The most distinctive item sold at McDonald’s during its early years wasn’t their cheap burgers – it was their french fries, served hot, crisp and salty-sweet. The McDonald brothers used Russet Burbank potatoes bought from a single source. Employees peeled, cut and deep-fried them at intervals throughout the day to make sure the fries were always hot and fresh. McDonald’s french fries were praised by virtually everyone, from their earliest local customers to American culinary icons like James Beard and Julia Child.
McDonald’s fries generated more profit than their burgers. As the chain began to grow in the 1960s, dozens of different suppliers were contracted to supply regional outlets, and the uniformity and quality of McDonald’s french fries suffered as a result. In 1965 Ray Kroc, the chain’s chief executive officer, met the Idaho potato grower J. R. Simplot, owner of the Simplot Potato Company: the french-fry world has never been the same since. Working with Simplot scientists, McDonald’s researchers devised ways of freezing raw, precut fries without compromising their quality. Employees had only to drop the prefabricated frozen potato sticks into the basket of a deep-fryer; that appliance kept the oil at a precise temperature, and a buzzer alerted the operator when the fries were done. This system eventually shaved 30 to 40 seconds off the delivery time. Multiplied by the millions of customers ordering fries, the time saved covered the equipment costs and generated huge profits. Just as important to Ray Kroc was the fact that this process meant that french fries served at any McDonald’s location in the United States would taste exactly the same. While other chains bought the same frozen potatoes and employed similar equipment, their french fries never tasted quite as good as the ones from McDonald’s.
In 1984 Bonnie Liebman, Director of Nutrition for the Center for Science in the Public Interest (CSPI), a Washington-based nonprofit, found something unexpected when she analysed french fry samples from various fast-food chains. She discovered that McDonald’s fries were high in cholesterol – something that’s not naturally present in vegetables. The reason, she discovered, was that McDonald’s fried their potatoes in fat that was 93 per cent beef tallow (rendered fat) and 7 per cent soy oil. At first, it was the beef fat that gave the fries their distinctive flavour – and their cholesterol. McDonald’s french fries were also very high in sodium. Liebman wrote exposés for the CSPI’s Nutrition Action HealthLetter and the CSPI launched a campaign to stop McDonald’s using highly saturated, cholesterol-laden animal fat for frying. The CSPI also urged the chain to reduce the amount of added salt in its french fries.
Today the unique taste of McDonald’s french fries has nothing to do with the type of potato, the technology that processes them or the equipment or oil that fries them. What gives McDonald’s fries their unique taste is the chemical flavourings that are added to the oil. The beef tallow has been replaced with taste enhancements, colourings and sweeteners produced by the flavour industry.1
Fast-food french fries have few nutritional benefits other than calories,2 but thanks to advertising targeting youth and a tasty menu item, 25 per cent of the total vegetables consumed by American children are in the form of french fries.3
The main objective of any restaurant is to entice customers to order food and drink – and encourage them to return. Fast-food purveyors learned early on that their customers were most attracted to menu items that were salty, fatty or sweet – or, if possible, all three. Researchers later concluded that the vendors were right: human brains are hardwired to crave fat, salt and sweetness. The really good news for fast-food chains was that sugar, sodium and fat are very inexpensive ingredients.
Fast-food recipe developers have used this knowledge to formulate menu items with optimal appeal: sugar, fat and salt are coupled with numerous flavourings and chemical additives. Milkshakes, ice cream-like menu items, and doughnuts, for instance, are both sugary and fatty. French fries, hamburgers, onion rings, fried chicken and pizza depend on plenty of fat and salt for flavour. To bring together all three key factors, hamburger buns and pizza crusts got sweeter with the addition of high-fructose corn syrup. Even fries were sprayed with a sugar solution (which also helps to crisp and brown them). The ketchup that customers slather on their fries is also sweet. Chicken menu items also have added sugar. McDonald’s Southern Style Chicken Breast contains sugars, salt, starch and artificial flavourings – and that is before being dipped in batter. KFC’s fried chicken is battered with a mixture that includes flour, salt, sugars, corn syrup and flavourings. And of course, fried chicken is cooked in plenty of fat. Salad dressings and ‘special sauces’ have a strong note of sweetness. With fat, sodium and sugar as common denominators, most fast-food menu items were (and are) high in calories and low in dietary fibre, vitamins and minerals (other than plenty of sodium).
Concern about the nutritional content of fast food began in 1984 with Marion J. Franz, the Director of Nutrition at the International Diabetes Center in Minneapolis. Her Fast Food Facts (1983) examined the nutritive value of menu items and she made recommendations for diabetics on what to eat – and what not to eat – at national fast-food chains.
A more systematic approach was taken by the CSPI, which began to seriously examine the nutritional composition of fast-food menus and assess the potential health consequences of eating fast food. Michael Jacobson and Sarah Fritschner’s The Fast-Food Guide (1986) analysed the nutrients in foods served at major fast-food chains. For each item, calories, fat, saturated fat, cholesterol, sodium, sugar and additives were published – information that the companies themselves did not want to share with the public. They decried the high fat, saturated fat, sugar and sodium contents of fast-food meals and despaired of their effect on public health. The Fast-Food Guide was the first significant exposé of fast-food formulas, and ignited interest in exploring the health consequences of eating fast food. The CSPI popularized the term ‘empty calories’, meaning foods and beverages with plenty of fat, sugar and calories, but little or no vitamins, minerals and other micronutrients.
One fast-food menu item that fell into the empty calorie category was sugary carbonated drinks (sodas), which Michael Jacobson, the CSPI’s executive director, called ‘liquid candy’.4 Beginning in the 1970s, soda companies saw fast-food chains as a way to build sales for their beverages. PepsiCo acquired several fast-food chains, including Pizza Hut, Taco Bell and KFC. All these chains sold soft drinks manufactured by PepsiCo. In 1997 PepsiCo divested itself of its restaurant subsidiaries, creating a separate corporate entity now called Yum! Brands. PepsiCo maintained the largest ownership in Yum! Brands. Consequently Yum! Brands’ fast-food companies continued to sell Pepsi beverages. Coca-Cola entered into agreements with competing chains, including McDonald’s. Soda companies convinced fast-food chains that they could draw in more customers with ‘combo meals’ that included a main dish, a side order (such as french fries) and a soft drink. These and other promotional efforts did attract customers, and soda sales soared in the 1990s.
Low ingredient costs, high profits and intense competition for market share encouraged fast-food chains to sharply increase soda portion sizes. Fast-food chains upped soda sizes from 8 ounces (236 ml, 90 calories) to 12 ounces (140 calories) to 32 ounces (354 ml, 310 calories) to 64 ounces (1.89 litres, 610 calories), and many outlets offered free refills. Soda from all sources (home consumption, fast-food chains, vending machines and restaurants) is estimated to be the source of 7–9 per cent of the total calories that Americans consume, and soda is the primary source of added sugars in the American diet.
In June 2012 Michael Bloomberg, the mayor of New York City, proposed a cap on the sale of sugary drinks supplying more than 25 calories per 8 fluid ounces. The proposal did not survive a court challenge, but had it gone into effect, it would have been illegal for the city’s fast-food outlets, cinemas and food trucks to sell sodas larger than 16 ounces (473 ml). Customers, of course, could have bought more than one soda, and this ban would not have affected sugary soft drinks sold in convenience or grocery stores. Researchers concluded that such a cap would have cut 63 calories from the average fast-food meal.5
Fast-food chains in other countries have also increased their beverage sizes. In France Quick and KFC installed free soda refills as well. Evidence emerged that this initiative fuelled a 10 per cent increase in the quantity of soda consumed. In 2015 French officials voted to ban unlimited soda refills at restaurants and fast-food chains nationwide.6
Soft drinks are not the only fast-food offering that have got bigger. Burgers have ballooned from a 1-ounce (28-gram) patty in 1957, with a few hundred calories, to the 1997 half-pound (227-gram) hamburger (or a double quarter-pounder) with 750 calories. In Japan the McDonald’s Mega Tamago, a variation on the Double Big Mac, has more than 1,000 calories. A Carl’s Jr. half-pound Guacamole Bacon Thickburger supplied 1,210 calories along with 89 grams of fat and 1,910 milligrams of sodium. A Hardee’s Monster Thickburger weighed in at 1,290 calories, 92 grams of fat and 2,840 milligrams of sodium. (The Double Donut Burger sold at Hungry Horse, a pub-restaurant chain in England, Wales and Scotland, had 1,996 calories.) Add a side of fries and a shake to the above burgers and a single fast-food meal could easily add up to more than a total day’s worth of calories, fat and sodium prescribed for adults.7
In the 1950s a standard portion of fries at McDonald’s was a modest 2½ ounces (71 g) and had about 230 calories. The chain subsequently added a medium portion of fries – about 4 ounces (113 g), with about 340 calories – and a large, about 6 ounces (170 g), with a little over 500 calories. In 1994 McDonald’s added 8-ounce (227 g) ‘Super Size’ fries to their menu – with 800 calories and 29 grams of fat, more than triple the size of the original serving. The company also offered supersized meals, consisting of a burger or other sandwich, supersized fries and a supersized beverage (42 ounces or 1.24 litres), which averaged in total about 1,500 calories – 75 per cent or more of the recommended adult daily calorie intake. (To burn off the calories in this combination, one would have to walk for about seven hours straight.) Signs at McDonald’s outlets encouraged customers to ‘Super Size It!’ and order-takers were required to ask customers if they wanted to supersize their order. A supersized meal cost less than the three items ordered individually, but McDonald’s still made higher profits on each supersized order.
The term ‘supersized’ was adapted for use in many other retail establishments, and fast-food chains created their own names for extra-large portions. Burger King’s, naturally, were called ‘King Size’. The reason for the tremendous success of supersized meals was simple: most people when eating out want value for their money. A much larger portion for just a little more cash looks like a good deal. This might well be a good option if two people were sharing the supersized meal, or if the customer ate a reasonable amount and took the leftovers home for another meal. But people typically clean their plates, which is precisely what our mothers always taught us to do. A fascinating study in 2005 suggested that many people are not aware of how much they have eaten. They eat until the food on the plate is gone – ignoring physical cues telling them that they are full.8 Dr David Kessler, former Surgeon General of the United States and the author of The End of Overeating (2009), concluded that many people are afflicted by ‘conditioned hypereating’, an intrinsic drive to eat beyond what they need.9
In 2004 the film Super Size Me was released. Written and directed by Morgan Spurlock, a New York-born journalist and filmmaker, the film documented a four-week period during which Spurlock ate nothing but McDonald’s food. Over the 28 days he gained 24 pounds (10.9 kg), suffered from depression and developed liver problems. While the film has its weaknesses, the relationship between increased portion size, calorie intake and weight gain is clear.10 It was also a public relations nightmare for McDonald’s, who stopped offering supersized meals and beverages a few months before the film debuted. (Company representatives claimed that the decision had nothing to do with the film, but that seems most unlikely.) Other fast-food chains, however, have had no problem continuing to sell gargantuan portions of food and drink. A 2015 U.S. Department of Agriculture-funded study of three fast-food chain menus concluded that there had been little change over eighteen years regarding portion sizes and the calorie, sodium, saturated fat and trans fat content of popular meal combos. It comes as no surprise that increased consumption of fast foods and beverages are associated with weight gain and obesity.
According to studies published in 2011 in the prestigious British medical journal The Lancet, the global prevalence of obesity has almost doubled since 1980, ‘when 4.8 percent of men and 7.9 percent of women were obese’.11 In 2014 the World Health Organization (WHO) estimated that ‘more than 1.9 billion adults, 18 years and older, were overweight. Of these, more than 600 million were obese.’12 The numbers are increasing in nearly every country in the world. Excess weight and obesity results in higher rates of chronic diseases, including high blood pressure, arthritis, infertility, heart disease, Type 2 diabetes, strokes, birth defects, gallbladder disease, gout, an impaired immune system, liver disease, osteoarthritis, sleep apnoea and several types of cancer (including breast, prostate, oesophageal, colorectal, endometrial and kidney cancer). It comes as no surprise that obese individuals have a 50 to 100 per cent increased risk of premature death from all causes compared with those who are at normal weights.13
The obesity crisis in America is acute. During the past 50 years, obesity rates have been rising, such that today 61 per cent of Americans are classified as overweight. U.S. obesity rates have risen from 12 per cent to 20 per cent of the population since 1991. Of particular concern has been weight gain among children. Over the past three decades, the obesity rate has more than doubled among preschool children and adolescents in the United States, and has tripled among all school-age children. Obesity now affects about 12.5 million American children. According to standards established by the International Obesity Task Force, 35 per cent of American children are overweight or obese. Research indicates that an overweight child has an 80 per cent chance of becoming an obese adult. The medical costs of dealing with diseases associated with obesity and overweight are high: the U.S. spent $210 billion treating obesity-related illnesses in 2010; by 2030 obesity-related healthcare costs are expected to hit $550 billion.
There is no single cause of obesity; genetics, environment and activity levels all play a role, but by definition people gain weight by consuming more calories than they expend. The rise in obesity correlates with the growth of the fast-food industry, which has made inexpensive, calorie-dense, high-fat foods universally available. Eating more fast-food meals usually means consuming more calories, fat and salt, and fewer fruits and vegetables. Studies have shown that fast-food meals on average contain 70 per cent more calories than meals eaten at home.14
Eating more than two fast-food meals a week has been linked to significantly more weight gain than occasional consumption.15 A WHO study concluded that fast-food consumption was a predictor of weight gain.16 The Centers for Disease Control and Prevention (CDC) examined the eating habits of Americans and concluded that 12.8 per cent of the total calories consumed by adults derived from fast food. The good news is that the total daily fast-food calories consumed by American adults have declined to 11.3 per cent of all calories consumed, a significant drop. For those aged 20 to 39, however, fast food accounted for more than 15 per cent of their daily calories. The percentage of total daily calories from fast food increased as weight increased. Obese young adults acquired 18 per cent of their daily calories from fast food.17
In the wake of the successful lawsuits against tobacco companies in the 1990s, overweight Americans filed lawsuits against fast-food giants, claiming that eating their food and drinking their beverages caused their diabetes, high blood pressure and obesity. In July 2002, 56-year-old Caesar Barber, who weighed 270 pounds (122 kg), was the lead plaintiff in a class-action suit against McDonald’s, Burger King, KFC and Wendy’s, alleging that the restaurants were responsible for the plaintiffs’ poor health. Another class-action suit, this time with two obese teenagers as plaintiffs, went after McDonald’s in 2003. That suit, Perlman et al. v. McDonald’s Corporation, alleged that the chain’s food had caused the youngsters to become obese, and that the company engaged in deceptive advertising and fraud, among other things. The charges accused McDonald’s of selling food that was harmful, and of being negligent in informing its customers of the danger. The Perlman lawsuit was dismissed, refiled and finally dismissed again in 2010: the judge’s decision was that the plaintiffs had not shown a clear cause and effect relationship between eating a particular company’s food and obesity.
Lawsuits like Perlman et al. v. McDonald’s and Monet Parham v. McDonald’s (2010) encouraged states to pass legislation to prevent people from suing fast-food restaurants or food manufacturers on grounds that their food is to blame for causing obesity or related illnesses such as heart disease, diabetes or hypertension. In June 2003 Louisiana was the first state to pass what was called a cheeseburger law, and subsequently at least eighteen other states have passed such laws. Similar bills have been introduced in other state legislatures.
Fortune magazine asked on the cover of its 3 February 2003 issue: ‘Is Fat the Next Tobacco?’ To date, the answer is no. Unlike tobacco, whose nicotine and tar are addictive and clear contributors to lung and other diseases, fast food is diverse – from burgers to salads to french fries to soda to coffee to doughnuts to ice cream. People eat fast food regularly and do not become obese, and many people who are obese do not eat fast food. No clear cause and effect relationship has been established, as it has been with tobacco and lung cancer.
Many studies have examined the connection between the location of fast-food outlets and obesity in the surrounding areas. A systematic review of these studies in 2011 found that fast-food restaurants were more prevalent in low-income areas and that higher body mass index was associated with living in areas with increased exposure to fast food.18 Subsequent studies in several countries have confirmed that fast-food outlets near homes, work and commuting environments are associated with greater body mass index. People with the greatest exposure to fast-food outlets were almost twice as likely to be obese.19 Several studies have suggested that zoning restrictions be placed on fast-food restaurants near low-income residents.20
In 2008 the Los Angeles City Council enacted a moratorium on the construction of new stand-alone fast-food restaurants in a 32-square-mile (83-square-kilometre) area in South Los Angeles, a low-income neighbourhood. They found that there were already 1,000 fast-food restaurants in this area, a far greater concentration than elsewhere in the city. They also found that 30 per cent of the 750,000 residents in the area were obese, double the rate in more affluent parts of the city. In 2015 the Rand Corporation found that obesity rates in South Los Angeles continued to rise after passage of the ban. Before the fast-food ordinance went into effect, 63 per cent of South Los Angeles residents reported being overweight or obese; three years later, 75 per cent reported being overweight or obese. Advocates for the ban responded by stating that they never thought the ordinance was a ‘silver bullet’ for solving obesity. They claimed instead that goal was to create more options for residents in South Los Angeles.21
Worldwide, the number of people with diabetes has increased from an estimated 153 million in 1980 to almost 350 million in 2011. The Centers for Disease Control has projected that one-third of American children will develop diabetes in their lifetime. It is a preventable disease that reduces life expectancy by several years. The most common form is Type 2, also called ‘adult onset’ diabetes as it was formerly rare in children. However, Type 2 diabetes is ‘increasingly diagnosed in youth and now accounts for 20% to 50% of new-onset diabetes case patients, disproportionately affecting minority race/ethnic groups’, according to a 2014 research study published in the Journal of the American Medical Association.22
Studies have linked eating fast food with Type 2 diabetes and other diseases. Researchers at the University of North Carolina studied the eating habits of 3,643 young adults over a thirteen-year period, and concluded that ‘Those who ate the most fast food weighed more, had larger waists and triglyceride levels, and showed signs of metabolic syndrome – a precursor to diabetes, heart disease and possibly cancer.’23
As fast-food chains have planted their flags in various countries, several studies have associated increases in fast-food consumption and Type 2 diabetes. A study published in 2005 in The Lancet examined the health and eating habits of 3,031 young adults who were 18–30 years old in 1985, and then followed them over a fifteen-year period. The authors concluded that ‘Fast-food consumption has strong positive associations with weight gain and insulin resistance, suggesting that fast food increases the risk of obesity and type 2 diabetes.’24
A study by researchers at Australia’s Garvan Institute of Medical Research concluded that the increase in Type 2 diabetes in Ho Chi Minh City, Vietnam, was caused by changing lifestyles, including fast-food consumption.25 An examination of Chinese Singaporeans in 2012 concluded that ‘Western-style fast food intake is associated with increased risk of developing type 2 diabetes mellitus and of coronary heart disease mortality in an Eastern population.’26
Foodborne illnesses have many causes. Fifty years ago the main culprit was improper handling or storage of food. Generally those outbreaks affected only a limited number of people in a particular area. But with increased industrialization and centralization of food systems, a problem anywhere in the food chain has the potential to explode into a crisis. As fast-food operations serve millions of customers daily, it comes as no surprise that some have been sources of outbreaks of foodborne illness.
Eric Schlosser, author of Fast Food Nation: The Dark Side of the All-American Meal (2001), pointed to a major cause of this increase in foodborne disease: the vast expansion of the meatpacking industry in response to increased demand from fast-food chains. Schlosser estimated that each year roughly 100,000 Americans, mainly children and the elderly, are sickened by E. coli bacteria. Indeed, outbreaks of the potentially deadly E. coli 0157:H7 have been traced to meat processors’ operations, just as Salmonella has increasingly been traced to poultry processing plants. A USDA study reported in 1996 that 7.5 per cent of the samples taken at processing plants were contaminated with Salmonella; 11.7 per cent were contaminated with Listeria monocytogenes (of which one in five cases proves fatal), 30 per cent with Staphylococcus aureus and 53 per cent with Clostridium perfringens; 78.6 per cent of ground beef contained E. coli (Biotype 1) – microbes that are indicators of faecal matter.27
Meat processing has changed over the past 50 years. A hamburger bought in 1970 would probably have contained meat from a single steer or cow. Today, a fast-food hamburger patty may contain meat from 1,000 cows that have been raised in five different countries. Using meat from many animals increases the chances that the hamburger will be contaminated with bacteria. According to the USDA, contaminated meat causes 70 per cent of all foodborne illnesses.28 The Food Safety and Inspection Service (FSIS), a branch of the U.S. Department of Agriculture (USDA), has tested more than 26,000 samples of ground beef since 1996. Of these, 25 tested positive for E. coli and none was associated with any outbreak of illness. Recently FSIS inspections of meat-processing plants have increased, and incidences of E. coli have decreased.
Foodborne illnesses have been traced to fast-food outlets. In January 1993 Jack in the Box distributed hamburger patties contaminated with foecal matter to its Pacific Northwest restaurants. Patties were served undercooked, and the surviving E. coli O157:H57 bacteria in the meat caused 600 customers to become ill; four children died. The company was served with hundreds of lawsuits, most of which were settled out of court. A nine-year-old girl who suffered kidney failure received $15.6 million. In addition to its legal costs, the company lost $44 million in sales, largely because of the bad publicity. It sued the supplier, Vons Companies of Arcadia, California, that had sent the contaminated meat to the company’s restaurants. The lawsuit was settled in 1998; Vons paid Jack in the Box’s parent company, Foodmaker, $58.5 million. Jack in the Box changed its policies and procedures to avoid future problems.
The Taco Bell distribution centre in New Jersey was the likely source of an E. coli O157:H7 outbreak in 2006. Taco Bell was also tied to other Salmonella outbreaks in 2010 and 2011.29 Employees who failed to wash their hands properly were the most probable vector of these illnesses. In 2009, 32 people, including two workers, were confirmed to have contracted hepatitis A after eating at a McDonald’s restaurant in Milan, Illinois. Hepatitis A is transmitted through faecal matter, and it is likely that employees did not follow proper sanitation procedures.
These are a few of the known cases in which fast-food outlets have been involved. In most cases the actual source of the foodborne illness is not determined. The CDC estimates that 48 million Americans – about one in seven – become ill from these illnesses every year. Of these, 128,000 are hospitalized and 3,000 die. The CSPI traced 44 per cent of foodborne illnesses to restaurants in general.30
Addiction is defined as the persistent, compulsive use of a substance regardless of its negative consequences. The addictive effects of alcoholism, drug abuse and chain smoking are well documented. Foods that contain large amounts of sugar, fat and sodium, such as most offerings at fast-food chains, have been specifically identified as potentially addictive. Sugar, fat and sodium stimulate neurons, cells that trigger the brain’s reward system, which releases dopamine, a ‘neurotransmitter that plays a key role in the brain’s reward centers, and can lead to pleasure producing behavior, such as drug abuse and overeating’.31
Howard Moskowitz, a marketing expert and experimental psychologist, coined the term ‘bliss point’ to identify the natural amount of sweetness, saltiness and fattiness that makes foods and beverages most enjoyable.32 Chemists micro-engineered foods with these inborn taste combinations and added colour additives and flavour compounds to create fast foods that were even more irresistible.
Dana Small from the University of Cambridge in the United Kingdom has argued that food addiction, such as binge eating and other compulsive behaviours, does exist, although it is not as powerful as addiction to addictive drugs.33 Existing research, including both animal and human studies, offers a number of findings that suggest food addictions. There are striking similarities between the brain patterns of people consuming excess amounts of sugar and those of heroin or cocaine users. These relationships suggest that certain foods and well-known addictive substances compete for the same brain pathways, which would help to explain why people who quit smoking may turn to food as a substitute for cigarettes.34
Scientific evidence also suggests that fatty, salty and sugary foods can trigger addictive behaviours. Recently researchers have gone further, stating that some people who overeat do have an addiction. Discussing a study on the excess of sodium in kids’ meals, Graham MacGregor, a professor at Queen Mary University, London, concluded, ‘Evidence suggests dietary habits in childhood can influence eating patterns later in life. Salt should therefore not be given to children as this could lead to a “salt addiction”’, which could ‘raise their blood pressure which tracks into adulthood, leading to increased risk of developing strokes and heart attacks’.35
Researchers now believe that food addictions contribute to the rise of obesity, and that addiction may account for the great difficulty encountered by most overweight people when they try to lose weight. In 2009 researchers at the Rudd Center for Food Policy and Obesity developed a food-addiction scale as a way to assess dependence on foods high in fat and sugar. Preliminary findings indicate that this scale can help identify people with addictive inclinations toward such foods.36
Fast-food chains have responded to their nutrition nightmare by offering healthier options, such as salads, but sales of such items are limited, and their inclusion on menus is often mainly for public-relations purposes. Salads and other ‘healthy’ items attract some adults with children to fast-food restaurants – the adults eat the salads while their children choose what they like. Fast-food companies trumpet their healthy items partly to combat the unhealthy image of their other foods and beverages. Healthy food on the menu also gives chains the ability to proclaim that eating is a ‘personal responsibility’, which means that companies should not be blamed if their frequent customers become ill, fat or obese.
Customers like the idea that they can order healthy food if they choose to do so, but few healthy foods have been successful. In 1991 McDonald’s introduced the McLean Deluxe burger containing a 91 per cent fat-free patty with a seaweed derivative; it was dropped from the menu six years later owing to miserable sales. Salads were also introduced as healthy alternatives and were heavily promoted, but sales have been limited. In 2013 salad sales in McDonald’s restaurants in the U.S. hovered between 2 and 3 per cent of total sales.37
There are several reasons for the minimal sales of healthy fast foods. Customers identify fast-food items marketed as healthy, lean or low-calorie as flavourless. For many customers, eating out is a treat, and they want food that tastes good – that is, high-calorie foods filled with plenty of salt, fat and sugar. Also, healthy items cost more than other items. Why spend more money for healthy items that are flavourless?
While many ‘healthy’ options are far better nutritionally than other fast-food menu items, some turn out to be not so healthy. Fried chicken or fish sandwiches, for instance, often have as much fat and calories as extra-large burgers. McDonald’s Fruit & Maple Oatmeal contains 290 calories, 4.5 grams of fat and 32 grams of sugar, more sugar than a Snickers bar. Some salads are higher in calories, fat and sodium than traditional fast-food choices such as hamburgers or tacos. When a large packet of fatty dressing – enough to drown the greens and their healthy potential – and other components, such as croutons and taco chips and shells, are added, some fast-food salads weigh in with as much as 1,300 calories, 54 grams of fat and 1,700 milligrams of sodium.
Despite these well-publicized claims of improved nutritional content, the amount of salt, fat and calories remains high in fast food, and publicly touted positive changes have made little overall difference, according to a study at Tufts University published in 2014. It compared the nutritional content of eighteen fast-food menu offerings in 1996 with the same items in 2013: six contained fewer calories, but nine contained more. Similarly the sodium content was lower in five of the eighteen items, but higher in seven.38
While most fast-food companies list the nutritional content of the food and beverages they sell on their websites, many health activists have advocated requiring chains to post calorie content in their stores. The assumption is that when customers know the calorie and nutritional content, they will make more rational decisions about the food they eat and have a better chance of avoiding chronic diseases associated with weight gain. New York and other cities have mandated nutritional labelling in chain restaurants. In the U.S. the Patient Protection and Affordable Care Act, passed in 2010, requires chain restaurants to post nutritional information in plain sight in their stores.
The effectiveness of menu labelling in reducing calorie consumption at fast-food restaurants has been questioned. A University of Washington study published in 2010 found that when parents were provided with calorie information, they chose meals containing around 100 fewer calories for their three- to six-year-old children than parents who didn’t have that information. Other studies have found that menu labelling had no impact on calorie consumption in outlets. TacoTime, a Mexican American-themed fast-food restaurant chain, placed nutritional information (calories, fat and sodium) at all its 350 outlets. One study published found that menu labelling at TacoTime did not promote healthier food-purchasing behaviour. Another study concluded that calorie counts made little difference in the choices low-income people made in KFC, McDonald’s, Burger King and Wendy’s restaurants in New York and New Jersey. Brian Elbel, the lead researcher in the study, concluded that ‘labeling is not likely to be enough to influence obesity in a large scale way. Other public policy approaches, as well as the efforts of food companies and other actors, will be needed.’39
In January 2005 Ireland required that fast-food wrappers carry the message ‘Fast food should be eaten in moderation as part of a balanced diet.’40 An Australian, Aaron Schultz, the founder of the Game Changer movement, has proposed that nutritional information be posted directly on each paper wrapper, box and cup, and that it be accompanied by obesity warnings, similar to the cancer warnings on cigarette packs.41