Food and Health

Trends in the healthiness of U.S. fast food meals, 2008–2017



This study aimed to examine trends in the healthiness of U.S. fast food restaurant meals from 2008 to 2017, using the American Heart Association’s Heart-Check meal certification criteria.


Data were obtained from MenuStat, an online database of the leading 100 U.S. restaurant chains menu items, for the years 2008 and 2012 through 2017. All possible meal combinations (entrées + sides) were created at the 20 fast food restaurants that reported entrée and side calories, total fat, saturated fat, trans fat, cholesterol, sodium, protein, and fiber. Chi-square tests compared the percent of meals meeting each American Heart Association (AHA) nutrient criterion; and the number of AHA criteria met for each year, by menu focus type.


Compared with 2008, significantly fewer fast food meals met the AHA calorie criterion in 2015, 2016, and 2017, and significantly fewer met the AHA total fat criterion in 2015 and 2016. Significantly more meals met the AHA trans fat criterion from 2012 to 2017, compared to 2008. There were no significant changes over time in the percent of meals meeting AHA criteria for saturated fat, cholesterol, or sodium.


Efforts to improve the healthiness of fast food meals should focus on reducing calories, total fat, saturated fat, and sodium.

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  1. 1.

    Centers for Disease Control and Prevention. Adult Obesity Facts 2018.

  2. 2.

    CDC. FastStats - Leading Causes of Death 2018 [updated 2018-09-11.

  3. 3.

    CDC. Salt 2018 [updated 2018-10-05.

  4. 4.

    Rosenheck R. Fast food consumption and increased caloric intake: a systematic review of a trajectory towards weight gain and obesity risk. Obes Rev. 2008;9:535–47.

    CAS  Article  Google Scholar 

  5. 5.

    Todd JE. Changes in consumption of food away from home and intakes of energy and other nutrients among US working-age adults, 2005–2014. Public Health Nutr. 2017;20:3238–46.

    Article  Google Scholar 

  6. 6.

    Duffey KJ, Gordon-Larsen P, Jacobs DR Jr, Williams OD, Popkin BM. Differential associations of fast food and restaurant food consumption with 3-y change in body mass index: the Coronary Artery Risk Development in Young Adults Study. Am J Clin Nutr. 2007;85:201–8.

    CAS  Article  Google Scholar 

  7. 7.

    Bowman SA, Vinyard BT. Fast food consumption of U.S. adults: impact on energy and nutrient intakes and overweight status. J Am Coll Nutr. 2004;23:163–8.

    Article  Google Scholar 

  8. 8.

    Pereira MA, Kartashov AI, Ebbeling CB, Van Horn L, Slattery ML, Jacobs DR Jr, et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet. 2005;365:36–42.

    Article  Google Scholar 

  9. 9.

    An R. Fast-food and full-service restaurant consumption and daily energy and nutrient intakes in US adults. Eur J Clin Nutr. 2016;70:97–103.

    CAS  Article  Google Scholar 

  10. 10.

    Fryar CD, Hughes JP, Herrick KA, Ahluwalia N. Fast food consumption among adults in the United States, 2013–2016. Hyattsville, MD: National Center for Health Statistics; 2018. Contract No.: 322

    Google Scholar 

  11. 11.

    Andrews C The most iconic fast food items in America: USA Today; 2020.

  12. 12.

    Jacobson MF, Havas S, McCarter R. Changes in sodium levels in processed and restaurant foods, 2005 to 2011. JAMA Intern Med. 2013;173:1285–91.

    CAS  Article  Google Scholar 

  13. 13.

    Bauer KW, Hearst MO, Earnest AA, French SA, Oakes JM, Harnack LJ. Energy content of US fast-food restaurant offerings: 14-year trends. Am J Prev Med. 2012;43:490–7.

    Article  PubMed Central  Google Scholar 

  14. 14.

    Urban LE, Roberts SB, Fierstein JL, Gary CE, Lichtenstein AH. Temporal trends in fast-food restaurant energy, sodium, saturated fat, and trans fat content, United States, 1996–2013. Prev Chronic Dis. 2014;11:E229.

    PubMed Central  Google Scholar 

  15. 15.

    Jarlenski MP, Wolfson JA, Bleich SN. Macronutrient composition of menu offerings in fast food restaurants in the U.S. Am J Prev Med. 2016;51:e91–7.

    Article  Google Scholar 

  16. 16.

    Rudelt A, French S, Harnack L. Fourteen-year trends in sodium content of menu offerings at eight leading fast-food restaurants in the USA. Public Health Nutr. 2014;17:1682–8.

    Article  PubMed Central  Google Scholar 

  17. 17.

    Eyles H, Jiang Y, Blakely T, Neal B, Crowley J, Cleghorn C, et al. Five year trends in the serve size, energy, and sodium contents of New Zealand fast foods: 2012 to 2016. Nutr J. 2018;17:65.

    Article  PubMed Central  Google Scholar 

  18. 18.

    Wolfson JA, Moran AJ, Jarlenski MP, Bleich SN. Trends in sodium content of menu items in large chain restaurants in the U.S. Am J Prev Med. 2018;54:28–36.

    Article  Google Scholar 

  19. 19.

    Hearst MO, Harnack LJ, Bauer KW, Earnest AA, French SA, Oakes JM. Nutritional quality at eight US fast-food chains: 14-year trends. Am J Prev Med. 2013;44:589–94.

    Article  PubMed Central  Google Scholar 

  20. 20.

    United States Department of Agriculture. Healthy Eating Index 2019. Available from:

  21. 21.

    Bruemmer B, Krieger J, Saelens BE, Chan N. Energy, saturated fat, and sodium were lower in entrees 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 Dietetics. 2012;112:1169–76.

    Article  Google Scholar 

  22. 22.

    Schoffman DE, Davidson CR, Hales SB, Crimarco AE, Dahl AA, Turner-McGrievy GM. The fast-casual conundrum: fast-casual restaurant entrees are higher in calories than fast food. J Acad Nutr Dietetics. 2016;116:1606–12.

    Article  Google Scholar 

  23. 23.

    Wu HW, Sturm R. Changes in the energy and sodium content of main entrees in US chain restaurants from 2010 to 2011. J Acad Nutr Dietetics. 2014;114:209–19.

    Article  Google Scholar 

  24. 24.

    Auchincloss AH, Leonberg BL, Glanz K, Bellitz S, Ricchezza A, Jervis A. Nutritional value of meals at full-service restaurant chains. J Nutr Educ Behav. 2014;46:75–81.

    Article  Google Scholar 

  25. 25.

    Scourboutakos MJ, Semnani-Azad Z, L’Abbe MR. Restaurant meals: almost a full day’s worth of calories, fats, and sodium. JAMA Intern Med. 2013;173:1373–4.

    Article  Google Scholar 

  26. 26.

    Dumanovsky T, Huang CY, Nonas CA, Matte TD, Bassett MT, Silver LD. Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: cross sectional customer surveys. BMJ (Clin Res ed). 2011;343:d4464.

    Article  Google Scholar 

  27. 27.

    Nation’s Restaurant News. 2017 Top 100: Chain Performance Nation’s Restaurant News, 2017.

  28. 28.

    Bleich SN, Wolfson JA, Jarlenski MP, Block JP. Restaurants with calories displayed on menus had lower calorie counts compared to restaurants without such labels. Health Aff (Proj Hope). 2015;34:1877–84.

    Article  Google Scholar 

  29. 29.

    MenuStat. MenuStat Methods. 2019.

  30. 30.

    American Heart Association. Heart-Check Meal Certification Program Nutrition Requirements. 2018.

  31. 31.

    Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). What We Eat in America, NHANES 2015–2016. 2017.

  32. 32.

    US Department of Health and Human Services. US Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th ed. Washington, DC: US Dept of Health and Human Services; 2015.

    Google Scholar 

  33. 33.

    Appel LJ, Frohlich ED, Hall JE, Pearson TA, Sacco RL, Seals DR, et al. The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association. Circulation 2011;123:1138–43.

    Article  Google Scholar 

  34. 34.

    World Health Organization. Sodium intake for adults and children. 2020.

  35. 35.

    European Commission Health Promotion and Disease Prevention Knowlege Gateway. Dietary salt/sodium. 2020.

  36. 36.

    Quader ZS, Zhao L, Gillespie C, Cogswell ME, Terry AL, Moshfegh A, et al. Sodium intake among persons aged >/=2 years - United States, 2013–2014. MMWR Morbidity Mortal Wkly Rep. 2017;66:324–238.

    Article  Google Scholar 

  37. 37.

    Moran AJ, Ramirez M, Block JP. Consumer underestimation of sodium in fast food restaurant meals: Results from a cross-sectional observational study. Appetite. 2017;113:155–61.

    Article  PubMed Central  Google Scholar 

  38. 38.

    New York City Department of Health and Mental Hygeine. New Sodium (Salt) Warning Rule: What Food Service Establishments Need to Know. 2016.

  39. 39.

    Byrd K, Almanza B, Ghiselli RF, Behnke C, Eicher-Miller HA. Adding sodium information to casual dining restaurant menus: Beneficial or detrimental for consumers? Appetite. 2018;125:474–85.

    Article  PubMed Central  Google Scholar 

  40. 40.

    New York City Department of Health and Mental Hygeine. The Regulation to Phase Out Artificial Trans Fat In New York City Food Service Establishments

  41. 41.

    AB-97 Food facilities: trans fats., California Legislature (2008).

  42. 42.

    FDA. Food Additives & Ingredients - Final Determination Regarding Partially Hydrogenated Oils (Removing Trans Fat) [WebContent]. Center for Food Safety and Applied Nutrition; 2019. Available from:

  43. 43.

    Angell SY, Cobb LK, Curtis CJ, Konty KJ, Silver LD. Change in trans fatty acid content of fast-food purchases associated with New York City’s restaurant regulation: a pre-post study. Ann Intern Med. 2012;157:81–6.

    Article  Google Scholar 

  44. 44.

    Patient Protection and Affordable Care Act (2010).

  45. 45.

    Food and Drug Administration. Food Labeling; Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments. 2014.

  46. 46.

    Krieger JW, Chan NL, Saelens BE, Ta ML, Solet D, Fleming DW. Menu labeling regulations and calories purchased at chain restaurants. Am J Prevent Med. 2013;44:595–604.

    Article  Google Scholar 

  47. 47.

    Finkelstein EA, Strombotne KL, Chan NL, Krieger J. Mandatory menu labeling in one fast-food chain in King County, Washington. Am J Prev Med. 2011;40:122–7.

    Article  Google Scholar 

  48. 48.

    Namba A, Auchincloss A, Leonberg BL, Wootan MG. 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.

    Article  PubMed Central  Google Scholar 

  49. 49.

    Tandon PS, Zhou C, Chan NL, Lozano P, Couch SC, Glanz K, et al. The impact of menu labeling on fast-food purchases for children and parents. Am J Prevent Med. 2011;41:434–8.

    Article  Google Scholar 

  50. 50.

    Elbel B, Kersh R, Brescoll VL, Dixon LB. Calorie labeling and food choices: a first look at the effects on low-income people in New York City. Health Aff (Proj Hope). 2009;28:w1110–21.

    Article  Google Scholar 

  51. 51.

    Wellard-Cole L, Goldsbury D, Havill M, Hughes C, Watson WL, Dunford EK, et al. Monitoring the changes to the nutrient composition of fast foods following the introduction of menu labelling in New South Wales, Australia: an observational study. Public Health Nutr. 2018;21:1194–9.

    Article  Google Scholar 

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We thank the New York City Department of Health and Mental Hygiene for the MenuStat data.

Author information




All authors contributed to the design of the study. EA led secondary data analysis and manuscript writing. EEM, LR, KG, and JEC contributed revisions to the manuscript and approved the final manuscript for submission.

Corresponding author

Correspondence to Eleanore Alexander.

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The authors declare that they have no conflict of interest.


This study was deemed Exempt by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board.

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Alexander, E., Rutkow, L., Gudzune, K.A. et al. Trends in the healthiness of U.S. fast food meals, 2008–2017. Eur J Clin Nutr (2020).

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