Customers can make fast-food combo meals healthier

(Reuters Health) - Combination meals in U.S. fast food and fast casual restaurants have lots of calories, saturated fat, sugar and sodium, but customers can make the meals healthier by substituting drinks and toppings, researchers say.

Combination meals include an entrée (such as a burger), a side dish (such as fries), and a beverage (typically a soda), for less money than it would cost to buy each item separately.

More than one third of American children and adults eat at a fast food restaurant each day, which is troubling because previous research has shown that restaurant food is generally unhealthy, lead author Kelsey Vercammen, a PhD student at the Harvard Chan School of Public Health in Boston, told Reuters Health by email.

In 2017 and 2018, Vercammen and colleagues used online menus from 34 U.S. fast food and fast casual restaurants to identify combination meal options, with nutrition information for each item obtained from MenuStat.

The researchers analyzed three options for each meal: the default option, as advertised on the menu, and two versions of the meal with substitutions (a low-calorie, or minimum option, and a high-calorie, or maximum option).

They compared their results to the Healthier Restaurant Meal Guidelines (, which say an adult meal should contain no more than 700 calories, with less than 10%, or less than 70, of those calories coming from saturated fat and less than 35%, or less than 245 calories, from sugars.

The average combination meal, in its default form, contained 1,193 calories, with 14 grams of saturated fat (126 calories) and 68 grams of sugar (272 calories),

The guidelines say an adult meal should contain no more than 770 milligrams of sodium, but the average default option contained 2,110 milligrams, the authors found.

Making changes to the default combinations - such as substituting a sugar-free beverage or plain water for a sugary drink, or removing toppings and dipping sauces from entrées - resulted in substantial changes to the overall calorie and nutrient content of a given meal, Vercammen said.

In both breakfast and lunch/dinner combination meals, beverages were the largest driver of increases in calories and sugar, whereas entrees and sides were the largest drivers of increases in saturated fat and sodium, she and her colleagues report in the American Journal of Preventive Medicine.

“We were surprised at just how much realistic customer modifications can change the nutrient profile of a meal,” Vercammen said, pointing out the maximum combination meal had nearly 500 more calories and significantly more sugar, sodium, and saturated fat compared to the default meal in the study.

Because it lacked sales data, the study can’t tell which meal options were actually popular. And the findings can’t be generalized to other types of restaurants, as the study looked only at fast food and fast casual restaurants.

Still, the results show that combination meals and especially “default” combination meals are generally not very healthy, said Tamara Dubowitz, a food policy researcher at RAND Corporation in Pittsburgh, Pennsylvania, who was not involved in the study.

Vercammen and colleagues believe government policies that regulate what restaurants serve, such as when local laws require children’s combination meals to include only healthy beverages instead of sugary drinks, are an important public health tool.

Calorie labeling on menus, or making ingredients and nutritional composition more understandable for the consumer, are also likely to help, Dubowitz said in an email.

“Our environment makes it hard to be healthy and to eat healthy,” Dubowitz said.

SOURCE: American Journal of Preventive Medicine, online August 1, 2019.