Since the start of the COVID-19 pandemic, almost all discussion of restaurant health has focused on one topic: how to protect diners and staff from the virus. But another health issue has been largely overlooked: how restaurants are compromising the health of Americans by selling foods high in calorie density, fat, added sugars, and sodium, but low in essential fiber. And during a pandemic where obesity and other pre-existing health conditions have been risk factors for serious illness, this discussion could not be more relevant.
It is common knowledge that fast food sold by chains such as McDonald’s, Burger King, Wendy’s, etc. has a poor nutritional profile. But the starters, main courses and desserts sold in full-service restaurants are hardly better.
This was made clear in a study from the Friedman School of Nutrition published last year. He showed that about 70% of the meals in fast food restaurants were of “poor quality” and only 30% were even of “intermediate” quality. In full-service restaurants, 47% of meals were of intermediate quality and 52% of poor quality.
Perhaps most strikingly, less than 0.1% of the meals consumed at these restaurants met the American Heart Association’s definition of “ideal quality”, namely meals high in fruits, vegetables, whole grains, legumes and vegetables. low in processed meats, sugary drinks, saturated fat and sodium.
Franchisees – fast food restaurants and others – have tried to balance their menu offerings. Burger King, for example, offers a garden salad. But more common are the offerings – like a triple bacon and pretzel cheeseburger sold by Wendy’s – that are high in calories, saturated fat, cholesterol, and sodium.
Beyond the nutritional profile
Another area of concern is portion sizes in restaurants. While the Cheesecake Factory’s monster portions may seem aberrant, the CDC reports that the average serving size of a burger and fries in a restaurant is now about three times as large as it was in the 1950s. .
Likewise, the authors of a 2019 study analyzed the menu items of 10 popular fast food chains in the United States from 1986 to 2016. They found that the number of calories and the size of the portions (in grams) of main courses had increased by 12% and 25%, respectively. ; desserts had increased by 46% and 37% respectively; and the calorie count of secondary orders had increased by 21%.
This double dose of large portions and unhealthy foods contributed to the increase in the obesity rate among American adults from 15% in 1980 to over 42%. Weight gain is of particular concern given that obesity and related conditions, such as diabetes and high blood pressure, have been linked to an increased risk of complications and death from COVID-19.
The evolving restaurant landscape
The rise in obesity rates comes against the backdrop of two major changes in the American gastronomic landscape.
The first is the dramatic expansion of access to food options outside the home. From 1977 to 2012, the number of food establishments in the United States increased by 77%, according to the United States Department of Agriculture. More recently, the number of “quick service” establishments has grown from around 150,000 in 2007 to nearly 200,000 last year.
The impact of increasing restaurant density was shown by the authors of a 2015 article. They showed a strong link between an increasing obesity rate and a per capita increase in the number of restaurants in a state. .
The second change in the restaurant landscape is that people eat a lot more in restaurants than before. In 1962, food consumed outside the home made up 27% of the total food budget of Americans. By 2017, this figure had risen to over 50%.
These trends, coupled with the troubling nutritional profile of the foods offered by restaurants, partly explain the poor state of the average American diet. Most American adults and children do not consume the recommended daily amounts of fruits, vegetables, whole grains, and legumes, while consuming higher than recommended amounts of added sugar, sodium, and processed meats.
These eating habits are correlated with adverse health effects. In 2012, more than 45% of American adult deaths from diabetes, heart disease and stroke were associated with suboptimal eating, according to a JAMA to study. This diet is defined as low in fruits, vegetables and whole grains, and high in sodium, processed meats and sugary drinks.
What needs to change?
There are no easy answers to getting Americans to develop healthier eating habits, but one step is to eat out less often and cook healthy foods at home more often. Researchers at Johns Hopkins University have found that when people cook their own food, they consume 12% less sugar, 6% fewer calories, and 6% less fat.
With delivery services making restaurant meals more accessible than ever, there is an urgent need for all food establishments to improve the health profile of their dishes. This means more offers that are low in fat and sodium and high in nutrient density. It also means smaller portions.
COVID-19 has shown the vulnerabilities of people facing food-related health issues. Restaurants should take the lead in helping Americans overcome these challenges and in doing so, help them improve their health.
Vanita Rahman, MD, is Clinical Director at Barnard Medical Center, Clinical Instructor in Medicine at George Washington University School of Medicine, and author of Simply Plant Based. Matthew Rees is editor of the Food and Health Facts newsletter, senior researcher at the Tuck School of Business in Dartmouth, and a former White House speechwriter.