Measured energy content of frequently purchased restaurant meals: multi-country cross sectional studyBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4864 (Published 12 December 2018) Cite this as: BMJ 2018;363:k4864
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‘Measured energy content of frequently purchased restaurant meals: multi-country cross sectional study’, by Roberts et al¹ conducted in five countries, shows that the energy content of meals served by both fast food and full service restaurants was generally excessive. They conclude that meals consumed in both types of restaurant may contribute to the overall obesity pandemic.
The study also seems to show that full service restaurant meals had an average dietary energy content higher than that estimated for fast food meals in Brazil, the US and China. But limitations of the study design, and problems with interpretation of the findings, make this conclusion questionable.
Firstly, ‘meals’ were poorly defined in the study. It is not clear whether they were defined in the same way in full service and fast food restaurants. For instance, the selection of the ‘bestseller meal’ in each type of restaurant in Brazil compared ‘complete’ (or ‘main’) meals served in full service restaurants such as combinations of rice, beans and other foods with snack meals such as fried chicken or ground beef croquettes.
Secondly, the study does not take into account differences in amounts of leftovers in full service and fast food restaurants. These tend to be larger when the meals have higher weights, since satiety control is strongly regulated by food volume 2. In Brazil, the US and China, full-service meals weighed more than fast food meals. In China (the country with the largest differences between restaurant types), customers typically take full service restaurants' leftovers home. It is unclear how the authors deal with this issue in their analyses.
Thirdly, the exclusion of side dishes such as drinks and desserts may also unevenly underestimate the energy content in each type of restaurant. Fast food restaurants often stimulate consumption of such items. 3,4,5
Fourthly, and most important, the study does not take into account what the people studied consumed for the rest of the day. Ultra-processed foods, typically served in fast food settings, are less satiating than meals made up from minimally processed foods and culinary ingredients that are typically served in full service restaurants. 6,7
Maria Laura da Costa Louzada1,2, Renata Bertazzi Levy1,3, Geoffrey Cannon1, Carlos Augusto Monteiro1,4
1Center for Epidemiological Research in Health and Nutrition, University of São Paulo, São Paulo 01246-906, Brazil
2 Department of Public Policies and Collective Health, Federal University of São Paulo, São Paulo 11015-020, Brazil
3 Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
4 Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
1 - Roberts SB, Das SK, Suen VMM. Measured energy content of frequently purchased restaurant meals: multi-country cross sectional study. BMJ. 2018;363:k4864.
2 – Rolls BJ. The relationship between dietary energy density and energy intake. Physiol Behav 2009;97(5):609-15.
3- Basch CH, Ethan D, Rajan S. Price, promotion, and availability of nutrition information: a descriptive study of a popular fast food chain in New York City. Glob J Health Sci. 2013;5(6):73-80.
4- Lee-Kwan SH, Goedkoop S, Yong R et al. Development and implementation of the Baltimore healthy carry-outs feasibility trial: process evaluation results. BMC Public Health. 2013;13:638.
5- Mazariegos S, Chacón V, Cole A, Barnoya J. Nutritional quality and marketing strategies of fast food children's combo meals in Guatemala. BMC Obes, 2016, 3:52. eCollection.
6- Fardet A.. Minimally processed foods are more satiating and less hyperglycemic than ultra-processed foods: a preliminary study with 98 ready-to-eat foods. Food Funct, 2016;7(5):2338-46.
7- Ludwig GDS. Technology, diet, and the burden of chronic disease. JAMA, 2011;305(13):1352-3.
Competing interests: No competing interests
Re: Measured energy content of frequently purchased restaurant meals: multi-country cross sectional study
The energy content of meals ordered in restaurants in four of the five different countries are higher than normal excepting for China. Many or most of us are dependent upon such restaurants for our daily food and nutrition. In a very competitive world both men and women work and find little time to cook their own meals or care to prepare food that is possibly healthy and suits the individual 's need. With a heavy workload, sometimes the taste of the food supplied and the avaricious longing to eat do play a very great role in our daily nutrition. The development of corporate culture and fast lifestyles have taken away the home food atmosphere in many countries, particularly in India. The tradition of cooking meals in mud pots, serving food with balanced nutrition, the availability of unadulterated groceries, the personal touch and supervision of a family member used to satisfy the taste and the requirements of good nutrition in an extended family in India. Food adulteration, unhygienic preparation and the neglect of health during the vigorous earning stage of adults end up in possible in obesity and other health related issues.
Designer foods and packed food items with chemicals added to prolong shelf life are some of the factors that may add to the woes of restaurant food. Not many restaurants one eats at have five star or seven stars rating. Most middle class people eat in smaller restaurants and many take their food in road side eateries. It is economical and affordable. The chemicals added to the food items to control satiety, pesticides, polishing of grains including rice all add up to the woes of the common man's health hazards. Therefore, restaurant food components are added to calculate the energy intake. One must also take into consideration other variables, the quality of food, the health of the cooks who prepare such food and the cost of the food items served. Food has to be the gourmet's delight and not the glutton's greed.
Prayers and wishes for a very happy Christmas and New Year to all editors, editorial staff, authors and readers of BMJ. Let us pray that all get their fair share of food and nutrition. Let food not become a luxury but a necessity for our healthy survival.
Competing interests: No competing interests