Development, implementation, and evaluation of a Planetary Health menu in a Canadian hospital: an experimental study

Background

Widespread adoption of plant-rich diets, such as the EAT–Lancet Planetary Health Diet (PHD), could mitigate climate change while providing health and societal benefits. In this study, we develop and implement a plant-rich menu for hospital inpatients, meeting the nutritional needs and constraints of an acute care setting, and we evaluate this menu’s acceptability to patients.

Methods

A Planetary Health (PH) menu was created by replacing greenhouse gas emission-intensive dishes with novel, low-emission dishes at lunch and dinner times. The PH menu was compared with the original hospital menu based on protein characteristics, nutritional adequacy, alignment with the PHD, and environmental impacts. The PH menu was then offered hospital-wide, and its acceptability was evaluated based on service frequency, patient satisfaction, and food waste.

Findings

18 novel dishes were integrated into a PH menu that was nutritionally adequate and more culturally diverse than the original menu. The proportion of lunch and dinner offerings containing exclusively plant-sourced foods increased from zero in the original menu to 11 (39%) of 28 dishes. The PH menu was associated with 39% lower greenhouse gas emissions (mean, from 4·82 kg CO2 equivalent to 2·93 kg CO2 equivalent) and a 51% reduction in land use (mean, from 10·42 m2 to 5·19 m2). The PH menu improved the alignment with the PHD by 32% (score, from 61·2 points to 81·0 points). On average, novel dishes were served to 443 (SD 66, 67%) of 661 hospitalised patients, with 84% of patients reporting moderate to high satisfaction. Waste rates for fish, soy, and pulses used in novel dishes were significantly lower than those used in original dishes containing these proteins.

Interpretation

Plant-rich diets can be adapted to an inpatient health-care setting to meet patient preferences and nutritional requirements while achieving considerable environmental benefits.