BMJ
                  Confidential: For Review Only
                      (Over)Eating Out: An observational study of the energy 
                   content of main meals served in major UK restaurant chains
                            Journal: BMJ
                        Manuscript ID BMJ.2018.046276.R1
                         Article Type: Christmas research
                         BMJ Journal: BMJ
                  Date Submitted by the  18-Oct-2018
                            Author:
                Complete List of Authors: Robinson, Eric; University of Liverpool, 
                                   Jones, Andrew; University of Liverpool
                                   Whitelock, Victoria; University of Liverpool
                                   Mead, Bethan; University of Liverpool
                                   Haynes, Ashleigh; University of Liverpool
                          Keywords: eating out, obesity, food environment, restaurant food, kilocalories
              
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  3    1   (Over)Eating Out: An observational study of the energy content 
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  7    2         of main meals served in major UK restaurant chains
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  11   3        Confidential: For Review Only
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  20   7    Eric Robinson , Andrew Jones , Victoria Whitelock , Bethan R. Mead  & Ashleigh Haynes
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  24   9       1 Institute of Psychology, Health & Society, University of Liverpool, L69 7ZA, UK
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  28  11     Correspondence: Eric Robinson, Institute of Psychology, Health & Society, University of 
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  31  12                Liverpool, L69 7ZA, UK. Email: eric.robinson@liv.ac.uk
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  3     23   Total Word Count: 3, 935 
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  5     24   Key Words: food environment; eating out; restaurant food; kilocalories; obesity
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  7     25                            What is already known on this topic?
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  10    26   Eating out of the home is common in the UK.
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  12    27   The poor nutritional quality of ‘fast food’ has been well documented. 
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  14    28   The energy content of traditional ‘sit down’ restaurants has received less attention.
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  19    30                                   What this study adds?
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  21    31   The average kcal content of main meals served in both fast food and sit down restaurants in the 
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  23    32   UK is larger than public health recommendations. 
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  26    33   The proportion of main meals in UK restaurant chains that meet public health recommendations 
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  28    34   for kcals is smaller than the proportion of meals that have an excessive number of kcals.
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  30    35   Compared to fast food restaurants, there are more significantly more kcals on average in sit down 
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  33    36   restaurant meals in the UK. 
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  7     49                                         Abstract
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  11    50   Objectives: Eating out of the home is common, but the kilocalorie (kcal) content of main meals 
  12    51   served by major UK restaurant chains has not been examined. The objectives of this study were 
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  14    52   to examine the kcal content of main meals served in major UK restaurant chains and compare the 
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  17    53   kcal content of fast food and ‘sit down’ restaurant chains.
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  19    54   Design: Observational study.
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  21    55   Setting: Menu and nutritional information provided by major UK restaurant chains.
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  24    56   Method: During April to July 2018, websites were accessed and visits were made to restaurant 
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  26    57   chains with 50 or more outlets in the UK. Menu items that constituted lunch or evening main 
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  28    58   meal dishes were identified and the kcal content of these meals was extracted. Beverage kcals 
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  31    59   were not included.
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  33    60   Main outcome measures: The mean kcal content of meals, the proportion of meals meeting 
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  35    61   public health recommendations for kcal consumption (600kcals or less) and the proportion of 
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  37    62   meals with an excessive kcal content (1000kcals or more). 
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  40    63   Results: Main meals from twenty-seven restaurant chains (21 sit down, 6 fast food) were 
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  42    64   sampled. The mean kcal content of all eligible restaurant meals (13,396 in total) was 977kcals 
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  44    65   (95% CIs: 973 to 983), the percentage of all meals that met public health recommendations for 
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  47    66   kcal content was low (10%) and smaller than the percentage of meals with an excessive kcal 
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  49    67   content (42%). Compared to fast food restaurants, sit down restaurants offered significantly more 
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  51    68   excessive calorific main meals, fewer main meals meeting public health recommendations and 
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  54    69   on average 268 kcals more (95% Cis: 102.6 to 433.4) in main meals.
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