People eating hamburgers and fries at a restaurant

Half of the meals Americans order at sit-down restaurants and 70 percent of the ones they choose at fast-food establishments would get a failing grade for nutrition, according to a new study from Tufts University published in The Journal of Nutrition.

Researchers looked at trends in what adults ate when dining out between 2003 and 2016, using data from 35,000 participants in the National Health and Nutrition Examination Survey. They evaluated the meals on four health-enhancing elements (fruits and vegetables, whole grains, nuts, and seafood) and on four unhealthy ones (sugar-sweetened beverages, processed meats, sodium, and saturated fat). The researchers determined that the majority of the choices people made were of poor nutritional quality. Less than 1 percent of the meals met the criteria for “ideal” quality. 

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The impact this has on our overall diets, researchers say, is huge. “On any given day, nearly a third of American adults eat at a full-service restaurant, and nearly half at a fast-food restaurant,” says study author Dariush Mozaffarian, M.D., dean of the Friedman School of Nutrition Science and Policy at Tufts University in Boston. While the study looked at what people are eating, not what the restaurants offer, Mozaffarian says the findings indicate that major efforts are needed to improve the nutritional quality of what’s available on the menu, and what Americans choose.

“It was initially surprising that half of all full-service meals in the U.S. are of poor nutritional quality—one might have expected better quality—although perhaps less so when one considers what is served across restaurants in the U.S., and the epidemic of diet-related illness in our country,” he says.

Room for Improvement

Experts see many opportunities for restaurants to help consumers’ health through their offerings. What’s missing most often on restaurant menus, Mozaffarian says, is meals that feature the most nutritious components—whole grains, fish, seafood, legumes, nuts, and seeds, as well as fruits and vegetables. “Adding more healthy foods to restaurant meals while reducing salt is the biggest opportunity for improving their healthfulness,” he says.

The researchers did see some small positive changes over the 14-year period of the study. For example, in 2003, 75 percent of fast-food meals were ranked as poor, compared with 70 percent in 2016. And more of the meals people ordered in 2016 had whole grains, legumes, and nuts and seeds, Mozaffarian says. Unfortunately though, that was offset by a decrease in fruits and vegetables.

To some extent, it is easier today to find a healthier restaurant dish, says Amy Keating, R.D., a Consumer Reports nutritionist. “You didn’t have quinoa on the menu 10 years ago,” she says. But for every avocado-topped whole-grain bowl, Keating says, it seems you’ll find a new extra cheesy pizza or double burger with extra bacon. To make a difference in terms of health and what restaurants serve, consumers need to choose better-for-you options when available. “Both consumers and restaurants have responsibility here: Restaurants can’t serve what doesn’t sell, and consumers can’t buy what’s not on the menu,” Mozaffarian says.

Making Healthier Choices

So how do you do better with the options that are available to us today and encourage restaurants to introduce healthier menu items?

For starters, it’s important to get out of the special occasion mindset. “In this study, 21 percent of calories were eaten at restaurants and other estimates suggest it may be as much as a third of calories,” Keating says. “You can’t throw caution to the wind every time you go out to dinner, because people do it way too often.” Here are ways to stay mindful when you eat out.

Pick your pleasure . . . occasionally. Is there a less nutritious part of the meal that gives you the most enjoyment? Then go for it—and balance it out. If you are looking forward to french fries, pair them with a colorful salad topped with grilled salmon. If you’re really there for the burger, marry it with a cup of veggie-based soup instead of fries.  

Skip the sweetened beverages. Choose seltzer, unsweetened iced tea, or water with lemon instead of soda, fruit punch, or sweetened teas. 

Hold the salt. Ask for your meal to be prepared without salt. “Restaurant meals are typically really high in sodium, so you probably won’t get a low-sodium dish, but you can reduce it,” Keating says. 

Swap it up. Don’t be afraid to ask for substitutions. Maybe your entrée comes with a loaded baked potato—but garlic-steamed broccoli is also on the menu. Or the sandwich you want isn’t served on whole-grain bread, but another sandwich is. Ask for the trade that helps give your meal the balance it needs. 

Avoid processed meats. While restaurant meals aren’t a big source for most people, any processed meat is too much. Skip foods such as bacon, sausage, hot dogs, and cured meat in favor of unprocessed protein like grilled chicken, fish, or beans. 

Fill in the gaps. A nutritious meal includes fruits and vegetables, Keating says. But sometimes those options are simply not available at restaurants. If you find yourself with a produce-lacking meal, make up for it the rest of the day. Snack on crunchy bell pepper slices; choose clementines for dessert. “The best mindset is to think about healthy eating in its totality,” she says.