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Agriculture, especially the livestock sector, hugely stresses the environment through its climate change, land use, and water use impacts, among others. Hence, reducing meat consumption can greatly reduce agriculture’s heavy environmental burden. Meat replacements can deliver similar nutrients, and some even mimic meat to facilitate substitution. However, replacements come with their own environmental impacts, which can be highly uncertain, particularly for emerging replacements. This chapter synthesizes the environmental impacts of meat (poultry, pork, and beef) compared to conventional (seafood, eggs, tofu and tempeh, pulses, and nuts) and emerging (plant-based meat analogs, algae, mycoprotein, insects, and cultured meat) meat replacements. We compare their environmental impacts based on life cycle assessment and highlight impact hotspots, opportunities for improvement, and key research gaps. Overall, while conventional replacements already offer more sustainable alternatives to meat, emerging replacements often result in trade-offs that we can proactively tackle today to reduce environmental impacts in the future.

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This report is the outcome of a consensus-building project to agree on best practices for environmental and nutritional Life Cycle Assessment (nLCA) methodology, and identify future research needs. The project involved 30 nutritional and environmental LCA researchers from 18 countries. It focused on the assessment of food items (as opposed to meals or diets).Best practice recommendations were developed to address the intended purpose of an LCA study and related modeling approach, choice of an appropriate functional unit, assessment of nutritional value, and reporting nLCA results. An nLCA study should report the quantities of as many essential nutrients as possible and aim to provide information on the nutritional quality and/or health impacts in addition to nutrient quantities. Outstanding issues requiring further research attention include: defining a minimum number of nutrients to be considered in an nLCA study; treatment of nutrients to limit; use of nutrient indexes; further development of Impact Assessment methods; representation of nutritional changes that may occur during subsequent distribution and food preparation in cradle-to-gate nLCA studies; and communication of data uncertainty and variability. More data are required for different regions (particularly developing countries); for the processing, distribution, retail, and consumption life cycle stages; and for food loss and waste. Finally, there is a need to extend nLCA methodology for the assessment of meals and diets, to consider further how to account for the multi-functionality of food in a sustainability framework, and to set nLCA studies within the context of environmental limits.These results provide a robust basis for improving nLCA methodology and applying it to identify solutions that minimize the trade-offs between nourishing populations and safeguarding the environment.

Food systems have become increasingly efficient and technologically advanced in providing food products to meet the needs of the world’s growing population. However, providing healthy diets within environmental limits remains a key sustainability issue as food systems continue to over use increasingly scarce natural resources while making a major contribution to environmental impacts such as climate change, water scarcity and biodiversity loss. At the same time, hundreds of millions of people suffer from chronic hunger or adult obesity, and healthy diets continue to be more expensive than energy- and nutrient-sufficient diets. Many stakeholders are interested in the question of how to assess the environmental impacts of healthy diets, and in exploring solutions for minimizing trade-offs between nourishing populations and safeguarding the environment. Life cycle assessment (LCA) studies have an important role in contributing to solutions because they evaluate the environmental impacts of different practices, products and systems, and they facilitate the exploration of benefits and trade-offs across multiple types of impacts. LCA studies of food items increasingly address nutritional as well as environmental aspects, and this requires consideration of additional methodological aspects. The Food and Agriculture Organization of the United Nations (FAO) initiated a project to identify opportunities for further developing environmental and nutritional LCA methodology and building consensus about best practice, and to propose future research needs. The project involved 30 environmental and nutritional LCA researchers from 18 countries and ran between May and November 2021. The project focused on assessing food items as opposed to raw materials, meals and/or diets, and it is a step towards more comprehensive meal and dietary LCA studies. A key issue concerns the intended purpose of an LCA study. This requires some consideration of the reason for the study, the intended application and the audience. Foods may be consumed for a variety of reasons including for their nutritional value, for enjoyment, and/or as a means of taking part in – or contributing to – socio-cultural functions. This report defines a nutritional LCA (nLCA) study as an LCA study where the provision of nutrient(s) is considered as either the main function or one of the main functions of a food item. nLCA studies should be undertaken by multidisciplinary teams involving nutritional and health scientists as well as environmental scientists. At the outset, the goal and scope of an nLCA study should be carefully defined following the recommendations in this report, including: • Undertake an nLCA when nutrients are and/or nutrition is relevant to the decision-maker and decision context (Chapter 3). • Clearly identify the target audience and the target population for a study because different populations have different nutritional requirements, and this may influence the assessment of nutritional value (Chapter 5). • Report the quantities of as many essential nutrients as possible (Chapters 5 and 6). • Aim to provide information on the nutritional quality and/or health impacts in addition to nutrient quantities (Chapter 5, Chapter 6, Section 7.5.4). • The system boundaries should include all stages of the product life cycle that affect nutritional value. The final processing, storage and/or preparation of food items may have a notable effect on their nutritional value, and this should be taken into consideration (including the potential fortification of foods) (Chapter 5). • Choose a modelling perspective (typically attributional or consequential) based on the relevance to the decision situation (Chapter 4). The functional unit in an nLCA study can be defined in many ways (Chapter 6). These include: a quantity of one or more nutrients, a nutrient density value (calculated using a nutrient index), a quality-corrected quantity of nutrient(s), or another nutritional property (such as energy content). Alternatively, the functional unit could be a serving size. In all cases it should be relevant to the target population and its nutritional requirements. If possible, nutrients not included in the functional unit should be listed and discussed in the LCA report. Figure 5 and Figure 6 provide decision trees for guiding the choice of a functional unit in an nLCA study. When assessing nutrition, consideration should be given to: accounting for nutritional value as well as nutrient quantities (for example, using nutrient indices), separate treatment of nutrients to encourage (e.g. calcium) and of nutrients to limit (e.g. sodium), and assessment of non-nutrients that contribute to nutrition (e.g. dietary fibre) (Chapter 5, Chapter 6). In the impact assessment, research on the potential human health impacts of food items is at an early stage (Section 7.5.4). This report recommends using a nutrition impact category to account for the benefits or impacts of nutrition on human health (Section 8.1.1). Other particularly relevant impact categories to consider in an nLCA of food items include (Chapter 7): climate change, water use, land use, eutrophication (related to fertilizer use), ecotoxicity (related to pesticide use), and other human health impacts (in particular, fine particulates from agricultural activities and indoor use of some stoves, pesticide exposure and residues in food, chemical migration into food from contact materials, persistent organic pollutants and metals that bioconcentrate in foods). Antibiotic resistance is an emerging issue that requires consideration in the context of an LCA of food items (Section 7.7). Additional insights may be gained from integrating elements of the ecosystem services approach into an LCA (Section 7.6). The project led to numerous recommendations about reporting nLCA results. To increase the usefulness of nLCA studies of food items for future meal and dietary studies, the results should be reported using a mass- or volume-based reference flow as well as a nutritional functional unit. The results should identify whether the approach is nutrient-based or whether it also includes nutritional aspects. And the reported result should discuss the limitations of the adopted approach, for example, not accounting for interactions with other food items in a meal or diet (i.e. food matrix and meal effects) (Chapter 5). Some additional outstanding issues were identified in the project that require further attention (Chapter 8): • definition of a minimum number of nutrients to be considered in an nLCA study, and whether this should be based on food groups (Chapter 6); • treatment of nutrients to limit alongside, or separately from, encouraged nutrients (Chapter 6); • use of nutrient indices to assess nutrition (Chapter 6); • nutrition impact category methodology (Section 7.5.4), and further development of impact assessment methods for other impact categories (Chapter 7); • how to represent nutritional changes that could occur during food storage, distribution and preparation if the system boundary for an nLCA study is set at a life cycle stage prior to consumption (Chapter 4); • guidelines for use of an nLCA in different applications, including use of attributional and consequential modelling perspectives (Chapter 4); • representation of data uncertainty and variability in nLCA studies (Chapter 4); and •representative data for different regions (particularly developing countries) for the processing, distribution, retail, and consumption life cycle stages, and for food loss and waste (Chapter 4). Finally, there is a need to extend nLCA methodology for the assessment of meals and diets, to consider further how to account for the multi-functionality of food in a sustainability framework, and to set nLCA studies within the context of environmental limits. In summary, the constructive consensus-building process described in this report led to the identification of key outstanding issues and recommendations for the environmental and nutritional LCA of food items. The results provide a robust basis for future research to improve nLCA methodology and apply it to identify solutions that minimize the trade-offs between nourishing populations and safeguarding the environment

Overdiagnosis and overtreatment have serious implications for individuals, healthcare systems, and society,1 2 and effective strategies are urgently needed to help the public, clinicians, and policy makers address this problem. Communication about overdiagnosis has been highlighted as essential for moving forward but presents several challenges, such as the potential to confuse the public, undermine trust, and adversely affect people who already have a diagnosis. Various communication based strategies offer real promise; we describe what is known and what we need to know to communicate effectively and safely about overdiagnosis and overtreatment. Key messages: Overdiagnosis provides no benefits to patients and is a challenge to the sustainability of modern healthcare systems Communication based strategies could help reduce overdiagnosis and its negative impact on individuals and health systems Mass media education, shared decision making, terminology changes for disease states, and deliberative methods (juries) all have potential as effective communication strategies KJMcC is supported by a National Health and Medical Research Council (NHMRC) career development fellowship (1029241), JJ is supported by an NHMRC early career fellowship (1037028), and. JW is supported by a career development fellowship from Cancer Research UK (C7492/A17219).