February 2014

Changes in the Energy and Sodium Content of Main Entrees in US Chain Restaurant from 2010 to 2011

            The role of food away from home has become increasingly popular and is approaching half of the food budget of US households and nearly one third of daily energy intake. Unfortunately, restaurant menu offerings do not encourage healthy eating. Restaurant marketing and media coverage of menu changes has been able to paint an overly optimistic picture of a changing nutrition environment.

            This study looked at restaurant menu changes by tracking the energy and nutrition content of main entrees over a 1-year timeframe. During this 1-year timeframe restaurants faced the passage of a federal menu labeling provision as part of the Patient Protection and Affordable Care Act. This act required chain restaurants with 20 or more US outlets to list the number of calories contained in the standard menu item as usually prepared and offered for sale.

            The study population was 213 restaurant brands, which totaled 155,021 US-based outlets and 26,256 regular menu entrees. Of the 213 restaurants, 109 had children’s menu data totaling 1,794 children’s menu entrees. The nutrition information was collected from restaurant web-sites or an email was sent to request the data if data were not posted online. Baseline and follow up data were collected about a year apart: between February and May 2010 and April and May 2011. The federal labeling law was passed in March during the timeframe of baseline data collection.

            The outcome measures were energy and sodium levels. Entrees that changed were classified as removed, if it appeared on the menu at baseline but not follow up, or added, if there was no unique match for an item with the same nutrition values in both time frames. Many restaurant menu items changed in reported nutrition content between 2010 and 2011, with about half the original remaining unchanged.

            The results of the study showed that the implementation of a federal menu labeling law did not lead to meaningful changes in the average energy or sodium content of entrees. On average, if healthy changes did occur, then the number of unhealthy changes to entrees also occurred that offset them. High sodium items decreased by 70 mg in added vs removed items. The mean energy decreased by 57 kcal in fast food restaurants for added vs removed children’s entrees. More restaurants significantly lowered energy and sodium compared with those who made changes in the opposite direction, although the vast majority made no significant menu nutrition changes.

            Despite public health efforts to improve restaurant nutrition, this study found little evidence of meaningful overall improvement in restaurant nutrition during its 1-year timeframe. Items that were removed were than replaced by items that were similarly high in energy and sodium. A longer time period is warranted to study the link between the restaurant food environment and health outcomes.

Wu, H. W., & Sturm, R. (2014). Changes in the Energy and Sodium Content of Main Entrées in US Chain Restaurants from 2010 to 2011. Journal Of The Academy Of Nutrition & Dietetics, 114(2), 209-219. doi:10.1016/j.jand.2013.07.035

Supplementary Article:

Ellison, B., Lusk, J. L., & Davis, D. (2013). Looking at the label and beyond: the effects of calorie labels, health consciousness, and demographics on caloric intake in restaurants. International Journal Of Behavioral Nutrition & Physical Activity, 10(1), 21-29. doi:10.1186/1479-5868-10-21