Changes in the Energy and Sodium Content of Main Entrées in US Chain Restaurants from 2010 to 2011

Published in: Journal of the Academy of Nutrition and Dietetics, v. 114, no. 2, Feb. 2014, p. 209-219

Posted on RAND.org on January 01, 2013

by Helen Wu, Roland Sturm

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Research Question

  1. Did the energy or sodium content in main entrées from top U.S. chain restaurants change between 2010 and 2011, as restaurants prepared for new federal menu labeling requirements?

BACKGROUND: The food environment shapes individual diets, and as food options change, energy and sodium intake may also shift. Understanding whether and how restaurant menus evolve in response to labeling laws and public health pressures could inform future efforts to improve the food environment. OBJECTIVES: To track changes in the energy and sodium content of US chain restaurant main entrées between spring 2010 (when the Affordable Care Act was passed, which included a federal menu labeling requirement) and spring 2011. DESIGN: Nutrition information was collected from top US chain restaurants' websites, comprising 213 unique brands. Descriptive statistics and regression analysis evaluated change across main entrées overall and compared entrées that were added, removed, and unchanged. Tests of means and proportions were conducted for individual restaurant brands to see how many made significant changes. Separate analyses were conducted for children's menus. RESULTS: Mean energy and sodium did not change significantly overall, although mean sodium was 70 mg lower across all restaurants in added vs removed menu items at the 75th percentile. Changes were specific to restaurant brands or service model: family-style restaurants reduced sodium among higher-sodium entrées at the 75th percentile, but not on average, and entrées still far exceeded recommended limits. Fast-food restaurants decreased mean energy in children's menu entrées by 40 kcal. A few individual restaurant brands made significant changes in energy or sodium, but the vast majority did not, and not all changes were in the healthier direction. Among those brands that did change, there were slightly more brands that reduced energy and sodium compared with those that increased it. CONCLUSIONS: Industry marketing and pledges may create a misleading perception that restaurant menus are becoming substantially healthier, but both healthy and unhealthy menu changes can occur simultaneously. Our study found no meaningful changes overall across a 1-year time period. Longer-term studies are needed to track changes over time, particularly after the federal menu labeling law is implemented.

Key Finding

  • There were no meaningful changes in average energy or sodium content in main entrées from top U.S. restaurant chains between 2010 and 2011. Although restaurants changed the nutrition content of thousands of entrées, those changes included both increases and decreases in energy and sodium content.

Author Statement

Across the restaurant industry, there was a pattern of one step forward, one step back. Restaurants make changes to their menus regularly, but they may make both healthy and unhealthy changes simultaneously. This study provided objective evidence that overall, we did not see a new wave of healthier entrées come in to replace less healthy ones. The urgency of the U.S. obesity epidemic requires a much larger and faster rate of change in the food environment, including and extending well beyond the restaurant setting.

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