Over the past 2 decades, Americans have significantly increased the number of meals consumed and the percent of their food budget spent on away-from-home foods.1, 2 Greater consumption of away-from-home foods has been associated with increased intake of calories, total fat, saturated fat, added sugars, and sodium, fewer fruits and vegetables, and less milk, fiber, and vitamins.3, 4, 5, 6, 7, 8 The trend toward larger portion sizes further encourages overconsumption,9 and higher fast-food consumption is associated with increases in body weight and insulin resistance.10 The prevalence of obesity in the United States has increased significantly over the same time period.11 Excess weight is associated with the development of type 2 diabetes, cardiovascular disease, some types of cancer, and other chronic conditions.12 Although individual behaviors are major determinants of overweight and obesity, growing evidence suggests that the problem is powerfully influenced by community food environments.13, 14 Focusing public health promotion efforts “upstream” could accelerate progress toward stemming the obesity epidemic. Because of the increases in away-from-home eating and its contribution to overweight and obesity, a change in restaurant offerings toward more low-calorie and healthful choices may be especially influential.15, 16 Few data describe factors influencing restaurants’ decisions about whether to offer healthier foods. This study aimed to understand the perspectives of senior menu development and marketing executives at major U.S. restaurant chains regarding their menu development process, factors influencing the chains’ decisions to offer healthier menu items, and future challenges to making healthier eating easier for restaurant customers. Understanding the restaurant industry perspective can give health professionals information needed to improve community nutrition environments.
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