Researchers looked at 37 studies involving thousands of adults living in Mediterranean countries to understand why people struggle to stick with the Mediterranean diet—even though it’s one of the healthiest ways to eat. They found that money matters: people with higher incomes tend to follow this diet better. Eating breakfast regularly and being retired also helped people stick with it. Surprisingly, being stuck at home during COVID-19 actually made people eat healthier. However, the studies weren’t very strong, and scientists need better research to understand all the reasons why some people succeed and others don’t.

The Quick Take

  • What they studied: What makes it easy or hard for adults living in Mediterranean countries to follow the Mediterranean diet, which is known to be very healthy
  • Who participated: 37 different studies involving between 190 and 13,262 adults per study, mostly from Italy, Spain, and Greece. Most were regular community members, and a couple of studies only included women
  • Key finding: People with more money, those who eat breakfast regularly, and people who are retired tend to follow the Mediterranean diet better. During COVID-19 lockdowns, people actually ate healthier Mediterranean food
  • What it means for you: If you want to eat healthier like people in Mediterranean countries do, start with breakfast and know that having financial stability helps. However, these findings are based on weaker studies, so talk to a doctor or nutritionist before making big diet changes

The Research Details

Scientists searched three major medical databases for all studies about why people in Mediterranean countries do or don’t follow the Mediterranean diet. They found 37 studies that fit their requirements and looked at what they all said together. This type of study is called a ‘systematic review’—it’s like collecting all the puzzle pieces to see the bigger picture.

Most of the studies they looked at were ‘snapshot’ studies, meaning researchers asked people questions at one point in time about their eating habits and their life situations. The studies came mostly from European Mediterranean countries, with Italy, Spain, and Greece being the most common. All the studies looked at regular people living in communities, not patients in hospitals.

The researchers organized the findings into three levels: personal factors (like how much money someone makes), relationships and social factors (like family influence), and environmental factors (like whether there was an economic crisis or pandemic happening).

Understanding why people do or don’t follow a healthy diet is important because the Mediterranean diet is proven to prevent serious diseases like heart disease and diabetes. Even in countries where this diet is traditional, people aren’t following it as much as they used to. By finding out what helps or hurts people’s ability to eat this way, scientists can design better programs to help people stay healthy.

The studies included were mostly weak in quality, meaning the results might not be completely reliable. The effect sizes (how big the differences were) were very small to small, suggesting the connections found weren’t super strong. Most studies were cross-sectional, which means they only show a snapshot in time and can’t prove one thing causes another. The review did follow strict scientific guidelines (PRISMA), which makes it more trustworthy than a casual summary would be.

What the Results Show

The biggest finding was that money matters: people with higher incomes and better jobs were more likely to follow the Mediterranean diet. This makes sense because Mediterranean foods like fresh fish, olive oil, and fresh vegetables can be expensive.

Eating breakfast regularly was strongly linked to following the Mediterranean diet better. People who were retired, unemployed, or actively looking for jobs also did better with the diet than those working full-time. This might be because they had more time to shop for and prepare healthy meals.

At the environmental level, something surprising happened: during COVID-19 lockdowns, people actually ate more Mediterranean-style food. This could be because people had more time at home to cook. However, when countries faced economic crises (times when the economy was struggling), the results were mixed—sometimes people ate healthier, sometimes they didn’t.

One important gap: the studies didn’t look much at social and psychological factors, like whether having family support or feeling motivated made a difference. This is a missed opportunity because these factors probably matter a lot.

The review found that most research focused on individual-level factors (personal characteristics) rather than looking at bigger picture issues like community resources or food availability in neighborhoods. This means we’re missing important information about how the environment around people affects their eating choices. The studies also didn’t explore enough how people’s beliefs, attitudes, and social circles influence their diet choices.

This review adds to what we already know about the Mediterranean diet being healthy, but it’s one of the first to systematically look at why people struggle to follow it, even in countries where it’s traditional. Previous research has shown the diet prevents disease, but this study focuses on the practical challenge of actually getting people to stick with it. The findings about money and income match what other nutrition research has shown—that poverty is a major barrier to healthy eating.

The biggest limitation is that most studies were weak in quality and design. They were mostly ‘snapshot’ studies that can’t prove cause and effect. For example, just because retired people follow the diet better doesn’t mean retirement causes better eating—maybe healthier people are more likely to retire early. The studies mostly looked at individual factors and didn’t explore social and psychological reasons enough. Also, most studies were from Europe, so the findings might not apply to Mediterranean countries in other regions like North Africa or the Middle East. The effect sizes were very small, meaning the connections found weren’t very strong.

The Bottom Line

If you want to follow a Mediterranean diet, start by making breakfast a priority—this appears to be linked with better success. If possible, focus on meal planning and cooking at home, which can help overcome cost barriers. Consider joining community groups or programs that support healthy eating. These recommendations have low to moderate confidence because the research is still developing, so consult with a healthcare provider for personalized advice.

Anyone interested in eating healthier, especially people living in Mediterranean countries or those wanting to adopt Mediterranean eating patterns, should care about these findings. People with limited budgets should know that cost is a real barrier and might benefit from programs that help make healthy food more affordable. Healthcare providers and public health officials should care because this research shows where to focus efforts to help people eat better. People who are working full-time might benefit from meal-prep strategies since having time to cook seems to help.

Changes in eating habits typically take 2-4 weeks to become routine, but real health benefits from following the Mediterranean diet take longer—usually 3-6 months to see improvements in energy and blood work, and 1-2 years to see significant disease prevention benefits. Don’t expect overnight changes.

Want to Apply This Research?

  • Track breakfast consumption daily (yes/no) and note which Mediterranean foods you ate. This simple metric connects directly to the research finding that breakfast eaters follow the diet better. Also track time spent on meal planning and cooking to identify barriers.
  • Set a specific breakfast goal: eat a Mediterranean-style breakfast (like whole grain toast with olive oil and tomatoes, or oatmeal with nuts) at least 5 days per week. Use the app to plan meals on weekends when you might have more time, reducing the time-pressure barrier during busy weekdays.
  • Weekly check-ins on breakfast adherence and monthly reviews of overall Mediterranean diet score. Track barriers you encounter (cost, time, availability) so you can problem-solve them. If you’re working full-time, use the app to batch-cook meals on weekends and track prep time to build confidence that you can do this despite a busy schedule.

This research is a review of existing studies and shows associations, not proven cause-and-effect relationships. The studies reviewed were generally weak in quality, so findings should be considered preliminary. This information is educational and should not replace advice from your doctor, registered dietitian, or healthcare provider. Before making significant dietary changes, especially if you have health conditions or take medications, consult with a qualified healthcare professional. Individual results vary based on personal health status, genetics, and other factors not covered in this research.