COVID-19, Climate Change, and Conflict in Honduras: A food system disruption analysis.

In Honduras, as in many settings between 2020 and 2022, food security was affected by the COVID-19 pandemic, climate change, and conflicts-what some refer to as "The Three Cs." These challenges have had overlapping impacts on food supply chains, food assistance programs, food prices, household purchasing power, physical access to food, and food acceptability. This article applies a food system disruption analysis-adapted from a fault tree analysis originally developed for a municipal context in the United States-to the context of Honduras to systematically examine how the Three Cs affected food availability, accessibility, and acceptability. This article demonstrates the value of approaching food security through a disruption analysis, especially for settings impacted by multiple, interconnected, ongoing crises.

When increasing vegetable production may worsen food availability gaps: A simulation model in India.

Translating agricultural productivity into food availability depends on food supply chains. Agricultural policy and research efforts promote increased horticultural crop production and yields, but the ability of low-resource food supply chains to handle increased volumes of perishable crops is not well understood. This study developed and used a discrete event simulation model to assess the impact of increased production of potato, onion, tomato, brinjal (eggplant), and cabbage on vegetable supply chains in Odisha, India. Odisha serves as an exemplar of vegetable supply chain challenges in many low-resource settings. Model results demonstrated that in response to increasing vegetable production 1.25-5x baseline amounts, demand fulfillment at the retail level fluctuated by + 3% to -4% from baseline; in other words, any improvements in vegetable availability for consumers were disproportionately low compared to the magnitude of increased production, and in some cases increased production worsened demand fulfillment. Increasing vegetable production led to disproportionately high rates of postharvest loss: for brinjal, for example, doubling agricultural production led to a 3% increase in demand fulfillment and a 19% increase in supply chain losses. The majority of postharvest losses occurred as vegetables accumulated and expired during wholesale-to-wholesale trade. In order to avoid inadvertently exacerbating postharvest losses, efforts to address food security through agriculture need to ensure that low-resource supply chains can handle increased productivity. Supply chain improvements should consider the constraints of different types of perishable vegetables, and they may need to go beyond structural improvements to include networks of communication and trade.

Food security and food access during the COVID-19 pandemic: Impacts, adaptations, and looking ahead.

The coronavirus disease 2019 (COVID-19) pandemic continues to alter US household food consumption and food spending. Although terminology used to describe food insecurity has varied during the COVID-19 pandemic, many reliable estimates illustrate a dramatic increase in food insecurity from approximately 10% of US households before the pandemic to 25%-30% of households during the pandemic, with an even higher prevalence reported by more vulnerable and socially disadvantaged populations. To address the increase in food and economic insecurity, food and nutrition assistance policies and programs made innovative and temporary changes, and enrollment in these programs generally increased. However, some changes to food, nutrition, and income assistance programs are now expiring or contracting even as food insecurity prevalence is again on the rise and elevated food and nutrition assistance needs are expected to persist based on historical patterns. American Society for Parenteral and Enteral Nutrition (ASPEN) practitioners can play an important role in identifying clients at elevated risk of food insecurity-related acute and chronic conditions and connecting high-risk clients to resources. ASPEN practitioners can contribute to the evidence base linking food insecurity and nutrition outcomes. ASPEN practitioners can also advocate for addressing the root social and structural determinants of food insecurity and for the continuation of effective food and nutrition policy changes and innovations.

Inedible Food Waste Linked to Diet Quality and Food Spending in the Seattle Obesity Study SOS III.

Americans waste about a pound of food per day. Some of this is represented by inedible food waste at the household level. Our objective was to estimate inedible food waste in relation to diet quality and participant socio-economic status (SES). Seattle Obesity Study III participants (n = 747) completed the Fred Hutch Food Frequency Questionnaire (FFQ) and socio-demographic and food expenditure surveys. Education and geo-coded tax-parcel residential property values were measures of SES. Inedible food waste was calculated from diet records. Retail prices of FFQ component foods (n = 378) were used to estimate individual-level diet costs. The NOVA classification was used to identify ultra-processed foods. Multivariable linear regressions tested associations between inedible food waste, SES, food spending, Nutrient Rich Food (NRF9.3) and Healthy Eating Index (HEI-2015) scores. Inedible food waste was estimated at 78.7 g/d, mostly from unprocessed vegetables (32.8 g), fruit (30.5 g) and meat, poultry, and fish (15.4 g). Greater inedible food waste was associated with higher HEI-2015 and NRF9.3 scores, higher food expenditures and lower percent energy from ultra-processed foods. In multivariable models, more inedible food waste was associated with higher food expenditures, education and residential property values. Higher consumption of unprocessed foods were associated with more inedible food waste and higher diet costs. Geo-located estimates of inedible food waste can provide a proxy index of neighborhood diet quality.

"Maybe it's still good?" A qualitative study of factors influencing food waste and application of the E.P.A. Food recovery hierarchy in U.S. supermarkets.

About 31% of post-harvest food available for human consumption is lost or wasted annually in the United States. Roughly one third (43 billion lbs.) of food loss occurs in grocery and other retail food stores. Supermarkets engage in food waste reduction, rescue, and recycling strategies, but little is known about frontline workers' and department managers' perspectives on food discards and strategies to limit waste. We aimed to increase understanding of factors influencing grocery retail employees' food waste decision-making at the store level, and of the perspectives of those frontline supermarket workers and managers responsible for food waste prevention and mitigation. We conducted 20 qualitative semi-structured interviews and used thematic analysis to explore how grocery workers and managers view food waste decision drivers, and how these impact the feasibility and effectiveness of waste reduction and food rescue and recycling in their stores. Workers and managers report personalized discard decision-making and confusion between quality and safety indicators. Interviewees described in-store policies, resources and trainings as lacking or inconsistently applied, leading to variability in food waste prevention, rescue, and recycling. Overall, interview participants considered waste reduction strategies that rescue profitable goods more feasible than other food rescue and recycling efforts like donation and composting. Workers' and managers' perceptions of in-store food waste drivers and views on extant food waste prevention and mitigation efforts point to areas for future research and intervention.

The importance of food systems and the environment for nutrition.

Global and local food system transformation is necessary in order to ensure the delivery of healthy, safe, and nutritious foods in both sustainable and equitable ways. Food systems are complex entities that affect diets, human health, and a range of other outcomes including economic growth, natural resource and environmental resiliency, and sociocultural factors. However, food systems contribute to and are vulnerable to ongoing climate and environmental changes that threaten their sustainability. Although there has been increased focus on this topic in recent years, many gaps in our knowledge persist on the relation between environmental factors, food systems, and nutritional outcomes. In this article, we summarize this emerging field and describe what innovative nutrition research is needed in order to bring about food policy changes in the era of climate disruption and environmental degradation.

Estimated Cost to a Restaurant of a Foodborne Illness Outbreak.

OBJECTIVES: Although outbreaks of restaurant-associated foodborne illness occur periodically and make the news, a restaurant may not be aware of the cost of an outbreak. We estimated this cost under varying circumstances. METHODS: We developed a computational simulation model; scenarios varied outbreak size (5 to 250 people affected), pathogen (n = 15), type of dining establishment (fast food, fast casual, casual dining, and fine dining), lost revenue (ie, meals lost per illness), cost of lawsuits and legal fees, fines, and insurance premium increases. RESULTS: We estimated that the cost of a single foodborne illness outbreak ranged from $3968 to $1.9 million for a fast-food restaurant, $6330 to $2.1 million for a fast-casual restaurant, $8030 to $2.2 million for a casual-dining restaurant, and $8273 to $2.6 million for a fine-dining restaurant, varying from a 5-person outbreak, with no lost revenue, lawsuits, legal fees, or fines, to a 250-person outbreak, with high lost revenue (100 meals lost per illness), and a high amount of lawsuits and legal fees ($1 656 569) and fines ($100 000). This cost amounts to 10% to 5790% of a restaurant's annual marketing costs and 0.3% to 101% of annual profits and revenue. The biggest cost drivers were lawsuits and legal fees, outbreak size, and lost revenue. Pathogen type affected the cost by a maximum of $337 000, the difference between a Bacillus cereus outbreak (least costly) and a listeria outbreak (most costly). CONCLUSIONS: The cost of a single foodborne illness outbreak to a restaurant can be substantial and outweigh the typical costs of prevention and control measures. Our study can help decision makers determine investment and motivate research for infection-control measures in restaurant settings.

A Systematic Review of Calorie Labeling and Modified Calorie Labeling Interventions: Impact on Consumer and Restaurant Behavior.

OBJECTIVE: Evidence on the effects of restaurant calorie labeling on consumer and restaurant behavior is mixed. This paper examined: (1) consumer responses to calorie information alone or compared to modified calorie information and (2) changes in restaurant offerings following or in advance of menu labeling implementation. METHODS: Searches were conducted in PubMed, Web of Science, Policy File, and PAIS International to identify restaurant calorie labeling studies through October 1, 2016, that measured calories ordered, consumed, or available for purchase on restaurant menus. The reference lists of calorie labeling articles were also searched. RESULTS: Fifty-three studies were included: 18 in real-world restaurants, 9 in cafeterias, and 21 in laboratory or simulation settings. Five examined restaurant offerings. CONCLUSIONS: Because of a lack of well-powered studies with strong designs, the degree to which menu labeling encourages lower-calorie purchases and whether that translates to a healthier population are unclear. Although there is limited evidence that menu labeling affects calories purchased at fast-food restaurants, some evidence demonstrates that it lowers calories purchased at certain types of restaurants and in cafeteria settings. The limited data on modified calorie labels find that such labels can encourage lower-calorie purchases but may not differ in effects relative to calorie labels alone.

Wasted Food, Wasted Nutrients: Nutrient Loss from Wasted Food in the United States and Comparison to Gaps in Dietary Intake.

BACKGROUND: Previous research has estimated that wasted food in the United States contains between 1,249 and 1,400 kcal per capita per day, but little is known about amounts of other nutrients embedded in the 31% to 40% of food that is wasted. OBJECTIVE: This research aimed to calculate the nutritional value of food wasted at the retail and consumer levels in the US food supply, and contextualize the amount of nutrient loss in terms of gaps between current and recommended intakes and estimated food recovery potential. DESIGN: Data from the National Nutrient Database for Standard Reference were used to calculate the nutritional value of retail- and consumer-level waste of 213 commodities in the US Department of Agriculture Loss-Adjusted Food Availability data series for 27 nutrients in 2012. RESULTS: Food wasted at the retail and consumer levels of the US food supply in 2012 contained 1,217 kcal, 33 g protein, 5.9 g dietary fiber, 1.7 µg vitamin D, 286 mg calcium, and 880 mg potassium per capita per day. Using dietary fiber as an example, 5.9 g dietary fiber is 23% of the Recommended Dietary Allowance for women. This is equivalent to the fiber Recommended Dietary Allowance for 74 million adult women. Adult women in 2012 underconsumed dietary fiber by 8.9 g/day, and the amount of wasted fiber is equivalent to this gap for 206.6 million adult women. CONCLUSIONS: This was the first study to document the loss of nutrients from wasted food in the US food supply, to our knowledge. Although only a portion of discarded food can realistically be made available for human consumption, efforts to redistribute surplus foods where appropriate and prevent food waste in the first place could increase the availability of nutrients for Americans, while saving money and natural resources.

Economic impact of thermostable vaccines.

BACKGROUND: While our previous work has shown that replacing existing vaccines with thermostable vaccines can relieve bottlenecks in vaccine supply chains and thus increase vaccine availability, the question remains whether this benefit would outweigh the additional cost of thermostable formulations. METHODS: Using HERMES simulation models of the vaccine supply chains for the Republic of Benin, the state of Bihar (India), and Niger, we simulated replacing different existing vaccines with thermostable formulations and determined the resulting clinical and economic impact. Costs measured included the costs of vaccines, logistics, and disease outcomes averted. RESULTS: Replacing a particular vaccine with a thermostable version yielded cost savings in many cases even when charging a price premium (two or three times the current vaccine price). For example, replacing the current pentavalent vaccine with a thermostable version without increasing the vaccine price saved from $366 to $10,945 per 100 members of the vaccine's target population. Doubling the vaccine price still resulted in cost savings that ranged from $300 to $10,706, and tripling the vaccine price resulted in cost savings from $234 to $10,468. As another example, a thermostable rotavirus vaccine (RV) at its current (year) price saved between $131 and $1065. Doubling and tripling the thermostable rotavirus price resulted in cost savings ranging from $102 to $936 and $73 to $808, respectively. Switching to thermostable formulations was highly cost-effective or cost-effective in most scenarios explored. CONCLUSION: Medical cost and productivity savings could outweigh even significant price premiums charged for thermostable formulations of vaccines, providing support for their use.

A systems approach to obesity.

Obesity has become a truly global epidemic, affecting all age groups, all populations, and countries of all income levels. To date, existing policies and interventions have not reversed these trends, suggesting that innovative approaches are needed to transform obesity prevention and control. There are a number of indications that the obesity epidemic is a systems problem, as opposed to a simple problem with a linear cause-and-effect relationship. What may be needed to successfully address obesity is an approach that considers the entire system when making any important decision, observation, or change. A systems approach to obesity prevention and control has many benefits, including the potential to further understand indirect effects or to test policies virtually before implementing them in the real world. Discussed here are 5 key efforts to implement a systems approach for obesity prevention: 1) utilize more global approaches; 2) bring new experts from disciplines that do not traditionally work with obesity to share experiences and ideas with obesity experts; 3) utilize systems methods, such as systems mapping and modeling; 4) modify and combine traditional approaches to achieve a stronger systems orientation; and 5) bridge existing gaps between research, education, policy, and action. This article also provides an example of how a systems approach has been used to convene a multidisciplinary team and conduct systems mapping and modeling as part of an obesity prevention program in Baltimore, Maryland.

Wasted Food: U.S. Consumers' Reported Awareness, Attitudes, and Behaviors.

The U.S. wastes 31 to 40% of its post-harvest food supply, with a substantial portion of this waste occurring at the consumer level. Globally, interventions to address wasted food have proliferated, but efforts are in their infancy in the U.S. To inform these efforts and provide baseline data to track change, we performed a survey of U.S. consumer awareness, attitudes and behaviors related to wasted food. The survey was administered online to members of a nationally representative panel (N=1010), and post-survey weights were applied. The survey found widespread (self-reported) awareness of wasted food as an issue, efforts to reduce it, and knowledge about how to do so, plus moderately frequent performance of waste-reducing behaviors. Three-quarters of respondents said they discard less food than the average American. The leading motivations for waste reduction were saving money and setting an example for children, with environmental concerns ranked last. The most common reasons given for discarding food were concern about foodborne illness and a desire to eat only the freshest food. In some cases there were modest differences based on age, parental status, and income, but no differences were found by race, education, rural/urban residence or other demographic factors. Respondents recommended ways retailers and restaurants could help reduce waste. This is the first nationally representative consumer survey focused on wasted food in the U.S. It provides insight into U.S. consumers' perceptions related to wasted food, and comparisons to existing literature. The findings suggest approaches including recognizing that many consumers perceive themselves as being already-knowledgeable and engaged, framing messages to focus on budgets, and modifying existing messages about food freshness and aesthetics. This research also suggests opportunities to shift retail and restaurant practice, and identifies critical research gaps.