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Restaurant meals make up 20% of our calories, but most are unhealthy, study finds

Researchers looked at the dietary quality of meals eaten at both full-service and fast-food restaurants over a 13-year period.
Young Asian woman sitting at a table by the window enjoying the warmth of sunlight and having meal joyfully in a restaurant
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/ Source: TODAY
By A. Pawlowski

America's love of dining out may come with real health consequences.

Restaurants of all kinds provide one out of five calories adults in the U.S. eat, but patrons are consuming food of “persistent low quality” when it comes to nutrition, researchers reported Wednesday.

Half of the meals Americans ate in full-service eateries and 70% of their fast-food orders in 2015 and 2016 were of poor diet quality, according to the study published in The Journal of Nutrition.

The findings are concerning as people eat outside the home more often, said Dr. Dariush Mozaffarian, senior author of the study and dean of the Friedman School of Nutrition Science and Policy at Tufts University.

“We’re a long way away from where we need to be," Mozaffarian, a cardiologist, told TODAY. "I don’t think many Americans really understand how important food is for health and how much we’re being harmed by it.”

“Food is now the single biggest cause of poor health in this country and that makes it the single biggest opportunity to improve health,” he said.

The findings are based on the food selections of more than 35,000 adults across the U.S. who took part in the National Health and Nutrition Examination Survey from 2003 until 2016. They were asked to recall everything they ate during a 24-hour period.

On any given day during the study period, almost a third, or 30%, of the participants ate a meal prepared by a full-service eatery and almost half, 46%, ate fast food. Fast-food breakfasts rose from 4% to almost 8% of all the breakfasts reported.

The study analyzed the nutritional quality of the restaurant meals consumed using the American Heart Association’s healthy diet score, which gives the highest grades to meals with plenty of fruits, vegetables, fish, whole grains and nuts, legumes and seeds; while cutting down on salt, sugar, saturated fat and processed meats.

Less than 0.1% of the restaurant meals were of “ideal quality” when measured by this standard, the study found.

The average nutritional quality for all types of restaurant meals was low, though there was a slight improvement in the fast-food restaurant meals reported over the study period.

But any positive changes were offset by lower amounts of fruits and vegetables in both full-service and fast-food meals, which was “surprising and unfortunate,” Mozaffarian said.

It's important to note this study was based on meals people actually ordered at restaurants, so it’s possible they had healthier menu options available, but didn’t choose them. Additionally, Mozaffarian said there are no studies similar enough to compare results before 2003.

Although some restaurants have included calorie counts on their menus, he said these are a “Band-Aid fix.”

“The problem is when people just look at the calories and try to make a decision, they could be led astray,” Mozaffarian said. “It’s always better to eat 1,000 calories of healthy food — rich in fruits, vegetables, beans, fish and healthy oils — than to eat 800 calories of unhealthy food rich in starch, sugar and salt.”

Part of the problem is awareness, he believes. If people truly understood how important nutrition is for health, they would be more likely to make a change. He also believes policy changes and incentives to make healthy foods less expensive and more available would help.

Other experts were concerned, too.

“The findings should not be taken lightly,” said Lisa Young, a registered dietitian nutritionist in New York and author of “Finally Full, Finally Slim.” She was not involved in the study.

“We used to eat out on a special occasion — it used to be a special treat, now it's a regular occurrence," she said. "It's up to you as a consumer to be very mindful when you’re eating out.”

People may see calories posted, but they’re not aware of just how much fat, salt and sugar they’re ingesting if they’re eating out all the time, she noted.

Young offered these tips to make restaurant meals healthier:

  • Choose the smallest entrée size possible or share a dish with someone else. Always order a healthy salad and extra vegetables on the side. “You have to be an architect of your own meal,” she said.
  • Opt for whole grains like brown rice, whole wheat pasta or quinoa whenever possible.
  • Get grilled or baked food instead of fried — “that’s very, very big,” she said.
  • Skip the soda and drink water.
  • Some appetizers have more calories than the main meals, so always start with a salad or healthy vegetable-based soup. They will fill your stomach and provide a dose of veggies.
  • If you ate out for lunch, don’t eat out for dinner. Likewise, if you’re planning to eat out for dinner, don’t eat out for lunch.
  • Eat before you eat. Opt for some yogurt, a handful of nuts or baby carrots and hummus before going out to dinner and you’ll be less likely to overindulge at a restaurant.