Putting Poor Nutrition On The Menu

Heading out to eat? Prepare for some poor nutrition choices, say the science types at Tufts University.

Across the board, Americans eat about 20 percent of their calories from restaurant food. According to new research from scientists at the Friedman School of Nutrition Science at Tufts University, a lot of those calories suck. Restaurant food might be a recipe for lousy nutrition.

The researchers applied the American Heart Association 2020 diet score and its’ criteria to the dietary choices of more than 35,000 American adults. Nutrition quality was determined by evaluating specific foods and nutrient content in meals. The choices were made at full-service restaurants (the kind with wait staff) and fast-food restaurants, pizza shops and fast-casual restaurants. The adults had all participated in the National Health and Nutrition Examination Survey (NHANES) between 2003 and 2016.

The research findings were published in the Journal of Nutrition.

The study findings saw some slight improvement in food choice and related nutritional quality. For example, at fast-food restaurants, about 75 percent of the meals eaten by Americans in 2003-2004 were of poor dietary quality. That percentage actually fell a bit to 70 percent in 2015-2016.

For full-service restaurants, the results were not so good. About 50 percent of meals were considered of poor nutritional quality, a statistic which remained the same across the tracking periods. The other 50 percent were only considered “of intermediate nutritional quality.”

According to the study authors, less than 0.1 percent of all the meals consumed by Americans in all manner of restaurants across the tracking periods were considered of “ideal nutritional quality.”


“Our findings show dining out is a recipe for unhealthy eating most of the time,” said Dariush Mozaffarian, senior author and dean of the Friedman School. “It should be a priority to improve the nutritional quality of both full-service and fast-food restaurant meals, while reducing disparities so that all Americans can enjoy the pleasure and convenience of a meal out that is also good for them.”

There were some interesting results when ethnicity was factored in. They found that for Mexican-Americans and non-Hispanic whites, the quality of meals eaten at fast-food joints improved slightly over time. For non-Hispanic blacks, no change was noted.

Education seems to matter, too. People with college degrees ate poor-quality fast-food meals at a declining rate over the tracking period. Their poor-quality food choice proportion dropped from 74 percent to 60 percent over the time period. Those without a high school diploma saw their proportion remain at 76 percent throughout.

The study team wanted to know how much Americans depended on restaurants for their meals during the study period. Here’s what they found:

  • Restaurant meals accounted for 21 percent of Americans’ total calorie intake.
  • Full-service restaurant meals represented 9 percent of total calories consumed.
  • Fast-food meals represented 12 percent of total calories consumed.
  • Fast-food breakfasts increased from just over 4 percent to nearly 8 percent of all breakfasts eaten in America.

They also looked at the content of restaurant meals – the specific constituent foods and nutrients – and identified some priorities for improvement, “We found the largest opportunities for enhancing nutritional quality would be adding more whole grains, nuts and legumes, fish, and fruits and vegetables to meals while reducing salt,” said first author Junxiu Liu, a postdoctoral scholar at the Friedman School. She noted the study findings showed no improvement in sodium levels in fast-food meals and worsening levels in full-service dishes consumed.

“Our food is the number one cause of poor health in the country, representing a tremendous opportunity to reduce diet-related illness and associated healthcare spending,” Mozaffarian said. “At restaurants, two forces are at play: what’s available on the menu, and what Americans are actually selecting. Efforts from the restaurant industry, consumers, advocacy groups, and governments should focus on both these areas.”

There is no doubt that eaters can make good, highly nutritious food choices when eating out at restaurants. It may be useful to study how restaurant atmosphere, layout and other factors like menu design impact how diners choose their food when eating out. But that is research for another time.

In the meantime, take some time when dining out to really look at the menu. Ask about ingredients and portion sizes. Maybe, just maybe, you can have your dinner and eat it, too – and have it be good for you!

Keep the faith and keep after it!

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Material Source – Tufts University, Health Science Campus

Journal Reference – Junxiu Liu, Colin D Rehm, Renata Micha, Dariush Mozaffarian. Quality of Meals Consumed by US Adults at Full-Service and Fast-Food Restaurants, 2003–2016: Persistent Low Quality and Widening Disparities. The Journal of Nutrition, 2020; DOI: 10.1093/jn/nxz299

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