Food
Most Americans still eat dinner at home most nights of the week, but they don’t necessarily cook it, as alternatives – such as prepared dishes sold in supermarkets, take-out from restaurants or quick service (aka “fast food”) restaurants, delivery, and ready-to-cook meal kits – promise taste with convenience. Each of these options affects health-related behaviors differently. For this category, we looked at three categories of products and services: 1) chain restaurants; 2) food/grocery delivery services; and 3) meal kit services.
Overall Ratings
Company
Segment
H-Score
Highlights
Meal kit services, through offering a simplified experience to preparing a home-cooked meal with fresh ingredients, scored consistently higher than the other categories. Grocery delivery services, which also support home cooking, were rated better than delivery services, like DoorDash and Grubhub, that emphasize restaurant meals or convenience store items. These latter types of delivery scored near the bottom of the Index, along with several of the restaurant chains.
Restaurant chains in particular saw ripple effects from their primary business of providing food across all the behaviors. In effect, there is a fast food lifestyle that emphasizes automobile driving and minimal social interaction.
The delivery services, the meal kit services and even the chain restaurants to some extent are all a part of (and are exacerbating) a larger trend of obtaining food, shopping, socializing and entertaining ourselves from home. It’s a trend that has served us well during COVID, but that creates long-term concerns around sedentary, indoor lifestyles and social isolation.
Chain Restaurants
The first group we analyzed within the broader category of food is restaurant chains. Chain restaurants, especially fast food chains, have had an enormous impact on the American food landscape. It’s estimated that 37% of Americans eat fast food on any given day.(1) We reviewed the top five restaurant chains (in terms of sales) that offer full meal service (leaving out coffee shops like Starbucks and Dunkin’).
Highlights and Opportunities
The five chain restaurants we profiled had H-Scores between 30 and 45, meaning that each, on balance, had more negative than positive influence across the five behaviors. Predictably, given the reputation of fast food, they scored the poorest on their influence on eating – although there was some variation: Chick-fil-A and Subway, which had better than average nutritional profiles, had higher scores than Burger King, McDonalds and Taco Bell, each of which was rated as having moderate to strong negative influences on eating. In addition to providing meals with questionable nutrition and relatively high calorie amounts, they each engage in some form of cross-selling, prompting users to order more before they complete their orders.
What’s striking about the results for the chain restaurants is how their influence appears negatively across the board. None of the restaurants had a positive score on a single behavior. In effect, the experience of fast food has ripples affecting physical activity, outdoor time, social connection, and even, especially for those emphasizing late night dining, sleep. Much of this effect stems from the drive-thru experience, which minimizes outdoor activity and social interaction. The concern at this time is that the industry appears to be developing new ways to lower the amount of effort needed to obtain food. (McDonald’s for example, has touted its three D strategy, based on drive-thru, delivery and digital sales.(2)) Digital sales creates new opportunities to up-sell, cross-sell and streamline the transaction process.
The key opportunities for this category are two-fold. First, they can use the digital ordering experience to become better partners with their customers – helping the customer create dietary preferences and values and then tailoring the ordering experience to align with those stated preferences. Second, they can start to migrate away from the car-dominated, highly transactional experience and towards a more of a social destination experience. Taco Bell’s Cantina line of restaurants, which encourage sit-down dining and which have limited parking and no drive-thru windows, is a promising start.
Methodology
For restaurant chains, we first looked at two methods of assessing the healthfulness of the foods they serve. The first was to use the results of a study that created a restaurant-wide nutritional quality score based on taking the median of a nutrition measure, a modified Ratio of Recommended to Restricted nutrients (RRR), for all of the restaurants’ menu items.(3) The resulting score, the RNQ, was calculated for over 500 chain restaurants, and included scores for all of the chains we analyzed, as well as giving the context of all 500+ chain restaurants. The second method was to estimate the typical amount of calories consumed at a restaurant by using calorie information provided on the restaurant’s website for the most featured (i.e. listed first through fifth on the menu) combination meals (both breakfast and standard menus). We also looked at menu presentation – whether the restaurants featured healthier items and whether they promoted additional consumption through cross-selling techniques such as recommending the purchase of additional items when a customer checks out.
We used a sample of location data, available from Yelp and Google, to measure the walkability of the neighborhoods where restaurants were located. For walkability we used the EPA’s National Walkability Index.(4) Walkability can affect both physical activity and getting outdoors. We tapped the same sources for information about hours of operation, busy times at the restaurants, and whether or not the restaurants had outdoor seating and drive-thru service. Hours of operation, and amount of business at night, are relevant to understanding potential influences on sleep. Outdoor seating creates opportunities to spend time outdoors and drive-thru service can potentially affect physical activity, social engagement and time present outdoors.
Food/Grocery Delivery Services
Picking up takeout or having a restaurant deliver an order are nothing new, but recent years have seen the development of new platforms that connect a wider variety of restaurants with customers and, increasingly, that enable online grocery shopping and online shopping from other retailers.
We reviewed the most popular services for both online groceries and food delivery services, knowing that the lines are beginning to blur. DoorDash and Uber Eats have expanded from their original focus on restaurants into deliveries from grocery stores and other retailers. Amazon Fresh, which started out as a purely online ordering service, has expanded into brick and mortar grocery stores. In addition to the leading players, we also included, for potential contrast, Imperfect Foods, an online grocery service that began with an emphasis on fresh fruits and vegetables.
H-Score
53
52
48
47
40
33
32
28
Highlights and Opportunities
The companies, like FreshDirect and Instacart, that focus primarily on groceries scored consistently higher than the companies, like DoorDash and Grubhub, who are still mostly delivering from restaurants and convenience stores. This difference is almost entirely explained by the different scores on their influence on eating. All the companies have somewhat negative influences on all four of the other behaviors (physical activity, sleeping, social engagement and getting outdoors) due to the nature of what they are – services that enable people to obtain food without leaving their homes. The food delivery companies wound up near the bottom of the overall index, across all industries, because, in addition to the sedentary, isolating effects, they are essentially making it more efficient to obtain food that is often unhealthy.
For all of these companies, there is a big opportunity to work together, along with search and ratings companies and nutrition experts, to develop industry standards for rating the healthfulness of individual foods, dishes, and even establishments. Having these kinds of ratings embedded in search engines and ordering systems would enable sorting and filtering based on healthfulness and also create opportunities for users to set dietary goals and preferences and then align ordering experiences to those expressed intentions.
In addition, the meal delivery could emphasize pickup options over delivery, especially where the restaurants are within walkable distances for the customers.
Methodology
The influences that these services have on eating are largely determined by the types of meals that result from using the services. Grocery shopping typically leads to home-cooking, which research has shown to be, in general, healthier than prepared meals or food eaten at sit-down or fast food restaurants. Therefore, we looked, where possible, at the splits between grocery deliveries and restaurant/fast food deliveries. We looked at the ways that the services facilitated the ordering of healthy options (whether ingredients or meals) through their menu and services designs. We also looked at the results of our original consumer research on how consumers perceive the healthfulness of the groceries they order, how often users of services cook at home, and, when they order food to be delivered, what types of meals their orders typically replace.(5)
Analysis of physical activity is based on 1) recognition of the avoided effort of grocery shopping, cooking or picking up food; and 2) in the case of online grocery deliveries services, the activity associated with preparing and cooking dinner.
Influence on sleep was determined by 1) whether the service facilitates late-night eating and thus the potential for sleep disruption; and 2) a recognition that time (and possibly stress) saved by the service could facilitate better sleep.
For engaging socially, we looked at how the nature of the service might lead to avoided social contact (from staying at home and having food or groceries delivered) and also whether the service offers group ordering.
Finally, for the effect on spending time outdoors, we looked at avoided trips out of the home and, for delivery services, the possibility of outdoor delivery points (e.g. for picnics).
Meal Kit Services
In the middle space between cooking dinner from scratch and ordering a prepared meal for delivery lies the meal kit. Customers can subscribe to plans that deliver, up to several days a week, the fresh ingredients and recipes needed to cook multi-serving meals.
For this subcategory, in which there are countless competitors, we selected what were the top three companies, in terms of market share, at the time we began our analyses – Blue Apron, HelloFresh and Home Chef.
Highlights and Opportunities
The three meal kit services scored positively and were the Index’s three highest rated companies within the food industry. Their scores, while not identical, were quite similar – each scored very well for their influence on their customers’ eating habits, somewhat positively on social engagement and neutral to slight negative on the other behaviors. Each of these companies offers meals with generally positive nutritional profiles, moderate amounts of calories, and opportunities for users to select healthier options. Research showing that meal kit users tend to eat alone less often than most Americans likely boosted their social engagement scores.
Key opportunities for this category include helping users with larger gatherings of friends and family and developing lines of meals designed for picnics.
Methodology
In order to assess the influence of meal kits on eating, we looked at two measures related to nutrition. First, we worked with researchers at UC Irvine to apply the Adjusted Dietary Inflammatory Index (ADII) to the nutritional information provided by each company for selected meals.(6) (For Blue Apron and Home Chef we looked at four weeks of meals; for HelloFresh, we looked at the 50 most popular recipes they featured on their website.) The ADII measures the degree to which a diet contributes to inflammation and has been linked to obesity and diabetes. In addition to nutritional content, we also examined the calories associated with each meal, taking the median calories for the same samples of meals. We also folded in data from survey research on meal kit users, which showed that a vast majority of meal kit users found their meals to be as healthy or more healthy than their home-cooked meals and meals they ordered in or picked up.(7)
We looked at three factors for social engagement: 1) the requirement for two or more servings for each meal that could facilitate shared dinners; 2) our survey research showing that meal kit users eat dinner with others more than the average American; and 3) the potential loss of social interaction through avoided trips to the grocery store.
For the rest of the behaviors we looked at how they could be affected by the nature of the service. For physical activity, there is a likely loss of activity due to reduced grocery shopping, which could be offset by the physical activity of cooking dinner. The time saved through more efficient cooking could possibly lead to more sleep. Fewer trips to the grocery store could lead to less time spent outdoors.
Team
Research, analysis and writing by Nathaniel Braun, Esther Olsen, Samara Shima and Steve Downs. Review and editing by Sara Singer and Steve Downs.
Nutritional analyses based on the Adjusted Dietary Inflammatory Index by Ali Rostami and Ramesh Jain.
Development and application of the Restaurant Nutrition Quality score by Abigail Horn and her team at the University of Southern California.
Location and amenity data acquisition, processing and analysis by Wael Kanj, Ali Rostami and Steve Downs.
Notes
Source: CDC, based on 2013-2016 data.
McDonald’s. 2020 Annual Report. P. 3
Iris Liu et al. A continuous indicator of food environment nutritional quality. MedRxiv. November 26, 2021
U.S. Environmental Protection Agency. National Walkability Index: Methodology and User Guide. June 2021
Steve Downs. A Survey of Modern Life: Food; Delivery Apps, Meal Kits, Groceries and Cooking Dinner. Building H on Medium. January 20, 2022
Geertruida J van Woudenbergh et al. Adapted dietary inflammatory index and its association with a summary score for low-grade inflammation and markers of glucose metabolism: the Cohort study on Diabetes and Atherosclerosis Maastricht (CODAM) and the Hoorn study. The American Journal of Clinical Nutrition, Volume 98, Issue 6, December 2013, Pages 1533–1542.
Downs (2022)