Sure, you can order salads and even fresh fruit in fast-food restaurants these days. But with the intoxicating smell of fries wafting through the air, it's not easy to opt for a more nutritious side dish.
Though all the major fast-food chains have added healthy options to their menus -- and some of these items are selling well -- many Americans are reluctant to forgo their beloved burgers and fries.
During restaurants' peak summer season this past year, the top picks were burgers, fries, and pizza, all of which have topped the list for the past 10 years, according to the NPD Group, a marketing research firm in Port Washington, N.Y.
Still, customer's interest in healthier food seems to be growing. Some 78% of restaurants in the "quick-service" category, which includes fast food, are seeing more orders for entrée salads, according to the National Restaurant Association (NRA), an industry group. In fact, entrée salads have shown the biggest increase of all menu items, in both quick-service and sit-down restaurants, the NRA says.
Bottled water and poultry items are doing well, too. And consumer interest in more nutritious menu choices is expected to keep increasing this year, according to the NRA's 2005 projections.
All this is important because Americans get about one-third of their calories at restaurants and other food-service establishments, according to the Center for Science in the Public Interest, a health advocacy group. So our restaurant choices have a big impact on our overall diets.
Experts say several factors are helping to drive the trend toward more healthy offerings at fast-food restaurants.
With obesity reaching near-epidemic levels in the United States, corporations and the media are paying more attention to health, nutrition, and anti-obesity efforts. There have even been a couple of high-profile (if unsuccessful) lawsuits filed against fast-food corporations claiming the restaurants contributed to obesity.
Further, the popularity of the so-called "fast-casual" restaurant (places like Panera, Chipotle, and Au Bon Pain) has inspired fast-food operators to expand their "premium" menu items, such as the popular entrée salads, according to the NPD Group.
McDonald's, with 13,000 franchises feeding 23 million people each day, is among the many fast-food chains now offering premium salads.
"We have sold 300 million salads in the U.S., equaling 600 million vegetable servings," says Cathy Kapica, PhD, RD, global director of nutrition for McDonald's.
Low-fat milk bottled in fun, easy-to-handle "chugs" has also been a home run for McDonald's. Sales have tripled since the introduction of the containers last year, Kapica said.
"Making food fun and nutritious is the key" says Kapica. She noted that when the restaurant tried offering carrot and celery sticks in its child-friendly Happy Meals, "they bombed."
Then McDonald's began offering Apple Dippers, sliced apples that children can dip into a container of caramel sauce. "Once we found a fruit that kids love, gave them the dipping experience that simulates French fries in ketchup, we made it easy for them to choose apples over fries," Kapica says.
Another nutrition success story is Subway, the quick-service sandwich shop. Former college student Jared Fogle became the face of Subway after "right-sizing" himself with the help of the chain's low-fat subs.
In the past four years, since Fogle has been doing commercials for Subway, annual sales in the United States have grown from $3.8 billion to $6.2 billion, says Subway spokesman Kevin Kane. And Fogle's low-fat favorite, turkey, is the leading seller at the fast-growing Subway chain.
Know Your Nutrition
One pitfall that could trip up some fast-food customers trying to eat leaner: Just because something sounds healthier doesn't mean that it is.
Take chicken, for example. The U.S. Department of Agriculture predicts that Americans will continue to increase their consumption of poultry in the next 10 years. One reason is that people see chicken as a healthy choice.
But not all chicken qualifies as healthy. In fact, a recent report from Consumer Reports found that some fast-food chicken salads pack more fat and calories than a Big Mac.
Fried chicken has one of the fastest-growing fast food menu items over the past 10 years, according to the NPD Group. Yet it generally has much more fat and calories than grilled chicken. Some restaurants use names like "crispy strips" rather than "fried" to describe these products, which could add to consumers' confusion.
Health-conscious diners may also think that a salad is a better choice than a burger, but that all depends on what you put on top of the salad.
For example, according to the company's web site, Arby's Chicken Club Salad has 530 calories and 33 grams of fat, even before you add dressing. With ranch dressing, the salad climbs to 860 calories and 67 grams of fat, or more than a day's worth of fat.
Arby's is not alone in offering higher-fat and higher-calorie salads. McDonald's has the Crispy Chicken Bacon Ranch Salad, Taco Bell has the Fiesta Taco Salad, and Wendy's has the Home-style Chicken Strips Salad.
All of these chains also feature healthy salads. To be on the safe side, order grilled chicken, not fried, and low-fat dressing. When in doubt, check the nutrition information before ordering.
While more fast-food companies than ever are offering healthy menu options, some health experts think they need to do more.
Marion Nestle, PhD, MPH, chairman of the department of nutrition at New York University, wants to see even more healthy foods on menus to help Americans meet the USDA's new Dietary Guidelines. The guidelines call for Americans to eat more produce and whole grains and to limit saturated fats, sugar, alcohol, and salt.
"There are not enough fruits, vegetables, or whole grains, but if consumers start demanding more of these foods, we will see them appear on menus," Nestle says.
David Katz, MD, author of The Way to Eat and associate clinical professor at Yale University, has a more radical idea about how to help health sell.
"We need to encourage the fast-food giants to use their resources to develop parallel franchises totally devoted to serving nutritious foods -- a new-age 'Mickey D's' with fun meals for the whole family, along with play areas and nutrition education," Katz says.
Healthy food can taste delicious, and if it is presented in a format that is familiar in terms of taste, convenience, and price, it will sell, predicts Katz.
For its part, the Center for Science in the Public Interest thinks posting calorie counts on menu boards will encourage customers to make healthier choices.
Of course, that will only work if people actually read them.
"Some folks drive through and order their regular favorites, paying no attention to the nutrition information, which makes it very difficult to educate some consumers," says Kapica.
The bottom line, of course, is that if consumers buy healthy options, restaurants will keep offering them. The reverse is true as well. Remember the McDonald's McLean Deluxe back in the '90s? It's no longer on the menu -- because sales were as lean as the burger.