The paper “Eighty-five percent of menu items from the six highest selling fast-food restaurants in the USA are ultra-processed“, published in Public Health Nutrition, has been chosen as the latest Editorial Highlight and is freely available to download for one month.

More than half of energy in the US diet comes from ultra-processed foods (UPFs), ¹ and UPFs are associated with many negative health outcomes, including overall mortality. ² Fast food is a staple in the US food system and although many papers refer to fast-food as ultra-processed, a reference was never provided to support this statement. Therefore, we decided to investigate the processing level of several fast-food restaurants and see what proportion of menu items is ultra-processed.

We collected menu information from the top six highest grossing fast-food restaurants in the United States and coded the menu items into one of four processing groups, per the NOVA Classification (minimally processed, culinary processed, processed, and UPF). Sure enough, the menu items were largely ultra-processed, with roughly 85% being ultra-processed across all menus. We also found that these restaurants offered very few minimally processed foods (only 11% of menu items across all restaurants), leaving very few healthful options for their customers.

The best way to identify an ultra-processed food is if the food contains a single ingredient that doesn’t exist in a typical home kitchen.³ Natural Flavours? Xantham Gum? Citric Acid? Yes, these are ultra-processed ingredients, and these were the three most common UPF ingredients across menus. In total, 46% of the ingredients that appeared on at least three of the restaurant menus were ultra-processed.

Considering nearly a third of US adults consume fast-food on a daily basis, ⁴ these results are of concern for public health nutrition. Pair this with the fact that the majority of grocery store items are also ultra-processed,⁵ consumers have very few sources of minimally processed foods in the US food environment.

To improve the nutritional quality of their menu items, fast-food companies should consider reformulation or the addition of more minimally processed foods to the menu to increase healthful food options for their customers. Perhaps apple slices and carrot sticks should not only be sides for the kid’s meals?

References:

1 – Marino M, Puppo F, Del Bo’ C, Vinelli V, Riso P, Porrini M, Martini D. A Systematic Review of Worldwide Consumption of Ultra-Processed Foods: Findings and Criticisms. Nutrients. 2021 Aug 13;13(8):2778. doi: 10.3390/nu13082778. PMID: 34444936; PMCID: PMC8398521.

2 – Lane MM, Gamage E, Du S, Ashtree DN, McGuinness AJ, Gauci S, Baker P, Lawrence M, Rebholz CM, Srour B, Touvier M, Jacka FN, O’Neil A, Segasby T, Marx W. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. 2024 Feb 28;384:e077310. doi: 10.1136/bmj-2023-077310. PMID: 38418082; PMCID: PMC10899807.

3 – Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada ML, Rauber F, Khandpur N, Cediel G, Neri D, Martinez-Steele E, Baraldi LG, Jaime PC. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019 Apr;22(5):936-941. doi: 10.1017/S1368980018003762. Epub 2019 Feb 12. PMID: 30744710; PMCID: PMC10260459.

4 – Fryar CD, Hughes JP, Herrick KA, Ahluwalia, N. Fast food consumption among adults in the United States, 2013–2016. NCHS Data Brief, no 322. Hyattsville, MD: National Center for Health Statistics. 2018.

5 – Gupta S, Hawk T, Aggarwal A, Drewnowski A. Characterizing Ultra-Processed Foods by Energy Density, Nutrient Density, and Cost. Front Nutr. 2019 May 28;6:70. doi: 10.3389/fnut.2019.00070. PMID: 31231655; PMCID: PMC6558394.

Each month a paper is selected by one of the Editors of the six Nutrition Society Publications (British Journal of Nutrition, Public Health Nutrition, Nutrition Research Reviews, Proceedings of the Nutrition Society, Journal of Nutritional Science and Gut Microbiome). Take a look at the entire Nutrition Society Paper of the Month Collection.