Public Health Nutrition

Nutrition and health

Fast-food menu offerings vary in dietary quality, but are consistently poor

Sharon I Kirkpatricka1 c1, Jill Reedya1, Lisa L Kahlea2, Jennifer L Harrisa3, Punam Ohri-Vachaspatia4 and Susan M Krebs-Smitha1

a1 Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, EPN 4005, Bethesda, MD 20892, USA

a2 Information Management Services, Inc., Rockville, MD, USA

a3 Rudd Center for Food Policy and Obesity, Yale University, New Haven, CT, USA

a4 School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA


Objective To evaluate five popular fast-food chains’ menus in relation to dietary guidance.

Design Menus posted on chains’ websites were coded using the Food and Nutrient Database for Dietary Studies and MyPyramid Equivalents Database to enable Healthy Eating Index-2005 (HEI-2005) scores to be assigned. Dollar or value and kids’ menus and sets of items promoted as healthy or nutritious were also assessed.

Setting Five popular fast-food chains in the USA.

Subjects Not applicable.

Results Full menus scored lower than 50 out of 100 possible points on the HEI-2005. Scores for Total Fruit, Whole Grains and Sodium were particularly dismal. Compared with full menus, scores on dollar or value menus were 3 points higher on average, whereas kids’ menus scored 10 points higher on average. Three chains marketed subsets of items as healthy or nutritious; these scored 17 points higher on average compared with the full menus. No menu or subset of menu items received a score higher than 72 out of 100 points.

Conclusions The poor quality of fast-food menus is a concern in light of increasing away-from-home eating, aggressive marketing to children and minorities, and the tendency for fast-food restaurants to be located in low-income and minority areas. The addition of fruits, vegetables and legumes; replacement of refined with whole grains; and reformulation of offerings high in sodium, solid fats and added sugars are potential strategies to improve fast-food offerings. The HEI may be a useful metric for ongoing monitoring of fast-food menus.

(Received July 09 2012)

(Revised October 18 2012)

(Accepted December 04 2012)

(Online publication January 15 2013)


  • Fast food;
  • Dietary quality;
  • Healthy Eating Index-2005;
  • Dietary guidance;
  • Food environment


c1 Corresponding author: Email