Table 1.

Barriers to making healthy dietary changes

Individual level barriers
Taste preferences	“If you talk to…patients where there’s lots of things like fried foods and pork grinds and different things like that you can’t tell patients not to eat them.” (Survivor coordinator, breast cancer) “Finding a diet that they’re able to adhere to and they like the taste of it. I mean that’s always an issue.” (Medical oncologist, multiple cancer types)
Lack of knowledge of healthy eating	“Some of them have never eaten healthy and have no idea what you’re even talking about and saying, and it’s overwhelming to them.” (Dietician)
Lack of time	“The preparation, that I know I should be eating healthy but I don’t have time.” (Medical oncologist, breast cancer)
Food as a coping mechanism	Some health care providers talked about patients who used food as a coping mechanism either for life stressors or for dealing with depression. They felt that dietary changes and weight loss would be unsuccessful until the underlying issues were addressed. “There’s you know psychological barriers, you know again the biggest one being stress you know ‘cause of family issues they’re eating more.” (Radiation oncologist, breast cancer) “I think part of that is depression…and that’s…even before the cancer that they just basically are sedentary people and eating is a way of like you know deal with things emotionally, and they get bored and they eat.” (Medical oncologist, multiple cancer types)
Lack of motivation	Difficulty breaking habits “I would say in general changing habits is almost by definition a barrier, you know. It’s just your motivation to overcome your, we, we are creatures of habit.” (Nurse practitioner, general patient population) Some patients try to make changes but are discouraged by the lack of progress: “Changing your diet when you’re like 80 and 90 years old it’s, it is difficult, and some of ‘em you know they just say you know even though they do change their diet they don’t see anything in terms of weight loss.” (Nurse practitioner, prostate cancer) “Well some people get frustrated when they are unsuccessful. I mean a woman today said she’s the only purpose who started going to the gym and gained weight, and so then that sort of causes people to lose interest in continuing.” (Medical oncologist, multiple cancer types)
Interpersonal
Social norms	“Eating is such a social function that it makes everybody feel good…They want to maintain the relationships that they have. They might have you know Friday night girl’s out go to the movies, popcorn, Cheesecake Factory.” (Nurse practitioner, breast cancer)
Lack of social support	“Especially young women who have like young children or families like you know if they, if the husband’s not eating healthy it’s hard, sometimes it’s very hard for the woman to eat healthy, especially if the kids are like eating unhealthy, so I think family support is one huge thing.” (Medical oncologist, multiple cancer types)
Environmental
Cost of healthy foods	“I mean money is an issue. People will say that. They’ll say you know, ‘I buy whatever’s cheap. Whatever’s on sale.’” (Nurse practitioner, general patient population) “I end up sometimes paying you know almost 200 dollars…and there are three bags of food, only because two of the bags are fresh produce, so how can we expect our poor people you know to have a good, balanced diet if to begin with you know food is so expensive.” (Radiation oncologist, multiple cancer types)
Lack of accessibility of healthy foods	“Certainly where we are you know people are sort of in a food desert so certainly not, not good grocery stores, so you know that is definitely a factor where I am.” (Primary care provider)
Convenience of unhealthy foods	“I do have a lot of my patients who are as a result of their work situation are on the move, on the road and you know they eat a lot of fast food and they know they eat a lot of fast food.” (Primary care provider)