Almost ALL meals in American restaurants are bad for you as researchers warn dining out is a 'recipe for unhealthy eating'

Less than 0.1 per cent of meals eaten in American restaurants are good for you, a study has warned.

Researchers analysed the food choices of more than 35,000 people who ate out regularly between 2003 and 2016. 

Half of the meals eaten at restaurants with table service were of poor nutritional value, and almost none reached 'ideal quality'. 

The researchers said this was a concern because restaurant meals accounted for a fifth of Americans' total calorie intake, and fast-food accounted for 12 per cent.   

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Less than 0.1 per cent of meals eaten in American restaurants are good for you, researchers have suggested (stock image) 

Study author Professor Dariush Mozaffarian, from Tufts University in Massachusetts, said: 'Our findings show dining out is a recipe for unhealthy eating most of the time.'

He added it was a 'priority' to improve the nutritional value of restaurant meals so Americans could choose health options without compensating on enjoyment. 

The findings come amid an obesity crisis in the US - it is thought 93million people – 39 per cent of the population – are obese.

The situation isn't much better in the UK, where more than a quarter of adults are classed as obese and six in ten are regarded as overweight. 

The latest findings suggest that improving restaurant meals may help to combat people's expanding waistlines.

Professor Mozaffarian and his colleagues gathered data from more than 35,000 US adults in the National Health and Nutrition Examination Survey (NHANES).

Those who took part were questioned about their dietary habits during 24-hour periods on several occasions throughout the 13-year study period. 

The respondents ate out at full-service restaurants or fast-food outlets, which included pizza shops.

The researchers assessed nutritional quality of the meals based on the American Heart Association 2020 diet score.

It takes into account factors such as the amount of fruit and vegetables, whole grains, salt, saturated fat, nuts and sugar-sweetened drinks.

The score ranges from one to 50, with an 'ideal' is more than 40.  

At full-service restaurants throughout the study period, about 50 per cent were of poor nutritional quality, scoring less than 20.

Some 70 per cent of meals eaten at fast food restaurants in 2015-2016 were poor quality, which was down from 75 per cent in 2003-4. 

Notably, the authors found that less than 0.1 per cent - almost zero - of all the restaurant meals consumed over the study period were of ideal quality - a score of 40.

The remaining meals were regarded as being of intermediate quality, between 20 and 30, the researchers said.

The researchers also looked at the extent to which Americans relied on restaurants, full-service restaurant meals represented nine per cent of total calories consumed.

Almost one in ten (eight per cent) Americans get their breakfast from fast-food outlets.

There were also differences between groups - the quality of fast food meals eaten by non-Hispanic white people and Mexican-Americans is improving, but the quality of food eaten by non-Hispanic black people has stayed the same.

And the proportion of poor quality fast food eaten by people with college degrees was 60 per cent at the end of the study, but was 76 per cent for those without high school qualifications.

Professor Mozaffarian and his colleagues also tried to identify priorities for improving restaurant meals.

Professor Mozaffarian added: 'Our food is the number one cause of poor health in the country, representing a tremendous opportunity to reduce diet-related illness and associated healthcare spending.

'At restaurants, two forces are at play: what's available on the menu, and what Americans are actually selecting.

'Efforts from the restaurant industry, consumers, advocacy groups, and governments should focus on both these areas.'

First author Dr Junxiu Liu said the 'largest opportunities' were in 'enhancing nutritional quality would be adding more whole grains, nuts and legumes, fish, and fruits and vegetables to meals while reducing salt'. 

The authors conceded that there were limitations to their study.

They said that people who took part may deliberately misreport their unhealthy choices, or say they have eaten more healthily than they have done, to make their choices more socially acceptable.

They also said that the fact the diets were self-reported meant that there may be some errors in the data, although their use of interviewers and 24-hour questionnaires reduced these, they said.

The findings were reported in the Journal of Nutrition.