Open Collections

Abstract

Healthcare systems have both an ethical responsibility and a mandate to decarbonize. Integrating plant-rich diets, such as the EAT-Lancet Planetary Health Diet, in healthcare settings could advance climate change mitigation, provide an opportunity to improve the food served to patients, and support a societal transition to healthier and more sustainable diets by changing social norms. Yet, their adoption in the healthcare sector have been limited. This PhD thesis therefore aims to explore how more plant-rich diets could be adapted in an acute inpatient setting, focusing on the experience at Vancouver General Hospital. After providing context for this work, in Chapters 2 and 3, I endeavour to better characterise the current state of patient satisfaction, nutrition, food waste and environmental impacts with the existing menu by conducting a hospital-wide survey and a prospective cohort study of surgical inpatients. I find substandard levels of patient satisfaction, insufficient nutrition, rates of food waste as high as 59%, and a prevalence of animal-based proteins in meal offerings which account for the largest proportion of the menu’s greenhouse gas emissions and land use. Then, I describe the development and implementation of a more sustainable menu developed by an interdisciplinary team, which comprises members from food services, clinical dietetics, sustainability teams, patient partners, and an Executive Chef. The novel menu features 18 new appealing dishes with plant-based or low-impact animal-based proteins, is more culturally diverse, nutritionally sound, better aligned with the Planetary Health Diet, and associated with considerable environmental benefits. This novel menu is then implemented across Vancouver General Hospital to assess patient acceptability with in-person patient surveys and waste audits. I find that the menu, served to the majority of patients, results in an increase of plant-based meals served from 8% to 25% of all dishes served at lunch and dinner. Patient acceptability scores are on average 84%, and food waste rates are lower across most protein types with the novel menu. In conclusion, I find in this thesis that more plant-rich diets can be adapted to a healthcare setting in a way that meets patient preferences and nutritional requirements, while resulting in considerable environmental benefits.