Whether we like it or not, fast food continues to be a staple of the American diet. In fact, the contribution of away-from-home foods to total energy has nearly doubled in the past 30 years, increasing from 18% in 1977 to 33% in 2010.1 Although some chains now offer healthier fare, the foods with disproportional amounts of dietary sodium, saturated fat, and trans fat continue to be the most frequently ordered items. And while portion size garnered attention in the early 2000s, such as in the documentary Super Size Me,2  little information exists for trends in the energy content of fast-food items since 2006 and retailers have done their best to minimize public scrutiny of portion sizes by “re-sizing” menu items (ie, a medium-sized item was renamed to small).

In a study published in the journal Preventing Chronic Disease: Public Health Research, Practice and Policy,1 researchers collected data over an 18-year period (1996–2013) on the most frequently ordered fast-food items from three national fast-food chains by portion size. The three fast-food chains were selected based on similar menu items, having a national presence, and being in the top 10 for total U.S. sales revenue. The restaurants were designated as Chain A, Chain B, and Chain C and items selected for comparison included French fries (small, medium, and large), cheeseburgers (2oz and 4oz uncooked), grilled chicken sandwiches (one available size) and regular cola (small, medium, and large). Data collected for the food items included energy (kcal/portion), sodium (mg/portion), saturated fat (g/portion), and trans fat (g/portion); cola was only assessed for energy content. The foods were also assessed as bundled meals, since chains frequently offer special value meals containing a cheeseburger, French fries, and regular cola.