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

May 25, 2010— -- Nine decadent restaurant meals got a slap on the wrist Tuesday when the Center for Science in the Public Interest (dis)honored them with its 2010 Xtreme Eating Awards.

"These meals are the calorie champions of unhealthy restaurant food, with all meals (and one dessert) weighing in at well over 1,000 calories and shocking amounts of sodium, saturated fat, and sugar," says Bonnie Liebman, co-author of the center's report.

"When two out of three adults in America are overweight and one out of three are too fat to join the military," she says, "we mean this [report] as a warning to people that some foods you order at restaurants are a lot worse for you than you think. People often target fast food but many sit-down restaurants actually have larger portions and more fat and calories."

But does calling out a handful of hefty meals make a difference?

Diet experts seem to be on the fence.

"This kind of 'reality check' is a useful…reminder of how far from reasonable the typical American diet can be, and often is," says Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine.

However, the actual affect on the American public tends to be limited, he says, because "the people who most often eat such meals will be least likely to read the report, or be influenced by it if they do."

Other diet experts point out that restaurants are responding to what people want to -- and will -- consume, so it may not be fair, or particularly useful, to lambast their offerings.

There's no question that America's diet is in need of an overhaul, experts say, but are these oversized offerings truly to blame?

Let's take a look at the lineup.

The Nine: Xtreme Eats of 2010

The following dishes made the cut for the CSPI's 2010 Xtreme Eating Award, though Liebman said, "It's hard to choose because there are so many contenders."

California Pizza Kitchen Tostada Pizza with Grilled Steak. The equivalent of a pepperoni pizza plus six beef tacos, this pie weighs in at 1,680 calories and 32 grams of saturated fat.

Five Guys Bacon Cheeseburger. This burger alone is 920 calories and a day-and-a-half's allowance (30 grams) of saturated fat. Adding a large order of French fries adds 1,460 calories (three times the amount in large McDonald's fries).

P.F. Chang's Double Pan-Fried Noodles Combo. It's hard to know what's more impressive: the days' worth (1,820) of calories in this dish, or the five days' worth of salt.

The Cheesecake Factory Pasta Carbonara with Chicken. Bacon-y, buttery, creamy, and carb-y -- this pasta dish brings 2,500 calories and 85 grams of saturated fat to the table.

The Cheesecake Factory Chocolate Tower Truffle Cake. Six inches long, three-quarters of a pound, and over 1,600 calories, this "slice" of cake is the equivalent of eating fourteen Hostess Ho Hos.

Outback Steakhouse New Zealand Rack of Lamb. The lamb alone has 1,300 calories and 60 grams of saturated fat, but add the buttery sides (even the veggies) and you're up to 80 grams of saturated fat.

California Pizza Kitchen Pesto Cream Penne. Before you add any chicken or shrimp, this creamy version of an Italian classic has 1,350 calories, 49 grams of saturated fat and 1,920 mg of sodium.

Chevy's Crab & Shrimp Quesadilla. Technically an appetizer, this cheesy platter has 1,790 calories and 63 grams of saturated fat.

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.

Requiring nutritional information on chain restaurant menus, as part of the bill, will likely have a larger impact than public reports, Liebman says.

"People need the calories right in front of them when they order" if there's going to be a change in buying behavior, she says.

But while labeling may have some positive effect, many diet experts worried that this alone would only reach those who are already health-conscious -- and people who aren't concerned about their health will not be slowed down by high caloric totals.

"Solutions to the obesity epidemic are going to be far more painful than just educating people on calorie content," Roslin says. It's going to take "social engineering," so that people pay attention to physical fitness after high school, and healthy foods are not the most expensive ones on a fast-food menu.

At the end of the day, "we can only hope that knowledge is power," Katz says, but knowledge certainly has to go beyond how many calories are in a food or which colossus dishes are a no-no.

It's going to take "a major societal shift," he says. "Calories per dollar should not be considered a measure of value. Nutrients per dollar…[should be the] right measure of food value in the modern world."