Diet Quality in the United States Improved during the Great Recession and Deteriorated During Economic Recovery

Published:December 21, 2021DOI:



      Macroeconomic changes are associated with population health outcomes, such as mortality, accidents, and alcohol use. Diet quality is a risk or protective factor that could be influenced by economic conditions.


      This study examined the trajectory of diet quality measured by the Healthy Eating Index 2015 before, during, and after the 2008-2009 Great Recession.


      Repeated cross-sectional survey data from the National Health and Nutrition Examination Survey were analyzed.


      The analytic sample included 48,679 adults who completed at least one dietary recall from National Health and Nutrition Examination Survey 1999-2018.

      Main outcome measures

      Diet quality was assessed with a 24-hour dietary recall to calculate the Healthy Eating Index 2015 total scores, a measure of the conformance with the 2015-2020 Dietary Guidelines for Americans.

      Statistical analyses performed

      Least squares regression was used to adjust for demographic changes across waves.


      Diet quality improved noticeably during the Great Recession and deteriorated as economic conditions improved.


      Deteriorating economic circumstances may constrain choices, but that does not necessarily imply a worsening of dietary quality. During the Great Recession, American diets became more consistent with Dietary Guidelines for Americans recommendations, possibly because of a shift toward food prepared at home instead of prepared food bought away from home.


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      A. Y.-A. Chen is an assistant policy researcher


      R. Sturm is a senior economist, RAND Corporation, Santa Monica, CA.

      Linked Article

      • Healthy Eating in Hard Times?
        Journal of the Academy of Nutrition and DieteticsVol. 122Issue 5
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          Do economic recessions harm human health? Researchers and policy makers have long been interested in this question as part of a broader area of inquiry around how social and economic conditions influence population health. Economic-related factors, including income, employment, and wealth, are consistently tied to health status and life expectancy, as well as obesity and other risk factors.1,2 Beyond simply measuring associations between these indicators of socioeconomic position (SEP) and health, researchers have studied economic cycles—including recessions and recoveries—to see whether these fluctuations are correlated with similar changes in population health.
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