Calorie and Nutrient Profile of Combination Meals at U.S. Fast Food and Fast Casual Restaurants


      The nutrient profile of combination meals in large chain restaurants is not well understood.


      Combination meals from 34 U.S. fast food and fast casual restaurants (lunch/dinner, n=1,113; breakfast, n=366) were identified from online menus in 2017–2018 and corresponding nutrition information for each menu item was obtained from a restaurant nutrition database (MenuStat). Three options for each combination meal were analyzed: (1) default (as advertised on menu), (2) minimum (low-calorie option), and (3) maximum (high-calorie option). In 2018, meal nutrient composition was compared with the Healthier Restaurant Meal Guidelines, and linear models examined to what extent each meal component (entrée, side, beverage) drove differences in nutrients across meal options.


      There was substantial variation across the default, minimum, and maximum options of lunch/dinner combination meals for calories (default,: 1,193 kilocalories;, minimum,: 767 kilocalories;, maximum,: 1,685 kilocalories), saturated fat (14 g, 11 g, 19 g), sodium (2,110 mg, 1,783 mg, 2,823 mg), and sugar (68 g, 10 g, 117 g). Most default meals exceeded the Healthier Restaurant Meal Guidelines for calories (97%) and sodium (99%); fewer exceeded the standards for saturated fat (50%) and total sugar (6%). Comparing the maximum and default lunch/dinner combination meals, beverages were the largest driver of differences in calories (178 kilocalories, 36% of difference) and sugar (46 g, 93% of difference), and entrées were the largest driver of differences in saturated fat (3 g, 59% of difference) and sodium (371 g, 52% of difference). Results were similar for breakfast meals.


      Combination meals offered by large U.S. chain restaurants are high in calories, sodium, saturated fat, and sugar, with most default meals exceeding recommended limits for calories and sodium.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Fryar CD
        • Hughes JP
        • Herrick KA
        • Ahluwalia N
        Fast food consumption among adults in the United States, 2013–2016. CDC, National Center for Health Statistics.
        NCHS Data Brief No. 322. Published 2018;
        • U.S. Department of Agriculture, Economic Research Service
        U.S. food-away-from-home spending continued to outpace food-at-home spending in 2017.
        Published 2018
      1. Todd JE, Mancino L, Lin B-H. The impact of food away from home on adult diet quality. U.S. Department of Agriculture, Economic Research Service. Economic Research Report Number 90. Published 2010. Accessed 8 April 2019.

        • Bowman SA
        • Vinyard BT
        Fast food consumption of U.S. adults: impact on energy and nutrient intakes and overweight status.
        J Am Coll Nutr. 2004; 23: 163-168
        • Paeratakul S
        • Ferdinand DP
        • Champagne CM
        • Ryan DH
        • Bray GA
        Fast-food consumption among U.S. adults and children: dietary and nutrient intake profile.
        J Acad Nutr Diet. 2003; 103: 1332-1338
        • French SA
        • Harnack L
        • Jeffery RW
        Fast food restaurant use among women in the pound of Prevention study: dietary, behavioral and demographic correlates.
        Int J Obes. 2000; 24: 1353‒1359
        • Pereira MA
        • Kartashov AI
        • Ebbeling CB
        • et al.
        Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis.
        Lancet. 2005; 365: 36‒42
        • Wu HW
        • Sturm R
        What's on the menu? A review of the energy and nutritional content of U.S. chain restaurant menus.
        Public Health Nutr. 2013; 16: 87‒96
        • Jarlenski MP
        • Wolfson JA
        • Bleich SN
        Macronutrient composition of menu offerings in fast food restaurants in the U.S.
        Am J Prev Med. 2016; 51: e91‒e97
        • Bleich SN
        • Wolfson JA
        • Jarlenski MP
        Calorie changes in chain restaurant menu items: implications for obesity and evaluations of menu labeling.
        Am J Prev Med. 2015; 48: 70‒75
        • Moran AJ
        • Block JP
        • Goshev SG
        • Bleich SN
        • Roberto CA
        Trends in nutrient content of children's menu items in U.S. chain restaurants.
        Am J Prev Med. 2017; 52: 284‒291
        • Bleich SN
        • Moran AJ
        • Jarlenski MP
        • Wolfson JA
        Higher-calorie menu items eliminated in large chain restaurants.
        Am J Prev Med. 2018; 54: 214‒220
        • Wolfson JA
        • Moran AJ
        • Jarlenski MP
        • Bleich SN
        Trends in sodium content of menu items in large chain restaurants in the U.S.
        Am J Prev Med. 2018; 54: 28‒36
        • Bauer KW
        • Hearst MO
        • Earnest AA
        • et al.
        Energy content of U.S. fast-food restaurant offerings: 14-year trends.
        Am J Prev Med. 2012; 43: 490‒497
        • Kirkpatrick SI
        • Reedy J
        • Kahle LL
        • et al.
        Fast-food menu offerings vary in dietary quality, but are consistently poor.
        Public Health Nutr. 2014; 17: 924‒931
        • Food and Drug Administration
        Guidance for industry: nutrition labeling of standard menu items in restaurants and similar retail food establishments.
        Published 2015
        • Dumanovsky T
        • Nonas CA
        • Huang CY
        • Silver LD
        • Bassett MT
        What people buy from fast‐food restaurants: caloric content and menu item selection, New York City 2007.
        Obesity (Silver Spring). 2009; 17: 1369‒1374
        • NPD Group
        Top quick service burger chains put a new twist on combo meal deals and consumers respond.
        Published 2016
        • Sharpe KM
        • Staelin R
        Consumption effects of bundling: consumer perceptions, firm actions, and public policy implications.
        J Public Policy Mark. 2010; 29: 170‒188
        • Stremersch S
        • Tellis GJ
        Strategic bundling of products and prices: a new synthesis for marketing.
        J Mark. 2002; 66: 55‒72
        • Cohen D
        • Bhatia R
        • Story MT
        • et al.
        Performance standards for restaurants.
        Rand Corporation. Published 2013;
        • New York City Department of Health and Mental Hygiene
        MenuStat methods.
        Published 2017
        • Efron B
        Bootstrap methods: another look at the jackknife.
        Breakthroughs in statistics. Springer Series in Statistics (Perspectives in Statistics). Springer, New York, NY1992: 569-593
        • Riis J
        • Ratner RK
        Communicating for action: the importance of memorability and actionability.
        in: Roberto CA Kawachi I Behavioral Economics and Public Health. Oxford University Press, Oxford, UK2015
        • Schwartz J
        • Riis J
        • Elbel B
        • Ariely D
        Inviting consumers to downsize fast-food portions significantly reduces calorie consumption.
        Health Aff Millwood. 2012; 31: 399‒407
        • Food and Drug Administration
        Calorie labeling on restaurant menus and vending machines: what you need to know.
        Published 2018
        • California legislative information
        SB 1192: healthy by default kids’ meals.
        Published 2018
        • Blumenthal K
        • Volpp KG
        Enhancing the effectiveness of food labeling in restaurants.
        JAMA. 2010; 303: 553‒554
        • Loewenstein G
        • Brennan T
        • Volpp KG
        Asymmetric paternalism to improve health behaviors.
        JAMA. 2007; 298: 2415‒2417
        • Beshears J
        • Choi JJ
        • Laibson D
        • Madrian BC
        The importance of default options for retirement saving outcomes: evidence from the United States.
        in: Brown JR Liebman JB Wise DA Social Security Policy in a Changing Environment. University of Chicago Press, Chicago, IL2009: 167‒195
        • Johnson EJ
        • Goldstein D
        Do defaults save lives?.
        Science. 2003; 302: 1338‒1339
        • Urban LE
        • Lichtenstein AH
        • Gary CE
        • et al.
        The energy content of restaurant foods without stated calorie information.
        JAMA Intern Med. 2013; 173: 1292‒1299
        • Urban LE
        • Weber JL
        • Heyman MB
        • et al.
        Energy contents of frequently ordered restaurant meals and comparison with human energy requirements and U.S. Department of Agriculture database information: a multisite randomized study.
        J Acad Nutr Diet. 2016; 116 (590‒598.e6)
        • Urban Lorien E
        • Roberts SB
        • Fierstein JL
        • Gary CE
        • Lichtenstein AH
        Temporal trends in fast-food restaurant: energy, sodium, saturated fat and trans fat content, United States.
        Prev Chronic Dis. 2014; 11