We’re bombarded with more messages to eat healthier — cut back on salt, fat, and sugar — and more products help us do so. But restaurants, fast food chains and food manufacturers aren’t making it easy to eat smarter.
Large restaurant chains have started listing calorie counts alongside their menu items, and fast food outlets now have salads next to the burgers and fries. But the latest analysis of the slat, fat and calorie counts on the most popular items we like to eat shows they aren’t much healthier now than they were either years ago. Some products have become less salty and lighter, but the pace of change, say the study’s authors, is too slow to have a meaningful impact of the public’s health.
Last week, a 14-year study published in the journal JAMA Internal Medicine on the menu items at eight popular fast food chains found that the nutritional quality of the meals had improved by a disappointing three points, from 45 to 48 on a 100-point healthy eating scale, between 1997 and 2010.
Now, researchers leading two additional studies have come to similar conclusions. In the first study, also published in the journal JAMA Internal Medicine, scientists from the Center for Science and the Public Interest, a nutritional non-profit watchdog and consumer advocacy group, and the Northwestern University Feinberg School of Medicine reported that sodium levels in 402 processed and fast food items have been stubbornly inconsistent and slow to decline.
Relying on the nutritional labels of the packaged foods, and on information provided by restaurants on their meas, the investigators measured how much sodium appeared in the same products in 2005, 2008 and 2011. Between 2005 and 2011, sodium in 402 processed foods dropped by 3.5% overall, but that average hid widely divergent fluctuations in salt content in these foods over that time. And the sodium in meals from fast food chains actually went up by 2.6%. The authors write:
Although some products showed decreases of at least 30%, a greater number of products showed increases of at least 30%. The predominant finding is the absence of any appreciable or statistically significant changes in sodium content during 6 years.
According to the Dietary Guidelines for Americans, which was revised in 2010, the average American adult should consume more more than 1500 mg of salt a day. Most Americans now down more than twice that amount — 3300 mg per day — with about 11% coming from the salt shaker and 80% hidden in packaged, prepared or restaurant food.
Not surprisingly, all that added salt is driving up blood pressure for more than 65% of adults. Readings over 120/80 mm Hg can increase risk of having a heart attack or stroke by up to 2.5 times compared to those with normal pressure. But keeping sodium levels down, and within recommended guidelines is a challenge given its ubiquity in the foods we eat. “While in an ideal world that recommendation would be sufficient to lower blood pressure in the patient population, in the real world it places unrealistic demands on both patients and physicians given the high sodium levels present in processed and restaurant foods,” the authors write.
The lack of significant progress in reducing sodium in prepared and fast foods is particularly disturbing given that 33% of American’s daily calories come from meals eaten outside of the home. “To ask people to cook everything from scratch or read food labels religiously is a pain,” says study author Dr. Stephen Havas, a professor of preventive medicine at Northwestern University Feinberg School of Medicine. “Most people won’t do it, or they don’t know what to look for. I have heard the food industry argue for years why they don’t need to bring down sodium levels. They have been very resistant to change. They may say it costs too much money to change recipes. But the interesting thing is that if you look at cereals for example, the identical cereal in a place like Finland has lower sodium levels than in the U.S. How did they change those?”
And it’s not just salt that poses a continued nutritional problem. In another study published in JAMA Internal Medicine, researchers looked at the nutritional content of breakfast, lunch and dinner offerings from 19 sit-down restaurants and discovered that the amount of calories, fat, saturated fat, and sodium levels are alarmingly high in these restaurant meals.
The researchers, from the University of Toronto, Canada assessed the nutrition of 3507 different variations of 685 meals and 156 desserts. On average, each meal added up to about 1,128 calories, which is close to the average recommendation of 2,000 calories for an entire day. The breakdown of the other nutrients was also concerning, since the meals contained, on average, 151% of the sodium content an adult should consume in a day, 89% of the daily amount of fat, 83% of the daily amount of saturated and trans fats and 60% of the suggested daily cholesterol intake.
Based on these results, the researchers concluded that addressing the nutritional profiles of restaurant meals should be considered a major public health priority. They noted that trans fats were relatively low — thanks to aggressive public health campaigns to remove trans fats-containing oils from cooking — and meals that were advertised as healthy did have better nutrition overall. Last July, for example, a study published in the Annals of Internal Medicine showed that New York City’s ban on using artificial trans fats in restaurants helped residents to consume fewer trans fats and pick healthier options. Those trends hint that efforts to curb sodium and fat content in restaurant foods may be paying off.
But the changes are still glacial, and unlikely to have a huge impact on American’s health, say nutrition experts, unless more drastic measures are taken to alter the way restaurant and fast food meals are made. Stronger regulatory action such as New York City’s ban on trans fats might be needed to bring down the high sodium levels in processed and restaurant foods, for example, and the authors of the sodium study say that even gradual lowering of sodium levels could lead to considerable health benefits; if the sodium in packaged foods were reduced by 50%, more than 150,000 people could avoid a premature death from chronic conditions such as heart disease, hypertension or stroke.
Food manufacturers can also take a proactive role in reducing the sodium in their products, say the researchers, but they aren’t likely to do so unless prompted by federal policy. “The only thing that will solve this problem is federal regulation by the Food and Drug Administration (FDA). Then the food processing industry and the restaurant industry will have to pay attention,” says Havas.
With Americans spending 42% of their food dollar on packaged foods or meals outside of the home, finding ways to reduce fat, salt and calories in these foods is becoming more urgent in order to curb diet-related problems such as obesity and diabetes. Not every strategy may work — such as New York City Mayor Bloomberg’s recent foiled attempt to ban large-sized sodas, but the data clearly show that current methods aren’t going far enough to change the way Americans eat.