Changes in the Energy and Sodium Content of Main Entrées in US Chain Restaurants from 2010 to 2011

Published:October 03, 2013DOI:



      The food environment shapes individual diets, and as food options change, energy and sodium intake may also shift. Understanding whether and how restaurant menus evolve in response to labeling laws and public health pressures could inform future efforts to improve the food environment.


      To track changes in the energy and sodium content of US chain restaurant main entrées between spring 2010 (when the Affordable Care Act was passed, which included a federal menu labeling requirement) and spring 2011.


      Nutrition information was collected from top US chain restaurants' websites, comprising 213 unique brands. Descriptive statistics and regression analysis evaluated change across main entrées overall and compared entrées that were added, removed, and unchanged. Tests of means and proportions were conducted for individual restaurant brands to see how many made significant changes. Separate analyses were conducted for children's menus.


      Mean energy and sodium did not change significantly overall, although mean sodium was 70 mg lower across all restaurants in added vs removed menu items at the 75th percentile. Changes were specific to restaurant brands or service model: family-style restaurants reduced sodium among higher-sodium entrées at the 75th percentile, but not on average, and entrées still far exceeded recommended limits. Fast-food restaurants decreased mean energy in children's menu entrées by 40 kcal. A few individual restaurant brands made significant changes in energy or sodium, but the vast majority did not, and not all changes were in the healthier direction. Among those brands that did change, there were slightly more brands that reduced energy and sodium compared with those that increased it.


      Industry marketing and pledges may create a misleading perception that restaurant menus are becoming substantially healthier, but both healthy and unhealthy menu changes can occur simultaneously. Our study found no meaningful changes overall across a 1-year time period. Longer-term studies are needed to track changes over time, particularly after the federal menu labeling law is implemented.


      To read this article in full you will need to make a payment


        • Brownell K.D.
        • Kersh R.
        • Ludwig D.S.
        • et al.
        Personal responsibility and obesity: A constructive approach to a controversial issue.
        Health Aff. 2010; 29: 379-387
        • Brownell K.D.
        Thinking forward: The quicksand of appeasing the food industry.
        PLoS Med. 2012; 9: e1001254
      1. US Department of Agriculture, Economic Research Service. Table 10—Food away from home as a share of food expenditures. Updated February 14, 2013. Accessed February 26, 2013.

      2. Lin BH, Guthrie J. Nutritional quality of food prepared at home and away from home, 1977-2008. Updated December 27, 2012. Accessed March 11, 2013.

        • Wu H.W.
        • Sturm R.
        What's on the menu? A review of the energy and nutritional content of US chain restaurant menus.
        Public Health Nutr. 2013; 16: 87-96
        • Cohen D.A.
        • Bhatia R.
        Nutrition standards for away-from-home foods in the USA.
        Obes Rev. 2012; 13: 618-629
      3. Jones-Mueller A. NRA CEO Dawn Sweeney addresses nutrition, menu labeling. Updated November 12, 2012. Accessed June 12, 2013.

        • Wootan M.G.
        Nutritional quality of menu offerings at eight fast-food chains in the U.S.: A commentary.
        Am J Prev Med. 2013; 44: 690-691
      4. Patient Protection and Affordable Care Act, Public Law 111–148, sec. 4205-nutrition labeling of standard menu items at chain restaurants. March 23, 2010. Accessed August 21, 2013.

      5. National Restaurant Association. Updated 2013. Accessed September 11, 2013.

      6. Restaurants & Institutions Magazine. 2009 Top 400 restaurant chains. Updated July 15, 2009. Accessed February 17, 2010.

      7. Infousa USA business list. 2010. Accessed April 4, 2011.

      8. California Conference of Directors of Environmental Health. California menu labeling guidelines. Updated July 2009. Accessed July 27, 2012.

      9. Research Report for Foodservice. Accessed March 15, 2011.

      10. Healthy Dining Finder nutrition criteria. Updated 2011. Accessed July 22, 2012.

      11. Nutrition and Your Health: Dietary Guidelines for Americans, 2010. US Government Printing Office, Washington, DC2010
        • Harnack L.
        • French S.
        Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices: A review of the literature.
        Int J Behav Nutr Phys Act. 2008; 5: 51
        • Harnack L.
        • French S.
        • Oakes J.
        • et al.
        Effects of calorie labeling and value size pricing on fast food meal choices: Results from an experimental trial.
        Int J Behav Nutr Phys Act. 2008; 5: 63
        • Roberto C.
        • Larsen P.
        • Agnew H.
        • Baik J.
        • Brownell K.
        Evaluating the impact of menu labeling on food choices and intake.
        Am J Public Health. 2010; 100: 312-318
        • Tandon P.S.
        • Zhou C.
        • Chan N.L.
        • et al.
        The impact of menu labeling on fast-food purchases for children and parents.
        Am J Prev Med. 2011; 41: 434-438
        • Elbel B.
        • Kersh R.
        • Brescoll V.
        • Dixon L.
        Calorie labeling and food choices: A first look at the effects on low-income people in New York City.
        Health Aff. 2009; 28: w1110-w1121
        • Elbel B.
        • Gyamfi J.
        • Kersh R.
        Child and adolescent fast-food choice and the influence of calorie labeling: A natural experiment.
        Int J Obes. 2011; 35: 493-500
        • Vadiveloo M.K.
        • Dixon L.B.
        • Elbel B.
        Consumer purchasing patterns in response to calorie labeling legislation in New York City.
        Int J Behav Nutr Phys Act. 2011; 8: 51-60
        • Finkelstein E.A.
        • Strombotne K.L.
        • Chan N.L.
        • Krieger J.
        Mandatory menu labeling in one fast-food chain in King County, Washington.
        Am J Prev Med. 2011; 40: 122-127
        • Bruemmer B.
        • Krieger J.
        • Saelens B.E.
        • Chan N.
        Energy, saturated fat, and sodium were lower in entrées at chain restaurants at 18 months compared with 6 months following the implementation of mandatory menu labeling regulation in King County.
        Washington. J Acad Nutr Diet. 2012; 112: 1169-1176
        • Saelens B.E.
        • Chan N.L.
        • Krieger J.
        • et al.
        Nutrition-labeling regulation impacts on restaurant environments.
        Am J Prev Med. 2012; 43: 505-511
        • Bauer K.W.
        • Hearst M.O.
        • Earnest A.A.
        • et al.
        Energy content of U.S. fast-food restaurant offerings: 14-year trends.
        Am J Prev Med. 2012; 43: 490-497
        • Namba A.
        • Auchincloss A.
        • Leonberg B.L.
        • Wootan M.G.
        Exploratory analysis of fast-food chain restaurant menus before and after implementation of local calorie-labeling policies, 2005-2011.
        Prev Chronic Dis. 2013; 10: E101
        • Van Camp D.
        • Hooker N.H.
        • Lin C.
        Changes in fat contents of US snack foods in response to mandatory trans fat labelling.
        Public Health Nutr. 2012; 15: 1130-1137
        • Wansink B.
        • Sobal J.
        Mindless eating: The 200 daily food decisions we overlook.
        Environ Behav. 2007; 39: 106-123
        • Saelens B.
        • Glanz K.
        • Sallis J.
        • Frank L.
        Nutrition Environment Measures Study in Restaurants (NEMS-R): Development and evaluation.
        Am J Prev Med. 2007; 32: 273-281
      12. Remarks by the First Lady in address to the National Restaurant Association meeting. Updated September 13, 2010. Accessed March 7, 2013.

        • Urban L.
        • Dallal G.
        • Robinson L.
        • et al.
        The accuracy of stated energy contents of reduced-energy, commercially prepared foods.
        J Am Diet Assoc. 2010; 110: 116-123


      H. W. Wu is a policy and research analyst, Institute for Population Health Improvement, University of California, Davis, Health System, Sacramento; at the time of the study, she was a doctoral fellow, Pardee RAND Graduate School, Santa Monica, CA.


      R. Sturm is a senior economist, RAND Corporation, Santa Monica, CA.