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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.
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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.

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Figures

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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

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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.

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