Sustainable food systems and diets in dietetic training standards: an international content analysis.

BACKGROUND: Low professional confidence and perceived competence create tangible barriers to integrating sustainable food systems (SFS) and diets into dietetic practice. One opportunity to facilitate more systemic integration into dietetic education and training is to include these concepts in professional standards. To better understand the barrier of low professional confidence and perceived competence for engagement with SFS-related practice, the purpose of this research was to investigate dietetic training standards for SFS content and to highlight opportunities for growth within the profession. Questions posed by this research are: (1) how, if at all, are SFS and diets articulated in dietetic training standards, and (2) to what level of cognitive complexity? METHODS: A content analysis of dietetic training standards documents was conducted between 15 April and 15 September 2021. Search terms included 'sustain*' or 'sustainable', 'food systems' and/or 'diets'. Extracted data with applicable SFS content were analysed for level of cognitive complexity requirements. RESULTS: Of 47 National Dietetics Associations, researchers obtained 23 dietetic training standards documents, of which 16 included SFS-related content. The majority of documents used broad descriptors of the concepts, with little granularity and at a lower level of cognitive complexity. CONCLUSIONS: Adoption of more robust frameworks for sustainability with specific learning outcomes that can be adapted to regional contexts would strengthen higher education curricula and thus the profession's ability to contribute more meaningfully to SFSs and diets.

Best practice recommendations for body composition considerations in sport to reduce health and performance risks: a critical review, original survey and expert opinion by a subgroup of the IOC consensus on Relative Energy Deficiency in Sport (REDs).

BACKGROUND: The assessment of body composition (BC) in sport raises concern for athlete health, especially where an overfocus on being lighter or leaner increases the risk of Relative Energy Deficiency in Sport (REDs) and disordered eating. METHODS: We undertook a critical review of the effect of BC on performance (29 longitudinal, prospective or intervention studies) and explored current practice related to BC considerations via a follow-up to a 2013 internationally distributed survey. RESULTS: The review found that a higher level of body fat was negatively associated with endurance performance, while a gain in muscle mass resulted in performance benefits across sports. BC did not contribute to early talent identification, and no unique cut-off to signify a performance advantage for BC was identified. BC appears to be one of an array of variables impacting performance, and its influence should not be overstated. The survey (125 practitioners, 61 sports and 26 countries) showed subtle changes in BC considerations over time, such as an increased role for sport dietitian/nutrition practitioners as BC measurers (2013: 54%, 2022: 78%); less emphasis on reporting of body fat percentage (2013: 68%, 2022: 46%) and reduced frequency of BC assessment if ≥every fourth week (2013: 18%, 2022: 5%). Respondents remained concerned about a problematic focus on BC (2013: 69%, 2022: 78%). To address these findings, we provide detailed recommendations for BC considerations, including an overview of preferable BC methodology. CONCLUSIONS: The 'best practice' guidelines stress the importance of a multidisciplinary athlete health and performance team, and the treatment of BC data as confidential medical information. The guidelines provide a health focus around BC, aiming to reduce the associated burden of disordered eating, problematic low energy availability and REDs.

Negotiating mental illness across the lay-professional divide: Role play in peer work consultations.

Patient involvement is a prominent policy aim in modern health care. Today, mental health services employ peer workers (PWs) who have personal experiences with mental illness. Based on 22 interviews with PWs and 26 audio recordings of real-life consultations, we show how PWs talk about their personal experiences as professional qualifications. Furthermore, we demonstrate how in real-life encounters, PWs and patients convert personal experiences into a professional approach through an interactionist role play that balance PWs role as former patients and current professionals. Our analysis shows that PWs combine the personal pronoun 'I' (stressing that it is personal) with the indefinite pronoun 'one' (referring to generalised patient experiences) when they recount illness experiences. This convey that PWs engage with mental illness as both a personal and professional topic. In addition, the analysis shows that PWs (and patients) use professional clues to manifest PWs' positions as professionals. Overall, the article demonstrates that instead of focussing on authentic patient relationships, as previous research has done, it is beneficial to investigate peer work from a symbolic interactionist approach revealing how PWs and patients skilfully manoeuvre the contradictions embedded in the PWs' dual role as former patients and current professionals.

Validation of the Athlete's Plate Nutrition Educational Tool: Phase I.

Nutrition education visual tools are designed to help the general population translate science into practice. The purpose of this study was to validate the Athlete's Plate (AP) to ensure that it meets the current sport nutrition recommendations for athletes. Twelve registered dietitians (RDs; 10 female and 2 male) volunteered for the study. Each registered dietitian was asked to create three real and virtual plates at three different times corresponding to breakfast, lunch, and dinner, and the three different AP training loads, easy (E), moderate (M), and hard (H), divided into two weight categories (male 75 kg and female 60 kg). Data of the real and virtual plates were evaluated using Computrition software (v. 18.1; Computrition, Chatsworth, CA). Statistical analyses were conducted by SPSS (version 23.0; IBM, Armonk, NY) to compare the difference between each training load category (E, M, and H) and the recommendations. No statistically significant differences were found among the created plates and the recommendations for energy, carbohydrates, fat, and fiber for E, M, and H. Protein relative to body mass (BM) was higher than recommended for E (1.9 ± 0.3 g·kg-1 BM·day-1, p = .003), M (2.3 ± 0.3 g·kg-1 BM·day-1, p < .001), and H (2.9+0.5 g·kg-1 BM·day-1, p < .001). No differences were found for the macronutrient distribution by gender when correcting for kilograms of body mass. The authors conclude that the AP meets the nutrition recommendations for athletes at different training intensities for energy, carbohydrates, fat, and fiber, but exceeds the recommendations for protein. Further research should consider this protein discrepancy and develop an AP model that meets, besides health and performance goals, contemporary guidelines for sustainability.

Agency and clientship in public encounters: co-constructing 'neediness' and 'worthiness' in shelter placement meetings.

This article seeks to develop our understanding of the agency of vulnerable groups who at first sight may not seem to have much agency in their lives. It explores the co-constructed nature of agency in three Danish homeless shelters. Unlike earlier interview-based studies, our research is based on naturalistic data drawn from 23 video-recorded placement meetings. Using concepts from Goffman, we examine how versions of the neediness and worthiness of homeless people are negotiated verbally and bodily between staff and clients. We find that homeless people have to juggle two partly contradictory roles when they are given or take the roles of either a (active) citizen or a (passive) client. Clientship is actively negotiated by both parties and demonstrates the agency of homeless people: they can collaborate with (as clients) or challenge (as citizens) the staff's attempts to formulate solutions to their troubles. We further examine how the professional ideology of client centredness affects the meeting between the two parties. However, we show that, like any discourse, client centredness has no intrinsic meaning and is played out by actors in very different ways. In work with the homeless, the discourse of client centredness is related to discourses of 'neediness', 'worthiness' and 'value for money' that define agency in different ways and make three different client positions available: the resolute client, the acquiescent client and the passive client.

Subcutaneous fat patterning in athletes: selection of appropriate sites and standardisation of a novel ultrasound measurement technique: ad hoc working group on body composition, health and performance, under the auspices of the IOC Medical Commission.

BACKGROUND: Precise and accurate field methods for body composition analyses in athletes are needed urgently. AIM: Standardisation of a novel ultrasound (US) technique for accurate and reliable measurement of subcutaneous adipose tissue (SAT). METHODS: Three observers captured US images of uncompressed SAT in 12 athletes and applied a semiautomatic evaluation algorithm for multiple SAT measurements. RESULTS: Eight new sites are recommended: upper abdomen, lower abdomen, erector spinae, distal triceps, brachioradialis, lateral thigh, front thigh, medial calf. Obtainable accuracy was 0.2 mm (18 MHz probe; speed of sound: 1450 m/s). Reliability of SAT thickness sums (N=36): R(2)=0.998, SEE=0.55 mm, ICC (95% CI) 0.998 (0.994 to 0.999); observer differences from their mean: 95% of the SAT thickness sums were within ± 1 mm (sums of SAT thicknesses ranged from 10 to 50 mm). Embedded fibrous tissues were also measured. CONCLUSIONS: A minimum of eight sites is suggested to accommodate inter-individual differences in SAT patterning. All sites overlie muscle with a clearly visible fascia, which eases the acquisition of clear images and the marking of these sites takes only a few minutes. This US method reaches the fundamental accuracy and precision limits for SAT measurements given by tissue plasticity and furrowed borders, provided the measurers are trained appropriately.

Energy Availability and Dietary Patterns of Adult Male and Female Competitive Cyclists With Lower Than Expected Bone Mineral Density.

The purpose of this study was to assess energy availability (EA) and dietary patterns of 10 adult (29-49 years) male (n = 6) and female (n = 4) competitive (USA Cycling Category: Pro, n = 2; 1-4, n = 8) endurance cyclists (5 road, 5 off-road), with lower than expected bone mineral density (BMD; Z score < 0) across a season. Energy intake (EI) and exercise energy expenditure during preseason (PS), competition (C), and off-season (OS) were estimated from 3-day dietary records, completed once per month, across a cycling season. BMD was measured by DXA at 0 months/5 months/10 months. The Three-Factor Eating Questionnaire (TFEQ) was used to assess cognitive dietary restraint. Seventy percent of participants had low EA [(LEA); < 30 kcal · kg fat-free mass (FFM) (-1) · day(-1)] during PS, 90% during C, and 80% during OS (range: 3-37 kcal · kg FFM(-1) · day(-1)). Ninety percent of cyclists had LEA during ≥ 1 training period, and 70% had LEA across the season. Seventy percent of cyclists were identified as restrained eaters who consciously restrict EI as a means of weight control. Mean daily carbohydrate intake was below sport nutrition recommendations during each training period (PS: 3.9 ± 1.1 g · kg(-1) · day(-1), p < .001; C: 4.3 ± 1.4 g · kg(-1) · day(-1), p = .005; OS: 3.7 ± 1.4 g · kg(-1) · day(-1), p = .01). There were no differences in EA and EI · kg(-1) between male and female cyclists and road and off-road cyclists. Low EI, and specifically low carbohydrate intake, appears to be the main contributor to chronic LEA in these cyclists. Adult male and female competitive road and off-road cyclists in the United States may be at risk for long-term LEA. Further studies are needed to explore strategies to prevent and monitor long-term LEA in these athletes.

Health promotion viewed in a critical perspective.

The aim of this paper is to reflect critically on the current health promotion initiatives targeting overweight individuals in Western countries. The paper's methodological approach is to draw on analytical findings from my and other sociologists' empirical work on how the problems of overweight people are being defined in various settings in Denmark, England, Australia and the US. I try to illustrate how health promotion targeting overweight individuals can not only be seen as a project aimed at securing longer lives and fewer illnesses for people carrying excess fat but also a moral project that, in a more general sense, aims to tell people how they ought to live their lives. I link this moral aspect of health promotion to a) the medicalization tendency in current Western society (e.g. a growing pharmaceutical industry and its economic interest in transforming the human condition of being overweight into a treatable disorder) and b) the strong focus on individual risk today. One of the main arguments in the paper is that health in relation to overweight is primarily defined from a biomedical perspective that praises certain physical measurements of the body, as well as dominant societal values such as self-responsibility and self-control, and that a combination of biomedicine and these dominating values can lead to health promotion becoming a problematic moral endeavour.

The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S).

Protecting the health of the athlete is a goal of the International Olympic Committee (IOC). The IOC convened an expert panel to update the 2005 IOC Consensus Statement on the Female Athlete Triad. This Consensus Statement replaces the previous and provides guidelines to guide risk assessment, treatment and return-to-play decisions. The IOC expert working group introduces a broader, more comprehensive term for the condition previously known as 'Female Athlete Triad'. The term 'Relative Energy Deficiency in Sport' (RED-S), points to the complexity involved and the fact that male athletes are also affected. The syndrome of RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency. The cause of this syndrome is energy deficiency relative to the balance between dietary energy intake and energy expenditure required for health and activities of daily living, growth and sporting activities. Psychological consequences can either precede RED-S or be the result of RED-S. The clinical phenomenon is not a 'triad' of the three entities of energy availability, menstrual function and bone health, but rather a syndrome that affects many aspects of physiological function, health and athletic performance. This Consensus Statement also recommends practical clinical models for the management of affected athletes. The 'Sport Risk Assessment and Return to Play Model' categorises the syndrome into three groups and translates these classifications into clinical recommendations.

Evaluation of food provision and nutrition support at the London 2012 Olympic Games: the opinion of sports nutrition experts.

The aim of this study was to evaluate the food provision and nutrition support at the London 2012 Olympic (OG) and Paralympic Games (PG) from the perspective of sports nutrition experts attending the event. Participants (n = 15) were asked to complete an online survey and rate on a Likert scale menu qualities, food safety, sustainability practices, nutrition labeling, and provision for cultural needs, dietary regimes and specific situations. Open-ended responses were incorporated to explore expert opinion and areas for improvement. Participants rated their overall experience of the food provision as 7.6 out of 10 (range 5 to 10), with the majority (n = 11) rating it greater than 7. The variety, accessibility, presentation, temperature, and freshness of menu items rated as average to good. A below average rating was received for recovery food and beverages, provision of food for traveling to other venues, taking suitable snacks out of the dining hall and provision of food at other venues. However, the variety and accessibility of choices for Ramadan, and provision of post-competition food were rated highly. A number of comments were received about the lack of gluten free and lower energy/fat items. The inclusion of allergens on nutrition labeling was considered more important than nutrient content. While dietetic review of the menu in advance of the OG and PG is clearly a valuable process that has resulted in improvements in the food supply, there are still areas that need to be addressed that are currently not implemented during the event.

How to minimise the health risks to athletes who compete in weight-sensitive sports review and position statement on behalf of the Ad Hoc Research Working Group on Body Composition, Health and Performance, under the auspices of the IOC Medical Commission.

A focus on low body weight and body fat content, combined with regulations in some weight-sensitive sports, are considered risk factors for extreme dieting, eating disorders (EDs) and related health consequences among athletes. At present there are, from a health perspective, no generally accepted optimum values for body weight or percentage of fat mass in different sports and there is no 'gold standard' method for body composition assessment in athletes. On the basis of health considerations as well as performance, medical support teams should know how to approach elite athletes who seek to achieve an unrealistic body composition and how to prevent restrictive eating practices from developing into an ED. In addition, these teams must know when to raise the alarm and how to advice athletes who are affected by extreme dieting or clinical EDs. However, there is no consensus on when athletes struggling with extreme dieting or EDs should be referred for specialist medical treatment or removed from competition. Based on the present review, we conclude that there is a need for (1) sport-specific and gender-specific preventive programmes, (2) criteria for raising alarm and 'does not start' (DNS) for athletes with EDs and (3) modifications to the regulations in some sports. Further, the key areas for research identified include the development of standard methods for body composition assessment in elite athletes; screening measures for EDs among athletes; development and testing of prevention programmes; investigating the short and long-term effects of extreme dieting; and EDs on health and performance.

Body composition for health and performance: a survey of body composition assessment practice carried out by the Ad Hoc Research Working Group on Body Composition, Health and Performance under the auspices of the IOC Medical Commission.

BACKGROUND: Successful performers in weight-sensitive sports are characterised by low body mass (BM) and fat content. This often requires chronic energy restriction and acute weight loss practices. AIM: To evaluate current use of body composition (BC) assessment methods and identify problems and solutions with current BC approaches. METHODS: A 40-item survey was developed, including demographic and content questions related to BC assessment. The survey was electronically distributed among international sporting organisations. Frequencies and χ(2) analyses were computed. RESULTS: 216 responses were received, from 33 countries, representing various institutions, sports and competitive levels. Of the sample, 86% of respondents currently assess BC, most frequently using skinfolds (International Society for the Advancement of Kinanthropometry (ISAK): 50%; non-ISAK, conventional: 40%; both: 28%), dual energy X-ray absorptiometry (38%), bioelectrical impedance (29%), air displacement plethysmography (17%) and hydrostatic weighing (10%). Of those using skinfolds, more at the international level used ISAK, whereas conventional approaches were more reported at regional/national level (p=0.006). The sport dietitian/nutritionist (57%) and physiologist/sports scientist (54%) were most frequently the professionals assessing BC, followed by MDs and athletic trainers, with some reporting coaches (5%). 36% of 116 respondents assessed hydration status and more (64%) did so at international than regional/national level (36%, p=0.028). Of 125 participants answering the question of whether they thought that BC assessment raised problems, 69% said 'yes', with most providing ideas for solutions. CONCLUSIONS: Results show high use of BC assessment but also a lack of standardisation and widespread perception of problems related to BM and BC in sport. Future work should emphasise standardisation with appropriate training opportunities and more research on BC and performance.

Body composition in sport: interobserver reliability of a novel ultrasound measure of subcutaneous fat tissue.

BACKGROUND: Very low body mass, extreme mass changes, and extremely low per cent body fat are becoming increasingly common in many sports, but sufficiently reliable and accurate field methods for body composition assessment in athletes are missing. METHODS: Nineteen female athletes were investigated (mean (SD) age: 19.5 (± 3.3) years; body mass: 59.6 (± 7.6) kg; height: 1.674 (± 0.056) m; BMI: 21.3 (± 2.3) kg/m(2)). Three observers applied diagnostic B-mode-ultrasound (US) combined with the evaluation software for subcutaneous adipose tissue measurements at eight ISAK sites (International Society for the Advancement of Kinanthrometry). Regression and reliability analyses are presented. RESULTS: US measurements and evaluation of subcutaneous adipose tissue (SAT) thicknesses (including fibrous structures: D(included); n=378) resulted in an SE of estimate SEE=0.60 mm, R(2)=0.98 (p<0.001), limit of agreement LOA=1.18, ICC=0.968 (0.957-0.977). Similar values were found for D(excluded): SEE=0.68 mm, R(2)=0.97 (p<0.001). D(included) at individual ISAK sites: at biceps, R(2)=0.87 and intraclass-correlation coefficient ICC=0.811 were lowest and SEE=0.79 mm was highest. Values at all other sites ranged from R(2): 0.94-0.99, SEE: 0.42-0.65 mm, and ICC: 0.917-0.985. Interobserver coefficients ranged from 0.92 to 0.99, except for biceps (0.74, 0.83 and 0.87). Evaluations of 20 randomly selected US images by three observers (D(included)) resulted in: SEE=0.15 mm, R(2)=0.998(p<0.001), ICC=0.997 (0.993, 0999). CONCLUSIONS: Subject to optimal choice of sites and certain standardisations, US can offer a highly reliable field method for measurement of uncompressed thickness of the SAT. High accuracy and high reliability of measurement, as obtained with this US approach, are essential for protection of the athlete's health and also for optimising performance.

Can alternating lower body negative and positive pressure during exercise alter regional body fat distribution or skin appearance?

The purpose of this study was to determine whether physical activity, with and without lower body pressure, leads to increased regional fat loss in the lower extremities of overweight females. Eighty-six obese women with a female phenotype were randomly assigned into four groups: control group (C), diet only (D), diet plus exercise (DE) or diet, exercise and lower body pressure intervention (DEP). The three treatment groups followed the same diet, the two exercise groups (DE and DEP) additionally followed an endurance training program of 30 min of cycling at 50%VO(2)max three times per week with or without lower body pressure. Body composition and fat distribution were assessed by DXA. Body size circumference measurements were recorded as well as subjective ratings of cellulite and skin appearance. As expected, all test groups (D, DE, DEP) showed a significant decrease (p < 0.05) in total body mass and fat mass. DXA revealed significant differences between the experimental groups and C. The DEP group also lost significantly more body mass and fat mass when compared with D, while no significant difference was observed between the other groups. A similar pattern was seen for circumference measurement data. A significant perceived improvement was made by the DEP group when compared with C, D and DE groups for skin condition and also between the DEP versus C and D groups for cellulite. The combination of diet and exercise is successful for weight reduction. The additional application of lower body pressure especially affects skin appearance.

The negotiation of the sick role: general practitioners' classification of patients with medically unexplained symptoms.

In encounters between general practitioners (GPs) and patients with medically unexplained symptoms (MUS), the negotiation of the sick role is a social process. In this process, GPs not only use traditional biomedical diagnostic tools but also rely on their own opinions and evaluations of a patient's particular circumstances in deciding whether that patient is legitimately sick. The doctor is thus a gatekeeper of legitimacy. This article presents results from a qualitative interview study conducted in Denmark with GPs concerning their approach to patients with MUS. We employ a symbolic interaction approach that pays special attention to the external validation of the sick role, making GPs' accounts of such patients particularly relevant. One of the article's main findings is that GPs' criteria for judging the legitimacy of claims by those patients that present with MUS are influenced by the extent to which GPs are able to constitute these patients as people with social problems and problematic personality traits.

Prevalence of amenorrhea in elite female competitive climbers.

Elite competitive sport climbers exhibit a high strength-to-weight ratio and are reported in the literature to be lighter and leaner than their athletic counterparts. Current research regarding nutrition among climbers is sparse but suggests that they may be at high risk for low energy availability and Relative Energy Deficiency in Sport (RED-S). The prevalence of amenorrhea, one of the primary indicators of RED-S, is unknown in this athletic population. The purpose of this study was to determine the prevalence of current (previous 12 months) amenorrhea among elite level competitive sport climbers. Methods: An anonymous online survey was distributed via email to 1,500 female climbers registered as competitors within the International Federation of Sport Climbing to assess the prevalence of amenorrhea over the past 12 months. Results: A total of 114 female sport climbers answered all survey questions regarding menstrual function and 18 athletes (15.8%) presented with current amenorrhea. The majority of the athletes (72%; n = 82) were categorized with eumenorrhea. An additional 14 athletes (12.3%) provided information that indicated irregular cycles, but answers to all menstrual cycle questions were not congruent to elicit a classification of amenorrhea and these athletes were categorized with a menstrual status of unsure. The average BMI for climbers with eumenorrhea was 20.8 ± 1.8 kg/m2 and 19.9 ± 2.4 kg/m2 for those with amenorrhea. A higher percentage of climbers with amenorrhea revealed they currently struggle with an eating disorder compared to those without amenorrhea (13.5 vs. 22.2%, respectively). Conclusion: This study indicates that some female climbers competing at the World Cup level do have menstrual disturbances with relatively normal BMIs and some currently struggle with one or more eating disorders. Even though World Cup competitions use BMI critical margins to screen competitors, this research highlights the need for more medical supervision of competitive elite female sport climbers in order to protect their overall health, including menstrual function. Further research is required to clarify how many climbers suffer from endocrine abnormalities related to RED-S. With more scientific evidence in this area practitioners will be better equipped to educate the athlete and coach with evidence-based nutrition recommendations.

Nutrition for winter sports.

Winter sports are played in cold conditions on ice or snow and often at moderate to high altitude. The most important nutritional challenges for winter sport athletes exposed to environmental extremes include increased energy expenditure, accelerated muscle and liver glycogen utilization, exacerbated fluid loss, and increased iron turnover. Winter sports, however, vary greatly regarding their nutritional requirements due to variable physiological and physique characteristics, energy and substrate demands, and environmental training and competition conditions. What most winter sport athletes have in common is a relatively lean physique and high-intensity training periods, thus they require greater energy and nutrient intakes, along with adequate food and fluid before, during, and after training. Event fuelling is most challenging for cross-country skiers competing in long events, ski jumpers aiming to reduce their body weight, and those winter sport athletes incurring repeated qualification rounds and heats. These athletes need to ensure carbohydrate availability throughout competition. Finally, winter sport athletes may benefit from dietary and sport supplements; however, attention should be paid to safety and efficacy if supplementation is considered.

Food Next Door: From Food Literacy to Citizenship on a College Campus.

Industrial agriculture and food corporations have produced an abundance of food that is highly processed, nutritionally poor, and environmentally burdensome. As part of a healthy campus initiative, generated to address these and other food production and consumption dilemmas, a student-run "local and sustainable" food establishment called Food Next Door (FND) was created. This intrinsic case study evaluated food literacy in health science students, faculty, and staff first as a pilot to build the case for FND and further explicated customers', volunteers', and leads' experiences with FND, identifying potential pathways from food literacy to citizenship. Ten returning customers, eight recurring nutrition student volunteers, and three graduate student leads participated in interviews that were analyzed for themes and subthemes. The findings show a progression in themes. Customers' experiences highlight FND's fresh, flavorful food, smiling and supportive staff, and personal transformation. Volunteers' themes identified greater awareness of new foods and plant-based eating, acquiring new knowledge and skills in commercial kitchens, and deepening their connection to food, each other, and to where food comes from. Leads' themes show opportunities to gain managerial skills, a deeper understanding of food and skills from being immersed in value-based food systems, and confidence in peer teaching. Experiencing and becoming part of the food value chain through FND built food literacy, shifted values, and transformed students into food citizens.