Major restaurant chains prioritize profit and sales over health when planning menus. Growing sales and increasing profits are the most important considerations for 61% of respondents. Only 21% noted health and nutrition as important factors. Restaurants may try to offer healthier options to attract "health seekers", but believe demand is low. Additional barriers to healthier menus include short produce shelf life, extra preparation time, and higher costs. Without increased consumer demand, the industry is unlikely to substantially increase healthy food offerings.

1. How Major Restaurant Chains Plan Their Menus
The Role of Profit, Demand, and Health
Karen Glanz, PhD, MPH, Ken Resnicow, PhD, Jennifer Seymour, PhD, Kathy Hoy, EdD, Hayden Stewart, PhD,
Mark Lyons, MS, Jeanne Goldberg, PhD
Background: 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 Medicine
Introduction tion,9 and higher fast-food consumption is associated
with increases in body weight and insulin resistance.10
O
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 of
spent 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 of
increased intake of calories, total fat, saturated fat, cancer, and other chronic conditions.12
added 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 evidence
larger portion sizes further encourages overconsump- suggests that the problem is powerfully influenced by
community food environments.13,14 Focusing public
From the Rollins School of Public Health, Emory University (Glanz), health promotion efforts “upstream” could accelerate
and 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 its
of Public Health, University of Michigan (Resnicow), Ann Arbor,
Michigan; Produce for Better Health Foundation (Hoy), Wilming- contribution to overweight and obesity, a change in
ton, Delaware; Economic Research Service, U.S. Department of restaurant offerings toward more low-calorie and
Agriculture (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. This
MPH, Department of Behavioral Sciences and Health Education, Rollins
School of Public Health, Emory University, 1518 Clifton Road, NE, study aimed to understand the perspectives of senior
Room 526, Atlanta GA 30322; E-mail: kglanz@sph.emory.edu. menu development and marketing executives at major
Am 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. U.S. restaurant chains regarding their menu develop- multiple executives per chain when responsibilities were
ment 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 were
making healthier eating easier for restaurant custom- contacted at least once until the quota of 40 interviews was
ers. Understanding the restaurant industry perspective reached, at which time no further contacts were attempted
can give health professionals information needed to for nonresponders. One respondent called back and was
improve community nutrition environments. interviewed after the quota was reached. That brought the
total number of interviews to 41.
Methods
Overview Interview Guide
The Healthy Menu Study used in-depth structured interviews The interview guide covered the following topics: general
with 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 of
obtain qualitative data about current practices, and in partic- “healthier foods” on restaurant menus and experience with
ular, barriers to offering more fresh produce. It was initiated healthful offerings, obstacles to adding more healthy foods to
by the Produce for Better Health Foundation, a 501(c)3 menus, marketing of healthy offerings, and views about future
nonprofit 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 be
environment. 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 and
at 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 and
ment, interviewing study participants, and the content and further revised to reduce redundancy and keep it to a
format 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, and
Sample
targeted questions about fruits and vegetables were asked
The target sample for the study was 40 senior menu develop- toward the end. If respondents asked who the information
ment 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 where
patrons order and pay for their food prior to consuming it, as Data Analysis and Data Synthesis
well as those with table service. Average check ranges per
eater 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 interview
of consumers, including low- to middle-income individuals was analyzed by two individuals to assure consistency. They
and 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 across
half 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 purposes
mid-sizeϭ$200 –999 million; and largeՆ$1 billion) (nϭ18 but are not attributed to individuals or their chains because of
each). 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 service
diverse menu categories, and history of cooperation with versus limited service; large, midsize, and small chains; menu
interviews 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 consistent
practices 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 respondents
Telephone interviews were conducted between September (n) who gave a specific answer in the Results. If there were
and December 2005. Technomic contacted the 54 chain multiple mentions from respondents at one chain (c), this is
headquarters 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 with
positioning, 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. Table 1. Summary of restaurant chain executives’ most frequent responses
Issue Most frequent response Secondary responses
Key marketplace issues and their impact Sales and profits Food safety
on the menu Meeting customer demand Labor issues
Most important considerations for Customer demand and response Ease of preparation
adding and retaining new menu Sales and profits
items
Definition of “healthier foods” Low calorie and low fat No hydrogenated fats
Fruits and vegetables Low carbohydrate
Low sodium
Perceptions of healthier foods Need enough customer demand Customers want indulgence when
Healthier options avoid “veto vote” eating out
Fruit and vegetables—“halo” effect
Obstacles 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 issues
Future 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 menus
What 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 produce
What 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 examples
Results 28% of sales from all U.S. chains with more than $50
Response Rate and Sample Characteristics million in annual sales (based on industry data).17
To complete 41 interviews, a total of 124 individuals
were contacted (Table 1). There were 10 refusals (8%). Key Marketplace Issues and Their Impact
The rest of the individuals who did not complete
interviews either referred the interviewer to other indi-
on the Menu
viduals (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 profits
keep an appointment (nϭ8). To check for bias in terms (mentioned by 25 respondents from 15 chains). They
of prior relationship with the foodservice research firm, are in business to sell products and make a profit, and
respondents were classified by Technomic research to do this, they must sell food items at a price point
staff as having a strong, moderate, or weak/no history acceptable to customers. About half as many operators
of cooperating with Technomic research. This revealed are concerned about food safety (nϭ13), meeting
that 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 responsibility
basis 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 unless
lasted between 30 and 70 minutes. The wide time range
they are confident that their customer base will accept
reflected 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 menu
and restaurant type categories (nϭ12 fast-food/quick- changes more often than did full-service restaurant
service 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 people
billion, and the number of locations per chain ranged don’t want to come to your restaurant, then you’re out
from 22 to 17,909. Together, these chains represented of business.”
May 2007 Am J Prev Med 2007;32(5) 385

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. We
changes 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 to
it will affect sales and profits (nϭ22; cϭ12). Many chain
operators 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, I
efficiently (nϭ11; cϭ8). With respect to determining want what I want. Don’t make me feel guilty when I’m
the 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 menu
preparation ease (nϭ20, cϭ15). Restaurants measure items. We find that people say one thing and do
profitability 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 are
target food cost or gross margin percentage, and do not advertised, but they usually wind up eating the same old
place undue burden on labor to produce. stuff.”
“We always want to add new items that will put more Achieving positive public relations was mentioned by
butts 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 their
level. 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 and
want to serve an item that’s going to take dollars away Surmounting Obstacles
from 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 these
product, the more successful it will be.”
products. If we did, we’d probably serve more of them.”
“We have been very aggressive in marketing healthier
Healthier Foods: Perceptions and Rationale for items, except that we don’t come right out and call
Current 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 chains
foods, they refer to fat and calorie content (nϭ41, from offering healthy foods focused on fruits and
cϭ28; 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 space
calorie 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 highly
Definitions 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 into
right 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 to
to 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 difficulty
of eating better and that enough diners want healthier getting a consistent, quality supply of produce to meet the
fare. Many also believe that within groups of diners, needs of the entire chain, and seasonality was thought to
there may be at least one person to whom healthier affect quality of the supply. For some chains seasonal
eating is important enough that they can influence the changes did not fit well with needs for consistency and
choice of the entire group through what is referred to predictability. Concern about low sales was seen as a
as the “veto vote” (nϭ11). To prevent that, some deterrent to offering or retaining many items with fruits
restaurants offer healthier items. However, many chain and vegetables.
386 American Journal of Preventive Medicine, Volume 32, Number 5 www.ajpm-online.net

5. Future Trends, Opportunities, and Strategies Discussion
Chain 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-service
foods with bolder and spicier flavors. Most stated that chain restaurants in the United States consistently
adding healthier food items to menus would be an identify profit as the key driver of decisions about what
opportunity, 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 sales
foods in chain restaurants may increase slightly but
or other benefits to the restaurant (e.g., avoid the “veto
more 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 more
creased 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 healthy
diners, especially those who desire healthier foods. food choices on menus because of perceptions of low
They see fruits and vegetables as a tool to give diners consumer demand, inconsistent quality and availability
creative and flavorful foods not available at most chains. of produce, high spoilage, increased storage needs, and
The use of ethnic products such as Asian vegetables and complexity of preparation. Underlying all of these is a
tropical 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. There
to develop a compelling platform of products that cater is some support for this point of view from consumer
to those consumers that demand healthier products. research.18
Doing 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 outside
the public. Many operators would like new ideas for the restaurant industry such as government, nonprofit
preparing healthier dishes and creative options for public health agencies, educational institutions, and
serving fruits and vegetables. They also would like health professionals. Government policies that offer
assurance 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 menus
sales 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 tax
add 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 the
share it with us.”
exemption of restaurants from nutrition labeling19—
“Academics really can’t help the operator much. The
might motivate consumers20 and provide a compelling
produce 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 encourage
importantly, 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 targeted
fresh produce and fruit in terms of quality. This might marking of less nutritious foods to low income
persuade 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 of
kudos 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 consistent
how to make customers feel good about their decisions quality. Prepackaged produce for restaurants would
without having to go through pain for it. Currently if reduce perishability, and preprepared products would
you 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 prepackaged
May 2007 Am J Prev Med 2007;32(5) 387

6. salad greens already exist, but others could be created ment of Agriculture, or the Centers for Disease Control and
and 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 produce
industry and health professionals to develop useful
ideas and products geared specifically for chain restau-
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388 American Journal of Preventive Medicine, Volume 32, Number 5 www.ajpm-online.net