Caloric Content in Restaurant Meals is in Excess of What We Actually Need

To follow up on my latest post, I read another paper was published simultaneously with the paper I discussed in JAMA Internal Medicine studied the food served in restaurants from a different angle. Investigators from the Human Nutrition Research Center on Aging (HNRCA) of Tufts University in Boston studied the energy content in the most commonly purchased foods in a random sample of independent and small-chain restaurants.

Inclusion criteria for a restaurant were: to be a “sit-down” restaurant, within 15 miles from downtown Boston, have a online menu with no nutrition labels. Restaurants were classified according to the number of employees (small <10 employees, large ≥10 employees), and the type of food served (Mexican, American, Chinese etc…), and then randomly selected according to these two categories. The research team led by Dr. Susan Roberts, The director of the Energy Metabolism Laboratory at the HNRCA, selected the 5 most popular entrée choices and their standard side dishes from each restaurant. They included 157 meals representing 42 meal categories from 9 restaurants in the present study.

Due to my inexperience in nutrition labeling and nutrition research methods, the next part is very interesting to me. The authors used the Bomb Calorimeter to estimate the energy content in each meal using the kilocalorie (kcal) as the measuring unit. The food must be grounded into fine powder. I found the following very interesting (and fun) interactive flash video explaining how the Bomb Calorimeter works. 

I embedded this video from its original source in McGraw-Hill.

Back to the paper! So the analysis of the energy content in the sample meals offers interesting results. To set the stage, the authors used the US federally-referenced daily energy requirement (as stated in the CFR Title 21, Volume 2§101.9(d)(9)(i)) to compare their results to it. This value is 2,000 kcal per day.

The mean energy content of all food categories of all the samples and all restaurants was 1327 kcal, which is already >66% of daily energy requirement reference value. The Italian meal categories had the highest mean energy content of 1755 kcal, and the Vietnamese meal categories had the lowest mean energy content of 922 kcal. Interestingly, some of the sample meals provided even more than 100% of the daily energy requirement. This includes; the Mexican Classic Nachos providing 2165 kcal, and the Italian Fettuccini Alfredo [yummy!!] providing 2270 kcal. The authors also found that 75% of individual sampled meals contained at least 50% of the daily energy requirement.

Overall, this study provides overwhelming evidence that “dining out” entails consuming food with energy content more than what our bodies need. One should pay more attention to how many calories are in the meals ordered in restaurants, regardless of its type (fast-food, small chain, or even independent), or cuisine. But this can’t be done without data. Restaurants should provide nutrition labels on their menus to help diners decide what to eat, and advocate for healthy choices.

The study authors concluded:

A national requirement for accurate calorie labeling in all restaurants may discourage menus offering unhealthy portions and would allow consumers to make informed choices about ordering meals that promote weight gain and obesity.

PS: If you are interested to know how many calories your need based on your BMI and Physical Activity Level (PAL), check this link from the Food and Agriculture Organization of the United Nations. 

Soduim Content in Foods is Almost Constant!

No doubt that sodium is an important risk factor for hypertension. The American Heart Association estimates that there are 78 million adults in the US (1 in 3) have high blood pressure. In a workshop organized by the National Heart, Lung, and Blood Institute (NHLBI) on sodium and blood pressure, the report stated

“There is an abundance of scientific evidence demonstrating a direct relationship with sodium intake and blood pressure”.

I came across an interesting article published in JAMA Internal Medicine this week titled “Changes in Sodium Levels in Processed and Restaurant Foods, 2005 to 2011”. Dr. Stephen Havas from Northwestern University Feinberg School of Medicine, and his colleagues collected the sodium content data in processed food from the nutrition facts label in 2005, and recollected the same data for the same food products in 2011.

The main finding with their analysis is that the sodium content in the 402 processed food products declined by only 3.5% over 6 years. On the other hand, the sodium content in 78 fast-food restaurants’ products increased by 2.6%. Table 1 in their paper shows that Caesar salad dressing and Turkey breasts are the top 2 food categories, with highest sodium content in 2005 to 2011. Canned tuna fish, canned tomato, sliced turkey breast, and vegetable soup had the highest decline of the sodium content by about 22%, from 2005 to 2011. For the rest of the processed foods, the sodium content either remained constant or changed by ±2%.

Among the restaurant foods, the sodium content in the French fries increased by 27% from 2005 to 2011. Cheese pizza’s sodium content increased by about 12% in the same period.

The authors outlined in Table 3 the names of some companies that committed to reduce sodium levels in their products. For example, the Domino’s Pizza committed to decrease the sodium content in the smart pizza slice for schools by a third. Wal-Mart committed to reduce sodium by 70% in fresh steaks and roasts.

The authors concluded that 

“It is clear from this analysis that reductions in sodium content in both processed and restaurant foods are both inconsistent and slow”

I think it is a time for the local, state and federal government to look into new ways to enforce sodium content reduction in processed and restaurant foods to alleviate the burden of preventable diseases (like hypertension). This could be similar to what Mayor Michael Bloomberg did by prohibiting the sale of soda cans more than 16 ounces. Although there has been a resistance against the implementation of this bill, public health advocates has long way to go.