Three recent studies published in JAMA Internal Medicine have analyzed the nutritional content of restaurant and processed foods, raising questions about consumer, industry and government efforts to curb calorie, sodium and fat consumption. Authored by Center for Science in the Public Interest (CSPI) Executive Director Michael Jacobson and colleagues at George Washington University and Northwestern University, the first study examined changes in the sodium levels of identical processed and restaurant foods from 2005 to 2011. Michael Jacobson, et al., “Changes in Sodium Levels in Processed and Restaurant Foods, 2005 to 2011,” JAMA Internal Medicine, May 2013. Using data collected by CSPI, researchers reportedly found that “sodium content in 402 processed foods declined by approximately 3.5%, while the sodium content in 78 fast-food restaurant products increased by 2.6%.” Although the study also noted that salt content decreased by 30 percent in some products and increased by 30 percent in others, “the predominant finding is the absence of any appreciable or statistically significant changes in sodium content during six years.”

“The strategy of relying on the food industry to voluntarily reduce sodium has proven to be a public health disaster,” said Jacobson in a May 13, 2013, CSPI press release. “Inaction on the part of industry and the federal government is condemning too many Americans to entirely preventable heart attacks, strokes, and deaths each year.”

Meanwhile, two additional studies focusing solely on restaurant foods have further assessed the calorie and nutrition content of both chain and non-chain venues. Lorien Urban, et al., “The Energy Content of Restaurant Foods Without Stated Calorie Information,” JAMA Internal Medicine, May 2013. Highlighting the calorie contents of foods served at small- or non-chain restaurants in the United States, one research article concluded that these types of establishments, “which provide no nutrition information, also provide excessive dietary energy in amounts apparently greater than popular meals from chain restaurants or information in national food databases.”

The other study examined menu items from 26 chain sit-down restaurants (SDRs) in Canada, compiling nutrition profiles for “3507 different variations of 685 meals, as well as 156 desserts from 19 SDRs.” Mary Scourboutakos, et al., Research Letter, “Restaurant Meals: Almost a Full Day’s Worth of Calories, Fats, and Sodium,” JAMA Internal Medicine, May 2013. The results evidently showed that breakfast, lunch and dinner meals from 19 chain SDRs contained, on average, (i) “1128 calories (56% of the average daily 2000 calorie recommendation)”; (ii) “151% of the amount of sodium an adult should consume in a single day (2269 mg)”; (iii) “89% of the daily value for fat (58 g)”; (iv) “83% of the daily value for saturated and trans fat (16 g of saturated fat and 0.6 g of trans fat); and (v) “60% of the daily value for cholesterol (179 mg).”

Reflecting on this new research, however, a concurrent editorial authored by Los Angeles County Department of Health Services Director Mitchell Katz questioned how far government should go in regulating food consumption beyond its efforts at making nutritional information more readily available and transparent. “Ultimately, the true limitation in regulating food consumption is that unlike tobacco, food is safe and necessary in reasonable doses,” writes Katz. “Regulating the maximum of a necessary nutrient, such as salt, will always raise questions of whether the government is going too far in regulating our lives. As we debate the controversial role of government in stemming the interrelated endemics of obesity, diabetes mellitus, and heart disease, we must insist on the right of our patients (as well as ourselves) to know what we are eating, whether fast food or slow, whether large chain, small chain, or individual restaurant.”