Eating-out: A Study of the Nutritional Quality of Canadian Chain Restaurant Foods and Interventions to Promote Healthy Eating

Canadians are increasingly eating outside-the-home. At the outset of this thesis there were no data on the nutritional quality of Canadian chain restaurant foods, the Sodium Working Groupâ s plan to monitor sodium reductions in the food supply was abandoned, and despite interest and numerous bills, there was no existing menu-labelling legislation in Canada. The specific objectives of this thesis were to 1) investigate the nutritional quality of the Canadian chain restaurant food supply; 2) explore consumersâ use of menu-labelling; and 3) test the potential of alternative forms of labelling in non-chain restaurant settings. Objective 1 was investigated by developing and analyzing a national database of over 9000 menu-items from Canadian fast-food and sit-down chain restaurants which was created in 2010. There was wide variation in calorie levels within each restaurant and food category; furthermore, portion size, as opposed to calorie density, was the most important driver of this variation. Sodium levels in menu items often exceed daily recommendations and despite reported efforts by the restaurant sector to improve, as of 2013, reductions were minimal. Objective 2 used an online, national consumer survey to test three menu-labelling treatments (calories; calories and sodium; and calories, sodium and serving size labelling). The effect of labelling on consumer choice varied depending on the restaurant setting, however, overall, labelling sodium in addition to calories led consumers to choose meals with significantly less sodium. There was no additional benefit from adding serving size information. Objective 3 was examined in a quasi-experimental, population-level nutrition labelling/education intervention study in a campus cafeteria. Results showed that this intervention could modestly increase fruit and vegetable consumption, and decrease sugar-sweetened beverage consumption among University students. Overall, this thesis provides food supply and consumer data to inform public health policy debates around issues concerning food consumed outside-the-home.Ph.D