Original Investigation | Health Care Reform

The Energy Content of Restaurant Foods Without Stated Calorie Information

Lorien E. Urban, PhD1; Alice H. Lichtenstein, DSc1; Christine E. Gary, MS1; Jamie L. Fierstein, MS1; Ashley Equi, BS1; Carolyn Kussmaul, BS1; Gerard E. Dallal, PhD1; Susan B. Roberts, PhD1
[+] Author Affiliations
1Energy Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
JAMA Intern Med. 2013;173(14):1292-1299. doi:10.1001/jamainternmed.2013.6163.
Text Size: A A A
Published online

Importance  National recommendations for the prevention and treatment of obesity emphasize reducing energy intake through self-monitoring food consumption. However, little information is available on the energy content of foods offered by nonchain restaurants, which account for approximately 50% of restaurant locations in the United States.

Objective  To measure the energy content of foods from independent and small-chain restaurants that do not provide stated information on energy content.

Design  We used bomb calorimetry to determine the dietary energy content of the 42 most frequently purchased meals from the 9 most common restaurant categories. Independent and small-chain restaurants were randomly selected, and 157 individual meals were analyzed.

Setting  Area within 15 miles of downtown Boston.

Participants  A random sample of independent and small-chain restaurants.

Main Outcomes and Measures  Dietary energy.

Results  All meal categories provided excessive dietary energy. The mean energy content of individual meals was 1327 (95% CI, 1248-1406) kcal, equivalent to 66% of typical daily energy requirements. We found a significant effect of food category on meal energy (P ≤ .05), and 7.6% of meals provided more than 100% of typical daily energy requirements. Within-meal variability was large (average SD, 271 kcal), and we found no significant effect of restaurant establishment or size. In addition, meal energy content averaged 49% greater than those of popular meals from the largest national chain restaurants (P < .001) and in subset analyses contained 19% more energy than national food database information for directly equivalent items (P < .001).

Conclusions and Relevance  National chain restaurants have been criticized for offering meals with excess dietary energy. This study finds that independent and small-chain restaurants, which provide no nutrition information, also provide excessive dietary energy in amounts apparently greater than popular meals from chain restaurants or information in national food databases. 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.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours


Place holder to copy figure label and caption
Figure 1.
Mean (SD) Gross Energy of the Most Popular Meals in the Most Prevalent Independent Restaurant Categories

Meal types within each category are in the same order as those in Table 1, and statistical comparisons are described in Table 1. The dotted line represents one-third of the mean daily energy requirement for the average adult (667 kcal).21

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Gross Energy of the Entrees Measured in This Study, Matching Entrees in Top National Chain Restaurants, All Entrees Measured in This Study, and the Most Popular Entrees Overall From the Top 9 US National Chain Restaurants

Solid lines are means.

Graphic Jump Location




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles