Challenges and Barriers Associated with Implementation of a Mediterranean Diet in the United States

Open Access
Blinn, Abigail Elizabeth
Area of Honors:
Nutritional Sciences
Bachelor of Science
Document Type:
Thesis Supervisors:
  • Penny Margaret Kris-Etherton, Thesis Supervisor
  • Alison Diane Gernand, Honors Advisor
  • Jennifer A Fleming, Thesis Supervisor
  • Cardiovascular Disease
  • Mediterranean Diet
  • perceived barriers
  • diet adherence
A Mediterranean diet (Med diet) has been shown to prevent and treat cardiovascular disease (CVD). The association between CVD risk and nutrition has led to an increased interest in the benefits of dietary intervention. In the United States, where 1 out of 4 deaths are related to CVD, attempts at implementing healthful dietary patterns, such as the Med diet, have proven unsuccessful. This is possibly because the food and lifestyle choices associated with these dietary patterns are not typical in the United States. The impact of barriers in relation to dietary adherence is an area of research necessary in order to improve the success of dietary interventions. As certain barriers may be specific to environment and location, this follow-up study was conducted to better understand the perceived and actual barriers specific to individuals residing in a rural Pennsylvania region. Study participants (n=30) in the main MED Beef Diet Study received 12 weeks of exposure to a Mediterranean cuisine. The follow-up study was designed to assess the individuals in a free-living environment. A total of 9 participants completed the 3-month follow-up study. Perceived and actual barriers to dietary change were assessed at baseline and the end of the 3 months, respectively. At 3 months, self-reported adherence to a Med diet was found to be negatively associated with both perceived (r=-0.760; p<0.02) and actual barriers (r = -0.877, p<0.01). Barriers such as difficulty shopping for foods and planning meals, lack of knowledge for food preparation, lack of time for food preparation, expense of foods, limited time in general, and inability to adapt in social settings were commonly reported. These findings support the idea that barriers are an important consideration when developing dietary interventions, and the specific barriers identified can then be of focus while trying to improve adherence to a Med diet and the prevention of CVD.