers to say – look, this works and it saves money! Why don’t you copy it?

But what can we do as general practitioners, apart from supporting these changes to hospital meals? Well educating ourselves on the harms of ultraprocessed food and excessive meat and dairy would be a start. Chris Van Tulleken’s book Ultraprocessed People is an excellent read, and chapter 8 of the National Food Strategy entitled ‘The Complexities of Meat’ (just four 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 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.

References

1. Winter G. The problem of ultra-processed food in healthcare settings. Br J Nurs 2024; 33(13): S6-S7; DOI: https://doi.org/10.12968/bjon.2024.0203doi: 10.12968/bjon.2024.0203.

2. Watkins RR, Smith TC, Bonomo RA. On the path to untreatable infections: colistin use in agriculture and the end of ‘last resort’ antibiotics. Expert Review of Anti-Infective Therapy 2016; 14(9): 785–788; DOI: https://doi.org/10.1080/14787210.2016.1216314.

3. Office for Health Improvement and Disparities. Healthy eating among adults; 2024 https://www.ethnicity-facts-figures.service.gov.uk/health/diet-and-exercise/healthy-eating-of-5-a-day-among-adults/latest/.

4. NHS Digital. Health survey for England , 2022, Part 1; 2024 https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2022-part-1/adults-health-related-behaviours#fruit-and-vegetable-consumption

5. Department for Environment, Food & Rural Affairs. National food strategy for England; 2021 https://www.gov.uk/government/publications/national-food-strategy-for-england

6. Dalton J. Food guru Tim Spector and health experts call on NHS to make vegan food the norm in hospitals. Independent; 2024 https://www.independent.co.uk/news/uk/home-news/hospital-food-tim-spector-health-vegan-plant-b2628101.html

Suggestion for budget healthy meal plan:

• BBC: https://www.bbc.co.uk/food/articles/student_budget_meal_plan
• Natural Comfort Kitchen: https://www.naturalcomfortkitchen.com/plant-based-vegan-batch-cooking-meal-plan-1/

Conflict of interest: The Author is director of Earth Medic and co-organiser of the Plants First Healthcare Campaign

Featured photo by Anna Pelzer on Unsplash