case study on food and nutrition

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.369; 2020

Food for Thought 2020

Food is medicine: actions to integrate food and nutrition into healthcare, sarah downer.

1 Center for Health Law and Policy Innovation, Harvard Law School, Harvard University, Cambridge, MA, USA

Seth A Berkowitz

2 Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

3 Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Timothy S Harlan

4 Section of General Internal Medicine George Washington University School of Medicine and Health Sciences, George Washington University Culinary Medicine Program, George Washington University, Washington, DC, USA

Dana Lee Olstad

5 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

Dariush Mozaffarian

6 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA

Associated Data

Sarah Downer and colleagues review new efforts to incorporate food and nutrition into prevention, management, and treatment of diet related disease in healthcare systems

Key messages

• In the face of the global epidemic of diet related chronic disease, there is increased experimentation with the use of “food is medicine” interventions to prevent, manage, and treat illness
• Interventions used with increasing frequency in the US and piloted to some extent in other countries include medically tailored meals, medically tailored groceries, and produce prescription programmes
• Scaled integration of these and other emerging nutrition interventions into healthcare would require significant investment in rigorous research to test different approaches and address knowledge gaps
• Clinicians need more and better education and training on the appropriateness and use of these interventions
• We also need to identify sustained funding streams to ensure equitable access and availability for patients

A global epidemic of diet related chronic disease has prompted experimentation using food as a formal part of patient care and treatment. One of every five deaths across the globe is attributable to suboptimal diet, more than any other risk factor including tobacco. 1 Individual interactions with the healthcare system are an important opportunity to offer evidence based food and nutrition interventions. An emerging but compelling body of research indicates that such interventions delivered in the healthcare system might be associated with improved health outcomes and reduced healthcare usage and costs. 2 3 4 5 6 7 8 9 10 These data point to the potential for food and nutrition interventions to play a prominent role in the prevention, management, treatment, and even in some cases reversal of disease. 11 When broadly deployed, interventions that are effective for individual patients have the potential to affect population health and shape broader food and health policy reform. Realisation of health benefits is, however, hampered by lack of investment in research, low levels of clinician nutrition knowledge and awareness of interventions, and narrow access to appropriate services and programmes. Tackling each of these challenges is critical to achieving a healthcare system in which nutrition and food are a routine part of evidence based disease prevention and treatment.

We argue for increased integration of specific food and nutrition interventions in—or closely coordinated with—the healthcare system, an initiative often known as “food is medicine.” We focus on novel interventions such as medically tailored meals and prescriptions for produce that incorporate food strategies to improve health in the structure and funding of the healthcare system rather than traditional medical nutrition interventions such as those that focus on vitamin or other nutrient supplements or medical foods.

Food is medicine interventions

Food is medicine interventions include medically tailored meals (also called therapeutic meals), medically tailored groceries (sometimes known as food “farmacies” or healthy food prescriptions), and produce prescriptions ( table 1 ). They are typically directed by clinicians through the healthcare system, provided at no cost or very low cost to the patient, and funded by healthcare, government, or philanthropy.

Food is medicine: key food and nutrition interventions used in healthcare systems

Through a PubMed database search and by polling our network of international colleagues, we found 32 studies in the literature evaluating food is medicine interventions. Most of the examples we found were in the United States, with a few in other Western nations including Australia, Canada, and the United Kingdom. 13 14 15 16 We found none in Brazil, Finland, Germany, Ireland, or Mexico. Most interventions were dependent on philanthropic rather than organisational or institutional support. Reflecting the relative novelty of these efforts, data on the health impacts of food is medicine programmes were variably available in the peer reviewed literature.

These interventions vary widely in intensity and breadth of patient coverage. Medically tailored meals are the highest intensity intervention, necessary for a small but high needs group—those with complex medical conditions who are unable to shop or prepare meals. Over the past three years, the US has launched multiple large medically tailored meal projects for this population in their public insurance programmes, with additional use for elderly people proposed through legislation. 17 18 19 The research on medically tailored meals cited in this article includes larger sample populations and more robust research designs (instrumental variable analyses, statistical matching, and a randomised crossover trial) than for the other interventions. 2 3 6 7 In a retrospective cohort study with 1020 participants, for example, receipt of medically tailored meals was associated with a 16% net reduction in overall healthcare costs, 49% fewer inpatient hospital admissions, and 72% fewer admissions into skilled nursing facilities compared with the control group. 2

Medically tailored groceries are appropriate for a broader range of patients—those with diet related chronic and acute conditions but who can cook and prepare food at home. Peer reviewed research on the impact of tailored packages of unprepared foods is scant, but co-location of food pantries and hospitals or health centres is increasingly common, along with ability to access this intervention at food banks. 14 20 21 Two randomised control trials are currently under way to assess recipient health impacts, one evaluating the impact of receiving nutritionally appropriate staple foods from a hospital located food pantry for people with diabetes and the second assessing home delivery of a medically tailored meal kit for low income pregnant women that meets certain diet related health eligibility criteria. 22 23

In theory, produce prescriptions are appropriate for the broadest number of recipients, for both disease prevention and management. Several studies have explored the impact of these programmes on participant attitudes, behaviours, and consumption of fruits and vegetables, but research assessing clinical outcomes and claims data are relatively recent. Research on this intervention is trending in recent years towards more robust study designs with larger sample sizes. 5 8 9 Modelling studies indicate that prescriptions for an array of healthful foods can be highly cost effective or even cost saving for the healthcare system when targeting key sociodemographic subgroups at highest risk, such as elderly people, adults with disabilities, and people with low income. 10 Researchers in the US found, for example, that, over a lifetime, a 30% subsidy incentive on fruits and vegetables would prevent 1.93 million cardiovascular disease events and save approximately $40bn (32bn; €36bn) in healthcare costs.

Food insecurity

We distinguish food is medicine interventions from programmes that respond to general food insecurity by being designed or administered with the express purpose of tackling health concerns. Food banks in the UK are an example of food insecurity response; access to food banks sometimes requires a referral from a healthcare provider, but the food received is not tailored, or not always appropriate, for people living with or at risk of specific health conditions. 24 By contrast, at a preventive food pantry in a hospital in the US a hospital dietitian reviews the patient’s medical record before selecting a mix of shelf stable and fresh foods that are nutritionally appropriate based on the individual’s health profile and personal preferences. 20

Given what we know about the impact of food insecurity on individual health and the healthcare system, 25 26 programmes like the UK’s food bank voucher system, the US Supplemental Nutrition Assistance Program (formerly known as Food Stamps), and Brazil and Mexico’s conditional cash transfer programmes are likely to provide some protection against adverse health outcomes. But the support they provide is not coordinated with the healthcare system, so specific health impacts are difficult to measure. Innovations that include clinical evaluations, clinical guidance, and financial support for food is medicine interventions in the healthcare system might be effective and expedient ways to improve both food insecurity and health, even if they do not comprehensively tackle the root structural causes of suboptimal diet.

In the US, government and private health insurers are adopting food and nutrition interventions in the hope of a return on their investment due to reductions in high expenditure healthcare claims. In light of emerging evidence, policy makers are experimenting with loosening the parameters of value based or capitated payment structures to allow public insurance money to be spent on food is medicine interventions. This flexibility can be expanded, administratively or through legislation, to all public health insurance programmes. However, large scale uptake of newly created flexibility to pay for food depends on confidence that food is medicine interventions are clinically effective and cost effective compared with other aspects of medical care.

Benefits of food is medicine

Referring patients to food is medicine interventions can change their ability to follow dietary recommendations, tackling several barriers to healthy eating, including the inability to afford or access recommended foods. 24 25 27 28 29 Providing food or food focused financial assistance can also alleviate budget constraints that prevent patients from affording medications and paying bills. 28 Some food is medicine interventions model appropriate portion size and ingredient selection, enabling recipients to maintain more healthful diets past the intervention duration. 28

Clinicians who refer patients to food is medicine interventions might also see better disease management and fewer admissions to hospital. 2 3 4 6 7 A patient with diabetes who typically runs out of food when monthly assistance is exhausted, for example, could be given anticipatory nutrition guidance and vouchers for supplemental food to avoid an episode of hypoglycaemia.

Integration in healthcare

Healthcare systems are a logical delivery or connection point for food is medicine interventions, but integration depends on many factors. We discuss the need for additional data on effectiveness of different food and nutrition interventions, increased clinician knowledge and familiarity, and sustainable funding.

We need more data

Most studies to date are quasi-experimental or small, short term pilot interventions. Key evidence gaps include the comparative efficacy of different interventions on physical, social, and mental health outcomes and healthcare utilisation, heterogeneity of treatment effects (which interventions work best for which groups, defined by both clinical and social circumstances), and the optimal intensity and duration of intervention needed for different situations. Given that the interventions might have effects throughout life, the appropriate timescale to assess benefits should also be considered.

Supportive evidence can be derived from careful modelling and microsimulation studies to forecast and compare dietary, health, and utilisation and cost benefits for different interventions and scenarios over the short and long term.

The promising findings observed in studies to date must be evaluated with larger implementation studies, including randomised trials with appropriate comparison groups. These might not always be feasible because nutrition research questions often involve long timeframes with treatments that might be difficult to standardise. Instead, quasi-experimental designs with low risk of bias can be used, when appropriate. These could include analyses of natural experiments, instrumental variable analyses, regression discontinuity studies, interrupted time series approaches, and difference-in-difference designs.

For food is medicine interventions to be most effective, the participant should be engaged and their experience evaluated. Qualitative research will better integrate individual perspectives into the design of food is medicine programmes and reveal how, why, and in what context they work best for participants. 30 To tackle historical mistrust of the healthcare system and ensure cultural appropriateness of offerings, research to integrate food is medicine services into healthcare and bring them to scale should contemplate co-design of interventions with eligible participants and appropriate community based organisations. 31

Improving clinicians’ knowledge

Clinicians should be knowledgeable enough to recognise a patient’s nutritional needs and understand the potential impact of available services, but this is not the case in many countries. In the US, for example, healthcare professionals (other than registered dietitians) receive very little or no food and nutrition education during training, with less than 1% of lecture hours spent on nutrition education in medical school. 32 An assessment of medical nutrition education initiatives in six countries outside Europe and 15 in Europe found that “nutrition is insufficiently incorporated into medical education, regardless of country, setting, or year of medical education.” 33

Numerous recommendations have been made over the past 20 years to advance policies to increase nutrition education, but change remains elusive. 34 Theories for the lack of progress include lack of leadership or faculty level nutrition champions at many medical schools, lack of compelling training opportunities (such as fellowships) focused on nutrition, and rapidly advancing nutrition science coupled with rampant public nutrition misinformation might have minimised the perceived credibility of nutrition science among physicians. 34 35 36 37 Most physicians, however, recognise their lack of sufficient nutrition education, and would like more information to tackle this key driver of health. 38

Nutrition training delivered across disciplines holds the promise of more effective patient nutrition education and treatment. 39 In the US, UK, and Spain, “culinary medicine” movements are blending clinical medicine with individual nutrition education focused on the practical aspects of food preparation and cooking. This supports a healthcare professional’s willingness and ability to recognise nutrition needs and provide appropriate and practical advice to patients. 40 41 Clinicians should have familiarity with validated nutrition assessment tools, the range of available food is medicine interventions, and the systems and incentive structures that enable and encourage their use in clinical practice. Doctors should also understand the role of, and actively collaborate with, dietitians to appropriately treat people who are at nutritional risk. Increasing nutrition education among doctors might also encourage use of dietitians’ expertise in patient care; rates of referral from physicians to dietitians are often quite low, even when diagnoses have a clear nutritional link. 42

Requiring comprehensive nutrition training as a component of healthcare clinician education will ensure equitable patient access to nutrition expertise across specialties and geographies. Ways to ensuring incorporation of nutrition into clinician curriculums include legislative mandates, making government funding for schools contingent upon such requirements, integration into accreditation standards, and inclusion of nutrition questions on board and other qualifying examinations. 43

Sustainable funding in and out of healthcare

The food is medicine interventions we found were largely funded by philanthropy and thus vulnerable to downturns in charitable giving and time limits on grants. The absence of sustainable funding mechanisms means that, in many locations, these services might simply not be available because health systems or community based organisations lack the resources. Thus, widespread implementation of food is medicine interventions, particularly those delivered through or with the healthcare system, requires financing models that consistently support these services. Sustainable support could be through public or private healthcare money or through other government funds.

In many healthcare systems, healthcare dollars pay for interventions such as enteral or intravenous feeding support and nutrition supplements for defined clinical deficiencies. But payment for food or meals is often allowed in only narrow circumstances—for example, for inpatients, people in assisted living facilities or nursing homes, or for specific nutritional items (as in the UK’s prescription for gluten-free breads and mixes). 44 This restrictive strategy might not be wise. In the US, an individual can receive seven months of medically tailored meals, nutrition counselling, and case management for the average cost of one inpatient hospital admission. 45 46 Because many of these interventions are provided in outpatient settings, trends towards shorter hospital stays would not decrease their efficacy and might make them even more important. If the provision of food was found to affect the rate of hospital admissions and other high cost services, 2 3 health policy makers would have a powerful incentive to alter healthcare funding restrictions. Some US health system entities, including healthcare payers and provider organisations, are using recent changes to healthcare funding parameters to provide nutrition interventions to patients who meet certain criteria ( box 1 ). 17 18

Examples of integration of food in medicine interventions in healthcare in the US

The states of Massachusetts 17 and California 18 are using food in medicine interventions with high risk populations. The government pays for these services through the healthcare system. The Massachusetts programme, launched in 2019, provides home delivered meals (medically tailored and non-medically tailored), groceries, assistance applying for non-healthcare nutrition programmes and legal advocacy for benefits, household supplies to meet dietary needs (cooking implements), nutrition skills development through education and cooking classes, and transportation to meet nutritional needs. To be eligible, patients must have one health needs based criterion (mental health condition, high risk pregnancy, complex health condition, has visited the emergency department more than twice in the past six months, has one or more limitations in activities of daily living) and one risk factor (homelessness, risk of homelessness, risk of nutritional deficiency or imbalance due to food insecurity). The programme measures the following outcomes: emergency department use, inpatient hospital admissions, overall healthcare expenditures, clinical outcomes, and the ability to live independently in the community. Results from the demonstration will be reported in 2022.

In addition to the food is medicine programmes funded through the healthcare system, the government has also appropriated millions of dollars of agriculture funding to establish produce prescription programmes in eight states around the country.

Payment mechanisms need not necessarily involve the healthcare system, as long as they are designed with health promotion in mind and are coordinated with interventions administered through the healthcare system. Health professionals in Alberta, Canada, for example, can confirm diagnosis of qualifying health conditions to enable social service recipients to receive an additional C$21-C$113 a month in cash to subsidise the costs of recommended foods. 15

When food is medicine interventions meet a standard of evidence that shows desired levels of impact on individual health outcomes and/or other desirable outcome measures, these services should be fully integrated into healthcare or other sustainable financing models. Reimbursement will support access to interventions, especially more complex services like medically tailored meals, by helping to create and sustain an infrastructure of organisations that can work with complicated and sensitive health information to deliver sophisticated interventions to anyone who meets eligibility criteria, whether they reside in urban or rural locations.

The food is medicine interventions reviewed in table 1 , administered in or closely coordinated with healthcare systems, are often enhanced and more targeted versions of services provided in anti-hunger programmes (see supplementary table online). These might include Germany’s food bank system, which is entirely divorced from the healthcare system; universal school meals programmes (in Finland and other European countries); and services delivered through cash transfers conditioneal on receipt of certain healthcare services (such as those in Brazil and Mexico) or health diagnoses (in Canada). 15 47 48 49 50

Future directions

Integration of food is medicine interventions into healthcare depends in large part on new investment in research to add to the evidence base. Improved clinician training and referral capacity, together with increased financial support for interventions both in and outside the healthcare system, will help to ensure that patients are assessed and referred to appropriate interventions available in every community. Access to interventions will be supported by the proliferation of organisations and entities that are able to deliver a range of food and nutrition interventions, some of which are quite complex. In the US, for example, an increasing number of non-profit and for-profit entities are contracting with the healthcare system to provide these services, many for the first time.

The global pandemic of covid-19 has brought the fragility of food and healthcare systems across the globe into sharp relief, with skyrocketing rates of food insecurity and people with diet related illness struggling with increased barriers to accessing healthy food. 25 26 Healthcare systems that integrate food is medicine interventions will enable more resilient systemic responses to such crises. An integrated system will support an infrastructure of food is medicine providers and access pathways that can be used to immediately meet increased demand for healthy food support.

The consequences of poor health caused by poor diet affect many sectors (resulting in high healthcare spending that diverts funds from other policy priorities such as education and enhancing economic prosperity); clinicians working to advance integration have a compelling case to make to a diverse range of decision makers. As healthcare systems continue to evolve to tackle the global crisis of nutrition related disease, food is medicine interventions should be held to rigorous standards when decisions about implementation, coverage, and care are made. But they can no longer be categorically excluded as outside of or ancillary to healthcare delivery, as they have been in the past across many healthcare systems. Integration of food and nutrition interventions into healthcare holds significant promise for meeting immediate nutrition needs while working in harmony with broader, long term health and food system reforms.

Acknowledgments

This article draws from the law and policy expertise and research of so many, especially Kathryn Garfield, Kristin Sukys, Emily Broad Leib, and Robert Greenwald.

Web extra. 

Extra material supplied by authors

Supplementary table: A continuum of international food insecurity and food is medicine programs

Contributors and sources The expertise of the authors includes dietary patterns (DLO, TSH, SAB, DM), nutrition and health related public policy (SD, DLO, DM), clinician nutrition education and training (TSH, DM), primary care and health related social needs interventions (SAB, DLO), and socioeconomic inequities in diet and health (all). SAB, DLO, TSH, and DM are clinicians. All authors contributed to drafting this manuscript, with SD taking a lead role. All authors gave intellectual input to improve the manuscript and have read and approved the final version. SD is guarantor.

Conflicts of Interest We have read and understood BMJ policy on declaration of interests and have the following interests to declare: SD reports organisational funding from the Rockefeller Foundation, the Laura and John Arnold Foundation, the MAC AIDS Fund, and the Bristol-Myers Squibb Foundation. She sits on the American Cancer Society’s National Lung Cancer Roundtable (unpaid) and on the Advisory Board for the Aspen Institute Food and Society Program’s food is medicine initiative. Funding for SAB’s work on the studies cited in this article was provided by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number K23DK109200. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. SAB has also received funding from the Aspen Institute, the US Department of Agriculture, the Robert Wood Johnson Foundation, and the Commonwealth Fund. He serves on the research advisory committee (unpaid) of the Social Intervention Research and Evaluation Network. TH reports past funding from the Robert Wood Johnson Foundation and the Humana Foundation; speaker fees from Optum, Omnia Education, beef.org, NACCME, DairyMAX; serves on the board of the Culinary Medicine Specialist Board; receives book royalties from Pritichett and Hull and Perseus; and is the owner and editor and chief of drgourmet.com and Dr Gourmet published materials. DLO reports research funding from the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council of Canada, the O’Brien Institute for Public Health, I Can For Kids Foundation, Alberta Innovates, Alberta Health Services, the Canadian Foundation for Dietetic Research, the Calgary Centre for Clinical Research, SecondBite, the University of Calgary, the Heart and Stroke Foundation of Canada, and the Libin Cardiovascular Research Institute of Alberta. DM reports research funding from the National Institutes of Health and the Gates Foundation; personal fees from GOED, Nutrition Impact, Bunge, Indigo Agriculture, Motif FoodWorks, Amarin, Acasti Pharma, Cleveland Clinic Foundation, America’s Test Kitchen, and Danone; scientific advisory board, Brightseed, DayTwo, Elysium Health, Filtricine, HumanCo, and Tiny Organics; and chapter royalties from UpToDate.

Provenance and peer review: Commissioned; externally peer reviewed.

This article is part of series commissioned by The BMJ. Open access fees are paid by Swiss Re, which had no input into the commissioning or peer review of the articles. T he BMJ thanks the series advisers, Nita Forouhi, Dariush Mozaffarian, and Anna Lartey for valuable advice and guiding selection of topics in the series.

• Methodology
• Issues in Focus
• Country Case Studies
• Policy Recommendations

Making Food a Right for All

India has made considerable progress in tackling hunger and undernutrition in the past two decades, yet this pace of change has been uneven and many have been left behind. now is the time to assert the right to food for all and make zero hunger a reality for everyone..

  When you have your godowns (warehouses) full and people are starving, what is the benefit? You cannot have two Indias.   Dalveer Bhandari, Judge of India’s Supreme Court, 21 April 2011

I ndia is a country of stark contrasts. In total, 22% of its population lives below the poverty line (Government of India 2013). At the same time, it is home to 84 of the world’s billionaires (Forbes 2016).

India’s top 1% own more than 50% of the country’s wealth. It is the world’s second largest food producer and yet is also home to the second-highest population of undernourished people in the world (FAO 2015).

One side of this story is clear from the score for India on the Global Hunger Index (GHI) – 28.5 (von Grebmer et al 2016). By contrast, Brazil, Russia, China and South Africa, all of whom share the BRICS high table with India, have a single-digit score. India’s neighbours, including Bangladesh, Nepal, Sri Lanka and Myanmar, have better GHI scores as well. Although the country has managed to reduce instances of stunting among children by nearly half in the past decade compared to the previous one (IFPRI 2015), India remains home to one third of the world's stunted children (UNICEF et al. 2016). It therefore falls into the ‘serious’ category in this year’s (2016) GHI.

Now, the 2030 Agenda for Sustainable Development is seeking to end hunger, achieve food security, improve nutrition and promote sustainable agriculture. The tangible outcomes will be to eradicate instances of stunting among children and guarantee every citizen with access to adequate food throughout the year through sustainable food systems, the doubling of smallholder productivity and income, and zero food loss or waste.

Although rainfed agriculture supports nearly 40% of India’s population (Government of India 2012), these farmers are highly sensitive to drought, which can cause crops to fail and lead to spiralling debt.

The key driver behind the goal to reach Zero Hunger and malnutrition is to ensure that no one is left behind in the pursuit of food and nutrition security. In the Indian context, this will also mean greatly improving the health of women and children.

The Government of India enacted the National Food Security Act (NFSA) in 2013, a law seeking to “provide for food and nutritional security […] by ensuring access to adequate quantity of quality food at affordable prices to people to live a life with dignity” (Ministry of Law and Justice 2013).

The 2013 NFSA created legal entitlements to existing governmental food and nutrition security programmes. Most significantly, it has changed the nature of discourse on food, making it a human right and putting the onus on the state to guarantee basic entitlements. However, the question is whether the quality of life has actually improved for everyone in the meantime. The food provided by the Government through its procurement and disbursement schemes serves the calorific requirement for some of the population. However, the system has also altered their food habits, made them dependent on rice and wheat and eliminated traditional diet diversity, thereby reducing the micronutrient content of the food on their plates.

Those Left Behind

Among the poorest people in India are those who belong to Scheduled Castes and Scheduled Tribes – traditionally oppressed classes for whom the Indian constitution provides special affirmative provisions to promote and protect their social, educational and economic interests.

The Scheduled Castes include millions of Dalits, or ‘untouchables’, who continue to be subject to endemic discrimination. This is also the case for the Scheduled Tribes, which comprise indigenous people, also known as Adivasis, who are often disadvantaged, in part because of the forested geographies in which they live.

As a consequence, Dalits and Adivasis are over-proportionally affected by poverty. With 104 million people belonging to nearly 700 distinct ethnic groups, India has the second-largest tribal population in the world (Government of India 2011). 47% of the rural tribal population lives below the national poverty line, compared to the national average for rural areas of 28% (Rao 2012). The level of poverty and food and nutrition insecurity of the tribal people continues to be a major issue, despite the affirmative action put in place by the architects of India’s Constitution for their protection and welfare.

The Adivasis have borne witness to the appropriation of their lands, destruction of their environment and commoditisation of their traditional knowledge – a lopsided bargain which has come at the cost of their way of life and well-being, beginning with their health and the security of resources for future generations. Safeguards such as informed consent have been thrown to the winds in the rush to acquire and trade forest produce and land on a large scale.

The problems faced by the indigenous people of India are further iterated by a recent study conducted by the United Nations Children´s Fund (UNICEF). Covering 11 states, it shows that every second Adivasi child is stunted, 68% of Adivasi mothers are less than 20 years old, 48% are undernourished and 76% are anaemic. Furthermore, the study states that the risk of severe stunting is nearly twice as high among girls aged 6-23 months compared to boys (UNICEF 2014). This may be due to food distribution practices within households and gender discrimination, resulting in woman receiving less food or men being served the best portions.

The efforts of the Food Security Act and a range of other laws to tackle these issues have encountered many challenges. Adivasi hamlets are often remote and poorly connected, making logistics and monitoring difficult. Indeed, the plight of those who suffer from hunger is only addressed when deaths resulting from starvation momentarily lead to public outrage. These are the groups that need support most urgently.

Growing Rich Diversity with Limited Land

  My friends were avoiding farming. I told them that we can’t afford to let the varieties of our village get lost. Last year, I grew 70 varieties. It sufficed us for the year. This year I have told fellow villagers to grow 80 varieties   Adi Kumbruka, young farmer in Kanduguda village, Odisha

Welthungerhilfe has been working in India since 1965. As part of its current efforts, it is increasingly focusing on mobilising and raising awareness among the marginalised and poor rural communities in order to help them access their rights and entitlements in relation to hunger and poverty.

Welthungerhilfe’s approaches address the four pillars of food and nutrition security, namely ensuring the availability of food of sufficient quantity and quality, guaranteeing that people have physical and economic access to this food, providing health and sanitation conditions that enable them to truly benefit from this food, and ensuring that these factors are stable all year round.

Welthungerhilfe works with a number of civil society partners across the country implementing a rights-based approach that addresses these four aspects of food and nutrition security. Many of these projects are established in states and regions suffering from extremely high levels of malnutrition.

Living Farms , a partner NGO, works with landless, small and marginalised farmers in the dry, hilly region of the state of Odisha in Eastern India to help them assert their food sovereignty and improve their well-being by means of an ecological and sustainable approach to agriculture. To this end, Living Farms is working to re-establish the control of these farmers over food and farming systems through the conservation, renewal and rejuvenation of biodiversity. Availability of food is improved at household level by initiating a series of interventions to enhance productivity on the limited land they have.

In the Kerandiguda village of Rayagada, Living Farms is working with Loknath Nauri (pictured), a farmer in his sixties who draws inspiration from how tribal people practised agriculture decades ago. Loknath is a repository of wisdom. For example, he can tell the direction the yearly rains will come from based on how a local bird’s nest is positioned. He can also predict when it will rain purely using the beans in the pods of a local creeping plant. These are just two of the many lessons he shares with other farmers. Although Loknath owns just 2.5 acres (1ha) of land, his food stocks at home are plentiful. He grows 72 different varieties of crops on his farm:

  Growing multiple varieties of crops reduces the risks from drought and other farm stress. I harvest from September until January and have vegetables throughout the year.  

Living Farms has an extensive list of small land-holding farmers who grow over 50 different varieties on their farms. Thousands more cultivate over 20 crop varieties and no longer have to endure the type of crisis faced by farmers in other rain-fed agricultural regions around the country. This stability is important, as farmers can otherwise become lured into growing cash crops instead, such as cotton, cashew, palm oil, sugarcane and eucalyptus, which reduces food availability.

Debjeet Sarangi from Living Farms explains that the NGO is working with researchers to rediscover the virtues of traditional local crop varieties that can withstand erratic rainfall and soaring temperatures and still produce bountiful yields.

  The community already has traditional rice varieties that are rich in micronutrients, zinc, iron, magnesium and calcium, while scientists are working on creating such seeds in laboratories around the world.  

...Debjeet says, adding that the Adivasis avoid using chemicals on their farms and make their own compost instead.

In Jharkhand, Pravah, another Welthungerhilfe partner, encourages landless families to set up kitchen gardens in their homesteads and harness common fallows to grow food for the family. On the farmlands, diversity is returning through the ‘Sustainable Integrated Farming Systems’ approach, which functions according to the principle of farm planning and the use of all available resources, including time and space, as efficiently as possible. Hardy, drought-resilient millet crops are now being reintroduced to the cropping cycle. Waste from livestock, poultry and aquaculture is recycled through a bio-digester in order to provide rich farm manure, and agroforestry is practised to provide fodder for animals.

Space on the homestead as well as on the farm is used to grow different crops, sometimes in multiple tiers. Crops are planned in such a way that food is available throughout the year, thereby resulting in different food products for the market. In addition, this directly addresses micronutrient deficiency and leads to diet diversity among the population.

Pravah has worked closely with farmers like Nandlal Singh, who owns 2.5 acres of land. Nandlal’s story was similar to any other farmer’s in the region, namely one of debt, crop failure, migration and mortgages. His situation has now changed. Thanks to farm planning and integrated farming Nandlal has not only cleared his old debts, but has money in the bank. Pravah’s training on vermicomposting, organic farming and integrated pest and nutrient management techniques have proven successful and led to the production costs on Nandlal’s farm being reduced.

The family has a diverse diet which incorporates up to eight food groups, including cereals, lentils, fruits and vegetables. Nandlal grows these vegetables throughout the year while also rearing cattle, fish and ducks on what was once a patch of wasteland.

A striking feature of the work of both organisations is the low incidence of indebted households among the farmers involved in the programme. Small and marginal farmers like Nandlal Singh and Loknath are not short of the resources they need for this kind of farming. This reduces their reliance on loans and avoids the problems associated with debt. Debjeet Sarangi from Living Farms cites examples of how farmers who used to be impoverished now grow multiple crops per year and how, together with poultry and animal husbandry, they are able to safeguard their families against food and nutrition insecurity. But, most importantly, Debjeet says, they depend on forests.

Securing Forests to Secure Nutrition

of the Indian population is undernourished , meaning that they do not receive enough calories per day

of children under five are stunted (low height for their age), reflecting chronic undernutrition

of children under five are wasted (low weight for their height), reflecting acute undernutrition

of children die before the age of five

  The diet of the Adivasi people used to be a highly diverse one. However, years of planning and the Government’s control over resources meant that these tribal farmers began to lose the ability to cultivate the seeds that kept their people fed for generations. One result of these developments is that the diversity of the crops grown and of the available forest resources has shrunk massively over the years.  

...explains Debjeet. Debjeet alludes to evidence that vast swathes of forests are being acquired fraudulently:

  Officials only see it as lost forest when in actual fact the loss of these forests is also affecting the eating habits and the nutrition of the tribal people. The range of forest fauna, flowers, fruits, vegetables and mushrooms previously consumed by tribal people has diminished over time due to governmental policies. Tribal people collect 25 varieties of roots and tubers, 35 kinds of fruits and various oil seeds from the forests. The forest also provides 40 different leaf vegetables, mushrooms and various birds, animals, edible insects and other food sources throughout the year. In addition, the bodies of water belonging to the forests are home to an abundance of snails, fish and crab.  

This diversity offered by the forests is now under threat and entire species have disappeared, thus depriving families of a varied diet.

Women in Rayagada are now resisting the forest department’s attempts to plant commercial trees, demanding that multipurpose trees are planted instead. The move has led to the protection of forest cover and the revival of over 275 varieties of wild foods that provide food rich in micronutrients.

Rua Ulaka, a farmer from the village of Lanji, Rayagada, is part of this active citizenship movement, as evidenced by the level of care that she shows for her forests and its ecosystem. By working together, the Adivasis are able to ensure that this asset is not commercialised. Ultimately, the work carried out by Living Farms and Pravah has shown that families with very small landholdings and continued access to the forest are more than able to survive another year. With dignity.

Fighting the Day-to-Day Nutrition Crisis

  Previously, women would not have their babies weighed or breast-feed their newborns due to superstition. This has changed. Mothers now ask me how much their child weighs. Women wear slippers, families have toilets, girls are resisting early marriage and babies are being born in hospitals. Not a single child has died in this village over the past five years.   Sharmishta Raj, Anganwadi worker at the center of Laxmipur village in Odisha

As well as working to ensure the availability of sufficient and nutritious food, both organisations promote awareness and changes in behaviour at community level in terms of health care and infant and young child feeding practices.

A promising approach introduced by Pravah in the villages of Jharkhand consists of ‘Positive Deviance Sessions’, whose aim is to improve the health of moderately malnourished children. With 15% of children below five years of age being classified as underweight for their height, India’s acute malnutrition rate is at the international threshold that indicates a nutrition emergency. Babita Sinha, Pravah’s Programme Manager, explains:

  80% of the children in the nutrition camps have recorded weight gain and have shifted from the Moderate Acute Malnutrition (MAM) category to the category of healthy children. This is due in part to a 15-day hands-on camp to introduce young and pregnant mothers to new, nutritious recipes, gathering and using nutritious, uncultivated food, child-care practices and hand-washing.  

These ‘Positive Deviance Camps’ have also implemented de-worming programmes and helped to change the behaviour of young parents in various villages. According to Babita, the mothers realised that their children were responding positively to these initiatives when they were weighed. She recalls:

  Seeing a gain of 500 grams in the child’s weight gave the mothers tremendous joy.  

The sensitisation process was revealing for the experts at Pravah as well. “We were able to understand why children in the red category (meaning those belonging to the lowest-weight-for-age section of the WHO Growth Monitoring Charts, signifying malnutrition) belonged to families from certain clusters of the villages,” states Sweta Banerjee, Nutrition Specialist with Welthungerhilfe in India. Sweta bore witness to how the process taught the village communities to link nutrition with good agriculture practices and proper management of natural resources.

As she states, “We realised it was not a coincidence that these children came from families that were either landless or owned land uphill that was not irrigated. As such, the nutrition programme had to be amended to benefit them.”

One key breakthrough was that women were able to grasp how the nutrition chain between generations could be broken by paying attention to the nutritional needs of different age and gender groups and by including adolescent girls, expectant mothers and women nursing children. The Pravah team noted that close to half of the households in the villages in which they were working have since improved their food and diet practices. There have also been visible changes in personal hygiene practices at household level. Combined, these actions will have a lasting impact on the health of the people living in these villages.

Putting the Right to Food into Action

The Fight Hunger First Initiative implemented by Welthungerhilfe in cooperation with several Indian partner organisations, including Living Farms and Pravah, is based on the premise that it is only possible for people to break out of the cycle of inequality and discrimination permanently if adequate welfare systems are in place and basic rights are fulfilled.

This includes access to proper education, sufficient and adequate access to food and income, better health services and treatment as equal citizens by the state.

The right to food guaranteed by the Food Security Act is translated into a number of entitlements ensured through different programs. Examples include the Integrated Child Development Services (ICDS), which provides health and nutrition services to pregnant women and young children, and the Mid-Day Meals (MDM) scheme, which is aimed at providing free lunches and thereby improving the nutritional status and attendance of school children.

Meanwhile, the National Rural Employment Guarantee Act (NREGA) guarantees the provision of paid employment to rural families. In some cases, it has reduced reliance on the Public Distribution System (PDS), which distributes subsidised food rations to those who are most in need.

Enforcement of the National Food Security Act is a challenge, especially in far-flung villages. In addition, many families have little access to work for wages that could be used to buy food, educate children and cover other household expenses.

At national level, for example, households covered by the Rural Employment Act, on average, only received 41 days of work per year between 2011/12 and 2013/14 (Desai et al 2015). This equates to less than half the amount set out in the constitutional provisions. The situation is similar in Jharkhand. Rather ironically, the Government has increased the minimum number of days of work to which the households are entitled under the law to 150.

As part of the Fight Hunger First Initiative, community-based organisations are formed or strengthened and social accountability mechanisms such as community score cards are introduced as a means of empowering community members to access various forms of entitlements and holding service providers accountable. In the state of Jharkhand, Pravah successfully campaigned with 13 Non-Governmental Organisations (NGOs) for the inclusion of eggs in the Mid-Day-Meals at schools three times a week. Likewise, Living Farms has been able to persuade Government authorities to include millets in the ICDS programme, especially in the form of take-home rations for pregnant women. Persuading ICDS officials to appreciate community inputs has been a lesson in advocacy.

“Community members feel the services do not make sense. On the other hand, service providers also feel handicapped. The gap is evident and the community participation tools we have employed help to bridge this gap,” says Babita Sinha.

A federation of self-help groups promoted by Pravah offers numerous examples of how leadership has been nurtured among women, who are now able to confront agents working at public distribution system outlets or others charged with managing governmental service provision agencies. At the same time, workers at the Anganwadi centres are now on equal terms with the village women. Rua Ulaka is now aware of her rights and entitlements as a citizen, what she can expect from the village’s own self-governance institution, the Panchayat, and of her right to participate in the Gramsabha (village assembly).

Awareness of these aspects of governance ensures that Adivasi women can demand accountability from those governing them. As a result of the work carried out by Pravah and Living Farms, more households are now receiving work. Furthermore, community access to an array of welfare schemes run by the Government has vastly improved, thereby breaking the cycle of poverty and building the community’s resilience.

By engaging with the Village Health and Nutrition Days and working with institutions like the Village Health Sanitation & Nutrition Committees, the project also strengthens the government health service delivery mechanisms regarding its coverage and quality. Sharmishta Raj and her colleagues from the Anganwadi child care centre in Lakhimpur highlight the difference that working with Living Farms has made thanks to effective communication between the centre and the community.

“Not a single child has died in this village over the past five years,” she says, her face brimming with pride. This is a reflection of how much a small group of front-line government functionaries has achieved through a partnership with a civil society organisation in a remote corner of the country.

Ending a Nutrition Paradox

  I grow enough and earn enough and can also take advantage of the government’s food schemes. We even have fish once a week and enough fruits and vegetables.   Geeta Devya, Dhanway Naya village in Jharkhand

India’s agricultural growth rate increased phenomenally in the decades following the green revolution that turned the country from a “ship-to-mouth economy” into a land able to provide food security.

This growth was propelled by technological changes, major investment in infrastructure such as irrigation, markets and roads, the development of credit institutions, auxiliary services and the facilitation of pricing policies. However, the revolution has come with several significant limitations. As a result, a more ecologically and socially sustainable ‘evergreen revolution’ is needed.

India still faces a long road ahead in its quest to achieve Zero Hunger. Over 25 years since India ushered in its economic reforms, the country’s economy has undergone significant structural transformations, encouraging planners to turn their focus away from agriculture and instead towards the service and manufacturing sectors.

The priority now is to return attention to agriculture and its central role of providing food security, reducing poverty and generating employment. Turning one’s back on agriculture, particularly in a time when the climate is changing considerably, will put the food security of the 1.25 billion people living in India in jeopardy.

The Government has recently set an ambitious target to double the income of farmers by 2022 (The Economic Times 2016). This corresponds to targeted annual agricultural growth of more than 14% per year. More needs to be done to enhance the role that agriculture can play in improving nutrition outcomes, for example via the implementation of cross-sector policies and programmes at national and sub-national levels.

Efforts must also be made to ensure that small-scale, marginal and landless farmers are the true beneficiaries of these policies, as too many people are being left behind in India’s efforts to reach Zero Hunger. This goal can only be achieved when the people who are most excluded are placed at the centre of all action and thinking.

Indian civil society, including Welthungerhilfe’s partners, has been working with these communities to enable them to take control of their own lives and demand their right to food. It has also been working in close cooperation with the Government to implement a range of innovative ideas that address issues of food insecurity and malnutrition in remote corners of the country.

Above all, in this land of plenty it will only become possible to overcome the national nutrition paradox by challenging the social, economic and political structures that lead to the discrimination of the most vulnerable people in India.

About this Case Study

The United Nations Sustainable Development Goals are an inspiring and essential call to action. We are being called upon to end hunger by 2030 for everyone – forever. So how do we respond? How can we make this a reality?

This case study highlights the work of Welthungerhilfe as part of efforts towards achieving zero hunger. Drawing on many years of experience and well-founded evidence, we work with governments and partner organisations to scale up solutions which are both sustainable and sustained.

People are at the heart of these programmes. Their stories highlight the diversity of challenges faced by ordinary people every day: coping with conflict while building resilience, living with as well as tackling social inequality, and dealing with and mitigating the impacts of climate change. Although these challenges are enormous, so, too, is the potential to turn the ambition of the Sustainable Development Goals into a reality for everyone.

• 2023 Lancet Countdown U.S. Launch Event
• 2023 Lancet Countdown U.S. Brief
• PAST BRIEFS

2020 CASE STUDY 3

Promoting food security, resilience and equity during climate-related disasters.

The U.S. is often viewed as a nation of abundance , yet paradoxically, one in ten households were “food insecure” in 2019, meaning that they struggle to get the proper nutrition to keep their family healthy. CS_77

These challenges are not borne equally. Rates of food insecurity were nearly three times higher for low-income and single mother-headed households and nearly twice as high for Black and Latino households than for White households.

Early research has found a doubling of the average food insecurity rate across the U.S. linked to the COVID-19 pandemic, with even greater increases among vulnerable populations. CS_78 , CS_79 , CS_80 , CS_81 Disruptive events, whether climate-related disasters or the COVID-19 pandemic, can exacerbate existing barriers to securing healthy food for vulnerable populations and further widen food and health disparities. CS_82

Food insecurity has clear health implications. Adults who are food-insecure may be at an increased risk of health problems, including obesity, heart disease, diabetes, depression, and increased susceptibility to COVID-19. CS_83 , CS_84 , CS_85 Food insecurity also puts children at a higher risk of asthma, anemia, and obesity, as well as behavioral, developmental, and emotional problems. CS_83 , CS_86

Climate-intensified extreme events are compounding existing food insecurity

Climate change is anticipated to worsen existing food insecurity as climate-related disasters, such as drought and flooding, become more frequent and severe and as agricultural pests become more persistent. CS_72 , CS_87 In 2019, there were fourteen climate-related disasters within the U.S. that each caused over a billion dollars in damages. CS_52

Historic floods in the Midwest destroyed millions of acres of agriculture and caused widespread infrastructure damage ( see  the Case Study ). In addition, an above-normal Atlantic hurricane season inundated coastlines with unprecedented rainfall, high winds, and storm surge; and wildfires in California and Alaska caused widespread energy disruptions, compromising the health and well-being of residents. CS_52

The mechanisms of food system disruption

Disasters such as these threaten all aspects of food production, distribution, and accessibility, with subsequent impacts for affordability that can further exacerbate food insecurity for vulnerable populations. When food is not consumed where it is produced, it must be processed, stored, transported, and then sold or donated. These processes involve complex interdependent, and at times, international systems. Roads, bridges, warehouses, airports, energy grids, and other transportation or telecommunication infrastructure are at risk of direct damage from climate change, severely disrupting the food system as a whole. CS_88 , CS_89

For example, following the 2019 floods in the Central states, the flood waters caused more than forty state and federal highways to close, hydroelectric dams to be breached, and threatened nuclear power stations (see Case Study). CS_90 , CS_91 These disturbances limited the movement and storage of goods throughout the region and prevented consumers from accessing food sources. CS_91 , CS_92 In the midst of an extreme fire season in California that same year, utility providers turned off power to millions of homes and businesses, plunging low-income households into hunger and financial crisis as their food spoiled. CS_93

Recent climate disasters decreased food security

Climate disasters can lead to acute food insecurity in the short-term and exacerbate chronic food insecurity in the long-term (see Table 1). Populations already struggling from chronic insecurity, or those who are only marginally food secure, are particularly vulnerable to the socioeconomic impacts of disasters, such as loss of livelihood, rising food prices, forced migration, loss of social support, and health-related impacts. Data from the aftermath of 2019 disasters is still scarce, but the impacts from previous disasters that are similar in nature are well documented.

Individual, household and community level risk factors to food insecurity following climate-related disasters.

For example, nearly five years after Hurricane Katrina, many of the households heavily impacted by the hurricane in Louisiana and Mississippi remained food insecure. This was especially true for women, Black households, and those living with chronic illness, mental health issues, or low social support. CS_94 Similar impacts were demonstrated in New York City following Hurricane Sandy, where one-third of surveyed households in the heavily impacted Rockaway Peninsula reported difficulty obtaining food due to economic hardship, disruption of public transportation, and long-term closure of grocery stores months after the storm. CS_95

A path towards equitable food security

Learning from baltimore.

In the era of complex disasters, community-level resilience is essential, as federal relief is often too slow and under-equipped to meet the immediate needs of individuals and households. A growing number of U.S. cities are working to protect and improve food security in the aftermath of climate-related disasters and help build climate-resilient local and regional food systems.

For example, officials from Baltimore, Maryland worked with researchers at the Johns Hopkins University in 2017 to assess the resilience of the city’s food supply to climate-related disruptions and to identify ways to support communities at risk of experiencing food insecurity both before and after disasters. CS_96 This is a wonderful example of the power of academic and public partnerships.

Baltimore also designated a food liaison to sit within the Office of Emergency Management during crises. This city received funding from FEMA to coordinate a collaborative regional food and water resilience plan with surrounding jurisdictions. When COVID-19 spread to Baltimore in early 2020 — closing schools and many businesses — the city quickly put its food resilience planning into action and convened a group of food assistance stakeholders to better coordinate responses supporting food access for residents.

Adaptive actions for health and equity

Local and state governments across the country can take similar steps to incorporate food insecurity risk analysis and adaptive planning into emergency management and climate adaptation planning ( see Table 2 ). Local governments and community partners can ensure food assistance programs provide well-balanced meals and are targeted to reach vulnerable individuals and communities.

It is critical to support federal and state assistance programs during non-disaster times, such as the Supplemental Nutritional Assistance Program (SNAP), Women, Infants and Children (WIC), and school lunches. As an example, SNAP and WIC services have been pathways to try to meet the rise in food insecurity during the pandemic, and many schools have attempted to continue to provide meals to children most in need. CS_97 , CS_98 Thus, ongoing support can ensure that these programs are even more adaptable, optimally funded, and able to be rapidly mobilized during a disaster of any kind, thus reducing vulnerability and supporting food security in the short- and long-term.

Simultaneously, addressing food insecurity in the wake of disasters goes hand in hand with combating the root causes of food insecurity and health disparities, such as poverty and food deserts. CS_99 Structural racism is also deeply interconnected through complex pathways, including through the creation of disadvantaged social and economic factors that contribute to food insecurity. CS_100 Yet, even when these factors are removed, some evidence suggests food insecurity remains for people of color, highlighting the need for further research. CS_100 Finally, applying a food systems approach to food security after disasters, such as production of and access to healthy foods, and supporting diverse, local, and regional agriculture, is an important long-term strategy with clear benefits for both health and climate change.

Suggested adaptive actions for communities and organizations.

Adaptive actions for communities and organizations.

• Identify and address the impact of systematic racism and discrimination in food insecurity and food distribution systems CS_100 , CS_114
• Assess and consider public access to food for people with limited capacity to travel CS_94
• Promote policies and practices to enhance access to affordability of nutritious foods, including food diversion programs that reduce food waste CS_115
• Increase flexibility and access to emergency food for vulnerable populations (D-SNAP, WIC, food banks, and school meals)
• Screen for food insecurity in the healthcare setting
• Address food sovereignty for tribal and Indigenous people116
• Identify and address food deserts within communities CS_99
• Foster partnerships with local food producers through community cooperatives in order to promote food access and local economic resilience
• Create community collaborations for resource sharing CS_117
• Strengthen social support networks among vulnerable populations CS_117
• Undertake risk assessments to understand climate change threats and the current state of preparedness, specifically with regard to food supply CS_118
• Undertake food vulnerability mapping to understand risk profiles among neighborhoods CS_119
• Promote resilient local and regional agricultural practices, including urban agriculture and community gardens CS_120
• Urban food chain supply resilience CS_121
• Local food system resilience and food insecurity CS_122
• A food systems approach to climate change preparedness CS_103

Introduction Compounding Food Insecurity Mechanisms of Food System Disruption Decreased Food Security A Path Towards Equitable Food Security – Table 1: Food Insecurity Risk Factors Adaptive Actions for Health and Equity – Table 2: Adaptive Actions

• AI Content Shield
• AI KW Research
• AI Assistant
• SEO Optimizer
• AI KW Clustering
• Customer reviews
• The NLO Revolution
• Press Center
• Help Center
• Content Resources
• Facebook Group

Creative Steps to Write a Nutrition Case Study

Table of Contents

Nutrition plays a vital role in improving a patient’s health. However, each patient has unique nutritional needs requiring a personalized healthcare approach. That’s where nutrition case studies come in. These case studies comprehensively assess a patient’s nutritional status and help develop an individualized nutrition plan. They also help to monitor and evaluate the patient’s progress toward their health goals over time. In this article, we will provide a step-by-step guide on  how to write a nutrition case study . This post will help you understand the importance of nutrition case studies, whether you are a healthcare professional or a student.

What Is a Nutrition Case Study?

A nutrition case study comprehensively reports an individual’s nutritional status, dietary habits, and health outcomes . Healthcare professionals typically use these case studies to evaluate and treat patients. This is with various nutritional concerns, such as obesity, malnutrition, or chronic diseases. If you are a nutrition student or practitioner, learning how to write a nutrition case study is an essential skill to have. 

Importance of Nutrition Case Study

Nutrition case studies are a crucial tool for healthcare professionals in nutrition and dietetics. Here are some of the reasons why nutrition case studies are essential:

Provides a Comprehensive Assessment of a Patient’s Nutritional Status

 Nutrition case studies involve a detailed analysis of a patient’s dietary intake, medical history, and lifestyle factors that may impact their nutritional status. This information is used to develop a personalized nutrition plan tailored to the patient’s needs.

Develops an Individualized Nutrition Plan

A nutrition case study’s personalized approach to healthcare leads to an individualized nutrition plan. This approach can lead to better patient outcomes, improved health outcomes, and a higher quality of life for the patient.

Monitors and Evaluates Progress Over Time

Nutrition case studies track a patient’s food intake, weight, body composition, and other health outcomes over time. This enables healthcare professionals to monitor and evaluate the patient’s progress toward their health goals and adjust the nutrition plan as needed.

Provides Education About Healthy Eating Habits and Lifestyle Changes

Nutrition case studies can help educate patients about healthy eating habits and lifestyle changes. By providing a detailed assessment of a patient’s nutritional status, healthcare professionals can help patients make sustainable changes to their diet and lifestyle.

Supports Evidence-Based Practice

Nutrition case studies are based on evidence-based practice, meaning the nutrition plan is grounded in scientific research and clinical expertise. This approach ensures that the patient receives the best care based on the latest research and clinical knowledge.

Steps on How to Write a Nutrition Case Study

Selecting the patient.

The first step in writing a nutrition case study is selecting the patient. Typically, the patient has sought out nutritional counseling or treatment for a specific reason. These reasons include weight management, a chronic disease, or a food allergy. The patient should be willing to participate in the case study and provide detailed information about their diet, health history, and lifestyle habits. When selecting a patient, obtaining their written consent to participate in the case study is essential. This should include an explanation of the purpose of the case study and how their information will be used. It should also add any potential risks or benefits of participating. The patient should know that they can stop participating in the research at any moment if they don’t want to.

Gathering Information

The next step in writing a nutrition case study is gathering information about the patient. This includes a comprehensive assessment of their dietary habits, health status, medical history, and lifestyle factors that may impact their nutrition. To gather this information, you may need to conduct a nutrition assessment, which typically includes the following components:

Anthropometric Measurements

This involves measuring the patient’s height, weight, body mass index (BMI), and other body composition measures.

Dietary Intake Assessment

This involves collecting information about the patient’s dietary habits, including food preferences, allergies, and cultural or religious dietary restrictions.

Biochemical Assessment

This involves analyzing the patient’s blood, urine, or other biological samples to assess their nutritional status.

Medical History

This involves collecting information about the patient’s past and current medical conditions, medications, and surgeries.

Lifestyle Assessment

This involves collecting information about the patient’s physical activity, stress, and other lifestyle factors that may impact their nutrition status. Gathering as much information as possible is essential to create a comprehensive nutrition case study. This information will help you develop an individualized nutrition plan addressing the patient’s needs and concerns.

Developing a Nutrition Plan

Once you have gathered all the necessary information, the next step is to develop a nutrition plan for the patient. The nutrition plan should be based on the patient’s dietary needs, health goals, and lifestyle factors. It should also consider any medical conditions or medications that may impact the patient’s nutritional status. The nutrition plan should include the following components:

Macronutrient and Micronutrient Recommendations

This involves recommending specific amounts of carbohydrates, protein, fat, and other essential nutrients the patient should consume daily.

Food Group Recommendations

This involves recommending specific food groups for the patient, such as fruits, vegetables, whole grains, and lean proteins.

Meal and Snack Recommendations

This involves recommending specific meals and snacks for the patient to meet their nutritional needs throughout the day.

Nutritional Supplements

This involves recommending specific nutritional supplements, such as vitamins, minerals, or protein powders, that may help patients meet their nutritional needs.

Behavioral Recommendations

This involves recommending specific behavioral changes that may impact the patient’s nutrition status, such as increasing physical activity or reducing stress. The nutrition plan should be individualized to the patient’s needs and preferences. It should also be realistic and achievable, considering any barriers the patient may face in following the plan.

Implementing the Nutrition Plan

Once the nutrition plan has been developed, the next step is implementing it with the patient. This may involve educating the patient about healthy eating habits and strategies for making dietary changes. The patient should also be encouraged to track their food intake and monitor their progress toward their health goals. Working collaboratively with the patient throughout the implementation process is essential, as ongoing support and guidance are needed. This may involve regular follow-up appointments or communication via phone or email. The patient should be encouraged to ask questions and share any concerns or challenges they may be experiencing.

Monitoring and Evaluating Progress

The final step in writing a nutrition case study is monitoring and evaluating the patient’s progress. This involves tracking the patient’s food intake, weight, body composition, and other health outcomes. The patient’s progress should be regularly assessed, and adjustments made to the nutrition plan as needed. Objective measures such as laboratory values or body composition assessments are essential to evaluate the patient’s progress. This can help ensure that the nutrition plan is effective and that the patient is progressing toward their health goals.

How to Write a Nutrition Case Study

Once the nutrition plan has been implemented and the patient’s progress has been evaluated, it is time to write the case study. The case study should be organized in a logical and easy-to-read format, and should include the following sections:

Introduction

This should provide an overview of the patient’s case and outline the purpose of the case study.

Patient History

You should provide a comprehensive overview of the patient’s medical history, dietary habits, and lifestyle factors that may impact their nutritional status.

Nutrition Assessment

This should provide a detailed assessment of the patient’s nutritional status, including anthropometric measurements, dietary intake, biochemical markers, and medical history.

Nutrition Plan

This should provide a comprehensive overview of the patient’s individualized nutrition plan. They include macronutrient and micronutrient recommendations, food group recommendations, meal and snack recommendations, nutritional supplement recommendations, and behavioral recommendations.

Implementation and Follow-Up

This should provide an overview of the patient’s progress in implementing the nutrition plan, including any challenges or barriers encountered. It should also outline the follow-up appointments or communication that took place between the patient and healthcare provider.

This should provide an overview of the patient’s progress towards their health goals, including any changes in weight, body composition, or laboratory values.

This should provide an interpretation of the patient’s results, including any limitations or strengths of the case study. It should also provide a summary of the key takeaways and implications for future practice.

Writing a nutrition case study may not be the most exciting task in the world, but it is a crucial one. By following these steps and using a bit of wit and creativity, healthcare professionals can effectively communicate their patient’s nutritional needs . This shows progress toward their health goals. Who knows, maybe writing a nutrition case study will be more fun than you thought!

Abir Ghenaiet

Abir is a data analyst and researcher. Among her interests are artificial intelligence, machine learning, and natural language processing. As a humanitarian and educator, she actively supports women in tech and promotes diversity.

Explore All Write A Case Study Articles

How to write a leadership case study (sample) .

Writing a case study isn’t as straightforward as writing essays. But it has proven to be an effective way of…

• Write A Case Study

Top 5 Online Expert Case Study Writing Services 

It’s a few hours to your deadline — and your case study college assignment is still a mystery to you.…

Examples Of Business Case Study In Research

A business case study can prevent an imminent mistake in business. How? It’s an effective teaching technique that teaches students…

How to Write a Multiple Case Study Effectively

Have you ever been assigned to write a multiple case study but don’t know where to begin? Are you intimidated…

How to Write a Case Study Presentation: 6 Key Steps

Case studies are an essential element of the business world. Understanding how to write a case study presentation will give…

How to Write a Case Study for Your Portfolio

Are you ready to showcase your design skills and move your career to the next level? Crafting a compelling case…

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Open access
• Published: 06 December 2017

Healthy food choices are happy food choices: Evidence from a real life sample using smartphone based assessments

• Deborah R. Wahl 1   na1 ,
• Karoline Villinger 1   na1 ,
• Laura M. König   ORCID: orcid.org/0000-0003-3655-8842 1 ,
• Katrin Ziesemer 1 ,
• Harald T. Schupp 1 &
• Britta Renner 1  

Scientific Reports volume  7 , Article number:  17069 ( 2017 ) Cite this article

135k Accesses

57 Citations

260 Altmetric

Metrics details

• Health sciences
• Human behaviour

Research suggests that “healthy” food choices such as eating fruits and vegetables have not only physical but also mental health benefits and might be a long-term investment in future well-being. This view contrasts with the belief that high-caloric foods taste better, make us happy, and alleviate a negative mood. To provide a more comprehensive assessment of food choice and well-being, we investigated in-the-moment eating happiness by assessing complete, real life dietary behaviour across eight days using smartphone-based ecological momentary assessment. Three main findings emerged: First, of 14 different main food categories, vegetables consumption contributed the largest share to eating happiness measured across eight days. Second, sweets on average provided comparable induced eating happiness to “healthy” food choices such as fruits or vegetables. Third, dinner elicited comparable eating happiness to snacking. These findings are discussed within the “food as health” and “food as well-being” perspectives on eating behaviour.

Similar content being viewed by others

Effects of single plant-based vs. animal-based meals on satiety and mood in real-world smartphone-embedded studies

Eating Style and the Frequency, Size and Timing of Eating Occasions: A cross-sectional analysis using 7-day weighed dietary records

Interindividual variability in appetitive sensations and relationships between appetitive sensations and energy intake

Introduction.

When it comes to eating, researchers, the media, and policy makers mainly focus on negative aspects of eating behaviour, like restricting certain foods, counting calories, and dieting. Likewise, health intervention efforts, including primary prevention campaigns, typically encourage consumers to trade off the expected enjoyment of hedonic and comfort foods against health benefits 1 . However, research has shown that diets and restrained eating are often counterproductive and may even enhance the risk of long-term weight gain and eating disorders 2 , 3 . A promising new perspective entails a shift from food as pure nourishment towards a more positive and well-being centred perspective of human eating behaviour 1 , 4 , 5 . In this context, Block et al . 4 have advocated a paradigm shift from “food as health” to “food as well-being” (p. 848).

Supporting this perspective of “food as well-being”, recent research suggests that “healthy” food choices, such as eating more fruits and vegetables, have not only physical but also mental health benefits 6 , 7 and might be a long-term investment in future well-being 8 . For example, in a nationally representative panel survey of over 12,000 adults from Australia, Mujcic and Oswald 8 showed that fruit and vegetable consumption predicted increases in happiness, life satisfaction, and well-being over two years. Similarly, using lagged analyses, White and colleagues 9 showed that fruit and vegetable consumption predicted improvements in positive affect on the subsequent day but not vice versa. Also, cross-sectional evidence reported by Blanchflower et al . 10 shows that eating fruits and vegetables is positively associated with well-being after adjusting for demographic variables including age, sex, or race 11 . Of note, previous research includes a wide range of time lags between actual eating occasion and well-being assessment, ranging from 24 hours 9 , 12 to 14 days 6 , to 24 months 8 . Thus, the findings support the notion that fruit and vegetable consumption has beneficial effects on different indicators of well-being, such as happiness or general life satisfaction, across a broad range of time spans.

The contention that healthy food choices such as a higher fruit and vegetable consumption is associated with greater happiness and well-being clearly contrasts with the common belief that in particular high-fat, high-sugar, or high-caloric foods taste better and make us happy while we are eating them. When it comes to eating, people usually have a spontaneous “unhealthy = tasty” association 13 and assume that chocolate is a better mood booster than an apple. According to this in-the-moment well-being perspective, consumers have to trade off the expected enjoyment of eating against the health costs of eating unhealthy foods 1 , 4 .

A wealth of research shows that the experience of negative emotions and stress leads to increased consumption in a substantial number of individuals (“emotional eating”) of unhealthy food (“comfort food”) 14 , 15 , 16 , 17 . However, this research stream focuses on emotional eating to “smooth” unpleasant experiences in response to stress or negative mood states, and the mood-boosting effect of eating is typically not assessed 18 . One of the few studies testing the effectiveness of comfort food in improving mood showed that the consumption of “unhealthy” comfort food had a mood boosting effect after a negative mood induction but not to a greater extent than non-comfort or neutral food 19 . Hence, even though people may believe that snacking on “unhealthy” foods like ice cream or chocolate provides greater pleasure and psychological benefits, the consumption of “unhealthy” foods might not actually be more psychologically beneficial than other foods.

However, both streams of research have either focused on a single food category (fruit and vegetable consumption), a single type of meal (snacking), or a single eating occasion (after negative/neutral mood induction). Accordingly, it is unknown whether the boosting effect of eating is specific to certain types of food choices and categories or whether eating has a more general boosting effect that is observable after the consumption of both “healthy” and “unhealthy” foods and across eating occasions. Accordingly, in the present study, we investigated the psychological benefits of eating that varied by food categories and meal types by assessing complete dietary behaviour across eight days in real life.

Furthermore, previous research on the impact of eating on well-being tended to rely on retrospective assessments such as food frequency questionnaires 8 , 10 and written food diaries 9 . Such retrospective self-report methods rely on the challenging task of accurately estimating average intake or remembering individual eating episodes and may lead to under-reporting food intake, particularly unhealthy food choices such as snacks 7 , 20 . To avoid memory and bias problems in the present study we used ecological momentary assessment (EMA) 21 to obtain ecologically valid and comprehensive real life data on eating behaviour and happiness as experienced in-the-moment.

In the present study, we examined the eating happiness and satisfaction experienced in-the-moment, in real time and in real life, using a smartphone based EMA approach. Specifically, healthy participants were asked to record each eating occasion, including main meals and snacks, for eight consecutive days and rate how tasty their meal/snack was, how much they enjoyed it, and how pleased they were with their meal/snack immediately after each eating episode. This intense recording of every eating episode allows assessing eating behaviour on the level of different meal types and food categories to compare experienced eating happiness across meals and categories. Following the two different research streams, we expected on a food category level that not only “unhealthy” foods like sweets would be associated with high experienced eating happiness but also “healthy” food choices such as fruits and vegetables. On a meal type level, we hypothesised that the happiness of meals differs as a function of meal type. According to previous contention, snacking in particular should be accompanied by greater happiness.

Eating episodes

Overall, during the study period, a total of 1,044 completed eating episodes were reported (see also Table  1 ). On average, participants rated their eating happiness with M  = 77.59 which suggests that overall eating occasions were generally positive. However, experienced eating happiness also varied considerably between eating occasions as indicated by a range from 7.00 to 100.00 and a standard deviation of SD  = 16.41.

Food categories and experienced eating happiness

All eating episodes were categorised according to their food category based on the German Nutrient Database (German: Bundeslebensmittelschlüssel), which covers the average nutritional values of approximately 10,000 foods available on the German market and is a validated standard instrument for the assessment of nutritional surveys in Germany. As shown in Table  1 , eating happiness differed significantly across all 14 food categories, F (13, 2131) = 1.78, p  = 0.04. On average, experienced eating happiness varied from 71.82 ( SD  = 18.65) for fish to 83.62 ( SD  = 11.61) for meat substitutes. Post hoc analysis, however, did not yield significant differences in experienced eating happiness between food categories, p  ≥ 0.22. Hence, on average, “unhealthy” food choices such as sweets ( M  = 78.93, SD  = 15.27) did not differ in experienced happiness from “healthy” food choices such as fruits ( M  = 78.29, SD  = 16.13) or vegetables ( M  = 77.57, SD  = 17.17). In addition, an intraclass correlation (ICC) of ρ = 0.22 for happiness indicated that less than a quarter of the observed variation in experienced eating happiness was due to differences between food categories, while 78% of the variation was due to differences within food categories.

However, as Figure  1 (left side) depicts, consumption frequency differed greatly across food categories. Frequently consumed food categories encompassed vegetables which were consumed at 38% of all eating occasions ( n  = 400), followed by dairy products with 35% ( n  = 366), and sweets with 34% ( n  = 356). Conversely, rarely consumed food categories included meat substitutes, which were consumed in 2.2% of all eating occasions ( n  = 23), salty extras (1.5%, n  = 16), and pastries (1.3%, n  = 14).

Left side: Average experienced eating happiness (colour intensity: darker colours indicate greater happiness) and consumption frequency (size of the cycle) for the 14 food categories. Right side: Absolute share of the 14 food categories in total experienced eating happiness.

Amount of experienced eating happiness by food category

To account for the frequency of consumption, we calculated and scaled the absolute experienced eating happiness according to the total sum score. As shown in Figure  1 (right side), vegetables contributed the biggest share to the total happiness followed by sweets, dairy products, and bread. Clustering food categories shows that fruits and vegetables accounted for nearly one quarter of total eating happiness score and thus, contributed to a large part of eating related happiness. Grain products such as bread, pasta, and cereals, which are main sources of carbohydrates including starch and fibre, were the second main source for eating happiness. However, “unhealthy” snacks including sweets, salty extras, and pastries represented the third biggest source of eating related happiness.

Experienced eating happiness by meal type

To further elucidate the contribution of snacks to eating happiness, analysis on the meal type level was conducted. Experienced in-the-moment eating happiness significantly varied by meal type consumed, F (4, 1039) = 11.75, p  < 0.001. Frequencies of meal type consumption ranged from snacks being the most frequently logged meal type ( n  = 332; see also Table  1 ) to afternoon tea being the least logged meal type ( n  = 27). Figure  2 illustrates the wide dispersion within as well as between different meal types. Afternoon tea ( M  = 82.41, SD  = 15.26), dinner ( M  = 81.47, SD  = 14.73), and snacks ( M  = 79.45, SD  = 14.94) showed eating happiness values above the grand mean, whereas breakfast ( M  = 74.28, SD  = 16.35) and lunch ( M  = 73.09, SD  = 18.99) were below the eating happiness mean. Comparisons between meal types showed that eating happiness for snacks was significantly higher than for lunch t (533) = −4.44, p  = 0.001, d  = −0.38 and breakfast, t (567) = −3.78, p  = 0.001, d  = −0.33. However, this was also true for dinner, which induced greater eating happiness than lunch t (446) = −5.48, p  < 0.001, d  = −0.50 and breakfast, t (480) = −4.90, p  < 0.001, d  = −0.46. Finally, eating happiness for afternoon tea was greater than for lunch t (228) = −2.83, p  = 0.047, d  = −0.50. All other comparisons did not reach significance, t  ≤ 2.49, p  ≥ 0.093.

Experienced eating happiness per meal type. Small dots represent single eating events, big circles indicate average eating happiness, and the horizontal line indicates the grand mean. Boxes indicate the middle 50% (interquartile range) and median (darker/lighter shade). The whiskers above and below represent 1.5 of the interquartile range.

Control Analyses

In order to test for a potential confounding effect between experienced eating happiness, food categories, and meal type, additional control analyses within meal types were conducted. Comparing experienced eating happiness for dinner and lunch suggested that dinner did not trigger a happiness spill-over effect specific to vegetables since the foods consumed at dinner were generally associated with greater happiness than those consumed at other eating occasions (Supplementary Table  S1 ). Moreover, the relative frequency of vegetables consumed at dinner (73%, n  = 180 out of 245) and at lunch were comparable (69%, n  = 140 out of 203), indicating that the observed happiness-vegetables link does not seem to be mainly a meal type confounding effect.

Since the present study focuses on “food effects” (Level 1) rather than “person effects” (Level 2), we analysed the data at the food item level. However, participants who were generally overall happier with their eating could have inflated the observed happiness scores for certain food categories. In order to account for person-level effects, happiness scores were person-mean centred and thereby adjusted for mean level differences in happiness. The person-mean centred happiness scores ( M cwc ) represent the difference between the individual’s average happiness score (across all single in-the-moment happiness scores per food category) and the single happiness scores of the individual within the respective food category. The centred scores indicate whether the single in-the-moment happiness score was above (indicated by positive values) or below (indicated by negative values) the individual person-mean. As Table  1 depicts, the control analyses with centred values yielded highly similar results. Vegetables were again associated on average with more happiness than other food categories (although people might differ in their general eating happiness). An additional conducted ANOVA with person-centred happiness values as dependent variables and food categories as independent variables provided also a highly similar pattern of results. Replicating the previously reported analysis, eating happiness differed significantly across all 14 food categories, F (13, 2129) = 1.94, p  = 0.023, and post hoc analysis did not yield significant differences in experienced eating happiness between food categories, p  ≥ 0.14. Moreover, fruits and vegetables were associated with high happiness values, and “unhealthy” food choices such as sweets did not differ in experienced happiness from “healthy” food choices such as fruits or vegetables. The only difference between the previous and control analysis was that vegetables ( M cwc  = 1.16, SD  = 15.14) gained slightly in importance for eating-related happiness, whereas fruits ( M cwc  = −0.65, SD  = 13.21), salty extras ( M cwc  = −0.07, SD  = 8.01), and pastries ( M cwc  = −2.39, SD  = 18.26) became slightly less important.

This study is the first, to our knowledge, that investigated in-the-moment experienced eating happiness in real time and real life using EMA based self-report and imagery covering the complete diversity of food intake. The present results add to and extend previous findings by suggesting that fruit and vegetable consumption has immediate beneficial psychological effects. Overall, of 14 different main food categories, vegetables consumption contributed the largest share to eating happiness measured across eight days. Thus, in addition to the investment in future well-being indicated by previous research 8 , “healthy” food choices seem to be an investment in the in-the moment well-being.

Importantly, although many cultures convey the belief that eating certain foods has a greater hedonic and mood boosting effect, the present results suggest that this might not reflect actual in-the-moment experiences accurately. Even though people often have a spontaneous “unhealthy = tasty” intuition 13 , thus indicating that a stronger happiness boosting effect of “unhealthy” food is to be expected, the induced eating happiness of sweets did not differ on average from “healthy” food choices such as fruits or vegetables. This was also true for other stereotypically “unhealthy” foods such as pastries and salty extras, which did not show the expected greater boosting effect on happiness. Moreover, analyses on the meal type level support this notion, since snacks, despite their overall positive effect, were not the most psychologically beneficial meal type, i.e., dinner had a comparable “happiness” signature to snacking. Taken together, “healthy choices” seem to be also “happy choices” and at least comparable to or even higher in their hedonic value as compared to stereotypical “unhealthy” food choices.

In general, eating happiness was high, which concurs with previous research from field studies with generally healthy participants. De Castro, Bellisle, and Dalix 22 examined weekly food diaries from 54 French subjects and found that most of the meals were rated as appealing. Also, the observed differences in average eating happiness for the 14 different food categories, albeit statistically significant, were comparable small. One could argue that this simply indicates that participants avoided selecting bad food 22 . Alternatively, this might suggest that the type of food or food categories are less decisive for experienced eating happiness than often assumed. This relates to recent findings in the field of comfort and emotional eating. Many people believe that specific types of food have greater comforting value. Also in research, the foods eaten as response to negative emotional strain, are typically characterised as being high-caloric because such foods are assumed to provide immediate psycho-physical benefits 18 . However, comparing different food types did not provide evidence for the notion that they differed in their provided comfort; rather, eating in general led to significant improvements in mood 19 . This is mirrored in the present findings. Comparing the eating happiness of “healthy” food choices such as fruits and vegetables to that of “unhealthy” food choices such as sweets shows remarkably similar patterns as, on average, they were associated with high eating happiness and their range of experiences ranged from very negative to very positive.

This raises the question of why the idea that we can eat indulgent food to compensate for life’s mishaps is so prevailing. In an innovative experimental study, Adriaanse, Prinsen, de Witt Huberts, de Ridder, and Evers 23 led participants believe that they overate. Those who characterised themselves as emotional eaters falsely attributed their over-consumption to negative emotions, demonstrating a “confabulation”-effect. This indicates that people might have restricted self-knowledge and that recalled eating episodes suffer from systematic recall biases 24 . Moreover, Boelsma, Brink, Stafleu, and Hendriks 25 examined postprandial subjective wellness and objective parameters (e.g., ghrelin, insulin, glucose) after standardised breakfast intakes and did not find direct correlations. This suggests that the impact of different food categories on wellness might not be directly related to biological effects but rather due to conditioning as food is often paired with other positive experienced situations (e.g., social interactions) or to placebo effects 18 . Moreover, experimental and field studies indicate that not only negative, but also positive, emotions trigger eating 15 , 26 . One may speculate that selective attention might contribute to the “myth” of comfort food 19 in that people attend to the consumption effect of “comfort” food in negative situation but neglect the effect in positive ones.

The present data also show that eating behaviour in the real world is a complex behaviour with many different aspects. People make more than 200 food decisions a day 27 which poses a great challenge for the measurement of eating behaviour. Studies often assess specific food categories such as fruit and vegetable consumption using Food Frequency Questionnaires, which has clear advantages in terms of cost-effectiveness. However, focusing on selective aspects of eating and food choices might provide only a selective part of the picture 15 , 17 , 22 . It is important to note that focusing solely on the “unhealthy” food choices such as sweets would have led to the conclusion that they have a high “indulgent” value. To be able to draw conclusions about which foods make people happy, the relation of different food categories needs to be considered. The more comprehensive view, considering the whole dietary behaviour across eating occasions, reveals that “healthy” food choices actually contributed the biggest share to the total experienced eating happiness. Thus, for a more comprehensive understanding of how eating behaviours are regulated, more complete and sensitive measures of the behaviour are necessary. Developments in mobile technologies hold great promise for feasible dietary assessment based on image-assisted methods 28 .

As fruits and vegetables evoked high in-the-moment happiness experiences, one could speculate that these cumulate and have spill-over effects on subsequent general well-being, including life satisfaction across time. Combing in-the-moment measures with longitudinal perspectives might be a promising avenue for future studies for understanding the pathways from eating certain food types to subjective well-being. In the literature different pathways are discussed, including physiological and biochemical aspects of specific food elements or nutrients 7 .

The present EMA based data also revealed that eating happiness varied greatly within the 14 food categories and meal types. As within food category variance represented more than two third of the total observed variance, happiness varied according to nutritional characteristics and meal type; however, a myriad of factors present in the natural environment can affect each and every meal. Thus, widening the “nourishment” perspective by including how much, when, where, how long, and with whom people eat might tell us more about experienced eating happiness. Again, mobile, in-the-moment assessment opens the possibility of assessing the behavioural signature of eating in real life. Moreover, individual factors such as eating motives, habitual eating styles, convenience, and social norms are likely to contribute to eating happiness variance 5 , 29 .

A key strength of this study is that it was the first to examine experienced eating happiness in non-clinical participants using EMA technology and imagery to assess food intake. Despite this strength, there are some limitations to this study that affect the interpretation of the results. In the present study, eating happiness was examined on a food based level. This neglects differences on the individual level and might be examined in future multilevel studies. Furthermore, as a main aim of this study was to assess real life eating behaviour, the “natural” observation level is the meal, the psychological/ecological unit of eating 30 , rather than food categories or nutrients. Therefore, we cannot exclude that specific food categories may have had a comparably higher impact on the experienced happiness of the whole meal. Sample size and therefore Type I and Type II error rates are of concern. Although the total number of observations was higher than in previous studies (see for example, Boushey et al . 28 for a review), the number of participants was small but comparable to previous studies in this field 20 , 31 , 32 , 33 . Small sample sizes can increase error rates because the number of persons is more decisive than the number of nested observations 34 . Specially, nested data can seriously increase Type I error rates, which is rather unlikely to be the case in the present study. Concerning Type II error rates, Aarts et al . 35 illustrated for lower ICCs that adding extra observations per participant also increases power, particularly in the lower observation range. Considering the ICC and the number of observations per participant, one could argue that the power in the present study is likely to be sufficient to render the observed null-differences meaningful. Finally, the predominately white and well-educated sample does limit the degree to which the results can be generalised to the wider community; these results warrant replication with a more representative sample.

Despite these limitations, we think that our study has implications for both theory and practice. The cumulative evidence of psychological benefits from healthy food choices might offer new perspectives for health promotion and public-policy programs 8 . Making people aware of the “healthy = happy” association supported by empirical evidence provides a distinct and novel perspective to the prevailing “unhealthy = tasty” folk intuition and could foster eating choices that increase both in-the-moment happiness and future well-being. Furthermore, the present research lends support to the advocated paradigm shift from “food as health” to “food as well-being” which entails a supporting and encouraging rather constraining and limiting view on eating behaviour.

The study conformed with the Declaration of Helsinki. All study protocols were approved by University of Konstanz’s Institutional Review Board and were conducted in accordance with guidelines and regulations. Upon arrival, all participants signed a written informed consent.

Participants

Thirty-eight participants (28 females: average age = 24.47, SD  = 5.88, range = 18–48 years) from the University of Konstanz assessed their eating behaviour in close to real time and in their natural environment using an event-based ambulatory assessment method (EMA). No participant dropped out or had to be excluded. Thirty-three participants were students, with 52.6% studying psychology. As compensation, participants could choose between taking part in a lottery (4 × 25€) or receiving course credits (2 hours).

Participants were recruited through leaflets distributed at the university and postings on Facebook groups. Prior to participation, all participants gave written informed consent. Participants were invited to the laboratory for individual introductory sessions. During this first session, participants installed the application movisensXS (version 0.8.4203) on their own smartphones and downloaded the study survey (movisensXS Library v4065). In addition, they completed a short baseline questionnaire, including demographic variables like age, gender, education, and eating principles. Participants were instructed to log every eating occasion immediately before eating by using the smartphone to indicate the type of meal, take pictures of the food, and describe its main components using a free input field. Fluid intake was not assessed. Participants were asked to record their food intake on eight consecutive days. After finishing the study, participants were invited back to the laboratory for individual final interviews.

Immediately before eating participants were asked to indicate the type of meal with the following five options: breakfast, lunch, afternoon tea, dinner, snack. In Germany, “afternoon tea” is called “Kaffee & Kuchen” which directly translates as “coffee & cake”. It is similar to the idea of a traditional “afternoon tea” meal in UK. Specifically, in Germany, people have “Kaffee & Kuchen” in the afternoon (between 4–5 pm) and typically coffee (or tea) is served with some cake or cookies. Dinner in Germany is a main meal with mainly savoury food.

After each meal, participants were asked to rate their meal on three dimensions. They rated (1) how much they enjoyed the meal, (2) how pleased they were with their meal, and (3) how tasty their meal was. Ratings were given on a scale of one to 100. For reliability analysis, Cronbach’s Alpha was calculated to assess the internal consistency of the three items. Overall Cronbach’s alpha was calculated with α = 0.87. In addition, the average of the 38 Cronbach’s alpha scores calculated at the person level also yielded a satisfactory value with α = 0.83 ( SD  = 0.24). Thirty-two of 38 participants showed a Cronbach’s alpha value above 0.70 (range = 0.42–0.97). An overall score of experienced happiness of eating was computed using the average of the three questions concerning the meals’ enjoyment, pleasure, and tastiness.

Analytical procedure

The food pictures and descriptions of their main components provided by the participants were subsequently coded by independent and trained raters. Following a standardised manual, additional components displayed in the picture were added to the description by the raters. All consumed foods were categorised into 14 different food categories (see Table  1 ) derived from the food classification system designed by the German Nutrition Society (DGE) and based on the existing food categories of the German Nutrient Database (Max Rubner Institut). Liquid intake and preparation method were not assessed. Therefore, fats and additional recipe ingredients were not included in further analyses, because they do not represent main elements of food intake. Further, salty extras were added to the categorisation.

No participant dropped out or had to be excluded due to high missing rates. Missing values were below 5% for all variables. The compliance rate at the meal level cannot be directly assessed since the numbers of meals and snacks can vary between as well as within persons (between days). As a rough compliance estimate, the numbers of meals that are expected from a “normative” perspective during the eight observation days can be used as a comparison standard (8 x breakfast, 8 × lunch, 8 × dinner = 24 meals). On average, the participants reported M  = 6.3 breakfasts ( SD  = 2.3), M  = 5.3 lunches ( SD  = 1.8), and M  = 6.5 dinners ( SD  = 2.0). In comparison to the “normative” expected 24 meals, these numbers indicate a good compliance (approx. 75%) with a tendency to miss six meals during the study period (approx. 25%). However, the “normative” expected 24 meals for the study period might be too high since participants might also have skipped meals (e.g. breakfast). Also, the present compliance rates are comparable to other studies. For example, Elliston et al . 36 recorded 3.3 meal/snack reports per day in an Australian adult sample and Casperson et al . 37 recorded 2.2 meal reports per day in a sample of adolescents. In the present study, on average, M  = 3.4 ( SD  = 1.35) meals or snacks were reported per day. These data indicate overall a satisfactory compliance rate and did not indicate selective reporting of certain food items.

To graphically visualise data, Tableau (version 10.1) was used and for further statistical analyses, IBM SPSS Statistics (version 24 for Windows).

Data availability

The dataset generated and analysed during the current study is available from the corresponding authors on reasonable request.

Cornil, Y. & Chandon, P. Pleasure as an ally of healthy eating? Contrasting visceral and epicurean eating pleasure and their association with portion size preferences and wellbeing. Appetite 104 , 52–59 (2016).

Article   PubMed   Google Scholar  

Mann, T. et al . Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist 62 , 220–233 (2007).

van Strien, T., Herman, C. P. & Verheijden, M. W. Dietary restraint and body mass change. A 3-year follow up study in a representative Dutch sample. Appetite 76 , 44–49 (2014).

Block, L. G. et al . From nutrients to nurturance: A conceptual introduction to food well-being. Journal of Public Policy & Marketing 30 , 5–13 (2011).

Article   Google Scholar  

Renner, B., Sproesser, G., Strohbach, S. & Schupp, H. T. Why we eat what we eat. The eating motivation survey (TEMS). Appetite 59 , 117–128 (2012).

Conner, T. S., Brookie, K. L., Carr, A. C., Mainvil, L. A. & Vissers, M. C. Let them eat fruit! The effect of fruit and vegetable consumption on psychological well-being in young adults: A randomized controlled trial. PloS one 12 , e0171206 (2017).

Article   PubMed   PubMed Central   Google Scholar  

Rooney, C., McKinley, M. C. & Woodside, J. V. The potential role of fruit and vegetables in aspects of psychological well-being: a review of the literature and future directions. Proceedings of the Nutrition Society 72 , 420–432 (2013).

Mujcic, R. & Oswald, A. J. Evolution of well-being and happiness after increases in consumption of fruit and vegetables. American Journal of Public Health 106 , 1504–1510 (2016).

White, B. A., Horwath, C. C. & Conner, T. S. Many apples a day keep the blues away – Daily experiences of negative and positive affect and food consumption in young adults. British Journal of Health Psychology 18 , 782–798 (2013).

Blanchflower, D. G., Oswald, A. J. & Stewart-Brown, S. Is psychological well-being linked to the consumption of fruit and vegetables? Social Indicators Research 114 , 785–801 (2013).

Grant, N., Wardle, J. & Steptoe, A. The relationship between life satisfaction and health behavior: A Cross-cultural analysis of young adults. International Journal of Behavioral Medicine 16 , 259–268 (2009).

Conner, T. S., Brookie, K. L., Richardson, A. C. & Polak, M. A. On carrots and curiosity: Eating fruit and vegetables is associated with greater flourishing in daily life. British Journal of Health Psychology 20 , 413–427 (2015).

Raghunathan, R., Naylor, R. W. & Hoyer, W. D. The unhealthy = tasty intuition and its effects on taste inferences, enjoyment, and choice of food products. Journal of Marketing 70 , 170–184 (2006).

Evers, C., Stok, F. M. & de Ridder, D. T. Feeding your feelings: Emotion regulation strategies and emotional eating. Personality and Social Psychology Bulletin 36 , 792–804 (2010).

Sproesser, G., Schupp, H. T. & Renner, B. The bright side of stress-induced eating: eating more when stressed but less when pleased. Psychological Science 25 , 58–65 (2013).

Wansink, B., Cheney, M. M. & Chan, N. Exploring comfort food preferences across age and gender. Physiology & Behavior 79 , 739–747 (2003).

Article   CAS   Google Scholar  

Taut, D., Renner, B. & Baban, A. Reappraise the situation but express your emotions: impact of emotion regulation strategies on ad libitum food intake. Frontiers in Psychology 3 , 359 (2012).

Tomiyama, J. A., Finch, L. E. & Cummings, J. R. Did that brownie do its job? Stress, eating, and the biobehavioral effects of comfort food. Emerging Trends in the Social and Behavioral Sciences: An Interdisciplinary, Searchable, and Linkable Resource (2015).

Wagner, H. S., Ahlstrom, B., Redden, J. P., Vickers, Z. & Mann, T. The myth of comfort food. Health Psychology 33 , 1552–1557 (2014).

Schüz, B., Bower, J. & Ferguson, S. G. Stimulus control and affect in dietary behaviours. An intensive longitudinal study. Appetite 87 , 310–317 (2015).

Shiffman, S. Conceptualizing analyses of ecological momentary assessment data. Nicotine & Tobacco Research 16 , S76–S87 (2014).

de Castro, J. M., Bellisle, F. & Dalix, A.-M. Palatability and intake relationships in free-living humans: measurement and characterization in the French. Physiology & Behavior 68 , 271–277 (2000).

Adriaanse, M. A., Prinsen, S., de Witt Huberts, J. C., de Ridder, D. T. & Evers, C. ‘I ate too much so I must have been sad’: Emotions as a confabulated reason for overeating. Appetite 103 , 318–323 (2016).

Robinson, E. Relationships between expected, online and remembered enjoyment for food products. Appetite 74 , 55–60 (2014).

Boelsma, E., Brink, E. J., Stafleu, A. & Hendriks, H. F. Measures of postprandial wellness after single intake of two protein–carbohydrate meals. Appetite 54 , 456–464 (2010).

Article   CAS   PubMed   Google Scholar  

Boh, B. et al . Indulgent thinking? Ecological momentary assessment of overweight and healthy-weight participants’ cognitions and emotions. Behaviour Research and Therapy 87 , 196–206 (2016).

Wansink, B. & Sobal, J. Mindless eating: The 200 daily food decisions we overlook. Environment and Behavior 39 , 106–123 (2007).

Boushey, C., Spoden, M., Zhu, F., Delp, E. & Kerr, D. New mobile methods for dietary assessment: review of image-assisted and image-based dietary assessment methods. Proceedings of the Nutrition Society , 1–12 (2016).

Stok, F. M. et al . The DONE framework: Creation, evaluation, and updating of an interdisciplinary, dynamic framework 2.0 of determinants of nutrition and eating. PLoS ONE 12 , e0171077 (2017).

Pliner, P. & Rozin, P. In Dimensions of the meal: The science, culture, business, and art of eating (ed H Meiselman) 19–46 (Aspen Publishers, 2000).

Inauen, J., Shrout, P. E., Bolger, N., Stadler, G. & Scholz, U. Mind the gap? Anintensive longitudinal study of between-person and within-person intention-behaviorrelations. Annals of Behavioral Medicine 50 , 516–522 (2016).

Zepeda, L. & Deal, D. Think before you eat: photographic food diaries asintervention tools to change dietary decision making and attitudes. InternationalJournal of Consumer Studies 32 , 692–698 (2008).

Stein, K. F. & Corte, C. M. Ecologic momentary assessment of eating‐disordered behaviors. International Journal of Eating Disorders 34 , 349–360 (2003).

Bolger, N., Stadler, G. & Laurenceau, J. P. Power analysis for intensive longitudinal studies in Handbook of research methods for studying daily life (ed . Mehl, M. R. & Conner, T. S.) 285–301 (New York: The Guilford Press, 2012).

Aarts, E., Verhage, M., Veenvliet, J. V., Dolan, C. V. & Van Der Sluis, S. A solutionto dependency: using multilevel analysis to accommodate nested data. Natureneuroscience 17 , 491–496 (2014).

Elliston, K. G., Ferguson, S. G., Schüz, N. & Schüz, B. Situational cues andmomentary food environment predict everyday eating behavior in adults withoverweight and obesity. Health Psychology 36 , 337–345 (2017).

Casperson, S. L. et al . A mobile phone food record app to digitally capture dietary intake for adolescents in afree-living environment: usability study. JMIR mHealth and uHealth 3 , e30 (2015).

Download references

Acknowledgements

This research was supported by the Federal Ministry of Education and Research within the project SmartAct (Grant 01EL1420A, granted to B.R. & H.S.). The funding source had no involvement in the study’s design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit this article for publication. We thank Gudrun Sproesser, Helge Giese, and Angela Whale for their valuable support.

Author information

Deborah R. Wahl and Karoline Villinger contributed equally to this work.

Authors and Affiliations

Department of Psychology, University of Konstanz, Konstanz, Germany

Deborah R. Wahl, Karoline Villinger, Laura M. König, Katrin Ziesemer, Harald T. Schupp & Britta Renner

You can also search for this author in PubMed   Google Scholar

Contributions

B.R. & H.S. developed the study concept. All authors participated in the generation of the study design. D.W., K.V., L.K. & K.Z. conducted the study, including participant recruitment and data collection, under the supervision of B.R. & H.S.; D.W. & K.V. conducted data analyses. D.W. & K.V. prepared the first manuscript draft, and B.R. & H.S. provided critical revisions. All authors approved the final version of the manuscript for submission.

Corresponding authors

Correspondence to Deborah R. Wahl or Britta Renner .

Ethics declarations

Competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher's note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Supplementary table s1, rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Wahl, D.R., Villinger, K., König, L.M. et al. Healthy food choices are happy food choices: Evidence from a real life sample using smartphone based assessments. Sci Rep 7 , 17069 (2017). https://doi.org/10.1038/s41598-017-17262-9

Download citation

Received : 05 June 2017

Accepted : 23 November 2017

Published : 06 December 2017

DOI : https://doi.org/10.1038/s41598-017-17262-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

This article is cited by

Financial satisfaction, food security, and shared meals are foundations of happiness among older persons in thailand.

• Sirinya Phulkerd
• Rossarin Soottipong Gray
• Sasinee Thapsuwan

BMC Geriatrics (2023)

Enrichment and Conflict Between Work and Health Behaviors: New Scales for Assessing How Work Relates to Physical Exercise and Healthy Eating

• Sabine Sonnentag
• Maria U. Kottwitz
• Jette Völker

Occupational Health Science (2023)

The value of Bayesian predictive projection for variable selection: an example of selecting lifestyle predictors of young adult well-being

• A. Bartonicek
• S. R. Wickham
• T. S. Conner

BMC Public Health (2021)

Smartphone-Based Ecological Momentary Assessment of Well-Being: A Systematic Review and Recommendations for Future Studies

• Lianne P. de Vries
• Bart M. L. Baselmans
• Meike Bartels

Journal of Happiness Studies (2021)

Exploration of nutritional, antioxidative, antibacterial and anticancer status of Russula alatoreticula: towards valorization of a traditionally preferred unique myco-food

• Somanjana Khatua
• Surashree Sen Gupta
• Krishnendu Acharya

Journal of Food Science and Technology (2021)

By submitting a comment you agree to abide by our Terms and Community Guidelines . If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate.

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Select a language

Case study: implementation of nutrition-sensitive interventions to improve food and nutrition security in kenya and honduras.

Nutrition-sensitive interventions are those whose primary objective is not nutrition, but that have the potential to improve the food and nutrition security of beneficiaries.1 Such programmes take place in sectors complementary to nutrition, such as agriculture and education, and are designed to address the underlying causes of malnutrition. The initiatives outlined in this case study aim to achieve this by increasing the availability of, access to, and consumption of food in the targeted populations.

Home gardens promote the production of nutrient-rich fruits and vegetables that grow well in local conditions. Household members, particularly women, are trained in cultivating crops and raising livestock. Such interventions have shown promising increases in food production and dietary diversity.2 Although the evidence of nutritional impact is limited, kitchen gardens have the potential to impact nutrition indirectly: by raising household income and purchasing power; through the empowerment of women in society; and through increased availability of food in markets when surplus from the kitchen garden is sold.3 In this case study, we explore one such initiative in Kenya.

We also explore a nutrition-sensitive initiative in the Dry Corridor area of Honduras, where a multi-donor alliance has been established to reduce poverty and malnutrition through strategic investments in vulnerable communities. The initiative aims to (a) mitigate the impacts of climate change on food security and nutrition by increasing the resilience of smallholder farmers; and (b) maximise integrated approaches for increasing smallholders’ productivity and income generation through more sustainable food systems.

Organization

Resource type.

• English download
• Español download
• Français download

• Interactivity
• AI Assistant
• Digital Sales
• Online Sharing
• Offline Reading
• Custom Domain
• Branding & Self-hosting
• SEO Friendly
• Create Video & Photo with AI
• PDF/Image/Audio/Video Tools
• Art & Culture
• Food & Beverage
• Home & Garden
• Weddings & Bridal
• Religion & Spirituality
• Animals & Pets
• Celebrity & Entertainment
• Family & Parenting
• Science & Technology
• Health & Wellness
• Real Estate
• Business & Finance
• Cars & Automobiles
• Fashion & Style
• News & Politics
• Hobbies & Leisure
• Recipes & Cookbooks
• Photo Albums
• Invitations
• Presentations
• Newsletters
• Sell Content
• Fashion & Beauty
• Retail & Wholesale
• Presentation
• Help Center Check out our knowledge base with detailed tutorials and FAQs.
• Learning Center Read latest article about digital publishing solutions.
• Webinars Check out the upcoming free live Webinars, and book the sessions you are interested.
• Contact Us Please feel free to leave us a message.

Dietetic and Nutrition Case Studies

Description: dietetic and nutrition case studies, keywords: diet,nutrition, read the text version.

No Text Content!

Perpustakaan PIM

Related publications.

Other content with the tag "Case Study".

The study investigates four Public-Private Partnerships (PPPs) in Mexico, revealing a lack of public information on their implementation and effect

To articulate what it means to take a food systems approach and support policymakers around the world to do so, R4D and City, University of London

Access to Nutrition Initiative (ATNI) has been commissioned to benchmark the world’s 25 largest food and beverage (F&B) companies’ lobbying-rel

Many impact-oriented initiatives are increasingly recognizing the opportunity to support the private sector to empower women in the workplace and g

This study is the result of a landscape analysis undertaken by Action Against Hunger UK for the Global Al

This study was in rural Bangladesh tested the cost effectiveness of a home micronutrient powder food fortification programme for children under the

The Consumer Good Forum (CGF)'s Collaboration for Healthier Lives (CHL) Coalition works to drive collaborative actions through local initiatives to

Almost half of the world’s population – 3 billion people – are directly affected by land degradation.

Nutrition programmes within commodity value chains provide a unique opportunity to improve health outcomes for workers, farmers,

This study looks at research around the implementation of a nutrition programme in a garment factory in Bangladesh.

In 2018, GAIN and HarvestPlus created a partnership with the shared ambition to expand coverage of biofortified nutrient dense foods to at least 20

This study summarises the findings of research undertaken by GAIN and NewForesight to explore the business case for investing in and implementing n

In this research paper, the authors build on nutrition sensitive value chain frameworks and then present an implementation case study that seeks to

As part of the principles of engagement, the global members of the SUN Business Network (SBN) support workforce nutrition commitments (including br

The Partnerships Resource Centre (PrC) conducts research projects to facilitate further knowledge accumulation and learning in the area of sustaina

People’s perception of their ability to meet their needs and the level of autonomy they feel they can exert over their own lives directly correlate

This is an uplifting evidence-based assessment of what it takes to successfully campaign against corporate power.

In this supplement issue of Maternal & Child Nutrition, Helen Keller International ( HKI ) authors have writte

The Global Alliance for Improved Nutrition’s Marketplace for Nutritious Foods program sparks private sector production and marketing of nutritious

This report provides an approach for collaborative policymaking and governance improvement for sustainable food systems.

Ever wondered what it’s like for the people growing your chocolate? Ever thought that they may be children?

The Center for Strategic and International studies have looked at the impact of Feed the Future Investments in Guatemala.

The Center for Strategic and International studies have looked at the impact of Feed the Future Investments in Bangladesh.

The Center for Strategic and International studies have looked at the impact of Feed the Future Investments in Tanzania.

Sight and Life, DSM, and John Hopkin’s Bloomberg School of Public Health have come together to publish lessons from a four decade partnership.

Partnerships for Forests provides financial and technical assistant to help partners do business differently when it comes to land use and preventi

Two page briefing by IBM looking at the causes of supply chain inefficiencies.

Irresponsible resource management does not make business sense – a truism that Kavita Prakash-Mani and Joao Campari at WWF call out in this blog.

Cocoa may not be the most nutritious of agricultural products, but it has huge environmental and economic importance.

This public private partnership in Nigeria demonstrates what can be done to improve crop safety and reduce the non beneficial impacts of toxic crop

Restricted access paper looking at the role for public private partnerships in making agriculture value chains work for smallholder farmers, based

The Demand Engine: Growth Hacking

Partnership between Ipsos – a social market and research company, and The Bill and Melinda Gates Foundation.

FoodSwitch is an example of innovation that is empowering consumers to make smarter nutrition decisions.

Public information on Pepsico's agricultural commodities. For more information on Pepsico’s core business and reporting standards go to our Advanci

Multinationals have the power to change people’s relationship with food – as this short opinion piece demonstrates.

Partnership between Unilever, DSM, Gain, Mondelez, U.N.

The South Asia Food and Nutrition Security Initiative (SAFANSI) is an example of a multi

The cost of a nutritious meal is not fixed and it can be heavily dependent upon the season.

One-page correspondence in the Lancet looking at the benefit of investing in workplace wellness programmes in India.

This report produced by the UK Health Forum provides case studies from around the world to help provide a framework for governing public private in

Realising the potential of workplaces to prevent and control NCDs: How public policy can encourage businesses and governments to work toget

A worksite intervention in South Africa demonstrates the importance of identifying employees with increased risk of cardiovascular disease.

China has undergone rapid change in recent years which has impacted on the health of its workforce.

Two-page briefing on a research study by the United Nations International Labour Organisation assessing Chile’s national workforce nutrition progra

An academic paper by the International Food Policy Research Institute looking at expectations that drive formal public private partnerships in agri

This study of agricultural PPPs in Ghana, Malawi, and Kenya calls for governments, donors, and companies to ensure greater participation from small

For anyone interested in the cost-benefit of food fortification as a public health intervention.

This short video shows the successes of public private collaboration in South Africa.

This article has a useful summary of challenges along the food value chain that prevent compliance with national standards.

Nearly half of India’s population suffer from micronutrient deficiency.

Case studies embedded in local political economy, covering: dairy value chains in Afghanistan, milk value chains in Bangladesh, flour fortification

Lindiwe’s personal story leads into an in-depth analysis of supply chain bottlenecks for subsistence farmers.

Companion document to the United States National Center for Chronic Disease Prevention and Health Promotion Food Service Guidelines in Public Servi

This is the full report from the 2015 Future Fortified Global Summit on Food Fortification - the first ever Global Summit dedicated to large scale

A highly recommended resource on consumer demand from the perspective of public private engagement.

Base of the pyramid typically refers to the largest and poorest socio-economic grouping, and it is estimated that people in this ‘category’ spend u

Improving diets in an era of food market transformation: Challenges and opportunities for engagement between the public and private sectors

Looking outside of the nutrition sector towards the climate change agenda brings a fresh perspective to the issue of incentivising responsible priv

This report, compiled for the European Competitiveness and Sustainable Industrial Policy Consortium, gives a detailed look into the impact of food

Briefing by ActionAid revealing that one in every two dollars of large corporate investment in developing countries is being routed from or a via a

Policy brief by the Global Panel on Agriculture and Food Systems for Nutrition looking at the evidence for gov

Working paper by Consultative Group for International Agricultural Research (CGIAR) looking at how corporate social responsibility and supply agree

Dietary Guidelines for Americans set the country’s nutrition policy and help direct over $80 billion federal spending.

This report from FAO and the Food Climate Research Network looks at national dietary guidelines as a practical intervention to improve nutrition an

In this policy brief, the Global Panel makes the case that healthy diets are a foundation underpinning positive progress towards the Sustainable De

Mars have produced a position statement on their contribution to greenhouse gas emissions.

Unilever’s Paul Polman is a Champion 12.3 – part of a global coalition to accelerate action to achieve UN Sustainable Development Goal 12.3 to half

Report from a workshop on collaborative learning at the Institute of Development Studies in 2017, Brighton, U.K.

This report by the European Union addresses challenges of implementing country cooperation frameworks that fall under the auspices of the New Allia

This report summarizes the findings of a workshop for representatives of the Tanzanian government, development partners, civil society, and private

This 21-page briefing by Society Works summarizes information on 152 social entrepreneurs working on food production, manufacturing, distribution,

Written evidence submitted by Farm Africa and Self Help Africa on December 2012 to the U.K International Development Committee.

Public-Private Partnership Lab: Food and Water is a four-year action research and joint learning initiative to explore the effectiveness of PPPs.

Blog, originally published on Food Security Portal, discussing how global and regional seed companies are working to support smallholder farmers to

This briefing addresses the distinct roles that each partner can play in promoting nutrition under the Comprehensive African Agricultural Developme

Covers a checklist for formal public private partnerships spanning: rationale, design, implementation, sustainability, and the roles for brokers at

A detailed review by the FAO on public private partnerships in agribusiness.

Health gossip is rife in Indonesia.

Presentation for the Wellcome Trust  looking at the role of policy on public food choices.

As a systematic and rigorous analysis, this Lancet paper provides perspective on the issue of consumer demand creation by systematically reviewing

The Access to Nutrition Index has produced a 2018 scorecard for Campbell Soup company.

Principles guiding Unilever’s food and beverage marketing communications, including a promise not to direct any marketing communications to childre

A look into how business models can be reshaped to respond to changing consumer preferences.

This is a detailed overview of why people did not take up fortified complementary foods in Ghana, Cote d'Ivoire, India, Bangladesh, and Vietnam.

Alive & Thrive is an initiative that aims to improve infant and young child feeding practices by increasing rates of exclusiv

This paper reviews 41 workforce nutrition interventions published between 1995 and 2006 in the South African Journal of Clinical

Blueprint for Business Action on Health Literacy supports the Europe 2020 strategy and the renewed EU strategy for Corporate Soci

This short report gives an overview of rice fortification literature indexed in PubMed, including examples of successful public private engagement

This lively blog series by Future Fortified - an online platform to explore micronutrient deficiency, covers a range of topics relating to public p

This book examines food fortification in all its forms.

In this synopsis - aimed at business leaders, governments and implementing agencies - IFPRI and Nourishing Millions provide recommendations on how

In 2015 the Nourishing Millions project reviewed literature and case studies to show the evolution of nutrition during the past 50 years.

A concise account of lessons learned on salt and iron iodization by world renowned economists, as part of the costs benefit analysis on leading dev

Written by world renowned economists, this paper highlights the cost efficiency of select nutrition interventions and ranks fortification among the

This report analyses fourteen projects in low and middle income countries working on reducing food loss and waste in food systems.

SNV is a team of advisers that work with business, governments, and implementing agencies.

This presentation is the outcome of a high level policy dialogue in 2015 by the Asia-Pacific Economic Cooperation.

This article by a non-profit called Concordia makes the simple argument that food insecurity and loss can only be addressed by increased collaborat

Recommendations from the Global Panel on Agriculture and Food Systems are targeted at policy makers in low- and middle-income countries

This report looks at supply chain waste based on Feedback's research on export supply chains in Peru, Senegal, South Africa, the UK and a major Eur