eating away from home: how eating patterns at fast food
TRANSCRIPT
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Author: Wendell, Kirsten L.
Title: Eating Away From Home: How Eating Patterns at Fast Food and Full-service
Restaurants Affect BMI
The accompanying research report is submitted to the University of Wisconsin-Stout,
Graduate School in partial completion of the requirements for the
Graduate Degree/Major: MS Food and Nutritional Sciences
Research Advisor: Maren Hegsted, Ph.D.
Submission Term/Year: Summer 2013
Number of Pages: 49
Style Manuel Used: American Psychological Association, 6th Edition
I understand that this research report must be officially approved by the Graduate School and that an electronic copy of the approved version will be made available through the University Library website
I attest that the research report is my original work (that any copyrightable materials have been used with the permission of the original authors), and as such, it is automatically protected by the laws, rules, and regulations of the U.S. Copyright Office.
My research advisor has approved the content and quality of this paper.
Student:
Name Kirsten Wendell Date: 08/02/13
Advisor:
Name Maren Hegsted Date: 08/02/13
---------------------------------------------------------------------------------------------------------------------
This section to be completed by the Graduate School This final research report has been approved by the Graduate School.
Director, Office of Graduate Studies: Date: ______
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Wendell, Kirsten L. Eating Away from Home: How Eating Habits at Fast Food and Full-
service Restaurants Affect BMI
Abstract
Obesity in the United States has remained on an upward trend for the past 20 years.
Research in the area of eating away from home and the effect on obesity is quite extensive, and
there continues to be controversial findings among researchers. Although there is extensive
research on eating away from home and obesity, little research has been conducted on eating
habits at fast food and full-service restaurants and the effect on obesity.
The purpose of this study was to determine the relationship between eating habits at fast
food and full-service restaurants and Body Mass Index (BMI) among adults aged 18 and older.
A 13 question survey was completed by 123 subjects. Subjects answered questions regarding
frequency at which they ate at fast food and full service restaurants in a week, their beverage of
choice while eating out, whether leftovers were taken home, what meal courses were eaten
(appetizer, soup, salad, entrée, and/or dessert), whether their meals were supersized or more than
one meal was ordered, what portions sizes were ordered, height, weight, and age group. Males
who ate more frequently at fast food and full-service restaurants were found to have a higher
BMI when compared to females. Subjects who took home leftovers from their meal out had
lower BMI, presumably because they reduced their energy intake at the restaurant by saving
some of the food portion for later consumption. Results from this study indicate that gender and
frequency of eating at fast food or full-service restaurants can be considered risk factors for
obesity.
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Acknowledgements
I would like to extend my personal thanks to those who helped me complete my research
and writing of my thesis, especially my thesis advisor, Dr. Maren Hegsted. Thank you for taking
on my project the last minute and guiding me through the process. Without you I would have
never gotten to this point.
I would also like to thank Dr. Carol Seaborn for all the support that she has provided over
the past two years. I would not be where I am at today without her guidance and constant
reminders that “I can do it”. She not only served as my professor and my graduate study advisor,
but as someone I could look up to and learn from. Thank you Carol for pushing me all these
years to be my best, I am truly grateful for everything.
Lastly, I would like to thank my parents, Butch and Nancy Wendell, for being so
understanding when I told you I was going to continue on to graduate school and forgo applying
for dietetic internships for another two years. Thank you for proving encouragement and
constant support throughout my graduate studies. You have taught me the importance of life,
and for that I am truly grateful.
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Table of Contents
…………………………………………………………………………………………………Page
Abstract……………………………………………………………………………………….......2
Acknowledgements……………………………………………………………………………….3
List of Tables……………………………………………………………………………………...6
List of Figures…………………………………………………………………………………….7
Chapter I: Introduction…………………………………………………………………………...8
Statement of Problem…………………………………………………………………….10
Purpose of Study…………………………………………………………………………11
Research Objectives……………………………………………………………………...11
Assumptions of Study……………………………………………………………………11
Definition of Terms………………………………………………………………………12
Limitations of Study……………………………………………………………………..12
Methodology……………………………………………………………………………..13
Chapter II: Literature Review……………………………………………………………………14
Serving Sizes……………………………………………………………………………..14
Increase in Obesity and Eating Away from Home and the Effect on BMI……………...17
Dietary Eating Patterns and BMI………………………………………………………...19
Restaurant Food Consumption and BMI………………………………………………...19
Chapter III: Methodology………………………………………………………………………..21
Subject Selection and Description……………………………………………………….21
Instrumentation…………………………………………………………………………..21
Data Collection Procedures……………………………………………………………...22
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Data Analysis…………………………………………………………………………….22
Limitations……………………………………………………………………………….22
Chapter IV: Results………………………………………………………………………………24
Demographics and Anthropometrics of Subjects………………………………………..25
Effect of Eating Frequency at Full-service and Fast Food Restaurants on BMI among
Gender……………………………………………………………………………………27
Effect of Beverage Choice with Meal on BMI among Gender………………………….29
Comparison of BMI and Consumption of Appetizer, Soup, Salad, Entrée, or Dessert….30
Comparison of BMI and Taking Home Leftovers……………………………………….32
Comparison of BMI and Super Sizing a Meal, Order More than One Meal, and Portion
Sizes……………………………………………………………………………………...33
Chapter V: Discussion…………………………………………………………………………...34
Limitations……………………………………………………………………………….34
Conclusions……………………………………………………………………………....35
Recommendations……………………………..................................................................38
References………………………………………………………………………………………..40
Appendix A: IRM Approval Memo……………………………………………………………...44
Appendix B: Informed Consent of Participation………………………………………………...45
Appendix C: Survey Questionnaire……………………………………………………………...47
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List of Tables
Table 1: Frequency of Subjects in Each BMI Category…………………………………..27
Table 2: Consumption of Appetizer, Soup, Salad, Entrée, or Dessert by Subjects……….31
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List of Figures
Figure 1: Prevalence of obesity among United States adults in 1985……………………...8
Figure 2: Prevalence of obesity among United States adults in 2010……………………...9
Figure 3: Height distribution of study subjects…………………………………………...25
Figure 4: Weight distribution of study subjects…………………………………………..26
Figure 5: BMI distribution of study subjects……………………………………………..27
Figure 6: Eating frequency at full-service restaurants on BMI by gender………………..28
Figure 7: Eating frequency at fast food restaurants on BMI by gender…………………...29
Figure 8: BMI by gender based on beverage choice with meal…………………………...30
Figure 9: BMI based on whether an appetizer was or was not consumed………………...31
Figure 10: BMI based on whether leftovers were or were not taken home…………….......32
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Chapter I: Introduction
Obesity in the United States has remained on an upward trend for the past 20 years.
According to the Centers for Disease Control (CDC) more than 35.7% of United States adults are
obese and 17% children and adolescents aged 2-19 are obese (2012). The previous statistics may
seem alarming; however, the prevalence of obesity is even more striking. As of 2010, no state
had a prevalence of obesity less than 20%. In addition, there were 36 states where the
prevalence of obesity was 25% or more with 12 of those states having a prevalence of obesity at
or above 30% (CDC, 2012). Figures 1 and 2 (all material is public domain, CDC, 2012) express
prevalence of obesity for adults across the United States for 1985 and 2010, respectively.
Figure 1. Prevalence of obesity among United States adults in 1985 (all public domain, CDC,
2012)
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Figure 2. Prevalence of obesity among United States adults in 2010 (all public domain, CDC,
2012)
Obesity can be classified by Body Mass Index (BMI) (Kg/M2). An adult (greater than 19
years of age) having a BMI between 25.0 and 29.9 Kg/M2 is considered overweight, whereas, an
adult (greater than 19 years of age) having a BMI of 30 or greater is considered obese (CDC,
2012b). Caloric intake, lack of physical activity, environment, and genetics are only a few
factors contributing to obesity. Of these factors, caloric intake is of high importance. To
maintain weight, the number of calories being consumed needs to be roughly equal to the
number of calories being used by the body through body functions and physical activity. To gain
weight, the number of calories being consumed is more than those being used by the body for
normal metabolism and physical activity (CDC, 2011b).
Environment can play a large role in the number of calories consumed by an individual.
An environment can include a person’s home, school, work, and community (CDC, 2011b). A
person’s environment can be the perfect place to prevent obesity. Ways to prevent obesity in the
home include reducing time watching TV or playing video games and promoting more outdoor
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activities. Schools could provide foods that are low in fat, calories, and added sugar and promote
physical activity. Work places could develop employee physical activity programs as incentives.
Communities could provide the facilities and safe areas needed of family activities and push for
restaurants to implement healthy and nutritious food items (CDC, 2011b).
Eating away from the home, especially at restaurants and fast food restaurants, has
become a common trend in the United States. In 2000, Americans spent 47% of their food
expenses on food consumed outside of the home, and this percentage continues to be on the rise
(Diliberti, Bordi, Conklin, Roe, & Rolls, 2004). In the article “Are Fast Food Restaurants an
Environmental Risk Factor for Obesity?” the authors point out that trends in eating away from
home approximately parallel the trends in obesity prevalence (Jeffery, Baxter, McGuire, &
Linde, 2006). When consuming meals away from home, people are looking to get the most
amount of food for a small price. This often means people are consuming energy-dense foods
(measure of the energy contained in food, which is usually quantified as calories) in large
portions thus resulting in overconsumption of calories leading to obesity (Diliberti, Bordi,
Conklin, Roe, & Rolls, 2004).
Statement of Problem
Research in the area of eating away from the home and BMI is quite extensive.
However, the research surrounding eating away from home and BMI has had many contradictory
results. Many studies focus on how many restaurants there are in relation to either the workplace
or a residential home and BMI. There are only a few studies focused on eating habits (frequency
of eating at restaurants, taking home leftovers, courses eaten, super sizing meals, and beverage
choices) at restaurants. Many of the studies completed in this area of research focus on women
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or children. The research in the area of eating away from home and BMI often target fast food
restaurants, and there is little research focusing on full-service restaurants.
Purpose of the Study
The purpose of this study was to compare eating habits at fast food and full-service
restaurants to BMI among adults 18 years of age and older. The study looked at the effect of
frequency of eating at fast food and full-service restaurants, meal courses eaten when eating out,
beverage selection when eating out, taking home leftovers, super sizing or order more than one
meal, and portion sizes ordered on BMI.
Research Objectives
The research will address the following objectives:
1. Determine the effect of eating frequency at full-service and fast food restaurants on BMI
by gender.
2. Determine the effect of beverage choice with meal on BMI by gender.
3. Compare BMI of subjects who consume an appetizer, dessert, salad, soup, or entrée
versus subjects who do not consume an appetizer, dessert, salad, soup, or entrée.
4. Compare BMI of subjects who take home leftovers versus subjects who do not take home
leftovers.
5. Determine if supersizing a meal, ordering more than one meal, or selecting normal versus
small portion sizes has an effect on BMI.
Assumptions of the Study
This study was conducted under the following general assumptions:
1. All participants would answer the questions accurately and honestly.
2. All participants carefully read and understood each question of the survey.
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3. The participants of the survey are assumed to be the general population of interest.
Definition of Terms
To aid in the comprehension of the study, the following terms are defined:
Body mass index. “A number calculated from a person’s weight in kilograms and height
in meters squared (kg/m2). Provides a reliable indicator of body fatness for most people and is
used to screen for weight categories that may lead to health problems” (CDC, 2011c).
Calorie. “Unit of energy supplied by food” (CDC, 2011b).
Energy-dense. “Measure of the energy contained in food,” usually quantified as calories
per gram or calories per portion (Medical-dictionary, 2007b).
Environment. “All of the many factors, both physical and psychological, that influence
or affect the life and survival of a person” (Medical-dictionary, 2009).
Fast food. “Of, relating to, or specializing in food that can be prepared and served
quickly.” “Designed for ready availability, use, or consumption and with little consideration
given to quality or significance” (Merriam-Webster, n.d.).
Full-Service Restaurant. “Establishment in which customers can be served their meal
at the table, receive waitress service, and typically pay at the end of the meal” (Answers, 2011).
Obesity. “A body mass index (BMI) greater than 30” (CDC, 2010).
Prevalence. “The total number of cases of a specific disease present in a given
population at a certain time” (Medical-dictionary, 2007a).
Serving size. “The portion of food used as a reference on the nutrition label of food.”
“The recommended portion of food to be eaten” (MedicineNet, 2012).
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Limitations
The limitations to the study include:
1. Participants may not have the patience to complete all survey questions due to
indifference or disinterest.
2. All data are self-reported, which can result in reporting false or inaccurate information.
3. Number of survey questions is limited due to time constraint to keep participants
interested.
4. The number of subjects is limited due to the students’ willingness to participate in the
online survey.
5. The survey was voluntary response, thus self-selecting. Therefore, the survey may not be
a representative sample of the student population at University Wisconsin-Stout.
6. Subjects represent a convenience sample; therefore, the results cannot be generalized to
the rest of the population.
7. The survey questions were developed by the researcher for the use in the online survey,
Qualtrics; a measurement of validity and reliability has not been done.
Methodology
Following approval from the University of Wisconsin-Stout Institutional Review Board,
this study was conducted from May 4 to May 9, 2013. A 25% random sample of University of
Wisconsin-Stout undergraduate students were sent, via e-mail, a description of the study, an
implied consent form, and a link to take the on-line survey regarding eating habits at fast food
and full-service restaurants. The survey was completed on a voluntary basis and all information
was self-reported. Statistical analysis was performed on the data collected using the Statistical
Program for Social Sciences, version 21.0.
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Chapter II: Literature Review
This chapter will examine relevant literature relating to the topic of eating away from
home and the effect on BMI. There will be a review on serving sizes with a greater detail
focusing on restaurant portion sizes. Next, eating away from home and the effect on BMI will be
examined, followed by, an examination of the effects of dietary eating patterns on BMI. The
chapter will conclude with restaurant food consumption and the effect on BMI.
Serving Sizes
Serving size is defined by Medicine Net (2004) as the recommended portion of food or
drink to be consumed. Americans are being surrounded by larger portion sizes; however, what
most Americans do not realize is how these larger serving sizes can be detrimental to our health.
With a slow economy, most Americans are looking to get the most amount of food for an
inexpensive price. Serving sizes are therefore not going to follow the recommended 1-ounce
snack bag or 8-ounce soda (CDC, 2006). Much of the blame is placed on restaurants, but the
problem does not solely lie in the hands of restaurants. Everyone is faced with larger than
normal serving sizes on an everyday basis, but it is up to the individual person to decide how
much or how little they eat.
Large serving sizes are seen in everyday snack foods. Snack sizes have been on the rise
since the 1970’s, and there seems to be no end in sight (CDC, 2006). One striking difference is
in the amount of popcorn served at a movie theater. In 1957, medium popcorn contained three
cups, and as of 1997, medium popcorn contained 16 cups (Nicklas, Baranowski, Cullen, &
Berenson, 2001). Grocery stores, convenience stores, and vending machines all have food items
or drinks containing more than the recommended serving size. Even though the packaging states
there is more than one serving per bag, most people eat the whole bag of chips or the whole
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candy bar or drink the whole bottle of soda. People should really remember moderation. In
doing so people need to watch how much they eat by only eating the recommended serving size.
Not only will they be cutting back on the calories and the health ailments that come along with
being overweight/obese but money will be saved because there will be some food and/or drink
left over for later consumption.
Restaurants are still a main focus when it comes to increased serving sizes. If people are
looking to get the most food for their money, more often than not, people choose to eat at fast
food restaurants. This is because food is cheap and comes in large quantities. However,
according to the Centers for Disease Control (2006) eating at fast food restaurants on a regular
basis is linked to higher energy intake and higher fat intake thus leading to a higher BMI. A
normal serving size at a fast food restaurant is two to five times larger than the standard
recommended portion (Young & Nestle, 2007). The larger portions are contributing to the
obesity epidemic by providing more calories, encouraging people to consume more calories, and
to underestimate their caloric intake (Young & Nestle, 2007).
In 2001, the United States Surgeon General’s Call to Action challenged health
professionals, communities, and the food industry to look at serving sizes as a factor in weight
control, provide foods in a more appropriate amount, and raise awareness of actual serving sizes
as a method to prevent obesity (Young & Nestle, 2007). However, fast food chains did exactly
the opposite. Some fast food chains have decreased their serving sizes, but to make up for the
decreased serving sizes, restaurants have either made existing products larger or created new
large products (Young & Nestle, 2007). Young and Nestle (2007) documented how three of the
most popular fast food restaurant chained, McDonald’s, Burger King, and Wendy’s, have or
have not changed their serving sizes of fountain soda, French fries, and hamburgers from 1998 to
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2006. Wendy’s had the most notable change in fountain soda per fluid ounces between 1998 and
2006. In 1998, Wendy’s offered the following fountain soda sizes: 12 fluid ounce kids, 16 fluid
ounce small, 22 fluid ounce medium, and a 32 fluide ounce biggie (Nestle & Young (2007). In
2006, the fountain soda sizes at Wendy’s were all increased and Wendy’s offered the following
fountain soda sizes: 12 fluid ounce kid, 20 fluid ounce small, 32 fluid ounce medium, and a 42
fluid ounce large (Young & Nestle, 2007). The most notable change in French fry sizes per
ounce was also seen at Wendy’s; in 1998 Wendy’s offered the French fry sizes: 3.2 ounce small,
4.6 ounce medium, 5.6 ounce biggie, and 6.7 ounce great biggie (Young & Nestle, 2007). In
2006, the French fry sizes at Wendy’s increased and Wendy’s now offered the following French
fry sizes: 3.2 ounce kids, 5 ounce small, 5.6 ounce medium, and 6.7 ounce large (Young &
Nestle, 2007). According to Young and Nestle (2007), McDonald’s, Burger King, and Wendy’s
did not make notable change in their hamburger size; however, Wendy’s was reported to have
the largest hamburger sizes. The only change documented in hamburger size was the addition of
a 12oz hamburger in 2006 to the Burger King menu (Young and Nestle, 2007). McDonald’s
hamburger sizes range from 1.6 ounce to 8 ounce, Burger King’s hamburger sizes range from 1.9
ounce to 12 ounce and Wendy’s hamburger sizes range from 2 ounce to 12 ounce (Young &
Nestle, 2007).
The studies conducted on serving sizes have really brought about some striking results.
Rolls and colleagues (CDC, 2006) conducted a study in which serving sizes were examined by
providing adults meals on four different days with four different serving sizes. The larger the
serving size the more participants consumed. Participants consumed 30% more energy when
eating the larger serving size. Only 45% of the participants knew they were being served
different portion sizes. Studies conducted by Wansink & Park and Smiciklas-Wright et al.
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(CDC, 2006) examined snacks such as potato chips and popcorn in relation to different serving
sizes. Participants were found to over eat and not notice a change in portion size. An increase in
serving size truly affects how much a person takes in, as adults can consume up to and even
more than 1.5 times the standard serving size. This strongly suggests larger serving sizes results
in consuming more food which can contribute to an increase in the prevalence of obesity
(Nicklas, Baranowski, Cullen, & Berenson, 2001).
Increase Obesity and Eating Away From Home and the Effect on BMI
In the last two to three decades, a 40% increase in the prevalence of obesity was observed
(Nicklas, Barankowski, Cullen, & Berenson, 2001). With the rise in obesity, there was an
increase in chronic diseases such as diabetes mellitus type two (Crawford et al, 2008). This
increase in chronic disease from the rising trends of obesity is why it is one of the major health
issues of the 21st century. With the prevalence of obesity still on the rise, there could very well
be a setback in the health gains established over the past decades (Crawford et al, 2008).
Unbalanced energy homeostasis from increased energy intake and decreased energy
expenditure is the major factor playing a prominent role in the obesity epidemic. The cause of
excessive energy intake and decreased energy expenditure stems primarily from behavioral
factors but is also influenced by genetics, environmental, socioeconomic, and cultural, factors.
Even though there are many speculations as to why there has been such a rise in the prevalence
of obesity, the cause of obesity prevalence always comes back to an environment that thrives on
excessive food intake and decreased physical activity. Along with the increase in obesity
prevalence, there was an almost parallel rise in going from homemade meals to preprepared
meals which includes microwavable, fast food, and casual dining meals. There was also a large
shift from milk-based drinks to fruit juices and carbonated sugary beverages such as soda
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(Simmons, McKenzie, Eaton, Cox, Khan, Shaw, & Zimmet, 2005). The consumption of
preprepared meals and non-milk-based drinks are believed to be two of main contributors to the
rise of the obesity (Simmons, McKenzie, Eaton, Cox, Khan, Shaw, & Zimmet, 2005).
Fifty-seven percent of Americans consume at least one food item away from home on a
daily basis. Eating away from home has become socially accepted, and society is seeing more
than half of meals eaten at fast food restaurants (Nicklas, Barankowski, Cullen, & Berenson,
2001). In the article “Eating Patterns, Dietary Quality, and Obesity,” Nicklas and colleagues
(2001) conducted a study with premenopausal women. Fifty-six percent of women reported
eating at a fast food or full-service restaurant five times or less per week with 44% stating they
ate at a fast food or full-service restaurant between six and 13 times per week. Women who
stated eating out between six and 13 times per week had a higher total energy intake and a poor-
quality diet. Eating out more times per week coincides with higher body fatness. Higher body
fatness can come from consuming a larger amount of food and/or food that is more energy dense
(Nicklas et al, 2001).
Jeffery, Baxter, McGuire, &Linde and Thompson and colleagues (2006) focused on
eating away from home and obesity. Their results were inconsistent due to differences in how
the researchers developed and conducted the studies along with how they defined “eating away
from home.” In a study conducted by Naska and colleagues (2011), the purpose of the study was
to find a relationship between BMI and weight gain with eating at restaurants or eating at work.
One significant finding was that men who reported eating at restaurants or similar establishments
had a higher BMI and a greater possibility of weight gain.
Thompson and colleagues (2004), examined whether eating food purchased away from
home led to a longitudinal change in BMI z-score in girls. When the study was first started, 71%
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of participants stated they ate food away from home, and at follow-up, varying from 1 to 10
years, the percentage increased to 86%. The average times in which girls ate food away from
home at the beginning of the study was two times per week, and this increased to three times per
week at follow-up (Thompson et al, 2004). The girls who reported eating quick-service foods
twice or more a week at the beginning of the study had in increase in their BMI z-score when
compared to those girls who reported eating quick-service foods once a week or not all. The
researchers found that the girls who were consuming quick-service foods had a higher energy
intake (Thompson et al, 2004). These findings are consistent with the findings of a study of
adult women done by Jeffery and French (1998). The researchers found that consuming quick-
service foods over a three year period led to weight gain in the participants (French & Jeffery,
1998).
Dietary Eating Patterns and BMI
Good dietary eating patterns formed early in life will follow on through the years into
adulthood. Leaving home to venture to college or a job is when eating patterns are most likely to
change or be challenged. People who have formed healthy eating patterns early in life, are less
likely to stray from what they have learned and to continue with healthy eating patterns (Uglem,
Stea, Frolich, & Wandel, 2011). Another upside to having formed good eating patterns early in
life is a reduced risk of overweight/obesity and non-communicable diseases later in life. A study
conducted in Trondheim, Norway on a military base camp by Uglem and colleagues (2011)
showed that participants who consumed unhealthy foods on the military base also consumed the
same unhealthy foods when they were living at home had a higher BMI. As for the participants
who consumed healthy foods, they consumed the same healthy foods when living at home had a
lower BMI (Uglem, Stea, Frolich, & Wandel, 2011).
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Restaurant Food Consumption and BMI
When eating food at fast food restaurants or full service restaurants there are usually
larger serving sizes which go hand and hand with higher energy intake. A study conducted by
Larson and colleagues (2011) examined eating away from home and eating at full-service
restaurants and how dietary intake and weight management may differ from what is seen at a fast
food restaurant. Eighty-eight percent of participants reported eating at fast food restaurants and
33% of participants reported eating at full-service restaurants. When it came to gender
differences, 92% of males reported eating at fast food restaurants, whereas, 85% of females
reported eating at fast food restaurants. The participants who ate at full-service restaurants were
more likely to consume fruits and vegetables (Larson, Neumark-Sztainer, Nelson-Laska, &Story,
2011). Participants reporting they ate at burger/fry restaurants more had a decreased intake of
fruits and vegetables. As for restaurant use and weight status, participants who reported eating at
burger/fry restaurants had a higher rate of being or becoming overweight or obese. The higher
rate of becoming overweight or obese is likely from an increase in total energy intake as sugar-
sweetened beverages, total fat and saturated fat. It is concluded that sub/sandwich shops and full
service restaurants were unrelated to weight status (Larson, Neumark-Sztainer, Nelson-Laska, &
Story, 2011). The University of Minnesota conducted a study to explore the relationship
between eating at fast food restaurants and obesity. Further, the researchers examined how
living or working by a fast food restaurant correlated with body weight. Eating at fast food
restaurants was positively associated with a high fat diet and an increase in BMI (Jeffery, Baxter,
McGuire, & Linde, 2006). There was no relationship between BMI and proximity of restaurants
to home address with any gender. There was an inverse relationship between men and proximity
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of restaurants to their workplace. The more restaurants closer to the male’s workplace, the
leaner the men were (Jeffery, Baxter, McGuire, & Linde, 2006).
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Chapter III: Methodology
This chapter will discuss the methodology of the research being conducted. The first
section will cover selection and description of the sample, followed by instrumentation. The
chapter then discusses data collection procedures followed by data analysis. Finally, the chapter
will conclude with limitations of methodology related to sampling, instrumentation, and data
collection procedures.
Subject Sample and Description
The subjects for this survey were randomly recruited from the undergraduate population
at University of Wisconsin-Stout. Recruitment was conducted via e-mail in which the researcher
received a 25% undergraduate student sample via the University of Wisconsin-Stout Survey
Clearing House. The sample population consisted of persons 18 years of age and older, and
those under the age of 18 were not eligible to participate. Participation in the study was
completely voluntary, and those participants deciding not to take part in the survey had no
adverse consequences. An implied consent form was provided to the subjects and was presumed
to have been read by all subjects prior to taking the survey. This consent form informed subjects
that all information provided is confidential and subjects would remain anonymous. Once
subjects decided to partake in the survey they were directed to click the “take the survey” link to
complete the survey.
Instrumentation
A survey was developed and delivered through the web-based survey tool, Qualtrics.
The University Wisconsin-Stout Institutional Review Board approved an implied consent form
and the survey which can be found in Appendixes A and B, respectively. The online survey
contained 13 questions and took no more than 10 minutes to complete. The survey was
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developed by the researcher to get information regarding eating habits and eating frequency in
one week at fast food and full-service restaurants which would later be compared to BMI. The
survey consisted of questions regarding frequency of eating at fast food and full-service
restaurants in a single week, what types of foods subjects consumed at full-service restaurants
(appetizer, soup, salad, entrée, dessert), what size portions subjects were ordering (small portions
or regular portions), whether or not subjects were taking home leftovers, if when eating at a fast
food restaurant subjects supersized or ordered more than one meal, and what type of beverage
subjects consume with their meal. The survey also asked subjects to provide information
regarding gender, age group, height, and weight.
Data Collection Process
The study was conducted from May 4 to May 9, 2013 after approval from the University
of Wisconsin-Stout Institutional Review Board. An online survey was administered via
Qualtrics. The questionnaire was developed to learn subjects eating out frequency in one week
and eating habits at fast food and full-service restaurants which would be compared to BMI.
Subject recruitment was conducted via e-mail. The researcher received a 25% undergraduate
sample from the University of Wisconsin-Stout Survey Clearing House.
Data Analysis
Data analysis was conducted by the researcher with help from Susan Greene of the UW-
Stout Planning, Assessment, Research and Quality service. The Statistical Program for Social
Sciences version 21 was used for a detailed statistical analysis of the data. Frequencies, 2-way
ANOVA, and independent samples T-test were conducted. Significance was set at p < 0.05.
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Limitations
This study had several limitations. One limitation of the study is that BMI is not a 100%
accurate determination of body fatness. Additionally, all information is self-reported. Therefore,
subjects may not have been truthful or honest when answering all the questions on the survey.
Some subjects may not have felt comfortable providing height and weight information even
though they were informed that all information would be kept confidential and all subjects would
remain anonymous. The survey was completed via the internet; the researcher was unable to
look over the survey to ensure the survey was accurate and completed. Further, participating in
the study was solely voluntary. The subjects may not be a representative sample of all the
students aged 18 and older currently attending the University of Wisconsin-Stout. Finally, the
survey instrument was not tested for validity or reliability, as it was developed specifically for
this study on restaurant eating patterns and BMI.
25
Chapter IV: Results
For this study a 25% random sample of undergraduate students from the University of
Wisconsin-Stout were selected. During data collection, an eating habits survey was administered
via e-mail to all eligible subjects. The survey aimed to determine how eating habits at fast food
and full-service restaurants were related to BMI. The five specific objectives of the study,
addressed through the use of the eating habits survey, included:
1. Determine the effect of eating frequency at full-service and fast food restaurants on BMI
by gender.
2. Determine the effect of beverage choice with meal on BMI by gender.
3. Compare BMI of subjects who consume an appetizer, dessert, salad, soup, or entrée
versus subjects who do not consume an appetizer, dessert, salad, soup, or entrée.
4. Compare BMI of subjects who take home leftovers versus subjects who do not take home
leftovers.
5. Determine if supersizing a meal, order more than one meal, or selecting normal versus
small portion sizes has an effect on BMI.
One hundred and fifty-three subjects completed the survey, 123 of which were used for
data analysis. Ten surveys were omitted from the final analysis due to failure of the subjects to
complete the survey accurately. Twenty surveys were omitted from the final analysis due to the
subjects answering the following question, “Do you currently eat at fast food or full-service
restaurants” with a “no”, and providing no further data to analyze. Survey data were analyzed
using the Statistical Program for Social Sciences, version 21.0. This chapter will discuss the
results of these analyses as they relate to the research objective of the study.
Demographics and Anthropometrics of Subjects
26
The gender of subjects participating in the study was primarily females. Females
accounted for 67.5% of the sample, while males accounted for 32.5% of the sample. The gender
distribution of the sample population contains more females compared to the University of
Wisconsin-Stout statistics. In 2012, the University of Wisconsin-Stout reported that
undergraduate males made up 52% of the student population, while undergraduate females made
up 48% of the student population (2012). The subjects were primarily in the 18-25 year old age
group. The 18-25 year old age group accounted for 87.8% of subjects, the 26-35 and 46-55 year
old age groups accounted for 9.8% and 2.4%, respectively.
The height of subjects ranged from 54-82 inches and followed a fairly normal distribution
(Figure 3). The mean and median height of subjects was 67.54 ±4.57 and 67.00 inches,
respectively. The weight of subjects ranged from 100 to 395 pounds and followed a fairly
normal distribution that was skewed to the left (Figure 4). The mean and median weight of
subjects was 168.59 ± 52.34 and 155 pounds, respectively.
Figure 3. Height distribution of study subjects. n = 123
27
Figure 4. Weight distribution of study subjects. n = 123
The subject’s height and weight were converted into kilograms and meters, respectively,
and a BMI was calculated for each respondent. The BMI of subjects ranged from 16.31 to 53.72
and followed a fairly normal distribution that was slightly skewed to the left (Figure 5). The
mean and median BMI of subjects was 25.84 ± 6.68 and 23.62 kg/m2, respectively. Subjects
were categorized into one of the weight groups based on their BMI as depicted in Table 1. More
than one-half (58.5%) of the study subjects were classified in the normal weight category, having
a BMI between 18.5 and 24.9 kg/m2. Three of the studies subjects were classified as
underweight by having a BMI less than 18.5 kg/m2. Twenty-three respondents were classified as
overweight by having a BMI between 25.0 and 29.9, and twenty-five respondents in the study
were classified as obese, thus having a BMI of 30.0 or greater.
28
Figure 5. BMI distribution of study subjects. n = 123
Table 1
Frequency of Subjects in Each BMI Category (N = 123)
Weight Status and BMI Frequency Percent
Underweight; Below 18.5 3 2.4
Normal; 18.5-24.9 72 58.5
Overweight; 25.0-29.9 23 18.7
Obese; 30.0 and Above 25 20.3
Effect of Eating Frequency at Full-service and Fast Food Restaurants on BMI by Gender
A 2-way ANOVA was conducted to determine the relationship of eating frequency at
full-service restaurants on BMI by gender. Eating frequency at full-service restaurants was
divided into two groups, 0-1 times per week and 2+ times per week. Ninety-eight subjects (31
male and 67 female) reported eating out at a full-service restaurant 0-1 times per week, whereas,
25 subjects (nine male and 16 female) reported eating out at a full-service restaurant 2+ times per
week. Figure 6, below, depicts the differences in BMI by gender as the frequency of eating at
29
full-service restaurants increases. There was a main effect for gender, F (3, 119) = 20.30, p <
0.05.Therefore, BMI is different among males and females. There was a main effect for
frequency of eating at full-service restaurants F (3, 119) = 8.92, p <0.05. This shows that BMI is
different based on eating frequency at full-service restaurants. There is an interaction between
gender and eating frequency at full service restaurants, F (3, 119) = 6.74, p < 0.05. As the
frequency at which males ate at full-service restaurants increased their BMI increased, but as the
frequency at which females ate at full-service restaurants increased their BMI remained stable.
Figure 6. Eating frequency at full-service restaurants on BMI by gender. n = 123
To determine the relationship of eating frequency at fast food restaurants on BMI by
gender a 2-way ANOVA was conducted. Eating frequency at fast food restaurants were divided
into two groups, 0-1 times per week and 2+ times per week. Eighty-nine subjects (27 male and
62 female) reported eating at a fast food restaurant 0-1 times per week, while, 34 subjects (13
male and 21 female) reported eating at a fast food restaurant 2+ times per week. Figure 7,
below, depicts the changes in BMI by gender as eating frequency at fast food restaurants
increases. There was a main effect for gender, F (3,119) = 15.85, p < 0.05, suggesting BMI is
different between males and females. There was no main effect for frequency of eating at fast
30
food restaurants, F (3, 119) = 0.82, proposing that BMI is not effected by frequency of eating at
fast food restaurants. There was an interaction between gender and eating frequency at fast food
restaurants, F (1,119) = 2.92, p < 0.05. As the frequency at which males ate at fast food
restaurants increased their BMI increased, however, as the frequency as which females ate at fast
food restaurants increased their BMI decreased slightly.
Figure 7. Eating frequency at fast food restaurants on BMI by gender. n = 123
Effect of Beverage Choice with Meal on BMI by Gender
A 2-way ANOVA was conducted to determine the relationship of beverage choice with
meal on BMI by gender. Beverage choice was divided into two groups, water and other (soda,
diet soda, coffee, tea, or alcoholic beverage). Sixty-seven subjects (16 male and 51 female)
reported choosing water with their meal, whereas, 56 subjects (24 male and 32 female) reported
choosing soda, diet soda, coffee, tea, or alcoholic beverages with their meal. Figure 8, below,
depicts the change in BMI by gender based on beverage choice with meal. There was a main
effect for gender, F (3,119) = 8.79, p < 0.05, suggesting BMI is different among genders. There
was a main effect for beverage choice with meal, F (3,119) = 12.12, p < 0.05, suggesting BMI is
different based on beverage choice with meal. There was not an interaction between gender and
31
beverage choice with meal, F (3,119) = 2.38, p > 0.05. As beverage choice with meal shifted
from water to soda, diet soda, coffee, tea, or alcoholic beverages the BMI among males and
females remained similar.
Figure 8. BMI by gender based on beverage choice with meal. n = 123
Comparison of BMI and Consumption of Appetizer, Soup, Salad, Entrée, or Dessert
Subjects were asked which meal courses they ate when going out to eat as depicted in
Table 3. An independent sample t-test was conducted to determine if there was a relationship
between consumption of an appetizer when eating out and BMI. Forty-five subjects reported
eating an appetizer, while 78 subjects reported that they did not eat an appetizer. Figure 9
(below) depicts the change in BMI based whether an appetizer was or was not consumed. BMI
was relatively similar among subjects who reported eating an appetizer (M=27.26, SD=8.61)
when compared to subjects who reported not eating an appetizer (M=25.01, SD=5.14). There
was no significant difference between BMI and eating an appetizer, t(121) = -1.83, p>0.05.
32
Figure 9. BMI based on whether an appetizer was or was not consumed. n = 123
Twenty-four subjects reported eating soup, while 99 subjects reported not eating soup
when eating out. Further, 40 subjects reported eating salad, whereas, 83 subjects reported not
eating salad when eating out. One hundred-fourteen subjects reported eating an entrée, while
nine subjects reported not eating an entrée when eating out. Lastly, eleven subjects reported
eating dessert, while 112 subjects reported not eating dessert while eating out. Data analysis was
not completed for these meal courses due to lack of variability among data. There is no
significance between consumption of soup, salad, entrée, or dessert and BMI.
Table 2
Consumption of Appetizer, Soup, Salad, Entrée, or Dessert by Subjects. n = 123
Yes No
Appetizer 45 (36.6%) 78 (63.4%)
Soup 24 (19.5%) 99 (80.5%)
Salad 40 (32.5%) 83 (67.5%)
Entrée 114 (92.7%) 9 (7.3%)
Dessert 11 (8.9%) 112 (91.1%)
33
Comparison of BMI and Taking Home Leftovers
An independent sample t-test was conducted to determine whether taking home leftovers
was related to BMI. Eighty-five subjects reported taking home leftovers, while 38 subjects
reported that they do not take home leftovers. Figure 10 (below) depicts BMI based on whether
leftovers were or were not taken home. BMI was higher among subjects who reported not taking
home leftovers after eating out (M=28.81, SD=8.55) when compared to subjects who reported
taking home leftovers after eating out (M=24.51, SD=5.18). There was a significant difference
between BMI and taking home leftovers, t(121) = -3.45, p < 0.05. The effect size, d = 0.63, was
a medium effect.
Figure 10. BMI based on whether leftovers were or were not taken home. n = 123
Comparison of BMI and Super Sizing a Meal, Order More than One Meal, and Portion
Sizes
Data analysis was not completed for comparing BMI and super sizing a meal, ordering
more than one meal, and portion sizes due to lack of variability among data. One hundred-
seventeen subjects reported ordering regular size portion versus six subjects reporting to order
smaller portion by eating off the kids menu or senior citizens menu. Three subjects reported
ordering more than one meal compared to 120 subjects reporting to order only one meal when
34
eating out. Nine subjects reported super sizing their meal, while 114 subjects reported that they
do not supersize their meal when eating out.
35
Chapter V: Discussion
The study explored how eating habits at fast food and full-service restaurants are related
to BMI. During the spring of 2013 a 25% sample of undergraduate students at the University of
Wisconsin-Stout were sent a survey (Appendix C) which asked questions regarding eating habits
at fast food and full-service restaurants. Questions included frequency of eating at fast food and
full-service restaurants in a week, what courses were typically eaten, whether leftovers were
taken home, beverage choice with meal, whether meals were supersized, whether more than one
meal was purchased, whether regular or small portions were ordered, age, height, and weight.
This chapter starts out with limitations of the study, draws conclusions from the results,
compares the findings to other research, and makes recommendations for future studies.
Overall, the population had a mean BMI of 25.84 kg/m2, which is considered borderline
overweight. The population used in this study was a younger, healthier population that trended
to have a lower average BMI when compared to the average BMI for the country. The mean
height was 67.54 inches, and the mean weight was 168.59 pounds. The dominant age group was
18-25, which accounted for 87.8% of the population, thus indicating the surveyed population
trended toward young adults, which is expected when surveying an undergraduate population.
With this being a convenience sample, the results cannot be generalized beyond the research
sample.
Limitations
As mentioned previously, it is prudent to consider several underlying limitations within
this research study. Limitations of this study include:
1. Participants may not have the patience to complete all survey questions due to
indifference or disinterest.
36
2. All data are self-reported, which can result in reporting false or inaccurate information.
3. Number of survey questions is limited due to time constraint to keep participants
interested.
4. The number of subjects is limited due to the students’ willingness to participate in the
online survey.
5. The survey was voluntary, thus self-selecting. Therefore, the survey may not be a
representative sample of the student population at University Wisconsin-Stout.
6. Subjects represent a convenience sample; therefore, the results cannot be generalized to
the rest of the population.
7. The survey questions were developed by the researcher for the use in the online survey,
Qualtrics; the measurement of validity and reliability has not been done.
Conclusions
Objective number one of this study was to determine the relationship between eating
frequency at full-service and fast food restaurants and gender with BMI. The data demonstrated
a significant difference between frequency of eating at full-service and fast food restaurants and
BMI among males and females. Males who ate more frequently at full-service or fast food
restaurants had higher BMI values. Females who ate more frequently at full service or fast food
restaurants had no difference in their BMI. The results of the current research study directly
relate to a study conducted by Naska et al. (2011), which concluded that eating at restaurants was
positively related to BMI among men but not women. The results of the current research are
further supported by research conducted by Binkley, Eales, and Jekanowski (2000). They
concluded that males had significantly high BMIs when consuming food at fast food and full
service restaurants (Binkely, Eales, & Jekanowski, 2000). Further, females were found to have
37
no change in BMI when consuming food at full-service restaurants, but did have a significant
increase in BMI when consuming food at fast food restaurants, which contradicts the results of
the current research (Binkley, Eales, & Jekanowski, 2000). McCrory et al. (1999) concluded
that the frequency of which adults consume restaurant food is positively associated with
increased body fatness. From the results, gender and frequency at which meals are consumed at
fast food and full-service restaurants can be considered as risk factors for obesity.
Objective number two of this study was to determine the relationship between beverage
choice with meal on BMI by gender. Within this research, statistically significant results were
not reported. As males or females chose a beverage other than water with their meals; BMI
remained relatively stable. Results of the current study are reinforced by the results found by
Forshee and Storey (2003). Findings concluded that BMI was not associated with beverage
choice at meal among both men and women. There was a slight contradiction, in that there was a
weak relationship between BMI and diet carbonated soda consumption, however, this
relationship was not significant (Forshee & Storey, 2003). Kant, Graubard, and Atchison (2009)
reported that water consumption was not related to increased energy intake or increased BMI.
Malik, Schulze, and Hu (2006) found that sugar sweetened beverages were related to weight gain
and obesity; however the results were not significant. These results suggest that beverage choice
with meal cannot be considered a risk factor for obesity.
Objective number three aimed to determine if BMI was related to the consumption of an
appetizer, soup, salad, entrée, or dessert. There was no significant difference reported for
appetizer consumption affecting BMI. Those subjects that ate an appetizer did not have a higher
BMI than subjects who did not report eating an appetizer. No conclusions can be drawn for
consumption of soup, salad, entrée, or dessert and their effect on BMI as there was not enough
38
variability in the data to run statistical analysis tests. Westerterp-Plantenga and Verwegen
(1999) reported that the consumption of an appetizer lead to eating a larger meal 30 minutes
later, but was not significant. Rolls, Bell, and Thorwart (1999) and Rolls, Roe, and Meenga
(2004) conducted studies to determine the effect of soup and salad consumption on energy intake
of a main meal, and the results found that those subjects who consumed soup or salad as a first
course had reduced energy intake when consuming their main meal. Taylor, Jatulis, Winkleby,
Rockhill, and Kraemer (1994) reported that when desserts were consumed BMI increased, but
these results were not significant. Significant results were not reported in the current research or
the supporting research; therefore, meal courses chosen when eating out cannot be considered a
risk factor for obesity. However, the small number of subjects consuming additions to their meal
beyond the entrée limited the statistical strength of these comparisons.
The fourth objective of this study was to determine if taking home leftovers was related
to BMI. Results reported a significant difference between BMI and taking home leftovers.
Subjects who reported not taking home leftovers from a meal had a higher BMI than subjects
who reported taking home leftovers after dining out at a full-service or fast food restaurant. The
implied conclusion is that those who took home leftovers consumed less food and energy at the
restaurant meal since they saved some of the meal for later consumption. Thus, they were
regulating their food (and energy) intake by decreasing the portion sizes served by the restaurant.
Taking home leftovers is an effective way to decrease potion size and energy intake which
corresponds to the lower BMI among subjects who took home leftovers.
Objective number five of this study was to determine if super sizing a meal, ordering
more than one meal, or ordering regular vs. small portions (eating off the kids or senior citizens
menu) while dining out was related to BMI. No conclusions could be drawn from this data due
39
to the lack of variability. Therefore, no statistical analysis tests were conducted. A previous
study (Diliberti et al., 2004) reported that portion size of an entrée had a significant effect on
energy intake. Those subjects who ordered a supersized portion had a 43% increase in energy
intake than those subjects who ordered the standard portion size (Diliberti et al., 2004). Rolls,
Roe, and Meengs (2006) found a significant effect with energy intake and portion size. As
portion sizes increased by 50% and 100%, intake increased by 16% and 26%, respectively,
suggesting that consuming larger portions can lead to increased body weight and increased BMI
resulting in obesity (Rolls, Roe, & Meengs, 2006).
Recommendations
Further research will undoubtedly take place in regards to eating habits at fast food and
full-service restaurants and how they affect BMI in relation to obesity. This research study
utilized a relatively selective, convenience sample that was quite small. It may be wise to use a
larger sample size to create more variability in data. In addition, the survey was distributed to
students during evaluation week at UW-Stout when students are taking final exams and less
likely to be willing to spend time on a survey. Further, the survey was distributed to the
undergraduate population at UW-Stout where many students live on campus and possess a
dining services food plan. While this study did include both male and female subjects, the
proportion of females outweighed males by a ratio of 2:1. Therefore, it is recommended to
include a larger sample of both males and females to obtain a more representative sample of each
gender.
Other recommendations for future research in regards to eating habits at fast food and
full-service restaurants in relation to BMI that could provide beneficial results include
administering the survey directly to subjects in a face-to-face manner. This allows the researcher
40
to physically take height and weight measurements to allow for more accurate results.
Delivering a survey in a face-to-face manner may result in the researcher being more selective in
participants it may also result in more age variability. Eighty eight percent of subjects in the
current research fell into the age group of 18-25 years old. Delivering a face-to-face survey
would allow for an actual age to be recorded rather than an age group. More age variability
would allow for data analysis in relation to age.
To lower the obesity risk factor, frequency of consuming meals at fast food and full-
service restaurants ought to be kept to a minimum by males, as a lower BMI was associated with
fewer meals eaten at fast food and full-service restaurants. Restaurant portion size and energy
intake can be reduced by taking home leftovers, which was associated with a lower BMI in this
study.
41
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45
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Appendix B: Informed Consent of Participation
Title: Eating Away From Home: How Eating Habits at Fast Food and Full-Service Restaurants Affect BMI Investigator: Research Sponsor: Kirsten Wendell Maren Hegsted 715-312-0102 205 Heritage Hall [email protected] 715-235-2545 [email protected] Description: The objective of this study is to determine how eating habits at fast food and full-service restaurants affect BMI of residents 18 years and older who are current residents of Wisconsin. Data of gender, age, height, weight, and eating patterns at fast food and full-service restaurants will be collected. Risks and Benefits: There are no risks involved in the participation of this study. Some sensitive questions including, age, weight, height, and eating habits will be asked. However, all information that is provided will be kept confidential and you will not be required to include any identifying information, such as your name, on the survey. The benefits of this study include learning how eating habits at fast food and full-service restaurants affect BMI. Minors: If you are under the age of 18 years you are not eligible to participate in this study. Time Commitment: The self-administered questionnaire will take approximately 10-15 minutes to complete. Confidentiality: Your name will not be included on any documents, and we do not believe that you can be identified from any of the information provided. All surveys will be kept secure and confidential. Surveys will be destroyed upon data analysis completion. Data from this research will not be released in any manner to identify you; only group data will be reported. Right to Withdraw: Your participation in this study is entirely voluntary. You may choose not to participate without any adverse consequences to you. You have the right to stop the survey at any time. However, should you choose to participate and later wish to withdraw from the study, there is no way to identify your anonymous document after it has been turned into the investigator for withdrawal. IRB Approval: This study has been reviewed and approved by The University of Wisconsin-Stout's Institutional Review Board (IRB). The IRB has determined that this study meets the ethical obligations required by federal law and University policies. If you have questions or concerns regarding
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this study please contact the Investigator or Advisor. If you have any questions, concerns, or reports regarding your rights as a research subject, please contact the IRB Administrator. Investigator: IRB Administrator: Kirsten Wendell Sue Foxwell, Director, Research Services [email protected] 152 Vocational Rehabilitation Bldg. 715-312-0102 UW-Stout Menomonie, WI 54751 Advisor: 715-232-2477 Maren Hegsted [email protected] 205 Heritage Hall 715-235-2545 [email protected] Statement of Consent: By completing the following survey you agree to participate in the project entitled, “Eating Away From Home: How Eating Habits at Fast Food and Full-Service Restaurants Affect BMI.”
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Appendix C: Survey Questionnaire
Eating Away From Home: How Eating Habits at Fast Food and Full-Service Restaurants Affect BMI
Please complete this survey as completely and accurately as possible. Completion of this survey indicates your willingness to participate in this research study. Do not complete this survey if you are under 18 years of age.
1. Do you currently go out to eat at fast food or full-service restaurants?
____Yes ____No (If No, please skip to question 10 and fill out the remainder of the survey)
2. How frequently do you eat at full-service restaurants in a week (examples: Applebee’s, Pizza Hut, Olive Garden, Outback, etc.)? ____0-1 ____2-3 ____4-5 ____6-7 ____7+
3. How frequently do you eat at fast food restaurants in a week (examples: McDonalds, Chipotle, Subway, Arby’s, etc.)? ____0-1 ____2-3 ____4-5 ____6-7 ____7+
4. When eating at a full-service restaurant what do you typically order (Check all that apply)? ____Appetizer ____Dessert ____Salad ____Soup ____Entree
5. Indicate the portion size you normally order while eating at a full-service restauarant. ____Regular portions ____Small portions (senior citizen or kids menu)
6. When eating at a fast food restaurant do you order more than one meal? ____Yes ____No
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7. When eating at a fast food restaurant do you normally supersize your meal?
____Yes ____No
8. When eating at a fast food and/or fuller-service restaurant out do you normally take home leftovers? ____Yes ____No
9. What kind of beverage do you normally consume while eating at a fast food and/or full service restaurant? ____Water ____Soda ____Coffee ____Tea ____Alcoholic drink ____Diet soda ____Other; please specify __________________________
Please tell me a little about yourself. 10. Are you: ____Male ____Female
11. Select the age group that best describes you. ____18-25 ____26-35 ____36-45 ____46-55 ____56-65 ____66-75 ____76+
12. What is your height in inches (to the nearest inch): ____Inches
13. What is your weight in pounds (to the nearest pound): ____Pounds
Thank you for participating in this survey!