(CNN) — American adults say sticker shock at the grocery store is making it harder for them to have a healthy diet, according to a nationally representative survey of adults by the Pew Research Center, a nonpartisan fact tank that conducts data-driven research.

Ninety percent of adults in the United States say the price of healthy food has risen over the past few years, and over two-thirds (69%) say higher food prices are making it difficult to eat a healthy diet.

Those with fixed or lower incomes were hardest hit, with 47% reporting difficulty in eating healthy meals compared with only 15% of upper-income adults, according to the survey of 5,123 adults conducted during the week of February 24 to March 2.

“It is a bigger challenge for the lower-income adults, but it’s not as if the middle- and upper-income Americans are completely spared,” said Eileen Yam, director of science and society research at Pew, which is based in Washington, DC.

“Even middle- and upper-income Americans are reporting the increased price of healthy food is making it more difficult to eat healthy,” Yam said.

That’s partly due to a reliance on a Westernized diet that focuses on costly animal foods, such as meat and dairy, said Dr. David Katz, a specialist in preventive and lifestyle medicine who founded the nonprofit True Health Initiative, a global coalition of experts dedicated to evidence-based lifestyle medicine. He was not involved in the Pew survey.

“Beans and lentils are stunningly nutritious, and very economical. Cooking grains are highly nutritious, and very economical,” Katz said in an email. “More dishes featuring these, and fewer featuring costly animal foods, would allow for a decisive improvement in diet quality while lowering overall cost.

“So, too, of course, would drinking more plain water and less sugar-sweetened beverages,” he added. “The impediment is not prices, but food label literacy.”

The American diet is unhealthy

More than 1 million Americans die each year from diet-related diseases such as obesity, cancer, heart disease and type 2 diabetes, while unhealthy diets and food insecurity cost the United States an estimated $1.1 trillion in health care expenditures and lost productivity annually.

Objective measures of diet quality in the US conducted by scientists show that the American diet is substandard. Over 50% of adults fail to meet the diet recommendations of the American Heart Association, an April analysis found.

Regardless, nearly 60% of adults in the Pew survey rated their diets as somewhat healthy.

“Americans’ ability to report the quality of their diet is highly suspect,” Katz said. “We do not rely on people to ‘guesstimate’ their own blood pressure; we should not be expecting them to ‘guesstimate’ their diet quality either.”

People who ate more meals at home were most likely to rate their diets as healthy, the survey found. About one-third of Americans who cook and eat at home rated their diets as extremely or very healthy. However, only 12% of those who ate out more often considered their diet satisfactory.

How Americans make food choices

Taste is the most important factor in choosing food, with 83% of adults listing taste as extremely or very important, according to the survey. Less than 50% of respondents said the same about the healthiness of food, however.

“Whether we’re looking at race, ethnicity, gender, income, taste is way up there at the top,” Yam said. “After taste, Americans care most about cost, the healthiness of the food and then convenience.”

Low cost, convenience and taste are hallmarks of ultraprocessed foods. Food manufacturers entice consumers with combinations of sugar, salt, fat and additives designed to meet a “bliss point” of tastiness. In the United States, some 71% of the food supply may be ultraprocessed, a 2019 study estimated.

Ultraprocessed foods contain ingredients “never or rarely used in kitchens, or classes of additives whose function is to make the final product palatable or more appealing,” according to the Food and Agriculture Organization of the United Nations.

Numerous studies find higher amounts of ultraprocessed food raise the risk of obesity and the development of chronic conditions including cancer, cardiovascular disease, obesity, type 2 diabetes and depression. Such foods may even shorten life.

Research also shows that switching to a plant-based diet, such as the Mediterranean diet, can improve health at any age.

“It’s never too late to adopt healthy eating patterns, and the benefits of eating a healthy diet can be substantial in terms of reducing total premature deaths and different causes of premature death,” said Dr. Frank Hu, a professor of nutrition and epidemiology and chair of the department of nutrition at the Harvard T.H. Chan School of Public Health.

“People also have a lot of flexibility in terms of creating their own healthy dietary pattern,” Hu told CNN in a previous interview. “But the common principles — eating more-plant based foods and fewer servings of red meat, processed meats, added sugar and sodium — should be there, no matter what kind of diet that you want to create.”

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