The rise of overweight and obesity in the UK is a well discussed phenomenon. Data from the last National Child Measurement Programme show that a quarter of children entering primary school are overweight or obese, which rises one third by the time they leave primary school at 11 (Public Health England, 2017a). In the UK, measures such as the sugar tax and the One You campaign issued in March 2018, are challenging the food industry to reduce energy in food thereby recognising the obesogenic environment in which we live. In 2019 the government plans to publish further guidelines for the wider food industry including restaurants and takeaway outlets (Public Health England, 2018).
Swinburn et al. (2011) point to the changes in the global food system and how this interaction with the local environment and individual characteristics has resulted in an increase in obesity globally. This study looks at one aspect of the local environment – the food service industry and examines how both fast food and full-service restaurants contribute to the diet of children in the UK.
The Food Standards Agency (FSA) also conducted research on eating out in the UK. The Wave 4 report concluded 96% of people ate out of home at least once in the previous month with 43% of people reporting they ate out once or twice a week. For those aged 16 to 24 and 25 to 34 this rose to 60% and 55% respectively (FSA, 2017). 67% of those surveyed reporting eating in a restaurant in the last month and 55% had consumed take away food either onsite or at home (FSA, 2017). The 2014 Food & You Survey reported 79% of people who had children under 16 had eaten out in the preceding week (FSA, 2014).
In the US the energy intake from fast food has increased from 10% to 13% between 1994 and 2006 and in 2011/12 34.3% of children consumed fast food on a given day (Vikraman et al., 2015). The BBC Good Food Nation survey 2016 (BBC, 2016) reported that 16 to 20-year olds ate fast food 4.5 times a week on average and that one in six ate fast food twice a day.
As people are eating out more frequently the nutritional content of the food served in restaurants becomes more important as it makes a more significant contribution to diet. The body of literature on this topic tends to be focused on the US. Powell and Nguyen (2013) and Nguyen and Powell (2014) have looked at the effect of eating out on energy and macro nutrient intake for adults, adolescents and children. They concluded that for all groups meals provided were too energy dense and contained too much fat. Adolescents also consumed more sugar sweetened beverages (SSB) when eating in a restaurant compared to the home environment. The study was done using dietary recall data from the National Health and Nutrition Examination study (NHANES). The advantage of this methodology is that it records what is consumed rather than what is served however these studies do rely on the participant remembering accurately what they have eaten (McCullough, 2018). Kirkpatrick et al. (2013) looked at the quality of the food at 5 fast food restaurants in the US by scoring them on the Healthy Eating Index 2005. Children’s meals scored higher than adult meals, but the overall quality of food was poor compared to dietary recommendations – all restaurants scored less than 50 out of a possible 100. However, it is not just fast food restaurants that falls short of dietary guidelines. Auchincloss et al. (2014) reviewed the nutritional content of full-service restaurants in the Philadelphia region of the US using nutritional data provided by the restaurant. They concluded meals were too energy dense and had too much saturated fat and sodium.
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