The Nine Worst in Restaurant Eats: Center for Science in the Public Interest

Bob Evans' Cinnamon Cream Stacked & Stuffed Hotcakes. Take pancakes, stuff them with cinnamon chips, spread cream cheese, top with cream sauce and whipped cream and you get a breakfast that brings in 1,380 calories and 34 grams of saturated fat. You could eat a hungry man's breakfast: two country-fried steaks and four eggs for about the same.

Special Treat or Heart Attack on a Plate?

Are restaurants accomplices in America's obesity epidemic?

Liebman says they are guilty of promoting unreasonable portion sizes and continually "kicking it up a notch" as they try to make sales.

The restaurants -- and a few dieticians -- would argue, however, that they are only giving people what they want.

Michael Donohue, spokesperson for the National Restaurant Association, says the CSPI report "paints a distorted picture of restaurants based on a single menu item. Certainly there are indulgent items on menus, but there are more diet-conscious items on menus than ever before, and our customers know it."

Given the poor track record of healthier food options at fast food restaurants, it's not always that these chains aren't trying, notes Dr. Mitchell Roslin, chief of bariatric surgery at Lenox Hill Hospital.

"If McDonald's could find something healthy that people would order, they would have it. You can't just blame restaurants that sell what we order. I'm sure they couldn't care less if they sold salad or burgers, as long as it sells," he says.

But "the truth is people go to these chains expecting 'big food'. Items are on the menu because people like them, pure and simple," says Dr. Keith Thomas Ayoob, associate professor of Pediatrics at Albert Einstein College of Medicine.

The cost of healthy food also becomes an issue when criticizing the popularity of so-called "big food."

"People equate value with how full they are," Roslin says, and the amount of satiety you get from a salad compared to how much it will set you back makes a cheeseburger seem like a more efficient use of your money.

Another consideration when evaluating the dietary cost of rich restaurant food is the way people consume them, dieticians say.

"Prohibition" of certain foods is a misguided approach to the obesity issue, says Dr. Richard Feinman, professor of cell biology at SUNY Downstate Medical Center and the founder of the Nutrition and Metabolism Society.

"'Healthy' is a value judgment," he says. "What's healthy for a football player may not be for a biology professor, but if you have a [big] burger and then at the next meal a salad with tuna, what's wrong with that?"

By attacking a few fatty meals and focusing predominantly on saturated fat and calories, Feinman says the CSPI report is actually doing the public a disservice.

"It's not a single meal, it's a pattern of eating," he says. What's more, he says that nutrition guidelines would better serve the public if they focused more on the role of carbohydrates than on the role of fats and even saturated fat.

Health Care Reform and the Future of Food

With the help of new efforts against obesity through the Health Care Reform Bill, the shape of American nutrition may change in the coming years, dieticians say, but what will best bring this change is a matter of debate.

Public warnings, like those published by CSPI, are likely only to reach "nutrition nerds," says Carla Wolper, a nutrition expert at St. Lukes/Roosevelt Hospital.

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