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Americans got about one in five calories from dining out, either in restaurants or fast-food joints, in the period between 2003 and 2016. And while those meals may have been convenient, fun, and even tasty, they typically weren’t very healthy, according to new research from Tufts University.

At fast-food restaurants, 70 percent of the meals Americans consumed were of poor dietary quality in 2015-16, down from 75 percent in 2003-2004. At full-service restaurants about 50 percent were of poor quality, about the same as in 2003-2004, according to the study by researchers at Friedman School of Nutrition Science and Policy at Tufts University, which was published Wednesday in the Journal of Nutrition.

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“Our findings show dining out is a recipe for unhealthy eating most of the time,” Dariush Mozaffarian, senior author and dean of the Friedman School, said in a statement.

Are there restaurants that serve extremely healthful food? Few and far between, apparently. Less than 0.1 percent of the meals consumed while dining out were rated as “ideal” in quality, the researchers said.

The problem has serious implications, the researchers noted. “Our food is the number one cause of poor health in the country, representing a tremendous opportunity to reduce diet-related illness and associated health care spending,” Mozaffarian said.

The researchers said it would help if restaurants used more healthful ingredients and cut back on the salt.

“We found the largest opportunities for enhancing nutritional quality would be adding more whole grains, nuts and legumes, fish, and fruits and vegetables to meals while reducing salt,” first author Junxiu Liu, a postdoctoral scholar at the Friedman School, said in the statement.

One of the study’s concrete suggestions: “Potential strategies could include altering the ‘default’ sides for major menu items, e.g., offering fruits or vegetables in exchange for french fries.”

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The study looked at the dietary selections of more than 35,000 US adults from the National Health and Nutrition Examination Survey from 2003 to 2016. The researchers graded what people ate, based on the American Heart Association 2020 diet score.

The researchers also found that some groups ate healthier over time, but others did not make progress. For example, the quality of fast-food meals consumed by non-Hispanic whites and Mexican-Americans improved, but there was no change in the quality of such meals consumed by non-Hispanic Blacks. The study also found that over the study years people with college degrees were getting better-quality fast-food meals, but people with only a high school education continued to eat a high percentage of poor-quality fast-food.

“These findings highlight the specific challenges and opportunities for improving the nutritional quality of restaurant meals consumed by US adults, which could be achieved by separate or joint actions by consumers, governments, and the restaurant industry,” the study said.

Dietitian Audrey Koltun, from Cohen Children’s Medical Center in Lake Success, N.Y., told US News & World Report, “Most restaurants — but not all — do have healthy, or at least somewhat better options. if one chooses. There have been trends focusing on healthier kids meals, whole grains and vegetarian options, but people want to eat what they want when eating out or getting take-out.”


Martin finucane can be reached at martin.finucane@globe.com