Adherence to voluntary UK sugar, salt, and calorie reduction targets in the highest-grossing restaurant chains: A cross-sectional study.

backgroundTo address high rates of diet-related disease, the UK Government has a series of voluntary targets for retailers, manufacturers, and the out-of-home sector (e.g., restaurants), to reduce the sugar, salt, and calorie content of food products. The sugar targets were intended to be met in 2020, the salt targets in 2024, and the calorie targets in 2025 (extended from 2024 due to Covid-19). There is limited evidence for how the out-of-home sector is performing against these targets, and individual company responses have not been evaluated. This study aimed to assess adherence to UK Government's sugar, salt, and calorie reduction targets for menu items offered by the 21 highest-grossing restaurant chains in 2024. METHODS AND

findingsNutritional information was collected from restaurants' online menus. Mean/median sugar, salt, and calorie content, per 100 g and per serving, was calculated for each restaurant and food subcategory. Sugar, salt, and calorie content for each menu item was compared against the UK Government's targets, and the proportion of menu items meeting (i) each and (ii) every applicable target, was calculated for each restaurant and food subcategory. Three thousand ninety-nine menu items were included. Across all restaurants, 61% of menu items met their calorie targets, 58% met their salt targets, 36% met their sugar targets, and 43% met all of their applicable targets. Six of the 12 food subcategories, and nine of the 21 restaurants, had over 50% of menu items meeting all of their applicable targets. Menu items from Papa John's were the lowest adhering for the calorie (35%) and salt (8%) targets, and menu items from Burger King, KFC, Nando's, and Vintage Inns were the lowest adhering for the sugar targets (0%). Menu items from pizza restaurants had the lowest adherence to all applicable targets (32% overall) out of all the restaurant types, but items offered by restaurants with similar menu foci were also found to vary in their adherence. We were unable to account for heterogeneity in item-level sales due to the lack of accessible sales data from the out-of-home food sector, and therefore we could only assess performance against the targets for available items as opposed to purchased items.

conclusionsOur findings suggest that while menu items from certain restaurant types appear to perform worse than others against the sugar, salt, and calorie targets, items from restaurants with similar menu portfolios also vary in their adherence, highlighting the potential for restaurants to improve the nutritional quality of their products without changing their menu focus. Our study demonstrates that there is low adherence to voluntary schemes across the out-of-home sector, and therefore mandatory regulations may be a more effective approach to improving the nutritional quality of out-of-home food.