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Fast Food Consumption of U.S. Adults: Impact

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Original Research

Fast Food Consumption of U.S. Adults: Impact on Energy

and Nutrient Intakes and Overweight Status

Shanthy A. Bowman, PhD, Bryan T. Vinyard, PhD

Beltsville Human Nutrition Research Center (S.A.B.), Biometrical Consulting Service (B.T.V.), U.S. Department of Agriculture—
Agricultural Research Service, Beltsville, Maryland
Key words: fast food, energy intake, energy density, nutritional quality, overweight, obesity

Objective: To compare the diet quality and overweight status of free-living adults, ages 20 years and older,
grouped based on their fast food intake status.
Methods: USDA’s 1994 to 1996 Continuing Survey of Food Intakes by Individuals (CSFII 1994 –1996) data
was used. Three separate analyses were conducted: (1) effect of fast food on diet quality of males and females
based on day-one data, (2) comparison of dietary and overweight status of adults who ate fast food on one- two-
or none of survey days and (3) within-person analysis comparing energy and macronutrient intakes of adults who
ate fast food on one of the two survey days. SUDAAN software package was used in pair-wise mean
comparisons and regression analyses (␣ ⫽ 0.05).
Results: At least one in four adults reported eating fast food. The diet of males and females who consumed
fast food was high in energy and energy density. Fast food provided more than one-third of the day’s energy, total fat
and saturated fat; and was high in energy density. Negligible amounts of milk and fruits, but substantially large
amounts of non-diet carbonated soft drinks were reported consumed at fast food places. After controlling for age,
gender, socio-economic and demographic factors, energy and energy density increased and micronutrient density
decreased with frequency of fast food consumption. Adults who reported eating fast food on at least one survey day
had higher mean body mass index values than those who did not eat fast food on both survey days. A small, but
significant, positive association was seen between fast food consumption and overweight status. Within-person
comparisons showed that energy intakes were higher on a fast food day than on a non-fast food day.
Conclusion: Fast food consumption was associated with a diet high in energy and energy density and low
in essential micronutrient density. Frequent fast food consumption may contribute to weight gain.

INTRODUCTION
Americans work more hours today than a few decades ago,
and some work more than one job. Among married couples, the
average combined weekly work hours increased by almost 20
percent over the past three decades [1]. More women are in the
work force today than in the past. About seventy five percent of
all mothers are in the labor force and unmarried mothers are
more likely than married mothers to work [2]. This situation
leaves adults with less time for food preparation which is
reflected in the increase in away-from-home food consumption.
In 1993, about 38 percent of total food expenditure dollars were
spent on food away from home. This amount increased to 42
percent in 2001 [3].
The number of fast food places increased by several fold
and more people eat in fast food places today than three
decades ago [3–7]. Fast food places are one of the popular
sources of away-from-home foods. Fast food is quick, conve-
nient, relatively inexpensive for the amount of food obtained,
and appeals to all age groups [3,5,6,8].
The U.S. Department of Agriculture (USDA) periodically
conducts dietary surveys to monitor food and nutrient intakes
of the U.S. population. Our preliminary analysis of USDA’s
1989 –1991 Continuing Survey of Food Intakes by Individuals
(CSFII 1989 –1991) showed that 16 percent of adults, ages 20
years and older, reported consuming fast food on day-1 of the
survey. We were interested in looking at fast food consumption
of adults in the latest USDA surveys conducted between 1994
and 1996 (CSFII 1994 –1996).
The objectives of the study were to compare the diet quality

Address reprint requests to: Shanthy A. Bowman, PhD, U.S. Department of Agriculture—Agricultural Research Service Beltsville Human Nutrition Research Center
10300, Baltimore Avenue, Building 005, Room 125, BARC-West, Beltsville, MD 20705-2350. E-mail: sbowman@rbhnrc.usda.gov

Journal of the American College of Nutrition, Vol. 23, No. 2, 163–168 (2004)
Published by the American College of Nutrition

163
Fast Food Intake and Diet Quality of U.S. Adults

of adults who ate fast food with that of adults who did not eat
fast food, to assess fast food’s contribution to the day’s dietary
intakes, and to examine potential association between fast food
consumption and overweight status.
METHODS
The CSFII 1994 –1996 data was used for the study [9]. The
CSFII is nationally-representative and includes people of all
ages from birth. Dietary intake data in the surveys was col-
lected through an interviewer-administered 24-hour dietary re-
call using a multiple-pass technique to reduce under-reporting
by the respondents. Data was collected on two non-consecutive
days which were 3 to 10 days apart. Overall day-1 response rate
for the survey was 80.0 percent [10].
This study included adults ages 20 years and older. There
were 9,872 adults who had complete food intake records for
day-one of the survey, and 9,323 of these adults also had
complete food intake records for day-two of the survey. The
survey respondents were asked where they obtained each of the
foods, including beverages, they reported consumed. Food ob-
tained at fast food places and pizza places were collectively
categorized, in the CSFII 1994 –1996, as “fast food” [11].
Nutrients and food group definitions in the analysis were the
same as those in the CSFII 1994 –1996. “Micronutrient den-
sity” is defined in this paper as the amount of micronutrient per
1,000 kilocalories, and “energy density” is defined as the
number of kilocalories of energy obtained per 100 grams of
total food amount consumed. The total food amount consumed
included all foods and all alcoholic and non-alcoholic bever-
ages in the form reported consumed (i.e., includes water present
in beverages, such as tea, coffee, fruit drinks made from dry
mixes, cocoa, and milk drinks), and excluded water such as tap
water or bottled water drunk separately (Tables 1, 2 and 3).
Socio-economic, and demographic characteristics of fast
food consumers were examined. These characteristics included
gender; age; race-ethnicity (non-Hispanic whites or Cauca-
sians, non-Hispanic blacks or African Americans, Hispanics,
and all others such as Asians, Native Americans, Pacific Is-
landers, and Alaskan Natives); annual household income (0%
to 130% of poverty, 131% to 350% of poverty, and above
350% of poverty); 1990 Census geographic regions (Northeast,
Midwest, South, and West); and urbanization (Metropolitan
Statistical Area-central city, MSA- suburban, and rural). The
percentages of adults reported consuming fast food on day-one
of the survey, and the odds of consuming fast food by different
socio-economic and demographic groups were estimated.
Fast food’s contribution to day’s total energy, macronutri-
ent, and selected food groups intakes of males and females was
estimated from day-one dietary intake data because of the
higher sample size (Table 1). The 9,872 adults were grouped
into two categories based on whether they ate fast food or not
on day-one. Mean comparisons were made within genders; two
means were to be considered statistically different at a level of
significance, ␣ ⫽ 0.05.
The effect of fast food consumption frequency (zero, one,
and two days in the survey) on energy, macronutrient, micro-
nutrient density, fluid milk, non-starchy vegetable, fruits and
fruit juices, and non-diet carbonated beverages intakes was
examined by analyzing two-day average dietary intakes of
9,323 adults who had complete food intake records for both
survey days. These adults were grouped into three groups: who
did not eat fast food on either survey day (N ⫽ 5861), who ate
fast food on one of the two survey days (N ⫽ 2,623), and who
ate fast food on both survey days (N ⫽ 839). A multiple

Table 1. Mean1 Intakes of Energy, Macronutrients, and Selected Food Groups by Adults Ages 20 Years and Over, by Gender
and Fast Food Consumption Status, CSFII 1994 –1996, Day-1 Dietary Intake Data

Males Females

No fast food Had fast food Had no fast food Had fast food
Variables N ⫽ 3,728 N ⫽ 1,328 N ⫽ 3,793 N ⫽ 1,023

day’s total day’s total from fast day’s total day’s total from fast
intake intake food intake intake food
Energy (kilocalories) 2303 ⫾ 24a 2814 ⫾ 65b 1022 ⫾ 31 1594 ⫾ 14c 1820 ⫾ 30d 653 ⫾ 15
Energy density (kilocalories per 100
grams of total food consumed) 95 ⫾ 0.7a 102 ⫾ 1.1b 158 ⫾ 2.9 89 ⫾ 0.8c 98 ⫾ 1.1d 163 ⫾ 3
Total fat (g) 86 ⫾ 1.2a 109 ⫾ 3.1b 46 ⫾ 1.3 58 ⫾ 0.7c 70 ⫾ 1.4d 29 ⫾ 0.7
Saturated fat (g) 29 ⫾ 0.5a 38 ⫾ 1.3b 16 ⫾ 0.5 19 ⫾ 0.3c 23 ⫾ 0.4d 10 ⫾ 0.2
Carbohydrate (g) 283 ⫾ 3a 337 ⫾ 8b 112 ⫾ 4 207 ⫾ 2c 229 ⫾ 4d 73 ⫾ 2
Added sugars (g) 79 ⫾ 2a 119 ⫾ 5b 38 ⫾ 3 58 ⫾ 1c 82 ⫾ 3d 25 ⫾ 1
Protein (g) 91 ⫾ 1a 103 ⫾ 2b 41 ⫾ 1 63 ⫾ 1c 66 ⫾ 1d 26 ⫾ 1
Total fluid milk (g) 181 ⫾ 6a 152 ⫾ 8b 15 ⫾ 4 137 ⫾ 4c 109 ⫾ 7d 14 ⫾ 4
Fruits and fruit juices (g) 181 ⫾ 5a 143 ⫾ 10b 11 ⫾ 3 170 ⫾ 5c 111 ⫾ 8d 7⫾2
Non-diet carbonated beverages (g) 235 ⫾ 13a 525 ⫾ 26b 229 ⫾ 15 140 ⫾ 7c 334 ⫾ 14d 128 ⫾ 9
1 a,b c,d
Includes means and standard errors of the means. Mean comparisons were made within genders. Superscripts are used for males and superscripts are used for
females. All means comparisons were significant at p ⬍ 0.01.

164 VOL. 23, NO. 2

 Fast Food Intake and Diet Quality of U.S. Adults

Table 2. Mean1 Energy, Nutrients, and Food Group Intakes and Body Mass Index Values of Adults Ages 20 Years and Over, by
Fast Food Intake Status, Adjusted for Age, Gender, Socio-Economic and Demographic Factors, CSFII 1994 –1996, 2-Day
Average Dietary Intake Data

No fast food on either Had fast food one Had fast food both
Energy, nutrients and food groups
day N ⫽ 5,861 day N ⫽ 2,623 days N ⫽ 839
Energy (kilocalories) 1901 ⫾ 16a 2047 ⫾ 18b 2308 ⫾ 121c
Energy density (kilocalories per 100 grams
of total food2 consumed) 91.2 ⫾ 0.6a 94.4 ⫾ 0.6b 97.2 ⫾ 1.4b
Total fat (g) 69 ⫾ 0.8a 79 ⫾ 0.9b 91 ⫾ 5.8c
Saturated fat (g) 23 ⫾ 0.3a 27 ⫾ 0.3b 32 ⫾ 2.5c
Total carbohydrate (g) 241 ⫾ 2.0a 250 ⫾ 2.5b 280 ⫾ 12.6c
Added sugars6 (g) 67 ⫾ 1.2a 79 ⫾ 1.5b 103 ⫾ 6.5c
Dietary fiber (g) 16.3 ⫾ 0.2a 15.1 ⫾ 0.2b 14.6 ⫾ 0.4b
Carotene per 1,000 kilocalories (mcg-re) 332 ⫾ 10a 238 ⫾ 7b 194 ⫾ 12c
Vitamin A per 1,000 kilocalories (mcg-re) 600 ⫾ 12a 471 ⫾ 9b 399 ⫾ 15c
Vitamin C per 1,000 kilocalories (mg) 57 ⫾ 1.3a 45 ⫾ 1.1b 40 ⫾ 1.9c
Calcium per 1,000 kilocalories (mg) 389 ⫾ 4a 374 ⫾ 4b 369 ⫾ 7b
Phosphorus per 1,000 kilocalories (mg) 635 ⫾ 4a 612 ⫾ 3b 596 ⫾ 4c
Magnesium per 1,000 kilocalories (mg) 149 ⫾ 1a 134 ⫾ 1b 123 ⫾ 1c
Total fluid milk (g) 153 ⫾ 5a 136 ⫾ 4b 133 ⫾ 7b
Fruits and fruit juices (g) 178 ⫾ 5a 142 ⫾ 5b 119 ⫾ 10c
Non-starchy vegetables (g) 148 ⫾ 3a 120 ⫾ 3b 109 ⫾ 8b
Non-diet carbonated beverages (g) 184 ⫾ 8a 282 ⫾ 9b 440 ⫾ 24c
Body Mass Index (kg/m2) 25.8 ⫾ 0.10a 26.3 ⫾ 0.15b 26.4 ⫾ 0.24b
1
Least squares mean ⫾ standard error of the mean from the regression models. Adults who did not eat fast food on either day were significantly different (p ⬍ 0.01) from
adults who ate fast food on one or both days, except for mean body mass index values where p-values for comparisons between non-fast food eaters and one- or two-day
fast food eaters were 0.002 and 0.030 respectively.
2
Total food amount includes the weight in grams of all the foods and all alcoholic and non-alcoholic beverages in the form reported consumed (includes water present
in beverages, such as tea, coffee, fruit drinks made from dry mixes, cocoa, and milk drinks; excludes water drunk separately, such as tap and bottled water).

regression model was used to control for age, gender, race-
ethnicity, household annual income, geographic region, and
urbanization (Table 2).
The odds of adults who ate fast food being overweight, or
not meeting each one of the recommendations for total fat,
saturated fat, or added sugars [12], were estimated by logistic
regression analyses after controlling for age, gender, and other
socio-economic and demographic variables. “No fast food on
both survey days” status was the reference category (Table 3).
Body Mass Index (BMI) values were not available for 225
adults (190 adults who did not eat fast food and 35 adults who
ate fast food). Adults who had no BMI values were excluded
from mean BMI estimations (Table 2) and the logistic regres-
sion analysis to determine the odds of being overweight (Table
3), but were included in all the other analyses.
We were interested to know whether adults who ate fast
food on only one of the two survey days had the similar energy
intakes on the two days. Energy, macronutrients, and food
intakes for 2,623 adults, who reported eating fast food on one
of the two survey days, were compared, to determine whether

Table 3. The Odds of Adults Consuming Fast Food Being Overweight1 or Not Meeting Recommendations for Fat and Added
Sugars, Adjusted for Gender, Age, Socio-Economic and Demographic Factors, CSFII 1994 –1996

Dependent variables by fast food consumption Fast food 95% lower 95% upper
Odds Ratio2 p-value
status consumption status limit limit
Being overweight1 one day 1.27 1.13 1.42 0.0001
both days 1.31 1.1 1.57 0.0035
Consuming more than 10% of total calories
from saturated fat one day 1.65 1.47 1.85 0.0001
both days 2.14 1.81 2.52 0.0001
Consuming more than 35% of total calories
from total fat one day 1.53 1.36 1.73 0.0001
both days 1.76 1.45 2.14 0.0001
Consuming more than 25% of total calories
from added sugars one day 1.26 1.04 1.52 0.0197
both days 1.64 1.27 2.11 0.0003
1
Having a Body Mass Index value at or above 25 kg/m2.
2
No-fast food status was the reference category.

JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 165

Fast Food Intake and Diet Quality of U.S. Adults
Table 4. Mean1 Energy, Macronutrient, and Food Group Intakes of Adults Ages 20 Years and Over (N ⫽ 2,623) Who
Consumed Fast Food on One of the Two Survey Days, CSFII 1994 –1996
Variables
Fast food day
Energy (kilocalories) 2,204 ⫾ 23
Energy density (kilocalories per 100 grams
total food amount3) 99.8 ⫾ 0.8
Total fat (g) 85 ⫾ 1
Saturated fat (g) 29 ⫾ 0.4
Carbohydrate (g) 269 ⫾ 2.8
Added sugars (g) 91 ⫾ 1.6
1
Mean ⫾ standard error.
2
Models adjusted for “among-respondent” characteristics (eg., age, gender, and socio-economic and demographic variables) do not affect “within-respondent” day-1 and
day-2 means comparisons. The day effect (whether fast food consumed on day-one or day-two of the survey) was not significant (␣ ⫽ 0.05).
3
Total food amount includes the weight in grams of all the foods and all alcoholic and non-alcoholic beverages in the form reported consumed (includes water present
in beverages, such as tea, coffee, fruit drinks made from dry mixes, cocoa, and milk drinks; excludes water drunk separately, such as tap and bottled water).
these adults consumed more energy and macronutrients on the
fast-food day than on the non-fast-food day (Table 4). Both
unadjusted means, and means adjusted for age, gender, socio-
economic and demographic variables, and day effect (whether
the respondent consumed fast food on the first or the second
day of the survey) were estimated.
Survey full sample weights and design effects were used in
the analyses to represent the U.S. population under study. All
estimates reported in this study were computed and compared
using SAS callable SUDAAN software (SAS release 8.2,
1999 –2001, SAS Institute Inc., Cary, NC, USA; SUDAAN
release 8.0.1, January 2002, Research Triangle Institute, Re-
search Triangle Park, NC, USA). The ␣ ⫽ 0.05 a priori level
of significance was chosen for all the regression analyses and
other comparisons in the study.
RESULTS
There were 26.5 percent (95% CI: 24.9 –28.1) adults who
reported eating fast food. Fast food was consumed by both
genders (30% males, 23.5% females). Higher household in-
come and living in suburban areas were associated with more
adults eating fast food. More African Americans (31%) than
other race-ethnic groups reported eating fast food. Adults living
in the Midwest (29%) or in the South (29%) were more likely
to be fast food eaters than adults living in the Northeast (20%)
or the West (22%).
Noteworthy differences were seen among age groups. The
odds of eating fast food decreased with increasing age. Young
adults ages 20 to 29 years were about 4 times (odds ratio 4.3;
CI 3.7–5.1; p ⬍ 0.0001) more likely to eat fast food than adults
55 years of age and older. These odds were 3.1 (CI 2.6 –3.7;
p ⬍ 0.0001) for ages 30 to 39 years and 2.4 (CI 2.0 –2.8; p ⬍
0.0001), respectively.
Both males and females who reported eating fast food had
substantially higher intakes of energy, total fat, saturated fat,
166
Unadjusted mean intakes
Non-fast food day Difference2 p-value2
1,998 ⫾ 21 206 ⬍0.0001
93.8 ⫾ 0.8 6.0 ⬍0.0001
75 ⫾ 1 10 ⬍0.0001
25 ⫾ 0.4 4 ⬍0.0001
246 ⫾ 2.6 23 ⬍0.0001
76 ⫾ 1.4 15 ⬍0.0001
carbohydrate, added sugars, and protein than their counterparts
who did not eat fast food (Table 1). Males who ate fast food had
especially high energy intake. They consumed about 500 kilo-
calories more energy than males who did not consume fast
food. Fast food eaters, males and females, had lower intakes of
nutritious foods such as fruits and fluid milk than the others.
They drank about twice the amount of non-diet carbonated soft
drinks than those who did not eat fast food.
An examination of fast food’s contribution to day’s total
intake showed that fast food provided more than one-third of
day’s energy, total fat and saturated fat in the diet of males and
females (Table 1). Also, fast food was high in energy density
(the number of kilocalories of energy obtained per 100 grams
of food amount consumed) and provided 158 to 163 kilocalo-
ries per 100 grams of food consumed. Fast food eaters’ diets
were lower in vitamin A, carotenes, and vitamin C density.
These antioxidants help promote good health and play a role in
the prevention of cancer and other health conditions [13–17].
Eating fast food was also associated with consuming a diet low
in calcium and magnesium density, nutrients that are associated
with bone health [18 –22]. Substantially high amounts of non-
diet carbonated soft drinks, a beverage high in calories but low
in essential micronutrients, and insignificant amounts of nutri-
tious foods such as fluid milk and fruits were consumed at fast
food places.
About 10 percent of adults reported eating fast food on both
survey days. Frequency of fast food consumption affected
nutrient intakes (Table 2). Energy and macronutrient intakes
increased, and micronutrient density decreased as frequency of
fast food consumption increased from zero days to 2 days.
Day’s intakes of nutritious foods such as fluid milk, fruits and
fruit juices, and non-starchy vegetables decreased and non-diet
carbonated beverages increased as the number of fast food days
increased. Small, but significant, differences were seen be-
tween the mean body mass index values of adults who reported
eating fast food and adults who did not eat fast food on either
survey day (Table 2).
VOL. 23, NO. 2

Eating fast food was associated with not meeting one or
more of the recommendations for total fat, saturated fat, and
added sugars (Table 3). Fast food eaters had a slightly higher
and statistically significant odds of being overweight (having a
BMI value 25 or more) than those who did not report eating fast
food (Table 3).
Substantial differences in energy, energy density, and ma-
cronutrient intakes were seen between consumption on the fast
food and non-fast food days for the 2,623 adults who ate fast
food on one of the two survey days (Table 4). The day effect
(whether adults ate fast food on day-one or day-two of the
survey) in the regression model was not significant. Mean
differences in energy and macronutrient intakes were calcu-
lated using day-1 and day-2 measurements “within” each re-
spondent. Hence, adjusted means for “among-respondent”
characteristics (eg., age, gender, socio-economic and demo-
graphic variables) has no effect on the estimation of “within-
respondent” mean differences.
DISCUSSION
In the CSFII 1994 –1996, at least one in four adults reported
eating fast food as compared to one in six adults who reported
eating fast food in the CSFII 1989 –1991. Fast food was con-
sumed by all socio-economic and demographic groups. Fast
food consumption was especially high among young adults.
The location of fast food places and higher household income
may play a role in more adults living in suburban areas eating
fast food.
Both males and females obtained similar percentages of
energy and macronutrients from fast food, although males
obtained higher amounts energy and macronutrients from fast
food than females (Table 1). Fast food provided a little more
than one-third the day’s energy for both genders. However, the
proportion of food groups obtained from fast food places varied
widely; milk and fruits and fruit juices were practically absent.
It is not possible to show cause (fast food consumption) and
effect (weight gain) from the CSFII 1994 –1996 which is a
cross-sectional survey. However, the study findings collec-
tively showed that eating fast food increased day’s energy
intakes; increased energy density of the overall day’s diet; and
simultaneously decreased micronutrient density. Secondly,
adults who ate fast food on one of the two survey days con-
sumed 206 calories (95% CI: 162–250) more on the fast food
day than on the non-fast food day. The energy density of the
day’s diet was also high (Table 4). Therefore, how often a
person eats fast food over an extended time period becomes
important in weight management, especially to adults who are
trying to either lose weight or maintain weight.
French et al. [6] found that frequency of fast food restaurant
use by women was associated with higher energy and fat
intakes and greater body weight. Eating out often has been
found to result in increased energy intake [23]. The nation’s
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION
Fast Food Intake and Diet Quality of U.S. Adults
energy intake has increased over the past 20 years [24]. Food
and beverages sold in fast food places often come in large
portion sizes [5]. One of the reasons for the observed increase
in energy intake could be attributed to consuming large por-
tions sizes of foods and beverages [25,26].
Eating fast food was associated with having higher BMI
values (Table 2); a weak, but positive association was seen
between fast food consumption and overweight status (Table
3). There are limitations to this finding; the body mass index
values were computed using self-reported height and weight.
The odds of being overweight was numerically higher for
two-days than one-day fast food consumption (Table 3), but
one-day and two-day odds were not significantly different from
each other. More long-term data is needed to study the effect of
frequency of fast food consumption on weight status of adults.
In the U.S., 64.5 percent of adults are overweight and 30.5
percent are obese [27]. Obesity increases the risk of many
health conditions such as cardiovascular disease, stroke, hyper-
tension, cancer, and diabetes [28 –30]. It is important that fast
food consumers should be aware of the nutritional conse-
quences of eating fast food.
CONCLUSION
The percentage of adults eating fast food increased from the
early 1990s (CSFII 1989 –1991) to the mid-1990s (CSFII
1994 –1996). This trend is likely to continue.
Adults who wish to restrict their energy intakes should be
cognizant of the high energy content of fast food. Adults who
eat frequently at fast food places may reduce the number of
visits to fast food places, if they wish to control their energy
intakes and improve their overall diet quality.
Fast food places should display or make available informa-
tion on energy and macronutrient content of foods and bever-
ages they sell. Consumers should strive to utilize the nutritional
information on foods and beverages sold. If no nutrition infor-
mation is provided, consumers should ask for nutritional infor-
mation.
As more mothers and meal-preparers continue to enter the
labor force, they are left with less time for food shopping and
food preparation. Making weekly meal plans and organizing
grocery shopping according to their meal plans will help adults
from not having to make spontaneous meal decisions that may
result in frequent fast food consumption.
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Received May 13, 2003; revision accepted September 23, 2003
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