June 3, 2009 -- When ordering a dinner entrée at a restaurant, few expect the waiter to return with a plate that holds more than their daily supply of calories -- or enough salt to meet their maximum daily intake for three days.
But if you order from the menu at some popular chain restaurants, this is exactly what you can expect to get. So says a scathing new report, titled "XTreme Eating 2009," released Tuesday by the nutrition and advocacy organization Center for Science in the Public Interest.
Margo Wootan, director of nutrition policy at CSPI, said that while the report covers just nine offerings from various chain restaurants, there are many more options that did not make the list, but which are nonetheless unhealthy.
"These items are just the tip of the iceberg in a growing trend of making restaurant foods bigger and badder," she said. "There are a number of trends in the restaurant industry right now that make it harder for Americans to eat well and watch their weight."
Restaurant industry representatives bristled at the annual report, which they said does not accurately portray most restaurant fare. Sheila Weiss, a registered dietitian and nutrition consultant for the industry group National Restaurant Association said many restaurants have made strides toward healthier options in recent years.
"I think that unfortunately reports like this focus on the negative aspects," she said. "What would be helpful for the consumer would be to show them the options that are the healthy options in restaurants.
"There is definitely a time to indulge, and definitely a time to eat your favorite foods, in the context of a healthy lifestyle."
Central to the discussion of what restaurants should be offering consumers is the role of personal responsibility. In other words, shouldn't customers be able to order what they want, no matter what it does to them if they clean their plates?
Calories, Fat and Salt Content
Wootan acknowledged that the responsibility ultimately comes down to the consumer. But, she said, restaurants should be required to put certain nutritional information like calories, fat content and sodium content on menus next to these offerings.
"We're not saying take it off the menu," she said. "But the least that restaurants can do is to tell you how many calories you're eating.
"How can you make an informed decision and exercise personal responsibility without information?"
But even when presented with the information, will consumers make the right choices? When it comes to these foods, nutritionists say maybe not.
"People like [these foods]," said Barbara Rolls, director of the Laboratory for the Study of human Ingestive Behavior at Pennsylvania State University in University Park, Pa. "A lot of them are playing to our basic taste. A lot of them are based on the comfort foods we grew up with.
"In the end it's our responsibility, but the restaurants are really good at making this stuff taste good and we need to really be giving people more choices in portion size."
Keith Ayoob, nutritionist at the Albert Einstein College of Medicine in New York, agreed. "All of these chains have one thing in common -- they make food people like to eat," he said. "One thing that applies to all of these meals is that they're way too high in calories."
On average, it turns out, people require about 2,000 calories per day -- usually a little less for women, sometimes a little more for men. But the dent that these options put into that daily figure is often large.
"Maybe if they knew the calories in the entrees they'd order differently -- or maybe they wouldn't. People do make some kind of choice when they choose to go these restaurants."
Another factor in the popularity of such dishes may be the illusion of value -- a throwback to the idea that the more food -- and hence more calories -- that we can get for our buck, the better. So noted Dr. David Katz, director of the Prevention Research Center at the Yale University School of Medicine in New Haven, Ct.
"The dishes profiled by CSPI offer the very opposite of value; they are the kind of purchase no well-informed shopper would make," Katz said. "They are like measuring the value of a car by tonnage in an era when what matters far more is fuel economy."
The following pages detail the nine foods spotlighted by the CSPI report -- and, in some cases, what you can do to limit the damage if you find them in front of you.
The Olive Garden: Tour of Italy
For those who can't decide, the Tour of Italy doesn't disappoint. Ordering this entrée treats diners to one serving each of lasagna, lightly breaded chicken parmigiana and creamy fettuccine alfredo.
It also packs 1,450 calories and 33 grams of saturated fat, as well as 3,830 milligrams of sodium, according to the CSPI's findings.
It's a tour that Ayoob said diners would be wise to cut short.
"Instead of going to three places in one day, go to a different place each day for three days," he said. "Order this dish and eat one item today and take the rest home -- you have a main course for two more days."
Doing this, Ayoob said, makes for three main courses for 500 calories apiece -- a much more manageable figure.
Sodium content may still be an issue; the United States Department of Agriculture recommends that most Americans limit their intake of sodium to less than 2,400 mg daily. Even divided by three, this entrée would add up to more than half of this daily amount.
But Ayoob said that the caloric cut achieved by dividing the entrée into three separate meals might even allow diners to indulge in a breadstick and a salad with low-fat dressing.
Chili's: Big Mouth Bites
Numerous restaurants these days offer "sliders" -- small burgers often meant to be enjoyed as appetizers before the real meal arrives.
But when it comes to many of these sandwich plates, diners are striking out.
CSPI included in its list Chili's Big Mouth Bites -- four burgers that each pack a little less than 400 calories. Eat them together, and you will ingest 1,580 calories and 28 grams of saturated fat. By comparison, for a 2,000-calorie diet, the USDA recommends that an individual eat no more than 20 grams of saturated fat per day.
The burgers also pack 2,930 milligrams of sodium.
If you really need your mini-burger fix, Ayoob said the philosophy of divide and conquer still applies.
"If you want to eat sliders for real, cut this 'appetizer' in half -- that's about 800 calories," Ayoob said. "And tell them you don't want fries with that. You want a side salad instead."
If you do opt for the fries, fried onion strings, and jalapeño ranch dipping sauce, be prepared to ratchet up to 2,350 calories, plus 38 grams of saturated fat and 3,940 mg of sodium.
The Cheesecake Factory: Fried Macaroni and Cheese
If macaroni sounds good to you, and macaroni and cheese sounds better, then the notion of fried macaroni and cheese could well be your idea of a perfect meal.
Just be sure not to glance at the nutritional impact of this offering. A plate of four of the crispy fried balls of mac and cheese, served with marinara sauce, will set you back 1,570 calories and 1,860 mg of sodium.
You can also expect to ingest 69 grams of saturated fat if you eat the whole thing yourself.
"OK, anything fried is a red flag; proceed with caution," Ayoob said.
The fact that the Fried Macaroni and Cheese is more likely to be enjoyed as an appetizer than as an entrée is potentially even more problematic, nutrition experts say.
"Even if you eat half this and take the rest home for tomorrow's dinner, you're still overdoing the sat fat," Ayoob said. "This is a once-a-year experience."
Red Lobster: Ultimate Fondue
Once considered a memory from neighborhood parties of the 1970s, fondue is mounting a comeback in many restaurants. Red Lobster's version, the Ultimate Fondue, serves up "shrimp and crabmeat in a creamy lobster cheese sauce served in a warm, crispy sourdough bowl."
Wootan said that fondue, in general, may not be the wisest choice for any diner.
"A big pot of melted cheese just can't be a healthy option," she noted.
But with its extra ingredients, the nutritional impact of the Ultimate Fondue may surpass its cheesy counterparts. Expect this offering to set you back 1,490 calories, 40 grams of saturated fat and 3,580 mg of sodium.
And because it is difficult to transport what remains of this dish in a doggie bag, some diners may be influenced by the knowledge that what is in front of them is either going to get eaten or thrown away.
"This one's hard to take home, so unless a couple of people are going to split this for an entree, I'd advise skipping it," Ayoob said. Alternatively, you can still choose to eat half, and send the rest back, but that's wasteful and it's still about 750 calories."
Gotta slake your cheese cravings? Ayoob suggests trying a healthier version at home instead.
"If you're a real cheese lover, you could have a better meal at home with a quarter of a pound of Brie, some whole grain crackers and fresh fruit -- and come in under 750 calories," he said. "And you won't have to leave a tip."
Chili's: Half Rack of Baby Back Ribs
Want ribs with that? Chili's lets its customers add a half rack of ribs to their entrée for about seven bucks more. But tacking this extra on will add 490 calories and 12 grams of saturated fat, plus an extra 2,050 mg of sodium to your meal.
The CSPI report lambastes the restaurant chain for this option. "Since when did people start adding an entrée to their entrée?" the report reads. "Adding a salad or vegetable, okay. But another main dish?"
If you really can't avoid ordering those ribs, Ayoob said, the best option may be to treat this add-on as a meal in and of itself.
"This is actually a nice-sized entrée," he said. "Pair it with an ear of corn and a salad and you're doing OK. Just watch the salad dressing."
But even this approach may not solve the sodium equation, as diners will get nearly all of their recommended maximum sodium intake from the ribs alone.
Uno Chicago Grill: Mega-Sized Deep Dish Sundae
Dessert, anyone? While some may be satisfied with a small bite of something sweet or a sorbet to cleanse the palate, Uno Chicago Grill offers up the Mega-Sized Deep Dish Sundae.
This offering consists of a hot cookie, baked in the restaurant's signature deep-dish pizza pan, topped with ice cream, chocolate sauce and whipped cream.
The dessert delivers 2,800 calories and 72 grams of saturated fat.
"Nobody thinks something called a Mega-Sized Deep Dish Sundae is a health food," Wootan said. "But as a nutrition professional, I was pretty shocked to see that it has 2,800 calories."
Ayoob said that whichever way the cookie crumbles, even sharing this dessert might not blunt its impact on your diet.
"This is just ridiculous for one person. It's ridiculous for four people -- still 700 calories for dessert alone," he said.
His advice? Limit yourself to a single bite -- and let your friends take the calorie bullet.
"You'll still have participated, and you'll actually be able to move on because your rear-end won't be as big as that of people who scarfed the dessert," he said.
"Here's a hint: while the rest have their mega-dessert, order a cappuccino with full-fat milk and add sugar if you like," Ayoob added. "It'll only add up to about 150 calories and it'll feel like total indulgence, but with calcium."
The Cheesecake Factory: Chicken and Biscuits
If you're in the mood for comfort food, it's hard to top chicken and biscuits. But The Cheesecake Factory's rendition of the home-style favorite packed enough calories to make CSPI's list.
The entrée, described in the menu as "Breast of chicken served over mashed potatoes with shortcake biscuits, mushrooms, peas and carrots. Covered with country gravy," has about 2,500 calories, according to CSPI.
"This is comfort food because it adds extra padding," Ayoob said.
Most likely among the prime culprits of the calorie load of this dish is the gravy, Ayoob said. His advice if you've just got to have it? "Eat half, save half, but also brush off the gravy so you only get a taste of it. You'll cut the calories at least by half.
"Then you can see if you want to get comfortable with the other half of it for dinner the next day," he added.
Applebee's: Quesadilla Burger
In previous years, CSPI has railed against certain offerings that have combined the best in taste -- and the worst in nutrition -- of two or more fattening foods. This year, the Quesadilla Burger at Applebee's drew their ire.
The offering combines the beef patty, cheese and bacon of a cheeseburger with the pico de gallo, cheese and tortillas of a quesadilla. Add in a condiment known as Mexi-ranch sauce, and you have your sandwich.
"It used to be enough to just have quesadillas on the menu," Wootan said. "Now they're sticking cheeseburgers in the quesadillas."
With fries, the calorie count tops out at 1,820, with 46 grams of saturated fat and 4,410 mg of sodium to boot. Take away the fries, and the calorie count looks slightly more approachable at 1,380. Further dividing this sandwich into two meals could mitigate some of the impact, Ayoob said.
"Just cut it in half and hold the fries on this one," Ayoob said.
But diet food it is not -- and even without the fries, the meal remains among the most sodium-filled on CSPI's list.
The Cheesecake Factory: Philly Style Flat Iron Steak
Cheese on steak; it's a Philadelphia tradition. But nobody ever said that it was a health food.
Steak, in and of itself, can be a calorie-dense food. At The Cheesecake Factory, the Charbroiled Flat Iron Steak with fries delivers 1,760 calories, 30 grams of saturated fat, and 3,840 mg of sodium. But when you order it with the cheese sauce, the calorie count goes up to 2,320, saturated fat goes up to 47 grams, and sodium hits 5,340 mg.
The Cheesecake Factory is far from the only restaurant to feature such cheese-on-meat options. But the authors of the CSPI report say this is becoming more common.
Ayoob said that the healthiest option in this case may be to hold the cheese -- and you might want to bring half of that steak home for good measure.
"If the cheese is an 'ingredient,' as with cheese sauces, skip it," Ayoob said. "With cheese sauce, it's a fatty food coating another fatty food, and that's not the best choice."
Joseph Brownstein contributed to this report.