June/July 2020 Issue

Foodservice Menu Planning: Healthful Fast Food
By Carrie Dennett, MPH, RDN, CD
Today’s Dietitian
Vol. 22, No. 6, P. 10

Why It’s Getting Easier to Make Good Choices On the Go

When making healthful eating recommendations, “avoid fast food” is a common piece of advice, and there are no shortages of articles targeting fast food chains in discussions of the ills of the modern food environment. But is fast food always a link in the chain of poor nutrition, or can these restaurants tick the boxes of convenience and health?

The National Restaurant Association’s annual “What’s Hot” trend report found that plant-based protein is top of mind for chefs across the restaurant industry, and that many quick-service restaurants added a plant-based protein or meatless option to their menus in 2019.1 These trends appear to have traction: In its 2030 forecast, the National Restaurant Association says demand will increase for healthful menu items, including plant-based proteins, fresh produce, and locally sourced, sustainable options.2 Reduction of added sugars and sodium, and inclusion of whole grains, also are priorities at some chains. Dietitians are playing a key role in this healthful evolution.

Amy Myrdal Miller, MS, RDN, FAND, founder and president of Farmer’s Daughter Consulting in Carmichael, California, works with the Healthy Menus R&D Collaborative, which brings together nutrition professionals and members from chain restaurants and other “volume foodservice” companies.3 The collaborative’s strategic priorities include increasing the number of plant-forward menu items, reducing sodium, increasing options for less/lightly sweetened beverages, and improving protein quality. Myrdal Miller points to Taco Bell’s vegetarian menu as a success story.

Plant Forward
In 2012, Taco Bell launched the CantinaBell Menu, which added ingredients such as black beans and romaine lettuce. In 2014, that menu became the Power Menu, offering high-protein items with fewer than 510 kcal. Taco Bell’s first in-house dietitian, Missy Schaaphok, RDN, now senior manager of global nutrition and sustainability, spearheaded that development.

In 2015, Taco Bell became the first quick-service restaurant to offer menu items certified by the American Vegetarian Association. Today, the chain has 41 certified vegetarian ingredients, 31 of which are also vegan. In March, Taco Bell activated “Veggie Mode”—a single-swipe feature that transforms menu favorites to vegetarian versions—on its self-ordering kiosks nationwide. Michelle Dudash, RDN, a Cordon Bleu–certified chef and owner of Dudash Nutrition in Carmel, Indiana, appreciates these changes, as both a dietitian and an eater. “I get the seven-layer veggie burrito with black beans when I’m on the road and won’t get lunch otherwise.”

Marissa Thiry, RD, a nutrition specialist on Taco Bell’s Food Innovation Team, says the option to order through Taco Bell’s website, mobile app, or in-store kiosks makes it even easier to customize menu items to fit dietary preferences, such as adding extra lettuce and onions to a burrito, a side of black beans, or extra grilled chicken to a quesadilla. Ordering items “Fresco Style” replaces mayo-based sauces, cheese, sour cream, and guacamole with pico de gallo, but customers who still want a little guacamole or Avocado Ranch Sauce can request “easy sauce.”

In 2019, several fast food chains, including Burger King, Del Taco, and Carl’s Jr., added products from Beyond Meat or Impossible Foods to their menus. When Burger King introduced the Impossible Whopper to its St. Louis market in April 2019, foot traffic increased 18.5% over the previous month.4

“Restaurants monitor what’s important to their core customers. They know that younger customers put a great emphasis on health, wellness, and sustainability,” Myrdal Miller says. For example, fast food chains that offer plant-based meat alternatives know it will attract diners who think plant-based meat is better for the planet—something she says isn’t necessarily true, because determining what’s sustainable requires complex assessments of many factors. “But for the average consumer, if they hear ‘meat is bad’ they think ‘plant-based is good … or better.’”

Plant-based meat may be trending, but not all fast food chains are going in that direction with their plant-based offerings. Taco Bell hasn’t, and neither has Panera Bread. “In the past several years, we’ve heard our guests say, ‘We want more plant-based options,’ so our goal is to increase plant-based options from 25% of our entrées to 50% of our entrées, with new plant-based products in every category by 2021,” says Katie Tyler, MS, RDN, senior nutrition manager at Panera Bread. Rather than meat substitutes, Panera’s new options will focus on whole foods such as nuts, seeds, quinoa, and edamame. Currently, a variety of Panera’s menu items can be made vegan with just a swap or two, including the Baja Grain Bowl and the Mediterranean Grain Bowl.

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Sugar, Sodium, and Stealth Health
While some fast food chains actively have promoted their efforts to offer more healthful menu options—for example, McDonald’s oatmeal with diced fresh apples—Myrdal Miller says this isn’t often the case. “Much of the work done by fast food chains has been quiet and stealthy. Few have openly talked about their significant efforts to reduce sodium across the menu. Why? Because customers think, ‘If there’s less sodium in my favorite menu item, it might not taste as good as before.’”

Thiry agrees, adding that while Taco Bell has been evolving their menu for more than a decade, many initial changes were centered around what she calls “stealth health”—they weren’t advertising them much, even though the chain has posted ingredient statements and nutrition information on its website since 2005.

To help address the issue of added sugars, in 2017 Panera introduced a new line of craft beverages in a range of sweetness levels—from unsweetened to moderately sweetened—to give consumers an alternative to full calorie fountain beverages. Taco Bell removed the 40-oz soda cup from its menu a few years ago, and by 2022, at least 50% of the 20-oz fountain beverages will top out at 100 kcal and 20 g sugar. Since 2008, the chain reduced sodium by 15% on average and is working toward an average total of a 25% sodium reduction by 2025. “With over 7,000 restaurants in the US that feed millions of people each week, even small tweaks to our menu items or ingredients can make a huge impact,” Thiry says.

Bowls and Whole Grains
Two more 2020 trends identified by the National Restaurant Association are healthful bowls and healthful kids meals.1 Panera introduced grain bowls last fall as the next step towards serving more grains, plants, and proteins. “These made-to-order grain bowls have been our most successful launch in the past several years,” Tyler says. While grain bowls largely are limited to smaller health-oriented chains, such as Sweetgreen, Chipotle’s burrito bowl becomes a whole grain bowl with the option of brown rice.

Dudash called Panera’s bowls a dietitian’s paradise. “The Mediterranean bowl is what I got all winter long. It’s really satisfying.” On the kid’s meal front, she likes that McDonald’s provides the option to get both fruit and a small serving of fries with the kids’ Happy Meals, and that milk and 100% fruit juice are options. “As a mom, that’s something I’m happy about.”

In addition to whole grain bowls, Panera introduced whole grain breakfast wraps in 2018. While chains such as Au Bon Pain and Jack in the Box have added flatbreads and pitas with whole grains, and Subway’s nine-grain wheat bread contains 24 g whole grains in a 6-inch roll, this is an area Dudash says has significant room for improvement.

Portion Size and Convenience
Despite the positive changes afoot at fast food restaurants, there’s still room for change. Dudash emphasizes that portion size remains an issue—in most restaurants, a burger bun is the equivalent of four bread servings—and adding condiments can increase sodium intake dramatically. “Can you get reasonable portions? Yes, but you have to go out of your way to do it. Why are value meals automatically larger sizes? I wish they took some of the thinking out of it for consumers.”

Myrdal Miller says dietitians can be powerful allies with clients and patients by helping them make the best choice no matter where they choose to dine. “There are healthful offerings at all fast food restaurants. We shouldn’t make anyone feel guilty for eating fast food,” she says. “Some people need the convenience of a quick meal they can eat in their car or truck. Others need a lower price point that fits with their budget. And others don’t have the cooking equipment, skills, time, or access to cook at home, whatever that ‘home’ may be.”

— Carrie Dennett, MPH, RDN, CD, is the nutrition columnist for The Seattle Times, owner of Nutrition By Carrie, and author of Healthy for Your Life: A Holistic Guide to Optimal Wellness.

1. National Restaurant Association. What’s hot: 2020 culinary forecast. https://restaurant.org/Downloads/PDFs/Research/Whats_Hot_2020.pdf

2. National Restaurant Association. Restaurant industry 2030: actionable insights for the future. https://restaurant.org/Downloads/PDFs/Research/Restaurant2030.pdf. Published November 2019.

3. Culinary Institute of America, Healthy Menus R&D Collaborative website. https://www.ciahealthymenus.com/

4. inMarket inSights. Impossible Whopper: inMarket inSights report card. https://cdn2.hubspot.net/hubfs/2750857/Reports_Whitepapers_Webinars/inMarket%