Are You Paying Your Restaurant Bill in Pounds?

Sated or uncomfortably stuffed? Here are the consequences.

Posted Jan 16, 2019

An uncountable number of articles have been written about how the increased portion size of everything has made us fatter as a nation compared with 20-30 years ago. Now research conducted by Susan Roberts of Tufts University, with a group of international collaborators, has shown that global obesity is also linked to the high caloric content of restaurant meals in various regions of the planet. They surveyed the calorie content of entrées in countries as diverse as China, India, Finland, Ghana and the U.S. The results were surprising. Looking only at the main dish, not the appetizer, or breads, beverages, and desserts, the average calorie content was above 1200 in all of the countries except China, where entrées ran about 700 calories. And, to their surprise, the calorie content of a fast-food restaurant entrée was approximately "only" 700 calories, but here, too, this did not include a beverage or sides such as French fries.

The increased calorie contents of these globally evaluated meals may have been due in part to the presence of higher-calorie ingredients. As a country's economy improves, the content of its meals can shift from low-fat staples such as rice, potatoes, tubers and beans, with small amounts of protein and fat, to meals containing higher-fat proteins such as pork, as well as high-fat ingredients such as oils, butter, cream, and eggs. If the portions were small, it is doubtful that adding such ingredients would elevate the calorie contents of the meals to considerably more than 1000 calories, but as in the United States, restaurants in these countries are also inflating the size of their meals. 

What is the explanation for the increase in the average size of a meal? Is it biological? Has something changed in the size of our stomachs so we are able to eat more food than our parents, and especially our grandparents? And if so, are we eating more because as we develop from infancy to adulthood we gradually stretch our stomachs to accommodate larger portions? Are we eating more because it takes more food to satisfy our hunger? Are eating more because we are ignoring signals from our stomach and brain to stop? Or are we eating more just because the food is there?

It is hard to believe that infants born today have stomachs that hold more food than infants of the same birth weight born a few generations ago. Toddlers today still rather play with their food than eat it. Elementary school children often throw away a good part of their lunch and often resist eating a full meal at dinnertime. Children taken out to a restaurant ignore the food on their plate so they can play with their iPad. When does the switch occur to wanting and enjoying eating large portions?

Is it during the teen years that eating large quantities of food feels normal? Might eating several slices of pizza or double bacon cheeseburgers, a large order of fries, and a gigantic cup of soda accustom a teen to expect to eat large quantities at a meal? It is true that some male teens eat prodigious amounts when going through their growth spurt, but usually return to normal when the rate of growth slows.

What is obvious is that at some point we become desensitized to the large amounts of food we are being served and expected to consume. An 8-ounce steak or chicken breast, or 6 ounces of fish looks like a small serving. Today, if we saw the size of a bagel of twenty-five years ago, it would look like a teething ring for a baby. A 3-ounce fast-food hamburger seems to be small enough to be eaten with a toothpick. I remember when several years ago I first saw the 500 or 600-calorie humongous muffins in a bakery shop. They looked like small cakes. Now it is hard to find a muffin that doesn’t require two hands to hold.

Because of this desensitization to the size of the food we are served, when we are given what used to pass as normal-size servings, we may think we are not getting enough. Or we feel cheated because, "For what we are paying for the meal, the portion size ought to be larger!"

Can we reverse the national tendency to inflate the size of what we eat outside the home, and to some extent, at home as well? Can we make ourselves regard outsized portions of pasta or chicken or tuna wraps as too large to consume in their entirety? Can we demand that restaurants serve portions of food compatible with the needs of our largely sedentary lives?  

The answer is that we must change the way we eat first, and hope restaurants will follow. A friend who oversees a weekly lunch for her organization told me that she now serves bagel thins rather than bagels, because the latter were so big people were removing the insides before eating. Muffins are often cut in half or in quarters if served at a breakfast or brunch. And that taking home at least a half of a restaurant dinner becomes so common that servers are surprised when you don’t. Sharing an entrée is another effective way of eating a normal-size portion, especially in restaurants known to have large portions; so is ordering an appetizer to be served as the main course. Some restaurants only serve small plates of appetizers and entrées so it is possible to ‘clean your plate’ without overeating.

Restaurants may be blameworthy for making it seem all right to eat too much by serving too much. But as a friend once said, “No one is putting a gun to your head and making you eat everything that you are served.” 


Roberts, S.B. et al. “Measured energy content of frequently purchased restaurant meals: multi-country cross sectional study,” BMJ 2018; 363:k4864.