Barriers to Nutrition Security in the US
Caroline E. Owens, Ronit Ridberg, Julia Reedy Sharib, Hope C. Craig, Dariush MozaffarianImportance
Nutrition security is increasingly recognized as a critical but underexamined driver of health. Identifying barriers to nutrition security is essential for developing effective interventions.
Objective
To examine associations among barriers to healthy eating, their prevalence by sociodemographics, and their associations with health conditions.
Design, Setting, and Participants
In this cross-sectional study, a population-based survey was conducted between February and April 2023 among English-speaking US adults aged 18 years or older recruited and surveyed through the Qualtrics panel service, with oversampling among people with annual household incomes less than $50 000. Data were analyzed from March 18 to November 9, 2025.
Exposures
Nutrition security status and barriers to nutrition security, assessed through the Nutrition Security Screener.
Main Outcomes and Measures
Primary outcomes were health conditions: type 2 diabetes, obesity, heart disease, high blood pressure, high cholesterol, stroke, and cancer. Independent variables were nutrition security barriers. Covariates included age, gender, race, ethnicity, educational attainment, annual household income, and food security status. Multivariable regressions with health condition outcomes were stratified by nutrition security status.
Results
Of 3009 survey respondents, 3000 provided information on barriers to nutrition security and were included in analyses (1518 [50.6%] were female; 1983 [66.1%] were between ages 18 and 49 years). A mean (SD) of 7.8 (3.0) barriers were reported among participants with nutrition insecurity compared with 4.4 (3.2) among those who had nutrition security. Most barriers were only modestly intercorrelated (mean [SD]
Conclusions and Relevance
In this study among US adults, barriers to nutrition security were interrelated, varied across demographics, and were associated with disease conditions. These findings provide new insights into how barriers to healthy eating can be assessed, informing more targeted clinical, public health, and policy initiatives.