Newswise — Eating the Mediterranean Diet way means not just including plenty of fruits and vegetables -- like those sold by the Organic Vegetable Project at CSU Chico -- in your meals, but also drinking plenty of water (and wine in moderation), staying physicallly active, and cultivating social connections. Photo courtesy of CSU Chico

With obesity rates climbing steadily — they're up 10 percent since 2000 — and nearly four in 10 of us tipping the scale at unhealthy weights, America has earned the unwanted title of Fattest Nation on Earth. In addition, obesity-related health care costs represent 20 percent of our health care spending, or some $190 billion annually.

Those astonishing figures led Meifang Chen, Ph.D., M.P.H., CHES, professor of public health at California State University, Los Angeles, to look deeper. Specifically, she examined adoption and adherence to the Mediterranean diet across the country.

The Mediterranean has been shown to lower risk of obesity and is also linked to the prevention of cancer, diabetes and heart disease —  in other words, the big killers. This traditional diet emphasizes fruits, vegetables, nuts, fish, whole grains, and olive oil, while reducing saturated fat, refined sugar, and processed foods. 

Coastal Embrace

Chen and her fellow researchers studied nearly 21,000 non-Hispanic adults 45 years or older in 48 states and Washington, D.C. to determine how they followed the diet. 

Participants completed a detailed food questionnaire at the start of the study, and the researchers calculated a Mediterranean diet adherence (MD) score for each participant based on the types of food they ate, ranging from zero to nine. The higher the score, the greater the adherence. The researchers also analyzed the geographical distribution of Mediterranean diet adoption across the U.S.


The average MD score was 4.36, and almost half (46.5 percent of participants) closely followed the Mediterranean diet. The researchers found that people in western and northeastern coastal areas, including California, Pennsylvania, New Jersey, New York City, Connecticut, and Massachusetts had the highest rates, whereas lower adherence clusters were largely seen in South and East North Central regions of the U.S., such as Arkansas, Louisiana, Alabama, Georgia, North Carolina, Michigan and the northern area of Indiana.

There are many potential explanations for this, says Chen. Coastal areas are usually more urban, with diverse populations and a larger influx of immigrants. These factors may influence local residents' dietary behavior by exposing them to the cuisines of different cultures and thus expanding their palates beyond the Standard American Diet (SAD).

Less TV = Healthier Diet

Beyond the geographic findings, Chen's team found that people who lived in poor and rural areas, minority neighborhoods, and smaller towns were least likely to follow the diet, while it was more popular among older people and non-smokers, as well as those who were African American, college-educated, and had an annual household income of at least $75,000. Subjects who exercised at least four times a week and watched fewer than four hours of television a day were also more likely to eat a Mediterranean-style diet.

"Our study turned up some surprises," says Chen. "While previous studies found being white correlated with healthier diet adherence, our study found you are more likely to adopt and follow the diet if you are black. Future studies examining how race influences adherence are needed to determine if these results generalize."

Chen, who says she's a part-time follower of the Mediterranean diet herself, points out that the research shows it is the combination of foods that appear protective against disease, so it's important not to add just nuts or olive oil to your meals.

And, she adds, "The Mediterranean diet is not a diet, but a lifestyle. Living an active and social life is emphasized in order to gain the greatest benefits." 

Learn more about the Mediterranean Diet at Chen presented her research at the European Congress on Obesity (ECO) in Vienna, Austria, in May 2018.


6 Tips for Following the Mediterranean Diet

  1. Eat fish and seafood at least twice a week while limiting red meat.
  2. Choose water as your main daily beverage while allowing a limited intake of wine with meals.
  3. Aim for moderate fat intake from fatty fish, olive oil, and nuts.
  4. It is important to not simply add single foods or nutrients (like olive oil or nuts) to your current diet, but to adopt the Mediterranean diet in its entirety. Research shows that it's the combination of the foods that appear protective against disease.  
  5. The Mediterranean diet is not a diet but a lifestyle. In addition to changing your dietary habits, living an active and social lifestyle is also important to reap the greatest benefits.
  6. Portion control is a factor even when eating healthy foods. It's essential to monitor food intake based on physical activity and body mass index(BMI). Daily calorie needs can be established by contacting a nutritionist or using apps such as