Trends In The Healthiness Of U.S. Restaurant Meals And Implications For Policy

This dissertation, presented in three papers, explores the healthiness of restaurant meals in the U.S. in 2017 (paper 1); trends in the healthiness of fast food meals from 2008 to 2017 (paper 2); and synthesizes the policy and evidence on the impact of sodium menu labeling on menu item sodium content (paper 3). Paper 1 analyzed data from MenuStat, an online restaurant menu item nutrition database, to examine the healthiness of meals at national U.S. chain restaurants in 2017, using the American Heart Association’s Heart-Check meal certification criteria (AHA criteria). Paper 2 explored trends in the healthiness (using the AHA criteria) of fast food meals between 2008 and 2017 using MenuStat data. Paper 3 synthesized proposed and enacted state- and local-level sodium menu labeling laws and summarized available evidence on the relationship between sodium menu labeling and menu item sodium content. The results of papers 1-2 show high levels of unhealthy nutrients in restaurant meals, and fewer fast food meals meeting AHA calorie and total fat criteria in recent years compared to 2008. Paper three found that sodium menu labeling laws have been increasingly proposed and enacted since 2010, and that the current evidence evaluating sodium menu labeling in the U.S. shows mixed results, with sodium menu labeling leading to reductions in menu item sodium content in some settings. Taken together, the results of the three papers suggest that policies are needed to improve the healthiness of restaurant meals