Research BriefNutritional Value of Meals at Full-service Restaurant Chains
Introduction
Rising trends in obesity have been attributed largely to increased caloric intake1 and have coincided with an exponential increase in the amount of money households in developed nations spend on food away from home, currently representing over one third of calories purchased in the US.2 Food prepared away from home is typically higher in calories and lower in nutrient density than foods prepared at home. Recent work characterizing the nutritional quality of foods sold at quick-service restaurants has documented high energy, fat, and sodium in those foods.3, 4, 5 Available data suggest that full-service restaurants serve oversized portions and foods of low nutritional quality.5, 6, 7, 8 Yet, very little work has been done that systematically characterizes the nutritional quality of foods sold at full-service restaurants and restaurants' “healthy choice” items, and that describes differences by restaurant price point.
An increasing number of full-service chain restaurants have chosen to tag a few menu items with “healthy choice,” yet they provide limited nutrition information about those items. Thus, it is not known whether tagged items conform to dietary guidelines.9 Within the full-service restaurant category, the type and range of menu offerings can vary by restaurant price point, but how much nutritional quality varies by price point is unknown. Characterizing restaurant menu profiles by price point is relevant to the ongoing discussion about how much the price of healthier foods relative to unhealthy foods contributes to income disparities in obesity, diet quality, and related chronic diseases.10
When fully implemented, a section of the US Patient Protection and Affordable Health Care Act mandates that fast-food and full-service chains with ≥ 20 locations provide nutrition information at point of purchase.11 This legislation was motivated by low consumer knowledge and awareness of the nutritional values of restaurant foods.12, 13 In addition, labeling may spur improvements in restaurant menus as restaurant owners, managers, and chefs become more cognizant of excessive calories, fat, and sodium in their food, and/or because they anticipate negative reactions from the media and their customers.14, 15
Information about nutrition at full-service restaurants has lagged behind fast-food restaurants, in part because many full-service chains have not disclosed nutritional information on their Web sites and Affordable Health Care Act menu labeling requirements have not yet taken effect. In 2010, Philadelphia passed a point of purchase menu labeling ordinance that required calorie disclosure for all items on menu boards; it also required that chain restaurants (≥ 15 locations anywhere in the US) display information about calories, saturated fat, trans fat, sodium, and carbohydrates adjacent to all standard menu items on printed menus.16 The Philadelphia labeling ordinance provided a unique opportunity to analyze the menus of these restaurants. The current study compiled and analyzed full-service chain restaurant menus for select menu categories. In addition, it examined the prevalence of healthy choice tags and whether tagged items correspond to federal dietary guidelines. Chain restaurants were stratified by price point to assess whether nutritional quality varied by restaurant price point.
Section snippets
Methods
Full-service restaurant chains in the Philadelphia region were eligible for inclusion if they displayed calories and sodium for all menu items on either their Web site or their printed menus at Philadelphia outlets between March, 2011 and May, 2011, and the majority of main dishes were single-serving entrees. Of 29 chains, 21 restaurants were eligible for inclusion (see Supplement Figure 1). Three higher-priced restaurants did not meet the criteria for displaying nutrient content, and 3
Nutrients and Prevalence of Healthier Menu Items
Mean calorie content of both a la carte entrees and appetizers was approximately 800 kcal (Table 1, Supplement Figure 1) and did not meet the healthier criteria for calories about 50% of the time (Table 2; see criteria in Supplement Table 1). Approximately 30% of a la carte entrees and appetizers exceeded the DRV for saturated fat and sodium; only 20% of items met recommended fiber minimums. Meals that were composed of an adult entree, side dish, and a shared appetizer totaled approximately
Discussion
This study of 21 full-service restaurant chain menus found that calories and nutrients were high. Values exceeded appropriate levels for a single meal, and under common meal scenarios, exceeded maximum recommended intakes for an entire day, particularly for sodium and saturated fat. Consumers tend to view full-service restaurants as superior in quality and healthfulness compared with quick-service restaurants.25, 26 Because of sample and classification differences, it is difficult to make
Implications for Research and Practice
The need to educate customers about the nutritional content of restaurant foods is acute because consumers increasingly eat away from home,2, 40 restaurants serve large portions of energy-dense and high-sodium foods, and the prevalence of obesity and other diet-related diseases are high.41 Nutrition educators and other health professionals can promote awareness of recommended intakes of calories, fat, saturated fat, and sodium and instruct consumers on how to use menu labeling to make healthier
Acknowledgments
The authors thank Jessica Clark for assistance with compiling data for this project. Funding was made possible, in part, by Cooperative Agreement 1U58DP002626-01 from the Centers for Disease Control and Prevention, US Department of Health and Human Services; and Get Healthy Philly, an initiative of the Philadelphia Department of Public Health. The views expressed in this report do not necessarily reflect the official policies of the Department of Health and Human Services or the Philadelphia
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