How Dining Out Leads to Unhealthy Eating for Most Americans

by Melissa Gallanter, RD

Overview: In a cross-sectional study of US adults published in the Journal of Nutrition, researchers at the Friedman School of Nutrition Science and Policy at Tufts University found that meals from fast food (FF) and full-service (FS) restaurants accounted for one in five calories consumed by American adults between 2003-2016 aimed to assess the nutritional quality of restaurant meals in general. 

Findings included that, based on validated diet scores from the American Heart Association, less than 0.1 percent of all restaurant meals consumed during the study period were of “ideal” quality. This score is determined by the American Heart Association’s 2020 Strategic Impact Goals and factors in consumption of fruits and vegetables, fish/shellfish, whole grains, sodium, sugar-sweetened beverages, nuts/seeds/legumes, processed meat, and saturated fat. The majority of the restaurant items assessed were low quality, with AHA diet scores of 31.6 (FS) and 27.6 (FF) out of a possible 80.“Ideal” quality meals had a score at or above 40 out of the possible 80. 

The study concluded that spending on food away from home has risen to more than half of all food dollars Americans spend, yet the nutritional quality of the restaurant meals have remained the same in full-service restaurants and only modestly improved in fast-food restaurants. The disparities between meal quality and sociodemographic factors of race/ethnicity, obesity status, education and income are widening, and there is a need for improvement in the nutritional quality of US restaurant meals. 

Because the study findings concluded that the nutritional quality of restaurant items is low overall, Dariush Mozaffarian, senior author of the study and dean of the Friedman School notes that “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.”

The researchers assessed specific foods and nutrients found in restaurant meals and identified priorities for improvement. Based on findings of no improvement over the study period in sodium levels of fast-food meals and worsening levels of dishes consumed at full service establishments, they prioritized adding more whole grains, nuts and legumes, fish, fruits and vegetables to meals while reducing the amount of sodium to restaurant meals.

Mozaffarian mentioned to Science Daily that “at restaurants, two forces are at play: what’s available on the menu, and what Americans are actually selecting.” Strategic improvements of nutritional quality must be carried out by the restaurant industry; however, advocacy groups, government, and consumers also have roles in advocating for improvements and making individual changes. 

Article Citation: 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,

Abstract Link: Here

Study Methodology: Cross-sectional study with 24-hour recalls in surveyed samples of US adults

Human or Animal Participants: Human

Study Populations: 35,015 nationally representative US adults ages 20 and older from 7 National Health and Nutrition Examination Survey (NHANES) cycles (2003-2016)

Who Does This Research Impact: The study was focused on US adults specifically; however, the conclusions can provide insight into restaurant food nutritional quality for all Americans, including children as well. 

How to Apply Findings:

  • Use mustard, lemon, salt, pepper or vinegar as fat-free ways to season your food. 
  • For salads, watch the nuts, croutons, cheese and other add-ons. 
  • Instead of cheese on your sandwich or burger, pick vegetables such as lettuce, tomato and onion. 
  • Order a salad or broth-based soup to enjoy before your main course.
  • If an item is labeled “healthy,” don’t take their word for it. Review the nutritional information. Look for items that are high in nutrients, with lots of fruits, vegetables and whole grains, and low in unhealthy oils and creamy sauces.
  • Read the menu and look for any of the following cooking techniques, which use less fat and are generally lower in calories: baked, grilled, broiled, poached or steamed.
  • Ask questions about preparation and don’t hesitate to make special requests. Make sure to ask:
    “How is this prepared?” even if it’s called “light” on the menu. “Is this fried? Can you make it baked, grilled, steamed or broiled without using much oil?”
    “Can you prepare this without the cheese/sauce and/or can you put the sauce on the side?”
    “How many ounces/how large is this dish?”


Number of Related Studies: 

Google Scholar: 20,200 articles published since 2016 appeared for the search “restaurant nutrition quality americans

PubMed: 965 studies (all results published in the last 5 years) appeared for the search  “restaurant nutrition quality americans

Related Studies:

Are Results Consistent With Related Studies? 

As mentioned, the study focused on meals consumed by adults, but a 2017 study in the American Journal of Preventive Medicine found similar issues on children’s menus. Results of this study suggest little progress towards improved nutrition in children’s menu items and concluded that efforts need to be made by restaurants to offer more healthful children’s meals. Additional studies on the role of the restaurant sector to promote healthy food environments and on a restaurant-based intervention to promote heart-healthy menu items also concluded that restaurants, as well as food manufacturers partnering with restaurants, could show leadership and adopt strategies to promote affordable and profitable offerings that support a healthier diet. Additionally, these studies emphasized the need for government agencies and individuals to request healthier options and hold the restaurant industry accountable for making these changes. 

Limitations of Study: Limitations of the study include the nature of the self-reported food recall data, which is subject to measurement error and, therefore, inaccuracies in reported food intake. The food intake reports, because of the subjectivity of self-reported data and socially constructed perceptions, participants may over- or under-report consumption of healthy or unhealthy foods. 

References and Related Information:

Rate this post

You may also like

Subscribe To The Weekly Food & Nutrition News and Research Digest
Our weekly email news and research digest is everything you need to know about food, nutrition, fitness and health.
No Thanks
Thanks for signing up. You must confirm your email address before we can send you. Please check your email and follow the instructions.
We respect your privacy. Your information is safe and will NEVER be shared.
Don't miss out. Subscribe today.