Sustainability is becoming an increasingly important consideration across healthcare, and medical nutrition is no exception. In 2020, the NHS became the first health system to commit to reaching net zero,¹ a commitment later embedded in legislation through the Health and Care Act 2022.²
Prescribing of oral nutritional supplements (ONS) has long been scrutinised for cost, and it is now increasingly being examined for its environmental impact too. Medicines, including ONS, account for around 17% of NHS greenhouse gas emissions3 and a 2025 report from the NHS London Procurement Partnership highlighted the growing importance of assessing the environmental implications of ONS.1,4
It is a complex picture because the carbon footprint of ONS is not determined by one ingredient alone or one part of the product. Several factors come into play, including:
- The source of its ingredients, particularly the protein source, including the land, water and emissions involved in growing and harvesting them.
- The manufacturing process
- Packaging
- Transportation
- Storage
- Recycling after use
- Wastage
For healthcare professionals prescribing ONS, the challenge is finding the right balance between clinical need, patient acceptability, nutritional value, cost and, increasingly, environmental impact. At the same time, malnutrition itself carries a substantial cost, estimated at £19.6 billion a year in England.5
Sustainability should be balanced with the need for effective nutritional care.
An ONS may have a lower environmental impact on paper, but if a patient does not like the taste, cannot tolerate it or does not consume it, it cannot deliver the intended nutritional benefit. Similarly, reducing the environmental impact of packaging is of limited value if changes make a product less practical or accessible for the people who need it.
One area that is beginning to gain traction in this space is plant-based ONS.
Why plant-based ONS?
The environmental impact of different protein sources can vary considerably. The second edition of Nutrition in Focus 26-27 report6 highlights research showing that dairy milk can have a carbon footprint up to 3.3 times higher than fortified soya drinks, while faba-bean protein has been associated with an 80–90% lower carbon footprint than dairy protein.7,8
This is particularly relevant for ONS because many formulations have traditionally relied on cow’s milk proteins which also underpin most of the evidence base. Moving towards plant-based formulations could offer medical nutrition another way to address its environmental footprint, while still delivering the nutritional support patients need.
Evidence for plant-based ONS is still emerging. A multi-centre prospective study reported high compliance rates and improved nutritional outcomes in community-based adults at risk of disease-related malnutrition who received plant-based nutritional support.9 More research is needed to build on these findings.
The Nutrition in Focus report recommends that environmental impact should be one factor in product selection, alongside efficacy, tolerability and cost.6 This is an important distinction. Patients who require nutritional support still need an ONS that meets their nutritional requirements and one that they are willing and able to consume.
This is where the development of plant-based ONS becomes particularly interesting. Rather than viewing sustainability and clinical nutrition as competing priorities, new formulations can help bring the two together.
A growing need for choice
There is also a practical reason for expanding plant-based options.
The number of people following vegetarian and vegan diets is increasing, including among older people living in care homes. Nutrition in Focus6 notes that more than 8,000 vegan and vegetarian residents were recorded in UK care homes in 2024.10
Plant-based ONS gives healthcare professionals greater choice when considering nutritional support for patients with disease-related malnutrition. This includes patients following a plant-based diet, those looking for an alternative to dairy-based ONS. It is also relevant to the wider conversation around more sustainable medical nutrition: the NHS net zero targets extend to emissions from its supply chain and the products it procures.1
More to do
Plant-based ingredients are only one part of the sustainability picture. Nutrition in Focus also points to challenges around packaging, recycling, food waste and to the lack of standardised ways to measure the environmental impact of ONS.11,12
There is also a need to avoid unnecessary prescribing and wastage. ONS that are produced, transported and stored but ultimately not consumed have an environmental impact without delivering a clinical benefit.4
So, while plant-based formulations can play a role, sustainable medical nutrition will require action across the whole product lifecycle. For now, though, the direction of travel is clear: sustainability is becoming part of the conversation around ONS, and plant-based nutrition has a role to play.
As a supplier and manufacturer of ONS, AYMES strives to help the NHS reach its net-zero goals. In 2024, the company introduced Tetra Pak packaging and committed to rolling it out across its range of ready-to-drink ONS. Following launch of ActaGain 1.5 Plant Powered in 2024, which is a Faba bean protein based ONS, AYMES has recently launched ActaGain 2.0 Plant Powered, which is a soy protein based high-energy, high-protein ONS. These products give patients more choice, as well as Healthcare Professionals more sustainable options. AYMES is committed to keeping prices on a par with dairy alternatives. From January the 1st 2027, ActaGain 2.0 Plant Powered will be the same price as its dairy counterpart.
To find out more about AYMES’s sustainability policy and practices, visit our sustainability page.
Find out more about plant-forward nutrition in Chapter 4 of Nutrition in Focus 26-27 by downloading it below: