How Major Restaurant Chains Plan Their Menus

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How Major Restaurant Chains Plan Their Menus

  1. 1. How Major Restaurant Chains Plan Their MenusThe Role of Profit, Demand, and HealthKaren Glanz, PhD, MPH, Ken Resnicow, PhD, Jennifer Seymour, PhD, Kathy Hoy, EdD, Hayden Stewart, PhD,Mark Lyons, MS, Jeanne Goldberg, PhDBackground: Increased away-from-home eating is associated with lower diet quality, and may contribute to the increasing prevalence of overweight and obesity. Healthier food choices in restaurants may help mitigate the rise in obesity and improve diet quality. This study sought to understand the views of executives at major U.S. restaurant chains regarding the process, motivation for, and challenges of offering healthier options on their menus.Methods: The Healthy Menu Study used in-depth structured telephone interviews with 41 senior menu development and marketing executives at leading casual dining and fast-food restaurant chains. The interview guide covered menu trends, influences on introduction and continuation of new menu items, and barriers to adding healthy foods. Data analysis included tabulation of responses, identification of themes, and examination of subgroup differences.Results: Growing sales and increasing profits are the most important considerations, mentioned by 61% of respondents; health and nutrition were noted as important by 21%. Restaurants may try to avoid losing groups with a “health seeker” by offering healthier foods (low in fat and calories, more fruits and vegetables) (27% of chains), but operators believe demand for healthier foods is not widespread. Additional obstacles to including healthier menu items are short shelf life of produce (46%), increased preparation time, low sales, and high labor costs.Conclusions: Not surprisingly, profit margins are the primary determinants of why restaurants do or do not add and continue to serve healthier food options. Without an increase in consumer demand, it is unlikely the restaurant industry will increase their offering of healthy food choices. Insight into the restaurant industry perspective is important for developing promising strategies to encourage healthier eating patterns. (Am J Prev Med 2007;32(5):383–388) © 2007 American Journal of Preventive MedicineIntroduction tion,9 and higher fast-food consumption is associated with increases in body weight and insulin resistance.10O ver the past 2 decades, Americans have signif- The prevalence of obesity in the United States has icantly increased the number of meals con- increased significantly over the same time period.11 sumed and the percent of their food budget Excess weight is associated with the development ofspent on away-from-home foods.1,2 Greater consump-tion of away-from-home foods has been associated with type 2 diabetes, cardiovascular disease, some types ofincreased intake of calories, total fat, saturated fat, cancer, and other chronic conditions.12added sugars, and sodium, fewer fruits and vegetables, Although individual behaviors are major determi-and less milk, fiber, and vitamins.3– 8 The trend toward nants of overweight and obesity, growing evidencelarger portion sizes further encourages overconsump- suggests that the problem is powerfully influenced by community food environments.13,14 Focusing publicFrom the Rollins School of Public Health, Emory University (Glanz), health promotion efforts “upstream” could accelerateand Division of Nutrition and Physical Activity, U.S. Centers for progress toward stemming the obesity epidemic. Be-Disease Control and Prevention (Seymour), Atlanta, Georgia; School cause of the increases in away-from-home eating and itsof Public Health, University of Michigan (Resnicow), Ann Arbor,Michigan; Produce for Better Health Foundation (Hoy), Wilming- contribution to overweight and obesity, a change inton, Delaware; Economic Research Service, U.S. Department of restaurant offerings toward more low-calorie andAgriculture (Stewart), Washington DC; Technomic, Inc. (Lyons),Chicago, Illinois; Tufts University, Friedman School of Nutrition healthful choices may be especially influential.15,16(Goldberg), Boston, Massachusetts Few data describe factors influencing restaurants’ Address correspondence and reprint requests to: Karen Glanz, PhD, decisions about whether to offer healthier foods. ThisMPH, Department of Behavioral Sciences and Health Education, RollinsSchool of Public Health, Emory University, 1518 Clifton Road, NE, study aimed to understand the perspectives of seniorRoom 526, Atlanta GA 30322; E-mail: kglanz@sph.emory.edu. menu development and marketing executives at majorAm J Prev Med 2007;32(5) 0749-3797/07/$–see front matter 383© 2007 American Journal of Preventive Medicine • Published by Elsevier Inc. doi:10.1016/j.amepre.2007.01.003
  2. 2. U.S. restaurant chains regarding their menu develop- multiple executives per chain when responsibilities werement process, factors influencing the chains’ decisions segmented, for example across menu planning and market-to offer healthier menu items, and future challenges to ing, to obtain more complete information. All chains weremaking healthier eating easier for restaurant custom- contacted at least once until the quota of 40 interviews wasers. Understanding the restaurant industry perspective reached, at which time no further contacts were attemptedcan give health professionals information needed to for nonresponders. One respondent called back and wasimprove community nutrition environments. interviewed after the quota was reached. That brought the total number of interviews to 41.MethodsOverview Interview GuideThe Healthy Menu Study used in-depth structured interviews The interview guide covered the following topics: generalwith 41 senior menu development and marketing executives business issues and menu trends, factors influencing intro-at leading casual dining and fast-food restaurant chains to duction of and continuation of new menu items, the role ofobtain qualitative data about current practices, and in partic- “healthier foods” on restaurant menus and experience withular, barriers to offering more fresh produce. It was initiated healthful offerings, obstacles to adding more healthy foods toby the Produce for Better Health Foundation, a 501(c)3 menus, marketing of healthy offerings, and views about futurenonprofit educational foundation that aims to increase con- trends. To assist with recording and tabulating, precoded re-sumption of fruits and vegetables and to foster a healthy food sponse lists were created for items where responses could beenvironment. Interviews were conducted by Technomic, an anticipated. Multiple answers were allowed for most questions.established foodservice research firm with access to executives The initial draft of the interview guide was reviewed andat major restaurant chains. A research advisory committee revised based on input from the research advisory committee.advised the Produce for Better Health Foundation on recruit- It was then pilot tested with three restaurant chains andment, interviewing study participants, and the content and further revised to reduce redundancy and keep it to aformat of the interview guide. They also monitored study manageable length. Special efforts were taken to avoid lead-progress and reviewed the study results. (Authors KG, JG, KR, ing questions, and respondents were encouraged to describe,JS, and HS were on the research advisory committee.) and use, their own definitions of “healthier foods.” Respondents were not made aware that the study was sponsored by the Produce for Better Health Foundation, andSample targeted questions about fruits and vegetables were askedThe target sample for the study was 40 senior menu develop- toward the end. If respondents asked who the informationment and marketing executives at leading U.S. restaurant was for, they were told; however, only one respondent asked.chains. The types of chains included those with limited Participants were assured of the confidentiality of their re-service, or quick-service restaurants—also known as fast sponses and identity.food—and midscale and casual dining full-service establish-ments. The latter two categories include restaurants wherepatrons order and pay for their food prior to consuming it, as Data Analysis and Data Synthesiswell as those with table service. Average check ranges pereater are $6 –$10 and $10 –$25 for midscale and casual The interviewer recorded responses and typed in the narra-dining, respectively. Restaurants in the sample serve a range tive comments directly on the interview guide. Each interviewof consumers, including low- to middle-income individuals was analyzed by two individuals to assure consistency. Theyand families. tabulated responses to closed-ended items, highlighted key The Top 500 list of chains17 was used to select 54 chains, points, and analyzed them for consistency of themes acrosshalf of them full service and half with limited service (nϭ27 respondents or within subgroups (by volume and category).each) and three sales volume categories (smallՅ$200 million; Supporting quotes were highlighted for illustrative purposesmid-sizeϭ$200 –999 million; and largeՆ$1 billion) (nϭ18 but are not attributed to individuals or their chains because ofeach). These 54 chains were selected based on four criteria:17 confidentiality considerations.industry leadership position, strong growth history or trend, Findings were analyzed by restaurant type: full servicediverse menu categories, and history of cooperation with versus limited service; large, midsize, and small chains; menuinterviews by Technomic. This is not a probability sample, development versus other roles of the interviewee; and Tech-and the results should be viewed as indicative of industry nomic relationship group. In general, data were consistentpractices rather than a precise accounting. across subgroups. Of particular note, prior relationship with the survey company did not appear to bias responses. Other differ- ences between subgroups are described in the Results section.Data-Collection Procedures Where applicable, we report the number of respondentsTelephone interviews were conducted between September (n) who gave a specific answer in the Results. If there wereand December 2005. Technomic contacted the 54 chain multiple mentions from respondents at one chain (c), this isheadquarters to interview senior-level executives with key also indicated. We do not report the names of specific restau-decision-making authority for their companies’ strategies, rant chains here. Illustrative quotes are provided along withpositioning, and/or menus. The research plan allowed for summaries. The analysis was conducted in 2005 and 2006.384 American Journal of Preventive Medicine, Volume 32, Number 5 www.ajpm-online.net
  3. 3. Table 1. Summary of restaurant chain executives’ most frequent responsesIssue Most frequent response Secondary responsesKey marketplace issues and their impact Sales and profits Food safety on the menu Meeting customer demand Labor issuesMost important considerations for Customer demand and response Ease of preparation adding and retaining new menu Sales and profits itemsDefinition of “healthier foods” Low calorie and low fat No hydrogenated fats Fruits and vegetables Low carbohydrate Low sodiumPerceptions of healthier foods Need enough customer demand Customers want indulgence when Healthier options avoid “veto vote” eating out Fruit and vegetables—“halo” effectObstacles to healthier menu offerings Low sales, limited appeal Reluctance to call foods “healthy” Spoilage and short shelf life of F&V Additional storage requirements Inconsistent supply Employee training/skill issuesFuture trends, opportunities, strategies Healthier foods may increase, but Use of ethnic products only slightly Fresh produce limited mainly to salads Fruits and vegetables add creativity and side dishes to menusWhat trade groups and industry Clearly demonstrate profitability of Educate new chefs on healthier food associations can do healthier eating options use and preparation Partner with chains to market Improve distribution to increase healthier eating fresher, riper produceWhat public health groups and Conduct consumer research and Rate healthfulness of restaurants to scientists can do share with industry drive more people to those chains Publicize good examplesResults 28% of sales from all U.S. chains with more than $50Response Rate and Sample Characteristics million in annual sales (based on industry data).17To complete 41 interviews, a total of 124 individualswere contacted (Table 1). There were 10 refusals (8%). Key Marketplace Issues and Their ImpactThe rest of the individuals who did not completeinterviews either referred the interviewer to other indi- on the Menuviduals (nϭ11), or were unavailable that day (nϭ29), For the majority of those interviewed, the most impor-set up an interview for another day (nϭ25), or failed to tant issues are growing sales and increasing profitskeep an appointment (nϭ8). To check for bias in terms (mentioned by 25 respondents from 15 chains). Theyof prior relationship with the foodservice research firm, are in business to sell products and make a profit, andrespondents were classified by Technomic research to do this, they must sell food items at a price pointstaff as having a strong, moderate, or weak/no history acceptable to customers. About half as many operatorsof cooperating with Technomic research. This revealed are concerned about food safety (nϭ13), meetingthat 83% of respondents had moderate or weak/no customer demand (nϭ12), and labor issues (nϭ12).history, suggesting little introduction of bias on the Health and nutrition (nϭ9) and social responsibilitybasis of relationship with the researchers. It is not (nϭ3) are less important than sales, profits, demand,possible to rule out response bias related to other food safety, and labor. The majority of chains inter-characteristics of the restaurant chains. Interviews viewed will not add new items to their menus unlesslasted between 30 and 70 minutes. The wide time range they are confident that their customer base will acceptreflected differences in respondents’ breadth of knowl-edge, the detail of their answers, and time constraints. them and that the items will contribute to sales and Forty-one executives from 28 companies (also called profit growth. However, limited-service chains (fast“operators” and “chains”) from all six sales volume food) indicated that their consumers wanted menuand restaurant type categories (nϭ12 fast-food/quick- changes more often than did full-service restaurantservice restaurants and nϭ16 full-service chains) com- respondents.pleted an interview. Most (82.9%) were menu develop- “If you want to stay employed and stay in business,ment or marketing executives. The sales volume per you have to grow your sales and increase your profits.”chain ranged from $64 million to more than $24 “Meeting consumer demand is critical. If peoplebillion, and the number of locations per chain ranged don’t want to come to your restaurant, then you’re outfrom 22 to 17,909. Together, these chains represented of business.”May 2007 Am J Prev Med 2007;32(5) 385
  4. 4. Key Considerations for Making Menu Changes operators felt that most diners prefer to indulge them-and Retaining New Menu Items selves when they eat out. Hence, they do not perceive a large-scale demand for healthier foods.Restaurants weigh several issues when considering “Low carbohydrate fits well with what we serve. Wechanges to their menus, but the most important are: offer a lot of meat, and it’s easy to just leave off the(1) whether it will attract new customers or maintain potatoes. However, we don’t lead with this.”the current customer base (nϭ24; cϭ20), and (2) how “Look what happened when [XXXX] attempted toit will affect sales and profits (nϭ22; cϭ12). Many chainoperators will not add items that they believe are too list the nutritional information—it backfired. Most res-complex or difficult for their kitchen staff to prepare taurant customers’ attitudes is,‘When I go out to eat, Iefficiently (nϭ11; cϭ8). With respect to determining want what I want. Don’t make me feel guilty when I’mthe success of new menu items, the key factors were: eating dinner!’”sales (nϭ29, cϭ22), profitability (nϭ19, cϭ18), and “We don’t concentrate on offering healthy menupreparation ease (nϭ20, cϭ15). Restaurants measure items. We find that people say one thing and doprofitability in different ways, but food costs, labor, and another when it comes to healthier eating.”gross margin appear to be the most common methods. “Offering healthier menu items is like putting lip-Items are considered profitable if they do not exceed a stick on a pig. People may go where healthier foods aretarget food cost or gross margin percentage, and do not advertised, but they usually wind up eating the same oldplace undue burden on labor to produce. stuff.” “We always want to add new items that will put more Achieving positive public relations was mentioned bybutts in our seats.” a few chains (nϭ5). Several executives saw offering “The item must be profitable at the unit (location) healthier menu items as a way to stand out from theirlevel. There may be lots of things customers want, but competitors (nϭ3).we won’t do them simply because they are not profit-able to sell.” “We’re concerned about cannibalization. We don’t Marketing Healthy Foods andwant to serve an item that’s going to take dollars away Surmounting Obstaclesfrom a more profitable item.” The chains are mixed in how aggressively they market “Because of the current labor situation, we have to healthier items.use less-skilled labor. The easier it is to prepare a “We don’t have a broad enough appeal for theseproduct, the more successful it will be.” products. If we did, we’d probably serve more of them.” “We have been very aggressive in marketing healthierHealthier Foods: Perceptions and Rationale for items, except that we don’t come right out and callCurrent Activities them healthy. We call them fresh, flavorful, or in season. The word healthy scares customers away.”When chain restaurant executives think about healthier Many of the obstacles that prevent restaurant chainsfoods, they refer to fat and calorie content (nϭ41, from offering healthy foods focused on fruits andcϭ28; 100%). Many perceive that their customers view vegetables. Key barriers included short shelf life (nϭ23,healthier foods the same way. Fruits and vegetables cϭ19), supply issues (nϭ14, c ϭ13), low sales (n ϭ12,were second (nϭ21, cϭ19). Offering low-fat and low- cϭ11), high cost (nϭ11, cϭ10), and storage spacecalorie foods and fruits and vegetables is seen as a way requirements (nϭ10, cϭ9). Specifically, chain restau-to serve what customers think of as healthier foods. rant operators view fruits and vegetables as highlyDefinitions mentioned less frequently included no hy-drogenated fats, low-carbohydrate, and low-sodium. perishable items that do not last long in storage, “Low fat and low calorie is where the marketplace is resulting in large amounts of waste that cut intoright now.” profits. Limited storage space is a barrier in many Restaurants that offer healthier menu items do so restaurants.mainly because they believe there is sufficient demand “If we don’t move enough of them, we’ll have toto make it worthwhile (nϭ22, cϭ18). They believe throw a lot away, and this costs us money.”there is greater customer awareness of the importance Many chain restaurants stated that they had difficultyof eating better and that enough diners want healthier getting a consistent, quality supply of produce to meet thefare. Many also believe that within groups of diners, needs of the entire chain, and seasonality was thought tothere may be at least one person to whom healthier affect quality of the supply. For some chains seasonaleating is important enough that they can influence the changes did not fit well with needs for consistency andchoice of the entire group through what is referred to predictability. Concern about low sales was seen as aas the “veto vote” (nϭ11). To prevent that, some deterrent to offering or retaining many items with fruitsrestaurants offer healthier items. However, many chain and vegetables.386 American Journal of Preventive Medicine, Volume 32, Number 5 www.ajpm-online.net
  5. 5. Future Trends, Opportunities, and Strategies DiscussionChain restaurant operators expect that in the future, Interviews with senior menu development and market-their menus will contain more fresh and innovative ing executives at leading full-service and limited-servicefoods with bolder and spicier flavors. Most stated that chain restaurants in the United States consistentlyadding healthier food items to menus would be an identify profit as the key driver of decisions about whatopportunity, rather than a reaction to a threat. At the to offer on their menus. Therefore, it is not surprising that restaurant chains are committed to serving health-same time, most predicted that offerings of healthier ier foods only if they generate profit through high salesfoods in chain restaurants may increase slightly but or other benefits to the restaurant (e.g., avoid the “vetomore indulgent items will continue to outsell healthier vote”). Issues of food safety and labor are also impor-ones. tant to these restaurants. Those who are interested in However, many chains see opportunities for in- changing the restaurant environment to offer morecreased offering of healthier options. They believe that healthful options need to address these issues.offering these items would give additional choices to Many companies are reluctant to increase healthydiners, especially those who desire healthier foods. food choices on menus because of perceptions of lowThey see fruits and vegetables as a tool to give diners consumer demand, inconsistent quality and availabilitycreative and flavorful foods not available at most chains. of produce, high spoilage, increased storage needs, andThe use of ethnic products such as Asian vegetables and complexity of preparation. Underlying all of these is atropical fruits is expected to increase. general belief that such products have not generated “Fruits and vegetables provide us with an opportunity profits for their business and their competitors. Thereto develop a compelling platform of products that cater is some support for this point of view from consumerto those consumers that demand healthier products. research.18Doing this might be a way for us to bring in new However, restaurants will respond to consumer de-customers.” mand if it exists. They are in the business of selling what According to respondents, when it comes to increas- people will buy and do not perceive it as their respon-ing offerings of healthier menu items, trade groups, sibility to increase demand for healthier food items.industry associations, and public health agencies can be Thus, the challenge of improving American consum-most helpful by providing information to them and to ers’ restaurant behavior will likely fall to others outsidethe public. Many operators would like new ideas for the restaurant industry such as government, nonprofitpreparing healthier dishes and creative options for public health agencies, educational institutions, andserving fruits and vegetables. They also would like health professionals. Government policies that offerassurance that there are good business reasons to offer chain restaurants incentives to offer more healthy op-healthier foods. If there is clear evidence of increased tions, including fruits and vegetables, on their menussales and profits, and simple strategies to achieve those should be evaluated. For example, it would be worth-ends, major restaurant chains would be more likely to while to evaluate the impact of incentives, such as taxadd healthier fare to their menus. incentives or price supports, in the interest of public “If these organizations do research on what diners health and reduced medical expenditures. Require- ments that chain restaurants provide nutrition informa-want or have information on eating trends, they should tion at the point of purchase—thus removing theshare it with us.” exemption of restaurants from nutrition labeling19— “Academics really can’t help the operator much. The might motivate consumers20 and provide a compellingproduce industry, however, should improve distribu- reason to develop more appealing, nutritious options.tion so we can have fresher, riper produce. Most Food assistance program innovations that encourageimportantly, the trade groups and industry associations recipients to select healthier menu options might re-should concentrate on teaching new chefs how to value duce health disparities and counteract the targetedfresh produce and fruit in terms of quality. This might marking of less nutritious foods to low incomepersuade them to use more of these items.” groups.21 “They should focus on the positive . . . Give some The produce industry needs to promote the use ofkudos to the restaurants who do it right. Even if they fruits and vegetables in restaurants as well. Grower–did it under pressure, they still did it.” shippers need to develop products to meet the unique “I’d love to see more information on balanced needs of food service with respect to spoilage, prepara-nutrition— eating everything in moderation . . . show tion ease, and year-round supply of foods of consistenthow to make customers feel good about their decisions quality. Prepackaged produce for restaurants wouldwithout having to go through pain for it. Currently if reduce perishability, and preprepared products wouldyou put something on the menu and say it’s healthy, it’s reduce the burden of preparation and storage. Some,the kiss of death.” such as sliced apples, melon chunks, and prepackagedMay 2007 Am J Prev Med 2007;32(5) 387
  6. 6. salad greens already exist, but others could be created ment of Agriculture, or the Centers for Disease Control andand marketed to expand selections available to restau- Prevention.rants. Packaging innovations to reduce spoilage are also No financial conflict of interest was reported by the authors of this paper.available. A concerted effort between the produceindustry and health professionals to develop usefulideas and products geared specifically for chain restau-rants would reduce many barriers to the use of fruits References 1. Lin BH, Frazao E, J Guthrie. Away-from-home foods increasingly importantand vegetables in these settings. Some of these efforts to quality of american diet. Agriculture Information Bulletin No. 749, 1999.are already underway. 2. Guthrie J, Lin BH, Frazao E. Role of food prepared away from home in the American diet, 1977–78 versus 1994 –96: changes and consequences. J Nutr Coordinated efforts among the restaurant and pro- Educ Behav 2002;34:140 –50.duce industries and public health hold important po- 3. Schmidt M, Affenito SG, Striegel-Moore R, et al. Fast-food intake and diettential.15,16 For example, by working with industry to quality in black and white girls: the National Heart, Lung, and Blood Institute Growth and Health Study. Arch Pediatr Adolesc Med 2005;159:626 –31.conduct formative research prior to initiating motiva- 4. Kant AK, Graubard BI. Eating out in America, 1987–2000: trends andtional campaigns, appealing healthier menu items may nutritional correlates. Prev Med 2004;38:243–9.be developed and marketed effectively. 5. Paeratakul S, Ferdinand DP, Champagne CM, Ryan DH, Bray GA. Fast-food consumption among US adults and children: dietary and nutrient intake Consumers claim that they want healthier choices at profile. J Am Diet Assoc 2003;103:1332– 8.restaurants, but purchase more indulgent fare when 6. Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977– 1998. JAMA 2003;289:450 –3.they eat out.4,7 People want taste and health, but are 7. Bowman SA, Vinyard BT. Fast food consumption of U.S. adults: impact onoften faced with a choice between the two. Health and energy and nutrient intakes and overweight status. J Am Coll Nutrculinary professionals have begun to work together to 2004;23:163– 8. 8. Zoumas-Morse C, Rock CL, Sobo EJ, Neuhouser ML. Children’s patterns ofdemonstrate that taste and health can coexist at an macronutrient intake and associations with restaurant and home eating.affordable price and these efforts should be expanded. J Am Diet Assoc 2001;101:923–5.The growing number of individuals who are both 9. Young LR, Nestle M. The contribution of expanding portion sizes to the US obesity epidemic. Am J Public Health 2002;92:246 –9.nutrition professionals and chefs are a potential re- 10. Pereira MA, Kartashov AI, Ebbeling CB, et al. Fast-food habits, weight gain,source that can assume a leadership role by building and insulin resistance (the CARDIA study): 15-year prospective analysis.their reputations, at least in part, on menu items that Lancet 2005;365:36 – 42. 11. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight andemphasize fruits and vegetables that are delicious as obesity in the United States, 1999 –2004. JAMA 2006;295:1549 –55.well as nutritious. 12. Bray GA, Bellanger T. Epidemiology, trends, and morbidities of obesity and the metabolic syndrome. Endocrine 2006;29:109 –17. This study is limited by the need to keep the inter- 13. Glanz K, Mullis RM. Environmental interventions to promote healthyview of moderate length, and the inclusion of respon- eating: a review of models, programs, and evidence. Health Educ Qdents who are not a true probability sample of restau- 1988;15:395– 415. 14. Hill JO, Wyatt HR, Reed GW, Peters JC. Obesity and the environment:rant executives. However, the information from these where do we go from here? Science 2003;299:853–5.interviews is an important step in understanding the 15. Glanz K, Hoelscher D. Increasing fruit and vegetable intake by changingmenu development process. Importantly, the study is environments, policy and pricing: restaurant-based research, strategies, and recommendations. Prev Med 1004;39:S88 –93.unique in achieving access to high-level decision mak- 16. The Keystone Center. The Keystone forum on away-from-home foods:ers who were willing to be candid on this increasingly opportunities for preventing weight gain and obesity. Washington DC:important public health issue. The Keystone Center, 2006. Available at http://www.keystone.org/spp/ documents/Forum_Report_FINAL_5-30-06.pdf. 17. Technomic, Inc. 2005 Technomic top 500 restaurant chains: report.This study was supported by a grant from the Robert Wood Chicago: Author. 18. Glanz K, Basil M, Maibach E, Goldberg J, Snyder D. Why Americans eat whatJohnson Foundation to the Produce for Better Health Foun- they do: taste, nutrition, cost, convenience, and weight control concerns asdation. The authors acknowledge the contributions of Joe influences on food consumption. J Am Diet Assoc 1998;98:1118 –26.Pawlak, Rona Henry, Don Peterson, and Brenda Fried Hum- 19. Mello MM, Studdert DM, Brennan TA. Obesity—the new frontier of publicphreys, and the Georgia Cancer Coalition for partial support health law. N Engl J Med 2006;354:2601–10. 20. Wootan MG, Osborn M. Availability of nutrition information from chainof Karen Glanz’s effort. restaurants in the United States. Am J Prev Med 2006;30:266 – 8. The views expressed here are those of the authors, and may 21. Warner M. Salads or no, cheap burgers revive McDonald’s. New Yorknot be attributed to the Economic Research, the U.S. Depart- Times, April 19, 2006.388 American Journal of Preventive Medicine, Volume 32, Number 5 www.ajpm-online.net

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