Open and available for virtual telehealth and in-person appointments. Book Now!

Dining Out After COVID-19

If you’re like most Americans, then you're probably itching to get out again and eat at your favorite restaurants. Cooking all your meals at home can be a lot of work! Before COVID-19, the typical American adult was getting 1 of every 5 calories from a restaurant! The quality of those calories were not good. 

A new study by researchers at the Friedman School of Nutrition Science and Policy at Tufts University published in The Journal of Nutrition looked at the dietary selections of more than 35,000 adults from 2003 to 2016 who dined at full-service or fast-food restaurants. The team of researchers found the nutritional quality eating out at fast food and full-service restaurants (i.e. those with a wait staff) were EXTREMELY POOR.  A whopping 70-75% of the meals Americans consumed from fast food restaurants, and 50% of the meals consumed at sit-down restaurants are of poor dietary quality. Most notably, they found that less than 0.1% – almost none – of all the restaurant meals consumed over the study period were of “ideal” quality.

What does this tell us? Dining out is a recipe for unhealthy eating all of the time. The nutritional quality of both full-service and fast-food restaurant meals hasn’t changed much in the past few decades.  The onus to improve the nutritional quality should be a priority for consumers since clearly, lawmakers, full-service and fast-food restaurants are not going to be leading the way nor are incentivized to do so. 

Reducing disparities so that all Americans can enjoy the pleasure and convenience of a meal out that is good for them is critical. The average quality of fast-food meals consumed by non-Hispanic whites and Mexican-Americans have slightly improved. There has been no change in the average quality of fast-food meals consumed by non-Hispanic blacks. At the same time, the proportion of poor-quality fast-food meals decreased from 74 to 60% from 2003 to 2016 for college graduates, but remained at 76% for people without a high school diploma.

Americans’ reliance on restaurants during the 2003-2016 study period also demonstrated the following: 

Consuming empty calories with an abundance of salt, sugar, and little to no nutrition at most meals is setting the stage for chronic disease starting early in life since children adapt similar eating habits as their parents. It also sets the stage for a compromised immune system and increased risk of catching recurrent infections. This correlates with what I see clinically. 

The largest opportunity we have to enhance the nutritional quality of our food and overall health is taking back control of what we choose to eat and how we prepare our meals.  Embracing cooking as not a chore, but finding easy ways to have a mix of raw vs. cooked veggies is a game changer to being nutritionally balanced.  Add a mix of whole ancient grains (i.e. oats, millet, amaranth, quinoa), small beans, and mushrooms into your daily diet. 

Our food is the number one cause of poor health in this country, representing a tremendous opportunity to reduce diet-related disease and associated healthcare spending. If we get it right with restaurants, we can really begin to make some headway. Remember, there are two forces at play when dining out in restaurants: what’s available on the menu and what Americans are actually selecting. Efforts from consumers, advocacy groups, governments, and even the restaurant industry itself should focus on both these areas.

Note, the National Health and Nutrition Examination Survey (NHANES) participants were representative of the national population and completed at least one valid 24-hour dietary recall questionnaire from nine consecutive cycles of NHANES between 2003-2016, including types of foods and beverages consumed and the source. The study team also used the American Heart Association diet score to assess meal quality, based on the AHA 2020 Strategic Impact Goals.  This score assesses the consumption of fruits and vegetables, whole grains, sodium, sugar-sweetened beverages, fish and shellfish, nuts, seeds, legumes, processed meat, and saturated fat.

The data is not perfect, but it gives a good indication of the food people consume when they do eat out. The main limitations of the study included the fact that self-reported food recall data is subject to measurement error (due to daily variations in food intake). Participants may have also overreported or unreported healthy or unhealthy foods due to social desirability perceptions. This is true with virtually all nutrition studies.

Dr. Bhandari and the Advanced Health Team Are Here to Support Your Health.

Our expert team of integrative holistic practitioners work with patients suffering from chronic health concerns.  We take the extra step to understand the root cause and how to optimize every organ’s functioning.  By better understanding how your environment directly fits into your overall well-being, we create personalized treatment plans which drive away sickness. To learn more and book an appointment, contact Advanced Health or call 1-415-506-9393.


Liu, J., Rehm, C.D., Micha, R., & Mozaffarian, D. (2020). Quality of meals consumed by US adults at full-service and fast-food restaurants, 2003-2016: Persistent low quality and widening disparities. The Journal of Nutrition.


Dr. Payal Bhandari Dr. Payal Bhandari M.D. is a leading practitioner of integrative and functional medicine in San Francisco.

You Might Also Enjoy...

The Truth About Where Your Food Comes From | Part 3

The unprecedented rise in life-threatening infections, such as the COVID-19 pandemic, is due to the fact that we are addicted to excess animal protein consumption and are running out of reliable and effective antibiotics to treat these infections.

The Truth About Where Your Food Comes From | Part 2

Climate change is one of the most urgent environmental and humanitarian challenges we face in the 21st century. The scientific literature makes it clear that global food production is one of the largest contributors to this change. Read more here!

Getting Older? Skip the Soda in the Era of COVID-19

The “it's only one drink per day” mentality is dangerous to human health, especially in the era of COVID-19. It has quickly led to a weaker immune system for Americans of all ages and high probability of getting infected with COVID-19.