Healthier Fast Food Choices

How to make smart decisions while eating out
Author: Sarah Aldridge

Eyebrows no longer automatically rise when the words “healthy” and “fast food” appear side by side. With new menu items such as salads with mixed greens, whole-grain breads and low-fat fruit parfaits, it is possible to eat healthy at the drive-through. But you have to be a savvy consumer to avoid nutritional pitfalls.

“Most fast food is going to be higher in fat, higher in calories and high in sodium,” says Tina Willis, MA, RD, CD, of the Indiana Hemophilia & Thrombosis Center in Indianapolis. Now that restaurants often post nutritional information, you can order smarter. “The only way you can make good choices is if you have the knowledge,” Willis says. “Reading the labels will give you that knowledge.”

Knowing what the daily recommendations are for essential nutrients and calories, you can start making healthier fast food choices.

Nutrition 101

Carbohydrates (carbs), fats and proteins provide essential nutrients that the human body needs to function. Carbs are broken down into sugar molecules, which provide energy for physical activity and proper functioning of organs. They are found in such foods as fruits and vegetables, whole grains and breads, cereals and pastas. Fats also provide the body with energy, help insulate organs and nerves, and help absorb the fat-soluble vitamins A, D, E and K. They are found in butter, cheese, fatty meats, dressings and oils. Proteins are part of every cell, tissue and organ. They are needed for growth and tissue repair, and they carry oxygen and other elements in the blood. Sources of protein include fish, meat and poultry; dairy products and eggs; and legumes and nuts.

The sodium in salt (sodium chloride) is an essential element that helps transmit nerve impulses, maintains water balance in the body and keeps muscles functioning properly. It also regulates blood pressure and blood volume. Sodium is used in condiments and seasonings to add flavor. It’s also found in processed meats, including bacon, ham and sausage.

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The US Department of Agriculture’s (USDA) 2010 “Dietary Guidelines for Americans,” the government’s research-based guidance for federally supported nutritional programs, recommends the following daily calorie consumption breakdown for most adults: 45% to 65% should come from carbs, 10% to 35% from protein and 20% to 35% from fat.

Calorie counting is important and so is figuring how many calories you consume daily. For example,“1,800 calories per day is a good average,” Willis says. That number could rise or fall, depending on your age, gender, how active you are, and if you’re pregnant or nursing. Willis assumes most people eat five times daily—three meals and two snacks. “A person should consume about 400 calories per meal,” she says. “But that’s just a rule of thumb. If you like bigger breakfasts or lunches, you can modify it.”

The USDA guidelines also recommend a daily sodium intake of less than 2,300 mg, about 1 teaspoon, for people younger than 51; 1,500 mg for those older than 51 or who have a health condition requiring them to limit salt. The American Heart Association (AHA), however, recommends that everyone consume less than 1,500 mg of sodium daily.

Eating in Excess

The problem with fast food is that you can easily top the daily recommendations in just one meal. For instance, at one fast food chain, an Angus burger with bacon and cheese, small French fries, a chocolate milkshake and apple pie elevate the calorie count to 1,840, which is more than the recommended daily total for an adult. The fat content is sky high—80 grams, exceeding the 78 grams of fat at the upper end of the USDA daily guidelines. That meal supplies a whopping 2,640 mg of sodium, surpassing the daily total for both the USDA and AHA.

“Foods high in sodium, fat and calories are related to obesity, diabetes, heart disease and strokes,” Willis says. A 2005 study in Lancet showed that young adults who ate fast food two or more times a week for 15 years gained 10 pounds. They also doubled their risk of developing insulin resistance, a risk factor for type 2 diabetes and heart disease.

The skinny on soft drinks is that they’re loaded with refined sugar. “Sodas and other sugary drinks have all those calories but don’t do anything to decrease your hunger,” says Willis. Further, they have no nutritive value, earning the description “empty calories.” A medium-sized Sprite at McDonald’s has 240 calories and 64 grams of sugar—more than 15 teaspoons, or five tablespoons. “Most of us wouldn’t think of eating five tablespoons of sugar, but that’s what we’re doing every time we drink soda,” says Willis. The AHA recommends that women and men limit their daily consumption of sugar to 6 teaspoons, or 100 calories, and 9 teaspoons, about 150 calories, respectively.

A 2010 study in the Journal of the American Dietetic Association showed that sugar-sweetened drinks are the largest source of sugar in teens’ diets, and they drink twice the amount of soda as they do milk daily. Willis suggests teens and adults offset their soft drink consumption by alternating soda and water. “That way they’re cutting their calories and sugar in half,” she says. Further, she encourages die-hard soda lovers to try ordering no-calorie soft drinks.

Using Your Smarts When Ordering Out

Although Americans like super-sized portions, Willis says downsizing is key when eating out. “I’m big on portion control. If you really want a hamburger, order the smallest you can get.” If your favorite burger comes with several patties and buns, throw out the extra bread, she says. If the special sauce makes your mouth water, get it on a regular or junior-sized burger.

Condiments can be hidden sources of fat, sodium, sugar and calories. Try substituting mustard, which is low-fat, for mayonnaise, which is not. Skip the bacon, which is high in fat and sodium, and request extra lettuce or tomatoes. Ask for sauces and salad dressings on the side. That way a dollop doesn’t turn into a drenching. Although cheese is often considered healthy because it has calcium, use it sparingly. “It’s a very concentrated source of fat and sodium,” Willis says. Order your personal pan pizza with less cheese or skip the cheese on your salad. 

Potatoes are good sources of vitamin C, beta-carotene and fiber, says Willis, but not when they’re fried and salted. Cooking French fries in oil at a high temperature destroys some of their vitamins and adds fat and calories. Choose a baked potato instead, with a healthy topping of broccoli or chives. Cut the sizeable spud in half and save the rest for another meal, Willis advises. If you can’t live without savory toppings, live by the adage “less is more.” “You can still have the butter, sour cream or cheese sauce, just ask for lower or reduced fat. Then use half the amount,” says Willis. Chili on a baked potato is an even better choice. “It would be more filling because you’re getting more protein.” But beware—the chili at Wendy’s, for instance, has 800 mg of sodium.

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Grilled chicken has less fat and fewer calories than fried or battered chicken. For healthier carbs, ask for your grilled chicken on whole grain bread, or in a low-carb wrap or taco shell. But limit toppings that add fat grams and sodium, such as bacon bits, cheese and guacamole.

Several fast food chains offer salads with mixed greens, nuts, and dried and fresh fruits. “You’re getting a lot of nutrients from the cranberries, which have vitamin C, and the apples, which contain the phytonutrient quercetin,” Willis says. Quercetin, a flavonoid antioxidant concentrated in the apple’s skin, protects the body against inflammatory diseases, cancer and heart disease. Plus, you’re getting 6 grams of fiber, compared to 1 gram in a cheeseburger, she says. To keep it healthy, choose a fat-free or low-fat dressing, such as a vinaigrette, or try lemon juice.

Fast food restaurants can accommodate special orders. To shrink your sodium, ask for your burger without seasoning or for unsalted fries. Substitute fattening fillers with healthier ones.  “You can get a double meat submarine sandwich and load up on all the vegetables they have,” Willis says. (See sidebar, “Special Orders and Substitutions.”)

If you’re hooked on high-calorie milkshakes or coffee drinks with whipped cream and caramel—which can pack on 500 or more calories, the equivalent of an entire meal—Willis recommends McDonald’s iced coffee with sugar-free syrup. “That would be a good alternative because it has flavor and sweetness,” she says. “It does have some fat, but it’s fairly low in calories.” Count on about 60 calories and 1 gram of sugar per 16-ounce cup. To satisfy a sweet tooth that’s begging for a frozen dessert with chocolate or cookie pieces, Willis has a solution. “You can order a small sundae at Dairy Queen with the Blizzard topping, which is half the calories.”

When children clamor for a kid-friendly meal and you don’t have time to cook, there are healthy options. Many fast-food chains now offer kids’ meals that contain sliced apples, carrot sticks or low-fat yogurt. Try buying hamburgers, chicken nuggets or grilled chicken sandwiches for everyone, then add healthy foods to the meal yourself, Willis says. “When you get home you can open a bag of carrots, slice some apples or cook some frozen vegetables—those are all very quick.”

All of these recommendations also apply to people with bleeding disorders. But there is one caveat. “If they’ve had several bleeds and their hemoglobin is low, they would need to eat foods that are higher in iron, such as red meat,” Willis says. Because vitamin C helps with iron absorption, try ordering a roast beef sandwich with orange juice. (See “Pumping Iron,” HemAware July 2010.)

Fast food restaurants are revamping their menus to offer more nutritious foods. “They’re trying to become healthier, but they can only do so much,” Willis says. “People have to make their own decisions. Eat what you like, just eat more moderate amounts of it.”

Learn More

Visit NHF’s Steps for Living Web site for nutrition information at various life stages.

Read the USDA’s 2010 “Dietary Guidelines for Americans."

Pereira MA, et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet 2005; 365(9453):36-42.

Reedy J and Krebs-Smith, SM. Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. Journal of the American Dietetic Association 2010; 110(10):1477-1484.