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Energy Content of U.S. Fast-FoodRestaurant Offerings

14-Year Trends

Katherine W. Bauer, PhD, MS, Mary O. Hearst, PhD, MPH, Alicia A. Earnest, BA,Simone A. French, PhD, J. Michael Oakes, PhD, Lisa J. Harnack, DrPH, RD

Background: Within the past decade, there has been increasing attention to the role of fast food inthe American diet, including a rise in legislative and media-based efforts that address the healthful-ness of fast food. However, no studies have been undertaken to evaluate changes in the energycontent of fast-food chain restaurant menu items during this period.

Purpose: To examine changes in the energy content of lunch/dinner menu offerings at eight of theleading fast-food chain restaurants in the U.S. between 1997–1998 and 2009–2010.

Methods: Menu offerings and nutrient composition information were obtained from archivalversions of theUniversity ofMinnesotaNutritionCoordinatingCenter Food andNutrientDatabase.Nutrient composition information for items was updated biannually. Changes in median energycontent of all lunch/dinner menu offerings and specifıc categories of menu items among all restau-rants and for individual restaurants were examined. Data were collected between 1997 and 2010 andanalysis was conducted in 2011.

Results: Spanning 1997–1998 and 2009–2010, the number of lunch/dinner menu items offered bythe restaurants in the study increased by 53%. Across all menu items, the median energy contentremained relatively stable over the study period. Examining specifıc food categories, the medianenergy content of desserts and condiments increased, the energy content of side items decreased, andenergy content of entrées and drinks remained level.

Conclusions: Although large increases in the number of menu items were observed, there havebeen few changes in the energy content of menu offerings at the leading fast-food chain restaurantsexamined in this study.(Am J Prev Med 2012;43(5):490–497) © 2012 American Journal of Preventive Medicine

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Introduction

Over the past 3 decades, regular consumption offood purchased at fast-food chain restaurants,which provide convenience foods in self-service

or carry-out eating venues,1 has become the norm forany children and adults.2,3 In 2003–2004, fast food ac-

counted for 15% of Americans’ daily energy intake,4 aubstantial increase from 1977–1978 when fast food ac-

From the Department of Public Health and Center for Obesity Researchand Education (Bauer), Temple University, Philadelphia, Pennsylvania;and Division of Epidemiology and Community Health (Hearst, Earnest,French, Oakes, Harnack), School of Public Health, University of Minne-sota, Minneapolis, Minnesota

Address correspondence to: Katherine W. Bauer, PhD, MS, Center forObesity Research and Education, Department of Public Health, TempleUniversity, 1301 Cecil B.Moore Ave., Ritter Annex, 9th Floor, PhiladelphiaPA 19122. E-mail: katherine.bauer@temple.edu.

0749-3797/$36.00http://dx.doi.org/10.1016/j.amepre.2012.06.033

490 Am J Prev Med 2012;43(5):490–497 © 2012 Amer

counted for 4% of daily energy intake.5 In 2010, salesamong the top 50 fast-food chain restaurants exceeded$141 billion in the U.S.6 A recent survey of adults foundthat 80% purchased fast food in the past month and 28%consumed fast food two ormore times aweek.7 Addition-ally, on a typical day nearly 40% of high school–agedadolescents consume fast food.8

Foods sold at fast-food chain restaurants are often of lownutritional quality,9 and frequent consumption of fast foodas been associated with less-healthful dietary patternsmong children,8 adolescents,10–12 and adults.13,14 Studieshave consistently found positive associations between fast-food intake and excess weight and weight gain amongadults,1,15–17whereas the relationshipbetween fast food andweight among children is less clear.18

Over the past decade there has been an increase inpublic discourse about the role of fast food in the Amer-

ican diet.Most notably, several mainstreammedia efforts

ican Journal of Preventive Medicine • Published by Elsevier Inc.

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Bauer et al / Am J Prev Med 2012;43(5):490–497 491

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detailing the poor nutritional quality of fast food and themethods of food production used by fast-food chain res-taurants have been released, including the book Fast FoodNation: The Dark Side of the All-American Meal by EricSchlosser19 and the movie Super Size Me.20 Manymunic-palities have also developed policy initiatives related toast food. These initiatives include laws requiring theoint-of-purchase publishing of nutritional data on res-aurant menus.21,22 Signed into law inMarch of 2010, thePatient Protection and Affordable Care Act of 2010 pre-empts local menu-labeling initiatives and mandates thatnationwide by 2012 restaurants and food vendors withmore than 20 locations post calorie information for thefood they sell.23

Scientifıc evidence is mixed regarding the effectivenessof efforts such as menu labeling in changing consumerbehavior.24–27 However, it has been suggested that analternative mechanism through which legislation andmedia attention may lead to lower-calo-rie intake by consumers is via changes inthe nutritional quality of fast food by theindustry itself.24,28 Fast-food chain res-aurants may be motivated to decreasehe energy content of their offerings tovoid further legislative requirements,emonstrate a commitment to consum-rs’ health, or attract new calorie-con-cious consumers.In recent years, specifıc restaurants, industry self-reg-latory programs, and leading restaurant associationsave announced several health-conscious changes to res-aurants’ offerings. These changes include elimination ofsuper size” portions,29 the addition of healthier entréeand side items,30 andmodifıcations to the default optionsin children’s meals.31 Despite these changes, a recentevaluation by Kraak et al.32 observed that specifıcally inhe area of children’s meals, limited progress has beenade by the fast-food industry in the expansion andromotion of healthier options.While some fast-food chain restaurants have commit-

ed to improvements to the health profıle of theirenus,29–31 to our knowledge, there have not been anyuantitative examinations of changes in the energy con-ent of fast food over time. This type of research haspecifıcally been called for in order to understand howestaurants may be responding to legislation to improvehe caloric and nutrient composition of their food.24,25

In light of this knowledge gap, this paper aims to ad-dress the following research questions: (1)Has the energycontent ofmenu offerings at eight of the leading fast-foodchain restaurants changed in the past 14 years? and(2) Are there differences between specifıc fast-food res-

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taurant chains in the pattern of change in energy content

ovember 2012

of the menu items during the past 14 years? The answersto these questions can help objectively evaluate whetherleading fast-food restaurants have modifıed the calorieprofıle of their menu offerings during a time period inwhich public scrutiny and legislative efforts related to thisindustry surged.

MethodsData for the current study were acquired from current and archivalversions of the University of Minnesota Nutrition CoordinatingCenter (NCC) Food and Nutrient Database. Currently, this data-base includes menu items available at 22 U.S. fast-food restaurantchains. Fast-food restaurants are selected for inclusion in this da-tabase on the basis of both popularity and availability of company-provided ingredient listing and nutrient composition informationfor standard menu items. Consequently, most but not all leadingfast-food restaurants are included in the database.Of the 22 restaurants currently in the NCC Food and Nutrient

Database, eight were selected for inclusion in the present study onthe basis of the following criteria: (1) the restaurantwas included in the database since 1997; (2) restau-rant has a defıned set of food offerings on themenu;and (3) all standardmenu items are included in thedatabase. The eight restaurants included in the cur-rent study are among the top restaurants in theU.S.with regard to annual sales andnumber of locations(Table 1). The menu items available at each of theselected restaurants and their nutrient compositionwere updated in the database biannually; thus, dataincluded in the study were collected between 1997

and 2010, and trends were examined in seven 2-year time periods(1997–1998, 1999–2000, 2001–2002, 2003–2004, 2005–2006,2007–2008, 2009–2010) to ensure that all eight restaurants arerepresented in each period.

University of Minnesota Nutrition CoordinatingCenter Food and Nutrient Database

The NCC Food and Nutrient Database is maintained using a stan-dard set of well-defıned and described procedures.34–37 When

ry byne.

Table 1. Fast-food restaurant sales information, 2010

Restaurant name RankU.S. sales(million $)

Number of U.S.locations

McDonald’s 1 32,395.0 14,027

Burger King 3 8,600.0 7,253

Wendy’s 4 8,340.0 6,576

Taco Bell 6 6,900.0 5,634

KFC 9 4,700.0 5,055

Arby’s 14 3,010.0 3,649

Jack in the Box 15 2,934.8 2,206

Dairy Queen 16 2,660.0 4,514

Source: QSR Magazine33

eetedntain issu

KFC, Kentucky Fried Chicken

smior

492 Bauer et al / Am J Prev Med 2012;43(5):490–497

updating nutrient information for a restaurant, all foods and bev-erages on the restaurant’s menus are obtained from the restaurantcorporation. Ingredient and nutrient composition information isalso sought from the corporation for all items. The ingredientinformation provided is generally a listing of ingredients in de-scending order of content in the menu item.Most restaurants provide information for only a limited set of

nutrients (e.g., kilocalories [kcal], macronutrients, saturated fat,sodium, and some vitamins and minerals) for their food items.Thus, NCC database nutritionists create formulations (recipes)for menu items using an NCC-developed program38 that esti-mates, via a linear optimization algorithm, the amount of eachingredient needed to produce a product with a nutrient profıleclose to that specifıed by the restaurant corporation for theproduct. From this recipe, the composition data for nutrientsbeyond those provided by the restaurant corporation arecalculated.As a general rule, all portion sizes available for food items on

restaurantmenus are included in the database (e.g., small,medium,and large french fries) are included in the database. Exceptions tothis rule include chicken nuggets and strips, which are included inthe database in the unit of “piece” or “each” rather than by ordersize. With respect to foods that may be ordered with various top-ping options, separate entries are generally included in the databasefor the food and each topping. For example, salads and dressingchoices are included as separate items in the database. One restau-rant offered a salad bar during some years included in the study.Items offered at the salad bar only were excluded because of theinability to accurately identify the energy content of meals com-posed from the salad bar.

Creation of Data Set for Trends Analysis

For the present analysis, a data set was created that included alllunch/dinner menu items available at the eight restaurants duringeach time point. Each available serving size of a food was includedas a unique menu item. Therefore, changes in portion size overtime and the accompanying changes in energy content of the itemwould be detected.In order to evaluate changes in the energy content of specifıc

types of menu items (e.g., entrées, desserts) over time, the range offoods sold by the restaurants each year were reviewed, categories ofmenu items were developed, and the menu items were then sortedinto categories (Table 2). These categories and the types of foodsassigned to them were then reviewed and confırmed. There were asmall number of items that did not easily fıt into a single category(e.g., milkshakes could be considered either a beverage or dessert)and consensus of their classifıcation was reached after discussionby the study team and review of the restaurant’s classifıcationscheme.

Statistical Analysis

In order to assess overall change over the 14 years of data acrossall eight restaurants, descriptive statistics including number ofitems on the menu and the mean, median, and interquartilerange of energy content were calculated for all menu items, aswell as specifıc food categories (e.g., desserts). To evaluate res-taurant-specifıc changes in the energy content of foods offeredbetween 1997–1998 and 2009–2010, the median and interquar-tile range for kcal/item during the fırst and last time periods

were examined for each restaurant’s overall menu and within p

pecifıc food categories where there were an adequate number ofenu items offered at all restaurants. Because the menu items

ncluded in the analysis represent the entire population of foodsffered at each restaurant and restaurants were not selectedandomly, statistical testing and related p-values are not appro-

Table 2. Fast-food category coding schema

1. Entire menu: Includes all foods, drinks, desserts, andcondiments on lunch/dinner menu

2. Entrées

a. Meat/fish sandwich (includes hamburger,cheeseburger, chicken sandwich, fish sandwich, roastbeef, “fresh” sandwich, pita sandwich, hot dog)

b. Chicken (includes chicken nuggets, tenders, pieces)

c. Entrée salad (no dressing)

d. “Mexican” entrée (includes tacos, burrito, fajita)

3. Sides

a. French fries/fried potatoes

b. Other fried food (e.g., onion rings, egg rolls, mozzarellasticks)

c. Side salad (e.g., lettuce salad, coleslaw, potato salad)

d. Soup/chili

e. Bread (e.g., biscuits, corn bread, cheese bread)

f. Nonfried potato

g. Other sides (e.g., nachos, baked beans, green beans)

4. Drinks

a. Hot drinks (e.g., coffee, hot chocolate, “coffee drinks”)

b. Sugar-sweetened drinks (e.g., regular soft drinks,lemonade, sweetened iced tea, juice drinks)

c. Diet soft drinks

d. 100% juice

e. Milk (e.g., low-fat milk, chocolate milk)

m. Shakes or slush drink

n. Unsweetened iced tea

5. Condiments

a. Salad dressing

b. Ketchup

c. Other condiments (e.g., mustard, mayonnaise, jelly,salsa, tartar sauce, croutons)

6. Desserts

a. Ice cream

b. Pie

c. Cookies

d. Cookies, cake (single serving)

riate. Data analysis was conducted in 2011.

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ResultsTrends in Number of Menu Items OfferedDuring the 14-year period, the number of food itemsoffered by the selected eight restaurants increased sub-stantially, from 679 to 1036 (Table 3). Within each ofthe food subcategories, the number of food items alsoincreased. For example, the number of lunch and din-ner entrées offered nearly doubled, increasing from

Table 3. Trends in energy content of fast-food restaurant

Fast-food category 1997–1998 1999–2000 2001–2

Entire menu

Items, n 679 670 672

M (SD) 300 (246) 303 (246) 311 (2

Median 265 267 284

Interquartile range 94–445 98–451 100–4

Entrées

Items, n 211 212 221

M (SD) 416 (196) 423 (201) 423 (1

Median 403 397 395

Interquartile range 285–533 279–538 309–5

Sides

Items, n 71 72 77

M (SD) 299 (178) 299 (178) 347 (2

Median 264 264 327

Interquartile range 164–424 164–424 198–4

Drinks

Items, n 229 213 200

M (SD) 226 (278) 220 (279) 214 (2

Median 120 115 115

Interquartile range 2�350 0�306 0�2

Condiments

Items, n 74 78 76

M (SD) 84 (83) 97 (92) 90 (8

Median 54 58 55

Interquartile range 34–109 34–134 34–1

Desserts

Items, n 94 95 98

M (SD) 390 (219) 391 (216) 400 (2

Median 334 344 340

Interquartile range 238–530 238–530 243–5

Note: Values are in kcal/item unless otherwise noted.

211 to 380. Some of this increase can be attributable to

ovember 2012

the increase observed in number of entrée salads of-fered, from 11 in 1997–1998 to 51 in 2009–2010. Al-though for most types of food the number of itemsavailable increased relatively gradually during the ear-lier years of data collection, between 2007–2008 and2009–2010 substantial increases in the number of fooditems were observed within many of the categories. Forexample, the number of drinks sold increased from 235

h/dinner menu offerings, 1997–1998 to 2009–2010

2003–2004 2005–2006 2007–2008 2009–2010

729 807 825 1036

310 (265) 341 (283) 335 (276) 329 (280)

264 291 288 269

108–445 119–512 117–483 100–488

230 297 315 380

420 (192) 461 (212) 459 (222) 453 (224)

381 426 417 409

300–531 317–599 312–577 300–574

78 94 93 105

295 (193) 288 (199) 266 (209) 263 (196)

278 252 202 219

130–421 109–455 89–395 91–372

220 233 235 341

235 (327) 265 (350) 246 (313) 231 (290)

113 125 129 123

0�280 0�359 0�345 6�344

92 96 96 108

104 (81) 113 (89) 111 (85) 103 (75)

77 84 87 82

41–143 44–182 43–167 45–140

109 87 86 102

416 (243) 443 (275) 447 (279) 502 (322)

347 356 363 414

243–603 248–620 250–619 252–719

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494 Bauer et al / Am J Prev Med 2012;43(5):490–497

attributable both to the addition of new types of drinksto the menus, such as sugar-sweetened teas, the num-ber of which increased from 0 to 35 across the studyperiod, and the addition of new portion sizes for exist-ing drink types.

Trends in Energy Content of Menu ItemsAcross the entire menu and within the entrée and drinkscategories, the median energy content of food items re-mained relatively stable during the study period. Mean-while, among the condiments and desserts categories, themean andmedian energy content of food items graduallyincreased. For example, the median kilocalories per des-sert item increased from 334 kcal/item in 1997–1998 to414 kcal/item in 2009–2010.Examining the interquartile ranges, the upper end of

the interquartile range for the entire menu, entrées, con-diments, and desserts increased during the time periodexamined, whereas the lower end remained relativelystable. For example, in 1997–1998, the interquartile rangefor dessert itemswas between 238 and 530 kcal/item. Thisrange shifted to span from 252 to 719 kcal/item in 2009–2010, an increase of 189 kcal/item at the 75th percentile.Among side items, there was a slight increase in themedian kcal/item in 2001–2002; however, starting in2003–2004 and continuing through 2009–2010 decreaseswere observed in themean andmedian energy content ofside items, with an accompanying downward shift in theinterquartile range.

Trends in Restaurant-Specific OfferingsWhen examining restaurant-specifıc changes in menuofferings between 1997–1998 and 2010–2011, the me-dian energy content of menu offerings overall either in-creased or remained stable at six of the eight restaurants(Table 4). Within specifıc food categories, fındings aremixed as to whether the median energy content of menuofferings increased, decreased, or held constant. For ex-ample, although the median energy content of menuofferings at McDonald’s increased by 42 kcal/item over-all, the median energy content among side items de-creased by 225 kcal/item. In comparison, at Dairy Queenthe median kcal/item for entrées increased by 137,whereas the median energy content of drinks decreasedfrom 261 to 158 kcal/item.

DiscussionResults from the present study suggest that there havebeen few decreases in the energy content of menu offer-ings across the eight leading fast-food chain restaurantsexamined in this study, which account for a substantial

share of fast food sold to Americans. Rather, it appears Ta

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that the median energy content of restaurant menus hasbeen stable for menus overall, entrées, and drinks, in-creasing for condiments and desserts, and decreasing forside items. Additionally, for the overall menu and forseveral of the food categories, the upper end of the inter-quartile range increased, suggesting the addition ofhigher-calorie items either via increased portion sizes orvia new types of food being added to the menu. Whenlooking at restaurants individually, for the majority, me-dian energy content of overall menu offerings remainedstable or increased, whereas among specifıc food catego-ries, fındings were largelymixed, with both decreases andincreases inmedian calories observed across food catego-ries within restaurants.One of the most salient fındings of the current study

was a 53% increase in the total number of foods sold overthe 14 years examined. This may be a positive change inthat restaurants are meeting customers’ demand for newproducts; however, there is evidence to suggest that in-creasing the number of menu choices may increase thenumber of itemspurchased by consumers. Several studieshave demonstrated that when individuals are presentedwith greater numbers or variety of food items, they willconsume greater volumes.39–41

However, this research has been primarily conductedby presenting subjects with actual food (e.g., a buffetmeal) rather than a menu. Other studies have suggestedthat when presented with more than an optimal numberof choices, individuals tend to become stressed and re-duce the number of items they select.42 Because of theseonflicting potential outcomes, further research is neededo understand how the increases in number of menutems, as well as the inclusion of additional informationn menus such as kilocalories per item, may alter con-umers’ choices.Although little change was observed in the median

nergy content of fast-food offerings as a whole, amongide items, a median decrease of 45 kcal/item over thetudy yearswas observed. This decrease in energy contentay be attributable to an increase in the number of sidealads (from 6 to 12); decrease in median kilocalories foride salads (from 87 to 39); and some restaurants limitinghe portion sizes of french fries.29,43 This change in me-ian energy content observed among side items has theotential to have a positive impact on population-levelnergy intake because of the frequency with which sidetems are purchased. For example, “combomeals,” whichackage together entrées, side items, and drinks, repre-ent approximately one third of the fast-food orders, andearly 12% of all fast-food purchases are side itemsnly.44

Modest decreases in the energy content of some types

of menu items via either changes in types of foods sold or

ovember 2012

decreases in portion sizes may reflect an effort by theindustry to meet the needs of health-conscious consum-ers. Efforts such as themodifıcation of types and portionssizes of side itemsmay also be used to alter public percep-tion of the restaurants and/or invoke a “health halo,”which leads consumers to believe that consuming foodfrom the restaurant is a healthful decision.45 Similarly,esearch suggests that the mere inclusion of healthfulptions on restaurant menus may prompt individuals tourchase higher-calorie food choices.46 Therefore, al-

though some consumers may benefıt from efforts by thefast-food industry to limit the energy content of a selectnumber of foods, evidence suggests that including a smallnumber of lower-calorie options while maintaining orincreasing the energy content of other foodsmay contrib-ute to increased caloric consumption.Use of the NCC Food and Nutrient Database for res-

taurant menu information is both a strength and limita-tion of the present study. Use of the database is a strengthbecause historical information about themenu items wasavailable, and their nutrient composition could be readilyascertained from a database in which consistent and rig-orous maintenance and update procedures are applied.Shortcomings relate to relying on a food and nutrientdatabase developed for the purpose of evaluating foodand nutrient intake of individuals as opposed to evaluat-ing the nutritional quality of foods in themarketplace. Asa result of this focus, some menu items, such as chickennuggets, were included in the analysis data set as individ-ual items as opposed to the order sizes available at restau-rants. This shortcoming may have contributed to a smallunderestimation of the energy content of the menu, aswell as limit the ability to identify changes in energycontent thatmay have occurred because of changing por-tion sizes of these items.Other limitations of relying on the NCC Food and

Nutrient Database are that the trends are reflective ofrestaurant offerings and do not provide any sales infor-mation in order to better understandwhat foods consum-ers are choosing, and that the restaurant chains includedin the analysis were not selected in a random manner.Consequently, the representativeness of the sample andgeneralizability of study fındings are limited. However,the way in which the data were analyzed and interpretedtakes this limitation into account, with fındings consid-ered to be representative of only those restaurant chainsincluded in the analysis.

ConclusionDespite increasing pressure and legislation directed to-ward the fast-food industry to improve the healthfulnessof their menus, as well as statements by the fast-food

industry that indicate they are increasingly providing

1

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2

2

2

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496 Bauer et al / Am J Prev Med 2012;43(5):490–497

healthful food to consumers, overall the energy content offast-food menu offerings has not decreased over the past14 years at the leading fast-food chain restaurants exam-ined in the current study. Although changes within somefood categories and at some specifıc restaurants seem tobe occurring, these changes may be offset by increases inthe energy content of other items and increases in thetotal number of menu items offered, which may promptincreased purchasing by consumers. Substantial shifts inthe healthfulness of food offered by fast-food chain res-taurants may prove diffıcult to implement because ofbeliefs by the industry that there is not a large demand formore such food and that offering new or modifıed op-tions may result in a loss of profıt.47

Consumersmay benefıt by being aware of the relativelylimited changes in the energy content of fast-food offer-ings despite efforts by the industry to promote more-healthful choices. As results from the current study canserve as a baseline againstwhich to benchmark changes infast-food offerings after implementation of the nationalmenu-labeling mandate, future analyses can providegreater understanding of whether initiatives that primar-ily aim to inform consumers can also change industrypractices.

This study was funded by a grant from the Robert Wood John-son Foundation Healthy Eating Research program (RWJF-68383), which provided support for conduct of the study, in-cluding data management, analysis, and interpretation. KWBwas supported by a postdoctoral fellowship at the University ofMinnesota (Grant No. T32DK083250) from the National Insti-tute of Diabetes and Digestive and Kidney Diseases.No fınancial disclosures were reported by the authors of this

paper.

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