An analysis of thousands of menu items from Britain’s biggest restaurant chains reveals widespread failure to meet voluntary nutrition targets, raising fresh questions about whether mandatory food regulations are needed to improve public health.
Study: Adherence to voluntary UK sugar, salt, and calorie reduction targets in the highest-grossing restaurant chains: A cross-sectional study. Image credit: Virojt Changyencham/Shutterstock.com
Major UK restaurants show low adherence to voluntary government targets for salt, sugar, and calorie content, according to a recent study published in the journal PLOS Medicine. These findings emerge amidst growing concern about the role of dietary risk factors in cardiovascular and metabolic disease and death.
Rising restaurant dining fuels public health concerns
The typical Western diet is high in sugar, salt, and calories. Such dietary patterns are linked to increased rates of lifestyle diseases, including type 2 diabetes, obesity and overweight, and cardiovascular disease. Dietary risk factors are estimated to contribute to 40 % of deaths from cardiovascular disease.
The UK government has published voluntary targets to reduce the salt, sugar, and calorie content of commercially prepared foods. These are intended for use by manufacturers and retailers of food products, as well as any source of out-of-home (OOH) food, such as a restaurant.
The targets aim to reduce average salt intake by 10 % to 6 g per day; sugar by 20 % across 14 food categories most closely associated with children’s sugar intake; and calorie content by 10 % in food sold by retailers and manufacturers, and 20 % in the OOH sector.
Along with the targets, the government also set timelines for meeting the sugar and salt targets by 2020 and 2024, respectively, and the calorie targets by 2025. Previous evaluations of the UK salt reduction program found that it was associated with a 2 % mean decrease in urinary sodium per year between 2004 and 2011, as well as lower salt content in retail foods. Conversely, sugar and calorie content have fallen by only 0.2 % to 2.3 % in data up to 2020.
Meanwhile, eating out rose by nearly 160 % from 2021 to 2022, probably in response to the removal of pandemic-related restrictions. It rose by another 3.5 % the next year. The OOH sector is dominated by a small number of multinational companies operating food chains, with sales rising from £8 billion in 2021 to £35 billion in 2023.
Limited evidence exists regarding how far the OOH food sector has complied with these norms, motivating this study of the 21 biggest restaurant chains in 2024.
Evaluating adherence
The researchers conducted a cross-sectional analysis of nutritional data from restaurant online menus. They calculated the mean and median sugar, salt, and calorie content per serving and per 100 g for each of 12 food subcategories and for each of 21 restaurants, with the primary reported averages based on mean values.
A total of 3,099 menu items were evaluated against the OOH targets first, and then for other manufacturer or retailer targets. The analysis assessed foods listed on menus rather than foods actually purchased by customers, because item-level sales data were unavailable.
Mean salt, sugar, and calorie content
The researchers found that, across all menu items, 100 g of the food contained, on average, 277 kcal, 1.1 g of salt, and 9.5 g of sugar. Per serving, the average was 450 kcal, 2.0 g salt, and 10.9 g sugar.
The highest sugar per 100 g or per serving was found in the Desserts subcategory. Calorie-wise, Desserts and Other Mains ranked highest in mean calorie content per 100 g and per serving, respectively. The mean salt content was highest for Sauces per 100 g, and Other Mains and Pizzas per serving.
Meeting voluntary targets
By menu item
Across all restaurants, 61 % of menu items were within the calorie target, and 58 % within the salt target. Only 36 % of menu items met sugar targets.
Approximately 43 % of menu items met all applicable nutritional targets, but restaurant-wise, this figure was lowest with pizza restaurants, at 32 %. The latter also had the lowest adherence to salt and calorie targets.
At least 50 % of menu items in six subcategories met all applicable targets, with similar findings across nine restaurants. Across subcategories, breakfast items met sugar and salt targets 74 % and 82 % of the time, respectively. Salads and Chicken items showed the highest calorie-target adherence, at 96 % and 78 %, respectively.
By restaurant type
The Burger restaurant category showed 59 % adherence to all applicable targets, 80 % adherence to the salt target, and 53 % adherence to the sugar target, though it had only 36 items qualifying for the sugar target.
Among individual chains, Papa John’s showed especially low adherence to calorie and salt targets, at 35 % and 8 %, respectively. Menu items across four other leading brands demonstrated zero percent sugar target adherence.
There were marked differences in adherence to menu items across restaurants, even when cuisines were matched. Subcategories from the same restaurant also showed similar discrepancies. The authors concluded that neither the menu type nor the restaurant identity should prevent improved adherence.
They also emphasized that some restaurants and food categories performed substantially better than others, suggesting that the targets are achievable across a range of cuisines and menu types.
The authors also noted that sugar targets may have been harder to meet because they were set per 100 g and therefore required reformulation of products, whereas calorie and some salt targets could potentially be met in part through reducing portion sizes.
Study limitations
The study was limited by the lack of standardized serving sizes and nutritional information for all items, incomplete online menus, and the lack of sales data distinguishing healthy from less healthy foods. The researchers also relied on nutritional information reported by restaurants and did not independently verify nutrient content through laboratory testing.
Moreover, this is a snapshot study, and cannot track changes in food quality over time. The authors also noted that the data were collected early in 2024, before the calorie-target deadline and during the final year for salt-target compliance, suggesting that adherence levels could improve over time.
The authors conclude: “Our study demonstrates that there is low adherence to voluntary schemes across the out-of-home sector, and therefore mandatory regulations may be a more effective approach to improving the nutritional quality of out-of home food.”
Since these restaurants are all part of global food chains, the findings of this study could have relevance beyond the UK. The authors also suggest a few important changes to the target guidelines and technical guidance that could facilitate and thus promote self-monitoring by companies.
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