Food for Thought

Fast food isn't the only type of restaurant deserving of the "unhealthy" label. Fast-casual and full-service restaurants also struggle to meet nutritional standards.

Figure of meals meeting nutritional criteria

Read Time: 2 minutes


Which is the least healthy restaurant: McDonald’s, Panera Bread, or Applebee’s? The answer might not be as simple as you think.

Before the pandemic, about 61% of U.S. adults ate at restaurants at least once a week. Covid-19 prevention measures prohibited or restricted indoor dining during the last year, yet a similar proportion of adults (60%) reported ordering takeout for dinner at least once per week in 2020.

Though our love for food may be good for the economy, it could be bad for our health. Nearly 40% of all U.S. adults are obese. Poor diet is a major factor for obesity, a condition linked to a variety of poor health outcomes.

Previous studies on restaurant food have focused on 1) fast food, 2) nutrient content, and 3) individual food items, not “healthiness.” But we usually don’t just order a sandwich. We need a side of fries too. Of course, there’s always room for dessert. Noting that people usually order multiple food items, researchers are now looking at the healthiness of meals across different types of restaurants.

Alexander et al. analyzed the healthiness of meals in three categories of chain restaurants: fast food (McDonald’s), fast-casual (Panera Bread), and full-service or “sit down” (Applebee’s). Meals were defined as an entrée with a side. Nutritional content was compared to guidelines set by the American Heart Association (AHA).

As the Figure shows, most restaurants reached the AHA protein and fiber standard. However, all restaurants surpassed AHA recommended calories, total fat, saturated fat, cholesterol and sodium. Meal sodium levels in all restaurants were nearly double the AHA guidelines. Full-service restaurants had the highest overall calories, fat, cholesterol and sodium levels. They were also less likely to meet certain standards, such as calories and cholesterol levels, than fast food vendors.

Overall, fewer than 10% of restaurants met AHA criteria in all categories.

Fast food may not reign as champion of the unhealthiest; fast-casual and full-service restaurants performed just as poorly, if not worse.

Databyte via Alexander E, Rutkow L, Gudzune KA, Cohen JE, McGinty EE. Healthiness of US Chain Restaurant Meals in 2017. J Acad Nutr Diet. 2020 Aug;120(8):1359-1367. doi: 10.1016/j.jand.2020.01.006. Epub 2020 Mar 10.