|Fast food is awesome.
You pull up in your car, speak into a microphone and in less than 30 seconds you are eating hot, tasty, inexpensive food. Fast food is any ready-to-eat food purchased and eaten away from home, including food from restaurants and convenience stores. Fast food is an American original; it was invented here. It reflects American attitudes and culture in that it embodies everything we value: it is tasty, convenient, inexpensive, and, most importantly, fast. Other factors in the popularity of fast food are that there is no preparation required before meals and no dishes to clean afterwards. Fast food is so popular, in fact, that today almost half of our food dollars are spent on fast foods.1
If you really care about your health, you know that avoiding tobacco, exercising regularly, and eating healthy foods are necessary. But is it possible to eat fast food and still be healthy? It is if you order the right kinds of fast food, and this guide will show you how to do it. By following three easy rules, you can eat out and still eat healthy. Before you turn to see if your favorite fast food items are healthy, however, you should read this introduction. It will explain why you should really care about choosing healthy fast foods, and it will help you understand how the guide was put together.
It is impossible to have a guide that everyone agrees with because people have different perspectives and ideas about what is and is not healthy. However, this guide was developed with the best science available and it was carefully reviewed by a national panel of nutrition experts. This is not the only fast food guide available, but it represents the most comprehensive collection of nutritional data for fast food restaurants across the United States. It will help you navigate the fast food maze and make food choices that actually contribute to good health, not chronic disease.
If fast food is so much a part of our American culture, why do we need a fast food guide?
As a population, Americans have more body fat now than any other population at any time in human history. That’s right. There has never been a population in world history that has had more body fat than Americans do right now. The most recent data from the Centers for Disease Control shows that 71% of men in the United States are overweight or obese.2 Just over 62% of women are overweight or obese, and children and adolescents are not immune. These two youngest groups in the American population have experienced the greatest increases in body fat of the past 20 years. Americans also have more type II diabetes than at any other time in history. Excessive body weight and diabetes cause many chronic diseases and will likely shorten the average lifespan in the United States by two to five years.3 Consequently, this may be the first time in the past century that children will die at a younger age than their parents. So what does any of this have to do with fast food?
Despite great taste, low cost, and convenience, there is a darker, less desirable side of fast food. Much of the fast food Americans eat does not contribute to a healthy weight, and most of it may actually cause chronic diseases like heart disease, cancer, diabetes, and many others.
Here’s the Proof
When you compare people who eat a lot of fast food with people who don’t, there are several differences between the two groups. Fast food eaters consume more dietary fat and saturated fat. They also have more body fat, and they eat fewer fruits and vegetables.4 Studies have shown this to be true for children, Black and White adolescent girls, college-aged adults, and middle-aged adults.5-7 One study that took 15 years to complete showed that eating fast food was associated with diabetes and weight gain.8
It also seems that if you live near a lot of fast food restaurants, you are likely to eat more fast foods. A study in Ontario, Canada, found that people who lived near a lot of fast food restaurants were more likely to have heart disease and even premature death.9 Another study revealed a correlation between the number of fast food restaurants per square mile and obesity in the 48 contiguous states: the states with the most fast food restaurants per square mile also had the highest rates of obesity.10 Researchers in New Zealand gathered information from 1,300 children and found a direct relationship between asthma and the number of hamburgers children ate: those who ate the most hamburgers had the most asthma.11
The bad side of fast food is not just a problem for American citizens. Hispanic and Asian-American adolescents who have recently immigrated to the United States quickly assimilate American culture. Within one year after arriving in the United States, many immigrants exercise less and start to eat more fast foods—typical American behaviors that lead to obesity and chronic disease.12 They learn to live like Americans and they will die like Americans.
But Wait, It Gets Worse
What the results of this research revealed is bad, but the problems with eating most fast food are much worse. Researchers from around the world have been carefully studying what people eat and what diseases they get later in life. Using very large research studies, they have been able to identify diets that either contribute to good health or are associated with chronic diseases.
There are two diet patterns that appear to either cause or prevent chronic diseases. The diet pattern associated with the best health is called the prudent diet. The diet that is the most unhealthy is called the Western diet. “Western” refers to countries that have become Westernized—basically the industrialized nations of the world that are a lot like America. This Western diet is fairly typical of what many Americans eat, especially those who eat a lot of fast food. Typical foods of the Western diet include the following:
The prudent diet, on the other hand, is quite different. The pyramid below shows what the prudent diet looks like. For many Americans, it may look nothing like what they normally eat.
The Prudent Diet Pattern
http://www.hsph.harvard.edu/nutritionsource - Used with permission.
The top of the pyramid suggests that foods shown here should be eaten sparingly. Notice that many of the foods listed there are part of the Western diet. The prudent diet is based on healthy plant oils, whole grains, fruits and vegetables, nuts and legumes (beans), fish, poultry, and eggs. Which of these patterns best describes your diet? Do you follow a prudent diet or a Western diet?
Through large studies with hundreds of thousands of participants, researchers determined that if you follow a prudent diet, you lower your risk of developing diabetes by 16%, but if you follow a Western diet, your risk of developing diabetes increases by 59%.13,14 The prudent diet is associated with a 34% decrease in risk of heart disease, and the Western diet was linked with a 64% increase in heart disease risk.15-17 These two diet patterns were even associated with other chronic diseases like colon cancer18 and strokes.19 Those who eat a prudent diet reduce their risk of chronic disease; those who eat a Western diet significantly increase their risk.
While these two diet patterns were accurate in describing who might and who might not get diabetes, heart disease, stroke, and colon cancer, not all chronic diseases are related to these two diet patterns. When the same patterns were used to determine who might get breast or prostate cancer, there was no difference between the two.20,21 However, a prudent diet does appear to help breast cancer survivors avoid other causes of death not associated with the cancer.22
Individuals who eat typical American fast food are eating a Western diet. Most fast food contains a lot of red and processed meats, white flour, butter, and other high-fat dairy products. French fries and sweets and desserts are very popular fast foods. In fact, fast food is a Western diet. That means that most fast food is actually causing many of the chronic diseases most Americans suffer from, including obesity.
There’s More . . .
Aaah . . . the smell of fresh pastries, cookies, and cakes. Who can resist? Almost all foods that are commercially fried are fried in trans fats. We’ve been hearing a lot about trans fats in the news, and now all packaged foods are required to display information about trans fat content. Trans fats are plant oils that are altered in a process called hydrogenation. In this process, healthy plant oils are heated to about 400 degrees and hydrogen gas and a metal catalyst are added. This makes the vegetable oil accept additional hydrogen atoms and—presto!—what used to be a healthy vegetable oil is now a saturated fat with special properties. It can be used to fry food over and over again without going rancid, and it has a very long shelf life. Almost all fast food restaurants use trans fats for frying because it is relatively inexpensive. Furthermore, trans fats have a texture most people like. For example, margarine, which is made mostly from trans fats, is softer than real butter and easier to work with, and pie crusts, crackers, and croissants are flakier when made with trans fats.
This is where science once again shows us some warning signs. There have been 16 studies that have looked at links between trans fats and chronic disease.23 All but 2 of the 16 studies showed that consuming trans fats is probably harmful. The prudent diet pyramid shows that healthy plant oils like olive, peanut, and soybean oil should be part of a healthy diet. These oils are high in poly- and monounsaturated fats. They are actually good for you because they improve your blood cholesterol. Trans fats, on the other hand, dramatically increase your risk of heart disease because they make cholesterol worse. In fact, trans fats are thought to be 10 times worse than saturated fats. If you are going to eat fast foods, you are going to dramatically increase your risk of heart attack and stroke because most fast foods contain a lot of trans fats.
This research is so convincing that the latest U.S. government nutrition recommendations encourage Americans to keep the intake of trans fats as low as possible. The minimum amount of trans fats a person can consume and not increase risk is zero.
Dr. Walter Willett, chair of the department of nutrition at the Harvard School of Public Health, recently stated,
In Europe [food companies] hired chemists and took trans fats out…. In the United States, they hired lawyers and public relations people. No one doubted trans fats have adverse affects on health, and still companies were not taking it out.
Any fast food that is deep fried is likely to be fried in trans fats. As you will see in this guide, some fast food companies no longer use trans fats, but most still do. If the safe recommended amount of trans fats is zero, should you eat a large order of McDonald’s french fries if it contains 8 grams of trans fats? What about the yummy doughnuts at Krispy Kreme? They are fried in trans fats, and in this guide they are all coded red to help remind you to avoid eating them.
Since fast food is purchased hot, it is not required to have a nutrition label and you will never really know about the trans fat content. Think of all the fried foods in American fare: french fries, onion rings, corn dogs, popcorn, seafood, chips, and, oooh, those bakery goods. Maple bars, doughnuts, croissants, éclairs—all of them are either made with trans fats or are deep fried in trans fats. The only way you would know would be if you were to see a list of the ingredients or to read the label on the oil being used. You won’t see the words “trans fats” in the ingredients. If a food has trans fats it will be listed as partially hydrogenated oil, the technical term for trans fats.
According to a survey conducted by the Center for Science in the Public Interest (CSPI), the biggest restaurant chains still fry french fries, chicken nuggets, and other foods in trans fats.24 The CSPI survey, which included 38 major food manufacturers, 100 restaurant chains, and 25 supermarket chains, revealed many interesting insights into the fast food industry. For example, while several major restaurant chains, including Taco Bell and Pizza Hut, are testing healthier oils, only a few chains have already taken action to actually use healthier oils.
The Good Guys
• Au Bon Pain, a 220-location café chain based in Boston, has eliminated trans fat from all of its cookies, bagels, and muffins, and is now using a nonhydrogenated margarine.
• Jason’s Deli, a 137-outlet sandwich and salad chain, has stopped using partially hydrogenated oils in all of its products.
• Panera Bread, a 773-outlet café chain that was formerly part of Au Bon Pain, is in the process of replacing all partially hydrogenated oils and plans to be trans fat–free by year’s end.
• California Pizza Kitchen has removed trans fat from deep-fried foods and is working on eliminating it from all other foods.
• In 2005 Ruby Tuesday, with some 700 table-service restaurants around the country, began deep-frying in heart-healthy canola oil.
• Chick-Fil-A fries in peanut oil in its outlets.
The Bad Guys
• Starbucks, ice-cream chain Friendly, and fried-chicken chain Popeyes indicated they had no plans to remove or reduce trans fat in their foods.
• Meals at other restaurants also are loaded with trans fat. KFC’s chicken pot pie contains 14 grams of trans, and Taco Bell’s Nachos BellGrande has 7 grams.
From http://www.cspinet.org/new/ pdf/trans_report.pdf
In 2002, McDonald’s promised to reduce and ultimately eliminate the trans fat in its cooking oil, but in 2003 it quietly backed away from this effort. McDonald’s lost a lawsuit related to this matter and was ordered to give $7 million to the American Heart Association to be used to educate the public about the dangers of trans fats. McDonald’s has reformulated its Chicken McNuggets and a few other products to have a little less trans fat, but its fried foods are still very high in trans fats. A McDonald’s meal that includes a five-piece Chicken Selects Breast Strips order and a medium order of french fries has about 9.5 grams of trans fats. A piece of baked apple pie at McDonald’s has 5 grams. Isn’t it strange that McDonald’s outlets in Australia, Denmark, and Israel all fry in trans fat–free oil but Americans still get the trans fats?
So What’s the Big Deal?
If Americans would reduce the amount of trans fats they are currently eating, it is estimated that 30,000 to 100,000 heart disease deaths would be prevented every year.25 That would provide a bigger improvement in public health than just about any other medical breakthrough in the past 100 years!
But this guide isn’t just about trans fats. Fruits and vegetables and whole grains are also very important. A review of the science reveals that Americans who increase their fruit and vegetable consumption from two servings per day to five or more can cut their risk of many cancers in half.26
Obviously, scientists haven’t answered all the nutrition questions, but they have discovered enough information to help Americans prevent, arrest, and even reverse most chronic diseases. All it takes is good nutrition, regular physical activity, and avoiding tobacco use.
Be Careful What You Order
A quick look at many of the foods in the guide reveals a few surprises. First of all, the calorie content of some of America’s fast food is shocking. Let’s put this into perspective. The average person weighs 156 pounds. When walking at a pace of 3 miles per hour, that person expends about 5.1 calories per minute. Say you decide to have dinner at Chili’s, and for a starter you order the Awesome Blossom. This “starter” contains 2,710 calories. If you were the average person, you would have to walk 27 miles to burn off all the calories you just ate and it would take you about 9 hours of walking to do it.
How This Guide Was Developed
To help you make healthy fast food choices, almost 3,500 different foods have been color coded after an exhaustive process used to determine if a food should be red, yellow, or green. We contacted the 200 largest fast food companies in America and requested nutrition information about each of their menu items. Companies are not required by law to provide the nutrition information for the foods they sell—this is strictly voluntary—and most companies do not have any nutrition information about their foods. Still, we were able to gather nutrition information from 68 restaurants.
The available nutrition information on these fast foods was then entered into a large database and specifically designed computer programs identified foods that had any of the following characteristics:
More than 1 gram of trans fat per serving
More than 10 grams of saturated fat per serving
More than 125 grams of cholesterol per serving
More than 1,250 milligrams of sodium per serving
Less than 2 grams of fiber per servings
There is nothing magical about these criteria, except that some of them represent half the daily value for an average person. In other words, if a single fast food serving had more than half the amount of saturated fat, cholesterol, or sodium that a person should have in a single day, it was identified. Foods that contained lots of trans fats and little fiber were also identified. Any food that met none or just one of these criteria started off as green. Any food that met two of the criteria was initially coded yellow and any food that met three or more of the criteria was coded red. (Kind of like three strikes and you’re out.)
There is an easier way to think about this coding. By using the prudent diet pyramid, a similar type of coding could be done. The pyramid shown below shows how foods could be coded according to where they are located on the pyramid. Healthy green-coded foods would be those at the bottom of the pyramid; yellow toward the middle; and red foods, which should be eaten sparingly, are located at the top.
Adapted from http://www.hsph.harvard.edu/nutritionsource
A further set of rules was also established to help in the coding process:
• Any food that had more than 1 gram of trans fat was automatically coded red.
• Foods that contained processed meats (meats like pepperoni, bacon, sausage, bologna, and hot dogs) or more than the recommended serving of red meat were also coded red.
• Foods that were initially coded as yellow and had amounts of sodium, saturated fat, or cholesterol that were not extremely high but were leaning in that direction, were moved to red.
To ensure consistent coding, the entire fast food dataset was reevaluated and coded three times. To further classify the foods, a distinguished panel of national nutrition and health promotion experts from across the United States was organized. These experts reviewed the entire process and suggested changes in the way the foods were coded. The experts are listed in the acknowledgments section. A final analysis shows that 33% of the foods in this guide are coded green, 20% are coded yellow, and 47% are coded red.
Fast Food and Good Health with Three Easy Rules
How can you make the best choices when you’re eating fast food? This guide codes food as red, yellow, or green, depending on how healthy they are or not. Here are three easy rules to help you use this system to make healthy fast food choices:
Rule #1: Avoid the red foods.
Rule #2: Go easy on the yellow foods.
Rule #3: Eat healthy with the green foods.
Red foods = Hit the brakes!
There are many factors that result in a red code for a food. The number one factor why many foods receive a red code is that they contain more than one gram of trans fat. Lots of foods are coded red because they have more than one gram of trans fat content. Almost all of the foods at Taco Bell, for example, are coded red because they contain large amounts of trans fats. Many restaurants do not report the trans fat content of their foods—indicated in the table as not available (NA)—leading us to believe that they are still frying in trans fats (see Popeyes Chicken & Biscuits, for example). Consequently, they are coded red.
French fries are coded red because almost all restaurants fry them in trans fats. Any company that switches to healthier oils could instantly get a change in its food colors. For example, the In-N-Out burger chain located in California, Nevada, and Arizona fries in 100% cottonseed oil that is not hydrogenated. It’s trans fat–free and better for you, but french fries should still be a small part of a healthy diet. In-N-Out Burger's french fries get a green code! The only other restaurant that uses healthy oils for frying is Chick-Fil-A, which has mostly green-coded foods because they fry in peanut oil.
As you will read later, foods fried in healthy oils can actually be good for you. Panda Express does not use trans fats in any of its fried food and is the only restaurant in this entire guide that receives a green code for all of its foods.
On the other hand, doughnut producers Krispy Kreme and Dunkin’ Donuts have only red-coded foods because they are all made with trans fats. One doughnut can have as much as 5 grams of trans fats! Doughnuts are a wonderful treat, but they are also a food that should be eaten very sparingly if you care about good health.
Foods made with processed meats or that have a large serving of red meat are also coded red. A McDonald’s regular hamburger—the small one that has just a squirt of ketchup, mustard, and a pickle—is actually coded green. It contains a small serving of red meat and not very many calories. A Big Mac, on the other hand, is a real heavy hitter with half the saturated fat for a whole day and trans fats. How would you color code a Pizza Hut Meat Lover’s pizza? Even though it doesn’t contain any trans fats, it gets a red in this guide because one slice contains a lot of saturated fat, sodium, and processed meat.
Desserts typically offered at restaurants are coded red because they generally contain a lot of calories, saturated fat, refined flour, and sugars. Therefore, desserts should be an occasional treat, not foods we eat a lot of.
Yellow foods = Exercise caution!
What about a pizza that doesn’t contain any processed meat? Your basic cheese pizza gets a yellow code. Although it doesn’t contain trans fats or processed meat, it also doesn’t contain any vegetables or whole grains. It’s kind of in the middle. That’s what yellow foods are like. They aren’t good enough to be coded green or bad enough to deserve being branded red. Some yellow foods include:
Sweet and sour chicken
A single taco or burrito
Green foods = You’re eatin’ healthy!
Green foods are the best. To earn the green badge of honor, a food has to have certain qualities that make it part of a healthy daily diet. Obviously foods made with whole grains, fruits, vegetables, and healthy oils will be coded green. Green-coded foods include vegetable pizza, many sandwiches, salads, eggs, and entrées made with vegetables, such as vegetable stir-fry. Green foods are low in saturated and trans fats, they don’t contain excessive amounts of sodium or cholesterol, and they are relatively low in calories compared to yellow and red foods. They are actually good for you and could be eaten every day. By choosing green foods you can eat fast food and still eat healthy . . . the best of both worlds. Another way to identify green foods is to ask the question: Is this food close to its natural/original form? A salad, for example, contains foods close to their natural form. A Hostess Twinkie, on the other hand, leaves us to wonder what its natural form actually was. A baked potato is going to be coded green, but trans fat–fried tater–tots are going to be red. You get the idea.
Some Restaurants Are Healthier Than Others
As you will see in this guide, some fast food restaurants sell a lot of red foods. Others have a lot more healthy choices. Based on the types of foods a restaurant serves, it is possible to produce a short list of restaurants ranked from best to worst according to the color-coding of the food they sell. Counting up the number of green, yellow, and red foods sold by different restaurants shows that some restaurants offer healthier foods than others:
A Few Fast Food Marketing Tricks You Should Know About
Fast food restaurants are really designed and created to do one thing—sell as much food as possible. It doesn’t matter if people eat the food because the main goal is to sell food. To do this, food venders use time-tested methods to get each customer to buy as much food as possible. No one likes to waste food, so when we do purchase a little extra food, the only responsible thing to do is eat it. Don’t fall prey to these tricks and you wont’ feel obligated to eat all the food you buy.
Would you like egg rolls with that order? Do you want me to super size your meal? Would you like to make that a combo meal? These are all questions you might be asked next time you order fast food. It’s called up-selling. You’ve already ordered what you want, you’re ready to pay, and the person working at the counter asks you an up-sell question. The idea is to get as much money out of you as possible by selling you more food—food that you may or may not want or need. McDonald’s Super sizing items and selling foods as part of a combo meal are examples of effective ways fast food restaurants get just a little more out of you each time you visit. Don’t fall for it! Decide what you want before you get to the counter (hopefully picking green-coded foods) and don’t buy any more food, no matter how hard the employee tries to sell it to you.
What smells so good?
Have you ever walked past a restaurant and smelled barbeque, fresh bread, or hot pastries? Most food producers don’t purposely fill the air with the smells of their foods, but some do. By setting up a barbeque grill outside or venting kitchen grill smoke to the outside, they are advertising their food to the olfactory senses of the masses. If you’re hungry and you’ve got a little extra cash, you may end up as their next customer.
It’s all about the playground
Forget about the food; the kids will want to play at the fast food playground. Slides, treehouses, ball pits, and swings are attractive to small children, and playgrounds and even arcades have become common features in fast food restaurants. Restaurants know parents want to watch their kids play in a relatively confined space while they eat in peace. The combination of food and an attraction for the kids is a powerful marketing ploy. Unfortunately, the food often doesn’t contribute to good health.
Forget the food, I want the toy!
The fast food industry excels at getting to us through our kids, and the kids’ meal is another powerful fast food marketing tactic. Hollywood and the fast food industry have collaborated to create a marriage between fast food and movie marketing that results in children begging for the next plastic action hero that comes with fast food they might or might not eat. After all, what could be better than a sharing a deep-fried meal with Luke Skywalker?
It’s all in a name
Restaurant owners are pros at getting us to buy and eat. If a menu has chocolate cake, it won’t sell well. But if the same menu has Black Forest Double-Chocolate Cake, the customer will be much more likely to purchase it and much more likely to approve of the taste. Why would Romano’s Macaroni Grill sell cheesecake when it can sell New York cheesecake with caramel fudge sauce? Just the name of the food can impact sales and customer satisfaction.27 Don’t be swayed too much by the names. Listen to your body and let your stomach tell you when you are full.
Fast Food Is Only Part of the Problem
It wouldn’t be fair to place all of the blame for America’s poor health on the fast food industry. There are several reasons why Americans are not as healthy as they should be. Regardless of what we eat, we eat too much. We don’t get much exercise, and we have a culture and environment that discourage healthy eating and regular physical activity. This guide is designed to help you still enjoy fast food by selecting fast foods that are actually good for you. When combined with regular exercise, you will be well on your way to good health and a healthy body weight.
When all is said and done, everyone eats fast foods.
Good health is just a matter of sorting through
and eating the right ones.
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