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Understanding price incentives to upsize combination meals at large US fast-food restaurants

  • Kelsey A Vercammen (a1), Johannah M Frelier (a2), Alyssa J Moran (a3), Caroline G Dunn (a2), Aviva A Musicus (a4), Julia Wolfson (a5), Omar S Ullah (a6) and Sara N Bleich (a2)...



To understand price incentives to upsize combination meals at fast-food restaurants by comparing the calories (i.e. kilocalories; 1 kcal = 4·184 kJ) per dollar of default combination meals (as advertised on the menu) with a higher-calorie version (created using realistic consumer additions and portion-size changes).


Combination meals (lunch/dinner: n 258, breakfast: n 68, children’s: n 34) and their prices were identified from online menus; corresponding nutrition information for each menu item was obtained from a restaurant nutrition database (MenuStat). Linear models were used to examine the difference in total calories per dollar between default and higher-calorie combination meals, overall and by restaurant.


Ten large fast-food chain restaurants located in the fifteen most populous US cities in 2017–2018.




There were significantly more calories per dollar in higher-calorie v. default combination meals for lunch/dinner (default: 577 kJ (138 kcal)/dollar, higher-calorie: 707 kJ (169 kcal)/dollar, difference: 130 kJ (31 kcal)/dollar, P < 0·001) and breakfast (default: 536 kJ (128 kcal)/dollar, higher-calorie: 607 kJ (145 kcal)/dollar, difference: 71 kJ (17 kcal)/dollar, P = 0·009). Results for children’s meals were in the same direction but were not statistically significant (default: 536 kJ (128 kcal)/dollar, higher-calorie: 741 kJ (177 kcal)/dollar, difference: 205 kJ (49 kcal)/dollar, P = 0·053). Across restaurants, the percentage change in calories per dollar for higher-calorie v. default combination meals ranged from 0·1 % (Dunkin’ Donuts) to 55·0 % (Subway).


Higher-calorie combination meals in fast-food restaurants offer significantly more calories per dollar compared with default combination meals, suggesting there is a strong financial incentive for consumers to ‘upsize’ their orders. Future research should test price incentives for lower-calorie options to promote healthier restaurant choices.


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1. Fryar, CD, Hughes, JP, Herrick, KA et al. (2018) Fast Food Consumption Among Adults in the United States, 2013–2016. NCHS Data Brief no. 322. Hyattsville, MD: National Center for Health Statistics.
2. Center for Disease Control and Prevention (2018) Percentage of youths aged 2–19 years consuming any fast food on a given day, by race and Hispanic origin – National Health and Nutrition Examination Survey, 2013–2016. MMWR Morb Mortal Wkly Rep 67, 1134.
3. Bowman, SA & Vinyard, BT (2004) Fast food consumption of US adults: impact on energy and nutrient intakes and overweight status. J Am Coll Nutr 23, 163168.
4. Paeratakul, S, Ferdinand, DP, Champagne, CM et al. (2003) Fast-food consumption among US adults and children: dietary and nutrient intake profile. J Am Diet Assoc 103, 13321338.
5. Todd, JE, Mancino, L & Lin, B-H (2010) The Impact of Food Away from Home on Adult Diet Quality. Washington, DC: US Department of Agriculture, Economic Research Service.
6. Glanz, K, Basil, M, Maibach, E et al. (1998) Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption. J Am Diet Assoc 98, 11181126.
7. Cohen, DA, Collins, R, Hunter, G et al. (2015) Store impulse marketing strategies and body mass index. Am J Prev Med 105, 14461452.
8. Harris, JL, Schwartz, MB & Brownell, KD (2010) Evaluating Fast Food Nutrition and Marketing to Youth. New Haven, CT: Yale Rudd Center for Food Policy & Obesity.
9. Steenhuis, IH, Waterlander, WE & De Mul, A (2011) Consumer food choices: the role of price and pricing strategies. Public Health Nutr 14, 22202226.
10. Drewnowski, A & Specter, SE (2004) Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr 79, 616.
11. Dobson, PW & Gerstner, E (2010) For a few cents more: why supersize unhealthy food? Mark Sci 29, 770778.
12. Kerr, D, Williams, E & Sargent, A (2016) Cash dieting – calories per dollar: a novel approach to inform food choices? Nutrition 32, 13061307.
13. Fast Food Menu Prices (2018) McDonalds Prices. (accessed January 2019).
14. Basch, CH, Ethan, D & Rajan, S (2013) Price, promotion, and availability of nutrition information: a descriptive study of a popular fast food chain in New York City. Glob J Health Sci   5, 73.
15. Krukowski, RA & West, D (2013) No financial disincentive for choosing more healthful entrées on children’s menus in full-service restaurants. Prev Chronic Dis 10, 94.
16. Food and Drug Administration, US Department of Health and Human Services (2014) Food Labeling; Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments. Final rule. Fed Regist 79, 71155711259.
17. Dumanovsky, T, Nonas, CA, Huang, CY et al. (2007) What people buy from fast-food restaurants: caloric content and menu item selection, New York City 2007. Obesity (Silver Spring) 17, 13691374.
18. New York City Department of Health and Mental Hygiene (2017) MenuStat Methods. (accessed December 2018).
19. US Census (2016) The 15 Most Populous Cities: July 1, 2016. (accessed December 2018).
20. US Census Bureau (2016) American Fact Finder. (accessed December 2018).
21. Social Explorer (2018) Explore Maps – United States. (accessed December 2018).
22. US Department of Agriculture, Economic Research Service (2018) US food-away-from-home spending continued to outpace food-at-home spending in 2017. (accessed January 2019).
23. Haws, KL & Liu, PJ (2016) Half-size me? How calorie and price information influence ordering on restaurant menus with both half and full entrée portion sizes. Appetite 97, 127137.
24. Haws, KL & Winterich, KP (2013) When value trumps health in a supersized world. J Mark 77, 4864.
25. Andreyeva, T, Long, MW & Brownell, KD (2010) The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food. Am J Prev Med 100, 216222.
26. Deliens, T, Deforche, B, Annemans, L et al. (2016) Effectiveness of pricing strategies on French fries and fruit purchases among university students: results from an on-campus restaurant experiment. PLoS One 11, e0165298.
27. Vermeer, WM, Alting, E, Steenhuis, IH et al. (2009) Value for money or making the healthy choice: the impact of proportional pricing on consumers’ portion size choices. Eur J Public Health 20, 6569.
28. Harnack, LJ, French, SA, Oakes, JM et al. (2008) Effects of calorie labeling and value size pricing on fast food meal choices: results from an experimental trial. Int J Behav Nutr Phys Act 5, 63.
29. Gollust, SE, Tang, X, Runge, CF et al. (2018) The effect of proportional v. value pricing on fountain drink purchases: results from a field experiment. Public Health Nutr 21, 25182522.
30. HM Government (2019) Closed consultation: Restricting promotions of food and drink that is high in fat, sugar and salt. (accessed January 2019).
31. Nakamura, R, Suhrcke, M, Pechey, R et al. (2014) Impact on alcohol purchasing of a ban on multi-buy promotions: a quasi-experimental evaluation comparing Scotland with England and Wales. Addiction 109, 558567.
32. Boniface, S, Scannell, JW & Marlow, S(2017) Evidence for the effectiveness of minimum pricing of alcohol: a systematic review and assessment using the Bradford Hill criteria for causality. BMJ Open 7, e013497.
33. Blumenthal, K & Volpp, KG (2010) Enhancing the effectiveness of food labeling in restaurants. JAMA 303, 553554.
34. Loewenstein, G, Brennan, T & Volpp, KG (2007) Asymmetric paternalism to improve health behaviors. JAMA 298, 24152417.
35. Voices for Healthy Kids (2019) Breaking News: Progress for NYC Kids’ Meals. (accessed January 2019).
36. Marteau, TM, Hollands, GJ, Shemilt, I et al. (2015) Downsizing: policy options to reduce portion sizes to help tackle obesity. BMJ 351, h5863.
37. US Food and Drug Administration (2018) Questions and Answers on the Menu and Vending Machines Nutrition Labeling Requirements. (accessed November 2018).
38. Datafiniti (2018) Ranking Cities with the Most and Least Fast Food Restaurants. (accessed January 2019).


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Understanding price incentives to upsize combination meals at large US fast-food restaurants

  • Kelsey A Vercammen (a1), Johannah M Frelier (a2), Alyssa J Moran (a3), Caroline G Dunn (a2), Aviva A Musicus (a4), Julia Wolfson (a5), Omar S Ullah (a6) and Sara N Bleich (a2)...


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