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How does eating out and fast food consumption affect obesity in the United States?

This is an excerpt from Science of Long-Term Weight Loss, The by Timothy Lohman & Laurie A. Milliken.

Energy intake is an important factor contributing to how obesity developed in the United States. Lisa Harnack, director of the Nutrition Coordinating Center at the University of Minnesota, has shown that the daily availability of food energy for each person in the United States remained stable from 1970 to 1980, then increased 15% over the next 14 years. Harnack was quick to point out, though, that research in this area has given us mixed results as to the alarming rate of increase in overweight individuals. She explained that “the increasing prevalence of overweight in the United States could be the result of an upward shift in energy intake, a downward shift in energy expenditure, or both” (Harnack, Jeffery, and Boutelle 2000, 1478).

How eating food away from home (FAFH) is related to obesity is a topic thoroughly explored by James Binkley (2008). After interviewing over 7,000 adults, Binkley and his team discovered that frequent trips to fast-food establishments were a significant predictor of increased BMI in both men and women. Simply stated, study participants who indulged more often in food away from home were found to be heavier than their counterparts. The researchers concluded that eating FAFH, particularly fast food, is likely a contributing factor to increased obesity (Binkley, Eales, and Jekanowski 2000).

How often do people eat fast food? Simone French, a researcher at the University of Minnesota, studied the frequency of fast-food consumption in 891 adult women, gaining valuable insight into this phenomenon. She discovered that by 1995, approximately 40% of food dollars in U.S. households was spent on food away from home, compared with only 20% in the early 1970s (French, Harnack, and Jeffery 2000). Results from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016 indicate that 44.9% of younger adults (20- to 39-year-olds) consumed fast foods on a given day, where a lower portion of older adults (37.7% for 40- to 59-year-olds and 24.1% for 60 and over) ate fast foods daily (Fryar, Carroll, and Ogden 2018).

Roughly a third of French’s study participants visited fast-food restaurants two or more times per week. Not surprisingly, high-fat foods such as hamburgers and french fries were consumed more frequently in that group, resulting in a higher BMI (28.2 kg/m2 in women who ate fast food more frequently, compared with 25.4 in women who visited these establishments less often). French concluded that fast food restaurant use could foster excess weight gain (NCD Risk Factor Collaboration 2017; French, Harnack, and Jeffery 2000).). The ever-expanding portion sizes of foods served in restaurants, including fast-food restaurants, has been another important contributor to the increases in obesity (Clemens, Slawson, and Klesges 1999; Ditschuneit et al. 1999; Harnack and French 2003; McCrory et al. 1999; O’Dougherty et al. 2006).

Barbara Rolls, professor of nutritional sciences at Pennsylvania State University and author of The Volumetrics Eating Plan, explored this possible connection in a well-designed study that focused on how portion size affects food intake during the course of a single meal. The results of her investigation were clear. The more food, such as macaroni and cheese, her study participants were offered, the more they ate, resulting in higher energy intake (Rolls, Morris, and Roe 2002). Her findings are in line with a survey on adult Americans, in which more than half acknowledged that—when dining out—they almost always finished what was on their plate (Ditschuneit et al. 1999; McCrory et al. 1995).

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