Is the Mediterranean Diet Ethnocentric? Embedded Autonomy and the Provisional Acceptance of Patients’ Goals in Health Messaging

2023 has been hailed as the Year of the Mediterranean Diet. The Mediterranean Diet (MD) is a healthy and sustainable diet that has been associated with numerous health benefits, including reduced risk of coronary heart disease, stroke, and dementia.

Yet the Mediterranean region is diverse, spanning cultures in southern Europe, the Levant, and northern Africa. The MD as advertised, however, is a largely white diet. It was first formally studied by Ancel Keys in the 1950’s. The version of the MD that is recommended by American dieteticians contains a subset of foods found in the Mediterranean region that are likely to be palatable to Western consumers—disproportionately, foods found in southern Europe.

In this presentation, I argue that it is not appropriate to recommend an ethnocentric diet like the MD to all patients. Diet is a profound life decision with implications beyond promoting good health outcomes. Patients generally come to providers with cultural and ethical constraints that already inform their dietary choices. Instead of recommending that South Asian patients or vegans switch to a diet largely practiced by southern Europeans, respect for patient autonomy involves provisionally adopting a patient’s dietary goals and constraints with advising them on dietary practice. Dietary advice that is truly respectful of patient autonomy would involve, I argue, helping a patient to practice a healthier diet consistent with their culture or ethos rather than to adopt the diet of another (white) culture.