June 2007

Breakfast on the Run
By Tracy Meadowcroft
Today’s Dietitian
Vol. 9 No. 6. P. 32

They may not have time for home-cooked and freshly squeezed, but your clients can still eat nutritiously during the morning scramble.

Everyone knows what it’s like to be busy. Who doesn’t use the busy excuse to explain why they haven’t called a close friend for several weeks, why they haven’t scheduled their six-month dental checkup even though it’s two months overdue, or why they rolled through the local fast-food drive-thru for breakfast this morning … and yesterday morning … and two mornings before that.

A growing number of people have turned nutrition on the run into nutrition on the steady decline. They reach for whatever convenient and tasty foods are readily available when they think they don’t have time to prepare a healthier option for that all-important first meal of the day.

Fast-food restaurants, while fulfilling their obligation to provide convenient and tasty foods, are often vilified for offering options that contain too many calories or grams of fat (including trans fat), carbohydrate, sodium, cholesterol, or more. The truth is, while some on-the-go breakfast options may not be so good, there are healthier choices out there or ways to make the not-so-good not so bad.

The Most Important Meal of the Day—or Fiscal Year
Breakfast is becoming a major focus of business for various restaurant chains across the country. While McDonald’s currently dominates this niche market, Starbucks, Burger King, and Wendy’s are among those establishments trying to give the Golden Arches a run for its bacon and eggs.

Among the initiatives underway, Starbucks is introducing five hot breakfast sandwiches; Wendy’s is taking another stab at the breakfast market after a failed attempt nearly two decades ago; Burger King is rolling out a new breakfast value menu; and Subway is planning to introduce a breakfast omelet sandwich at one third of its stores. McDonald’s is also dabbling with a value menu.1

Already supplying bagels, croissants, muffins, and scones at its stores, Starbucks has begun making hot breakfast sandwiches, starting in approximately 1,200 of its 9,400 U.S. locations. These sandwiches feature “fancier” names, including Peppered Bacon, Egg, & Natural Aged Cheddar Cheese on an English Muffin.1

Burger King already serves a variety of breakfast items, but now, several are being featured on a value menu, priced at roughly $1 each. Items on the menu include the Enormous Omelet Sandwich—which caused a stir upon its unveiling because it packs a 730-calorie, 45-grams-of-fat punch—the Croissan’wich and Double Croissan’wich, Cheesy Tots, hash browns, and French toast sticks.

McDonald’s began testing a breakfast value menu itself more than one year ago in some of its bigger markets, such as Baltimore and Washington, D.C. Costing roughly $1, the menu features eight items, including the Egg and Cheese Biscuit, snack-size Fruit and Walnut Salad, and Sausage McGriddle.1

When Wendy’s attempted to break into the breakfast market 20 years ago, the venture failed, mainly because the made-to-order choices took too long to cook. With its second go-round, Wendy’s plans to streamline its new breakfast items in the hopes of avoiding a similar fate. The items include Buttermilk Frescuits—pan-bread sandwiches made with bacon, sausage, or ham—French toast sticks, sausage and egg burritos, and a steak and egg breakfast sandwich. The rollout of these items began slowly, first in roughly 160 locations with approximately one half of the restaurants scheduled to feature the items by the end of 2008, according to the company’s marketing chief, Ian Rowden.1

Subway wants in on the action by offering omelet sandwiches at approximately 7,000 of its 20,600 U.S. locations. “We’ve had breakfast on our radar screens for many, many years,” says spokesperson Les Winograd, adding that the chain became more serious about breaking into the breakfast market after installing toasters in its stores roughly two years ago.1

Maybe Ignorance Is Bliss
So what exactly is the deal with these on-the-go breakfast options? Are they really that unhealthy? Are these restaurants simply catering to their customers by offering the options that they do? Do consumers bother to investigate the nutritional information of their favorite breakfast foods? Do they even care, or is ignorance really bliss?

“I think there are definitely customers who care about nutrition information. It is why most fast-food establishments make that information available to consumers,” says Bonnie Modugno, MS, RD, a private practice nutrition consultant who has worked with McDonald’s owners and operators in southern California.

“At the same time, people don’t eat nutrients—they eat food. I don’t believe most people want to run around counting grams of carbohydrate, protein, or fat all day. That’s not practical,” she adds.

“They [consumers] are all in the mode of thinking that breakfast must contain meat for protein, bread, juice, etc. They are not aware of the nutritional information in these items,” says Dina Kimmel, RD, who offers nutritional counseling at Kingsley Institute, a medical wellness facility in New Jersey. “Fast-food establishments do make nutrition charts available, but the average consumer does not ask to see these, nor do they check online.

“When I show clients nutrition charts from fast-food establishments—even relatively healthier options at fast-food places such as Subway or Wendy’s—they are quite surprised,” Kimmel adds. “I do believe they care about the nutritional profile of these foods, but finding out is not a priority because they think the numbers wouldn’t be as bad as they really are.”

And in the competitive business world, these restaurants want to offer their customers delicious meal choices made quickly, but they also want to turn a profit. To do that, they’ve got to keep customers rolling in by giving them what they want, and what they want may very well include something with bacon, egg, and cheese—nothing green or fruity, please. “In any business, consumer demand rules,” says Keith-Thomas Ayoob, EdD, RD, FADA, associate professor in the department of pediatrics at Albert Einstein College of Medicine in Bronx, N.Y. “Over the years, fast-food restaurants have tried many healthier options, but if consumers don’t respond, the restaurants cannot continue to offer items that consumers refuse to buy.”

And as Ayoob points out, “education doesn’t always dictate behavior. Just because people know the fat and calorie content of their meals doesn’t ensure that their food choices will be any different. There has to be some motivation.”

“At the end of the day, taste wins out,” says D. Milton Stokes, MPH, RD, owner of One Source Nutrition, LLC, a counseling and consulting firm in southern Connecticut. “Knowledge doesn’t change behavior. It’s just not that cut-and-dry. Knowing doesn’t equate to perfect dietary intake.”

And sometimes, consumers get burned when restaurants produce so-called healthier options, as taste, texture, consistency, or other attributes may be compromised in the process.

“Consumers are suspicious when they see some foods marketed as ‘healthier’ or ‘better for you,’” notes Stokes. “Who can blame them? These foods are frequently synonymous with bland, tasteless, etc.”

Pitfalls in the Glass Display Case
So take away the bacon, sausage, eggs, cheese, or other foods that can often pack a high fat or calorie punch, and breakfast options like muffins, bagels, croissants, and scones are among the remaining options. But don’t let those blueberry muffins staring at you through the glass case at Starbucks or similar establishments lull you into thinking they’re a better option.

“All of the baked goods at places like Starbucks contain high amounts of simple carbohydrates and do nothing for us. They are empty calories made from mostly white flour,” says Kimmel. “We need to eat foods closer to their natural state, and bakery items from these types of establishments have been stripped of their nutrients and are highly processed.”

“A number of consumers think muffins are better for them because the muffins contain some type of fruit or nuts, but really, muffins are just cake in a muffin shape,” explains Stokes.

Sometimes, it’s also the portion size of these foods that presents a problem, along with the seeming lack of more healthful ingredients.

“People often don’t have any idea about the calorie content of many of these foods. Also, they’re used to eating a single portion of them, but the sizes of the single items have grown over the years,” says Ayoob. “A muffin used to be about 11/2 to 2 ounces. Now, a muffin can be up to 8 ounces or more, but consumers still see it as a single portion.”

The carbohydrates in an average bagel are equivalent to five slices of bread, notes Kimmel. Consumers may think a bagel is a healthy choice because it contains little fat, but a Starbucks bagel, for example, is not a healthy choice. It is empty calories, since these bagels are not a complex carbohydrate as they lack fiber, she adds.

"Scones aren't any better,” says Kimmel, “as they can contain a lot of saturated fat from butter."

There Are Good Options…
Even when you can’t convince your client to avoid the fast-food drive-thru or local coffee bar, there are ways to avoid the complete destruction of a day’s nutritional profile when a fast-food breakfast item is involved.

Adjusting the day’s food intake is one possibility for redemption. For example, if your client eats an Egg McMuffin from McDonald’s, he or she should skip the fried hash browns, Stokes says. “If you want this for breakfast, have it—just make accommodations or alterations later.”

Your client can also turn that Egg McMuffin, which contains approximately 300 calories, into a 400-calorie complete meal by adding an appropriate size glass of orange juice, Ayoob offers. “That’s way under most of those muffins or the huge bagel with cream cheese,” he says.

Modugno adds that an Egg McMuffin along with a snack-size Fruit and Yogurt Parfait or Apple Dippers “provides a balanced intake of protein, carbohydrate, and fat, providing a steady source of energy over time. The regular-size Fruit and Yogurt Parfait is a light option, while scrambled eggs and an English muffin with fruit provides a heartier breakfast.

“I have happily gone to McDonald’s for breakfast to enjoy two scrambled eggs, an English muffin, and apples with a carton of low-fat milk,” says Modugno. “There is nothing in that breakfast to atone for.”

Some Starbucks restaurants also offer a fruit and cheese platter, which can be a breakfast option. Kimmel suggests limiting the pieces of cheese that are eaten, though, because it is usually not low-fat cheese. Some locations also offer small bags of almonds and green or herbal teas, she adds.

In lieu of fast-food establishments, Kimmel says she has found some healthy options at convenience stores such as QuickChek and 7-Eleven. These include vegetable juice, raw nuts (depending on the type and portion size), low-fat string cheese, cottage cheese and fruit, yogurt smoothies, hard-boiled eggs, fresh fruit, apples and peanut butter in a small bag, celery and carrots with hummus dip, and single-serving–size cereals (preferably ones with the least sugar and highest amount of fiber—3 grams per serving or more).

“A bowl of whole grain cereal with fresh fruit and low-fat milk only runs about 250 to 300 calories and takes about two minutes to make,” Ayoob says. “If people have no time, this is a great option. It has fruit, low-fat dairy, and whole grains—three things most people need a lot more of in their diets.

“Breakfast is a meal of habits and consistency, too, so if we get people eating better at breakfast, it goes a long way toward improving their total nutrient intake,” he adds.

Balancing the Sausage and Biscuits
“I try to avoid saying things are ‘bad’ or ‘good,’” says Stokes. “That paints this picture of ‘right’ and ‘wrong,’ which is part of a dieting mentality. Dieting isn’t a good way to live or eat.”

“Balance is everything,” notes Ayoob. “Anything is OK if you’re willing to balance. Consumers get into trouble when they dismiss a high-calorie meal or snack by saying, ‘I didn’t have time’ or ‘I was on the run’ or even, ‘It’s only once in a while.’ Even occasional high-calorie meals and snacks need to be balanced later in the day or over a few snacks. If the balance doesn’t happen, then what will happen is the ‘creeping 5 pounds.’”

The power can also lie with the people, according to Kimmel. “If they [fast-food restaurants] do try to offer something healthy, like a veggie burger, they will discontinue it from the menu if the demand just isn’t there,” she says. “This is where consumers could really make a difference. We need to speak up to management, write letters to fast-food company headquarters, and let them know what we want.

“Then, just as important, we need to frequent these establishments and buy the healthier choices. As dietitians, we can then spread the word to our clients about new, healthier choices being offered. If the demand is there, the fast-food restaurants will meet it,” Kimmel adds.

Kimmel also notes that some restaurants that have dabbled with healthier menu options may still have them available even if they aren’t listed on the menu, so it is wise to ask when ordering.

“Most of my clients aren’t in touch with their bodies or how they feel when they eat,” notes Modugno. “I have to teach them to observe how protein helps them feel content when they eat, how fat allows them to feel satisfied longer, and how whole fruits, vegetables, and other complex carbohydrates help stabilize their energy. When people receive solid information about food and nutrition, they can effectively make choices that work for them.

“It is misguided to think that the location that you eat at determines whether the food is healthful,” says Modugno. “People can eat well or eat poorly anywhere.”

Modugno also poses her own questions on the topic of fast-food breakfasts. “Why do you presume that fast food has to be unhealthy? Sometimes, fast food is actually fresh food prepared as fast as they can. And don’t we all prepare food as fast as we can some of the time?”

— Tracy Meadowcroft is the production editor at Today’s Dietitian.


1. Horovitz B. “Fast-food rivals suit up for breakfast war.” USA Today. February 20, 2007. Available here. Accessed February 20, 2007.