News · Nutrition & Diet
Time, transport and cost: what actually blocks healthy eating
A JAMA Network Open survey of 3,000 US adults counted the obstacles to eating well and found people facing more of them had higher rates of diabetes, heart disease and stroke.
Based on a peer-reviewed cross-sectional study in JAMA Network Open
- Researchers at Tufts University surveyed 3,000 US adults between February and April 2023, oversampling households under $50,000, publishing in JAMA Network Open.
- Nutrition security means reliable access to food that is healthy, not merely enough food. It is a separate idea from food security.
- People who were nutrition insecure reported a mean 7.8 barriers, against 4.4 among those who were nutrition secure.
- The barriers were only modestly related to each other, meaning they are largely separate problems rather than one problem wearing different hats.
- The strongest pairing was between having too little time to shop and too little time to cook.
- Black adults had higher odds of transportation barriers; Hispanic and Latinx adults had higher odds of barriers accessing nutrition assistance.
- Each extra barrier tracked with higher rates of diabetes, heart disease and obesity among the nutrition secure, and heart disease and stroke among the insecure.
- This is a cross-sectional online panel survey, so it shows associations at one moment, not causes.
Advice about eating well assumes the obstacle is knowledge. A study in JAMA Network Open, published by the American Medical Association, went looking for the actual obstacles and found a list that has very little to do with knowing what a vegetable is.
Surveying 3,000 US adults, researchers found a higher number of barriers was associated with higher prevalence of diabetes, heart disease, and obesity.
A different question from hunger
The framing here is deliberately not about going without food. Nutrition security is increasingly recognized as a critical but underexamined driver of health, and it asks whether people can reliably get food that keeps them well, not merely food.
The distinction has practical teeth. A program that closes a calorie gap does not necessarily close a nutrition gap, and until now the barriers themselves had not been catalogued and tested against health outcomes together.
How it was measured
The design was a population-based survey conducted between February and April 2023 among English-speaking US adults aged 18 or older, recruited through an online panel with oversampling among people with annual household incomes less than $50 000.
Of 3009 survey respondents, 3000 provided information on barriers to nutrition security and were included in analysis. Barriers were captured with a purpose-built instrument, the Nutrition Security Screener.
Many problems, not one
The headline count is stark. A mean of 7.8 barriers were reported among participants with nutrition insecurity compared with 4.4 among those who had nutrition security.
More interesting is how loosely those barriers hang together. Most barriers were only modestly intercorrelated, and they clustered into 2 factors that explained 61.4% of the variance.
That structure is the finding. If money alone explained everything, the barriers would move together tightly. Instead they behave like separate problems, and the tightest pairing was between insufficient time to shop and to cook, which is not a money problem at all.
Who faces which barrier
The obstacles were not evenly distributed. Black adults had higher odds of transportation barriers than White adults, whereas Hispanic and Latinx adults had higher odds of nutrition assistance barriers.
Those are different failures requiring different repairs: one is about getting to food, the other about reaching the programs meant to help.
The link to disease
Barriers tracked with illness, and did so in both groups. Among adults with nutrition security, each additional barrier was associated with higher prevalence of diabetes, heart disease, and obesity. Among those with nutrition insecurity, the associations were with heart disease and stroke.
The effect sizes are modest per barrier, but they accumulate, and the pattern held in people who were not going hungry.
What it cannot show
This is a snapshot. Barriers and diseases were measured at the same moment, so nothing here establishes which came first. Chronic illness makes shopping, standing and cooking harder, which would produce exactly this correlation in reverse.
The sample also came from an online panel of English speakers, which is not a probability sample and excludes some of the people most likely to struggle with nutrition assistance.
The authors keep their claim to description: barriers to nutrition security were interrelated, varied across demographics, and were associated with disease conditions.
The useful implication is for anyone designing an intervention. A campaign about healthy choices lands differently on someone who cannot reach a shop than on someone with no evening left to cook, and this study says those are largely different people.
People also ask
What is nutrition security, and how is it different from food security?
Food security asks whether you can get enough food. Nutrition security asks whether you can reliably get food that supports health. Someone can be food secure and nutrition insecure: enough calories, from sources that will not keep them well. Separating the two matters because programs designed to close a calorie gap do not automatically close a nutrition gap.
Are these barriers just poverty in disguise?
Partly, but the data argue against collapsing them into one thing. Most barriers were only modestly intercorrelated, with a mean correlation of 0.45, and they clustered into two factors explaining 61.4% of the variance. If cost alone drove everything, you would expect much tighter correlations. The strongest link was between insufficient time to shop and insufficient time to cook, which is a time problem more than a money one.
Why did the barriers differ by group?
The study reports the pattern, not the cause. Black adults had higher odds of transportation barriers than White adults, and Hispanic and Latinx adults had higher odds of nutrition assistance barriers. Those point at different fixes: one is about how people physically reach food, the other about whether support programs are reachable and usable. A single national intervention would serve neither group well.
Does having more barriers cause disease?
This study cannot establish that. Barriers and health conditions were measured at the same moment, so the arrow could run either way. Chronic illness makes shopping and cooking harder, which would generate the same correlation. What the study establishes is that the two travel together, strongly enough to be worth measuring in clinical settings.
How representative is the sample?
Reasonably but not fully. It was a population-based survey of 3,000 English-speaking US adults recruited through an online panel, with deliberate oversampling of lower-income households. Online panels are not probability samples, and English-only recruitment excludes part of the population most likely to face nutrition assistance barriers, which if anything understates the problem.