Diets high in refined grains, added sugars, and added fats are both good tasting and affordable. Although inexpensive, such diets are energy dense and nutrient poor. The current emphasis is on replacing refined grains, fast foods, desserts added sugars and added fats with more whole grains, lean meats, fish, and fresh vegetables and fruit. However, such diets, although palatable and nutritious, are usually associated with higher costs per MJ and per day.
Goulet, et al.
found that promoting a Mediterranean dietary pattern need not necessarily be associated with higher overall dietary costs20
. The key to avoiding increased overall dietary costs lies in educating consumers about lower cost foods while selectively purchasing limited amounts of higher cost ones.
In controlled clinical trials, variations of the Mediterranean diet have demonstrated efficacy for both weight loss and improving glycemic measures in diabetics. Shai, et al
. recently reported on a two-year intervention study in which those individuals assigned to an energy-restricted Mediterranean diet lost more weight initially and gained less back over time in comparison to those assigned to an energy-restricted low-fat diet21
. For female participants, the Mediterranean diet proved even more efficacious for weight loss. The diabetic subjects assigned to the Mediterranean diet group experienced greater improvements in fasting plasma glucose and insulin21
Attempts to steer Western consumers toward lower cost yet nutrient dense foods have encountered resistance. Many diets composed of mostly plant foods with meat used only as a condiment; vegan-style diets, or diets based exclusively on rice and beans are outside the American or European mainstream. Consumers generally resist eating less-familiar foods; particularly if they believe that doing so means abandoning their cultural heritage, or that those foods are associated with people of different culture or different social class. People prefer eating within their own food culture, such that any recommended diet must meet the triple test of nutrition, cost, and social norms (see ).
The elements of consumer food choice (Western diet)
The multiple challenges involved in improving diet quality include helping people recognize the lower cost foods within their cultural heritage, reducing any stigma attached to (other) low cost foods, increasing the convenience and accessibility of lower cost, lower energy density foods, and finally, doing so without sacrificing taste or enjoyment.
The barriers are not insurmountable. The Mediterranean diet, recently described as the cultural heritage of all mankind, offers a way to incorporate nutritious yet lower cost foods within a coherent gastronomic structure. Many cultures around the world feature plant-based dishes that include small amount of meats, and incorporate legumes, grains, and other nutritious lower cost foods. The Mediterranean diet provides a viable cultural framework to incorporate low cost yet nutritious foods into the diet, notably pasta and beans, vegetables (tomatoes, eggplant), oil, wine, dried fruit, nuts and seeds.
Allowing consumers to explore their shared cultural food heritage through culinary education might represent a first step. Adapting the traditional food preparation techniques to the modern world would help promote the Mediterranean diet. As with dried legumes, preparation techniques can facilitate convenience of preparing foods made using whole, unprocessed grains. Low- or nonfat dairy products and eggs represent less expensive protein sources. Fermented dairy products such as yogurt or kefir are traditional in the Mediterranean region. Pasta, grains and beans can help replace the more expensive meats and fresh fish. Mixed dishes featuring combinations of meat and plant based foods are one staple of the Mediterranean diet. Replacing added sugars and fats with dried fruits, nuts and oils could enhance taste while providing increased nutrient value.
The combination of high enjoyment, low cost and good nutrition can be a powerful tool against the obesity epidemic (see ). The Mediterranean diet, whether the traditional or the North American modified version, provides a social and gastronomic framework that need not be associated with higher diet costs.
The elements of consumer food choice (Mediterranean diet)