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A narrative review in Applied Sciences says long working hours, food prices, urban routines and convenience foods can make the Mediterranean diet and lifestyle harder to maintain. It describes possible workplace and school interventions, but its literature selection was not systematic, and the authors caution that disease trends cannot be attributed to diet alone.
A narrative review published in the journal Applied Sciences says long working hours, rising food costs and convenient ultra-processed meals are making the Mediterranean diet and its associated lifestyle harder to maintain. Researchers from institutions in Portugal and Spain reviewed existing studies and described food-environment and lifestyle strategies that could support adherence, while noting limits in how the evidence was selected.
The review describes the Mediterranean diet as a pattern built around fruits, vegetables, olive oil, legumes, nuts and whole grains, with more modest amounts of fish, dairy and eggs and little red meat. The authors say the traditional lifestyle also included communal meals and everyday physical activity. They describe wine as a cultural practice, not a health recommendation.
The researchers searched PubMed, Web of Science, ScienceDirect and Google Scholar from October 2024 to December 2025, focusing on English-language peer-reviewed research, especially work from the previous decade. Their final reference list contained 116 sources, including journal articles, book chapters and online resources. The review considered diet, lifestyle, adherence measures and possible interventions in settings such as workplaces and schools.
Among the examples discussed, a workplace study of 96 male workers reported that after 12 months of Mediterranean-style canteen lunches, participants’ diet scores rose from 4.8 to 7.4; the proportion with metabolic syndrome fell from 24% to 15.6%. A separate trial involving 485 U.S. firefighters reported a 10% improvement in diet adherence after supermarket discounts, samples, online education and chef demonstrations. A school program for 150 sixth graders in Cyprus, with food tasting and cooking lessons, improved nutritional knowledge and diet-quality scores, according to the review.
Cost and Time Shape Food Choices
The review frames adherence as more than a matter of individual preference: time, affordability and the surrounding food environment influence what people can routinely eat. It reports that lower adherence was associated in cited research with lower income, urban residence, stress, smoking and low physical activity. The authors also cite an estimate that around 3 billion people cannot afford a healthy diet.
One cited price comparison put ultra-processed foods at $0.55 per 100 calories, against $1.45 for unprocessed foods. That figure reflects the comparison reported in the source material; it does not establish that every processed product is cheaper than every unprocessed option. The review’s broader point is that healthier choices can be difficult to sustain when inexpensive, ready-to-eat food is more accessible and people have little time to prepare meals.
The intervention examples suggest that changing access and routines may help, rather than placing the burden solely on individuals. However, the studies took place in particular workplaces, a U.S. firefighter group and one school program. They do not establish that the same measures will have the same results across populations or settings.
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A Traditional Pattern Under Pressure
The authors note that Mediterranean diet adherence has declined since the 1960s, especially among younger, urban and lower-income groups. They connect this shift with longer working hours, reduced time for cooking and greater reliance on ready-to-eat products. Some ultra-processed foods contain high amounts of sugar, fat or sodium and few micronutrients, the review says.
The report also places the issue alongside wider health trends. It cites World Health Organization data on noncommunicable disease mortality in several Mediterranean countries from 1960 to 2020, as well as global figures indicating that obesity rates have more than doubled since 1990 and roughly 2.5 billion adults were living with overweight in 2022. Those figures describe population-level trends; they do not show that changes in Mediterranean diet adherence caused the trends.
The authors explicitly caution that rising noncommunicable disease mortality in some Mediterranean countries could reflect population aging and other risk factors, not dietary change alone. The review draws on varied literature to discuss these issues rather than reporting a new clinical trial or measuring diet adherence in a single newly recruited population.
“The traditional Mediterranean lifestyle is becoming increasingly difficult to maintain.”
— The review authors
Limits of the Review Evidence
This is a narrative review, not a systematic review with a predefined screening protocol. The authors did not use predefined exclusion criteria, and the source report says selection depended on how closely full texts matched the review’s objectives. The authors acknowledge that this approach leaves room for selection bias.
The interventions described report improvements in particular groups, but the material provided does not establish how durable those changes were or whether they would translate to broader populations. It also does not show that diet changes caused lower disease rates. The review discusses links and potential strategies; the scale and long-term effects of those strategies remain uncertain.
Testing Practical Food Strategies
The review points to workplaces, schools and food-product design as places where future efforts could make Mediterranean-style choices more accessible. The examples suggest that meal provision, discounts, cooking education and food tasting can be evaluated as components of such efforts. The review itself does not announce a new intervention or a follow-up trial.
Further research would need to test these approaches across different communities and measure whether changes in diet and activity persist over time. Until then, the review’s conclusions are best read as a synthesis of existing evidence and proposed responses, not as proof that a single program can overcome cost and time barriers.
Key Questions
What does the review say is making the Mediterranean diet harder to follow?
It identifies long working hours, rising food costs, limited cooking time and convenient ultra-processed foods, alongside lower physical activity and urban routines.
What foods are central to the Mediterranean diet described?
The pattern centers on vegetables, fruits, olive oil, legumes, nuts and whole grains, with moderate amounts of fish, dairy and eggs and little red meat. The authors describe wine as a cultural practice, not a health recommendation.
Did the review prove that diet changes caused rising disease rates?
No. The authors caution that mortality trends may also reflect population aging and other risk factors. The review does not establish that dietary change alone caused those trends.
What strategies showed improvements in the studies reviewed?
Examples included Mediterranean-style workplace lunches, supermarket discounts and food education for firefighters, and cooking lessons and tastings for schoolchildren. The reported improvements came from specific groups and programs and may not apply everywhere.
How strong is the evidence in this review?
The review gathered 116 sources, but it did not use predefined exclusion criteria or a systematic screening protocol. The authors acknowledge possible selection bias, so its conclusions should be understood as a narrative synthesis rather than a definitive test of interventions.
Source: news-medical.net
