Despite public health progress in cutting calories, as well as salt and fat
from fast foods and supermarket products, neighborhood
restaurants
are still packing big helpings of each into their meals, a trio of studies
suggests.
Small independent eateries are not required to display nutritional
information for consumers - if they did, the researchers report, patrons would
routinely see single meals containing nearly a full day's worth of calories and
fat plus one and half times the daily recommended intake for salt.
"It's really a disgrace. Every day the newspapers say things about the
obesity epidemic… To a large extent, you can trace that to too many
calories," said Susan Roberts, director of the U.S. Department of
Agriculture Energy Metabolism Lab and professor of nutrition at
Tufts University,
in
Boston.
About two thirds of Americans are considered overweight or obese, according
to the U.S. National Institutes of Health. And as American waistlines continue
to expand, public health policy has focused on the quality of food available in
supermarkets and
restaurants.
President
Barack Obama's
2010 Affordable Care Act, for example, contains a requirement that restaurants
with at least 20 outlets in the
U.S.
make their nutritional information available to customers.
But one of three new studies published in JAMA Internal Medicine on Monday
points out that policy only applies to about half of the nation's restaurants.
The other half is made up of smaller chains or independent restaurants exempt
from the requirement.
For their analysis, Roberts and her colleagues measured the calories in 157
meals at small Mexican, American, Chinese, Italian, Japanese and Thai
restaurants in and near
Boston
between June and August 2011.
Overall, the researchers found the average meal at those restaurants
contained 1,327 calories. That's about 66 percent of the 2,000 daily calories
recommended by the U.S. Food and Drug Administration.
About 8 percent of the meals exceeded 2,000 calories.
The meals from small restaurants also contained up to 18 percent more
calories than comparable dishes from larger chains - suggesting the requirement
to display nutritional information is keeping the large-chain restaurant meals
healthier, according to the researchers.
In another of the studies published Monday, Canadian researchers led by Mary
Scourboutakos from the University of Toronto found similarly high calorie
counts in more than 3,500 meals from Ontario restaurants they analyzed.
What's more, Scourboutakos and her fellow researchers found that individual
meals contained an average of 89 percent of the daily recommended amount of fat
and 151 percent of the daily recommended amount of salt.
A third study also zeroed-in on salt as a major area of concern.
Several organizations, including the U.S. Department of Agriculture, the
Department of Health and Human Services, the American Medical Association, the
American Heart Association and the World Health Organization have all called
for reductions in the amount of sodium people consume.
The
Institute
of Medicine recommends
that most healthy people get 1,500 milligrams (mg) of sodium per day, with an
upper limit of 2,300 mg. But the average American eats closer to 3,600 mg each
day, largely in processed foods.
For their new study, Dr. Stephen Havas of the Northwestern University
Feinberg School of Medicine in
Chicago
and his colleagues analyzed 402 processed foods and 78 fast-food products to
see if their salt content had changed between 2005 and 2011.
They found a small decrease in the amount of salt in processed foods over
that period but also a similarly-sized increase in the amount of salt in
fast-food products. The differences in each category, however, were small
enough that they could have been due to chance.
Havas said the results show that the calls for voluntary reductions in salt
have been a "total failure."
"The only thing that will solve this problem is for the amount of salt
in our food to be regulated," he added.
But regulating food and what goes into it has been a controversial topic,
according to Dr. Mitchell Katz, from the Los Angeles County Department of
Health Services in
California.
Instead, he suggests in a commentary accompanying the three studies that
doctors should advocate for their patients' right to know what they're eating.
"As we debate the controversial role of government in stemming the
interrelated endemics of obesity, diabetes mellitus, and heart disease, we must
insist on the right of our patients (as well as ourselves) to know what we are
eating, whether fast food or slow, whether large chain, small chain, or
individual restaurant," he wrote.
One encouraging finding from the study of Toronto restaurant meals
highlighted by Scourboutakos and her colleagues is that entrees identified on
the restaurant menus as "healthy" were generally at least healthier -
with about 474 calories, 20 percent of the day's value of fat and 50 percent of
the recommended daily intake of sodium.
Roberts told Reuters Health she'd like to see restaurants add a few healthy
choice options to their menu to at least give people an alternative.
"That would mean the restaurant doesn't have to calculate the whole
menu and that would give people choices," she said.