Plenty of restaurants have been advertising their efforts to offer healthful choices, and it's possible to eat carefully just about anywhere. But researchers say nearly all the entrees they reviewed at 245 U.S. chains fail to meet federal guidelines.
Think about it, and you can figure out some likely culprits: burgers with cheese, bacon and sauce; pastas with four cheeses and sausages; outsize servings of meat; salads covered in fatty, salty dressings.
For a study published online in the journal Public Health Nutrition, researchers looked at the nutritional content of 30,923 menu items, including those from children's menus, from 245 brands of restaurants. They found that 96 percent of them failed to meet recommendations for the combination of calories, sodium, fat and saturated fat set by the U.S. Department of Agriculture.
The restaurants included fast-food, buffet, takeout, family style and upscale restaurants, said Helen Wu, one of the authors and an assistant policy analyst at the RAND Corp. The study was supported by the Robert Wood Johnson Foundation.
The majority of the entrees did not exceed 667 calories -- one-third of the calories the USDA estimates the average adult needs each day, said Wu and Roland Sturm, senior economist at RAND. They looked at restaurants' websites from February to May 2010.
But they found that few of the entrees met recommended limits when considering calories, sodium, saturated fat and fat combined.
"Many items may appear healthy based on calories, but actually can be very unhealthy when you consider other important nutrition criteria," Wu said.
The sodium count often put a restaurant over the limit. (The USDA's daily recommended limit for most adults is 2,300 milligrams.)
The entrees in family style restaurants -- places such as Pizza Hut, Red Lobster and Denny's -- had higher levels of the items studied than fast-food restaurants: 271 more calories on average, and 16 grams more fat and 435 mg more sodium, Wu said.
Serving size counts, too.
Pizza restaurants often listed an entree as one slice -- good luck with that. Or a single piece of fried chicken. Really? "This could end up being very confusing for consumers," Wu said in a telephone interview.
And of course, the diner determines the size of a meal from buffet restaurants. "People don't typically go to buffets to have a light meal," she said.
Wu and Sturm also discovered that appetizers have more calories, fat, saturated fat, and sodium than all other types of menu items. From the sample studied, appetizers had an average of 813 calories.
Chicken wings with dip were a big culprit, Wu said, adding: "I'm not ordering chicken wings anymore."
The study also found that not all restaurants provided nutrition information on their websites. Some provided it only upon email request, Wu said. And those spots tended to have "menu items with significantly more calories, fat and sodium."
The U.S. Food and Drug Administration is soon to publish final regulations that require chains with 20 or more locations to put calorie counts on menus and provide additional nutrition information on request.
"It's a start, because before diners didn't have any information at all," Wu said.
The regulations might encourage restaurants to come up with healthier choices, especially when it comes to sodium, she said, adding that a slow decrease over time might not be noticed by customers.
"Once upon a time people were perfectly happy eating foods that were lower in sodium, and we need to get back to that," Wu said.
The researchers began by looking at 400 restaurant brands, but found that only 245 listed full data on their websites. They are doing another study, looking at menu items a year later. Wu said she couldn't reveal anything from that study yet.
In case you're wondering how much this all matters: 82 percent of adults eat out at least once a week.
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