Eating-Out: A Study of the Nutritional Quality of Canadian 
        Chain Restaurant Foods and Interventions to Promote 
                      Healthy Eating 
                          by      
                     Mary J. Scourboutakos 
              A thesis submitted in conformity with the requirements 
                  for the degree of Doctor of Philosophy 
                   Department of Nutritional Sciences 
                      University of Toronto 
                © Copyright by Mary J. Scourboutakos 2016 
        Eating-Out: A Study of the Nutritional Quality of Canadian Chain 
        Restaurant Foods and Interventions to Promote Healthy Eating 
                       Mary J. Scourboutakos 
                        Doctor of Philosophy 
                     Department of Nutritional Sciences 
                        University of Toronto 
                           2016 
       Abstract 
          Canadians are increasingly eating outside-the-home. At the outset of this thesis there 
       were no data on the nutritional quality of Canadian chain restaurant foods, the Sodium Working 
       Group’s plan to monitor sodium reductions in the food supply was abandoned, and despite 
       interest and numerous bills, there was no existing menu-labelling legislation in Canada.  
          The specific objectives of this thesis were to 1) investigate the nutritional quality of the 
       Canadian chain restaurant food supply; 2) explore consumers’ use of menu-labelling; and 3) test 
       the potential of alternative forms of labelling in non-chain restaurant settings. 
          Objective 1 was investigated by developing and analyzing a national database of over 
       9000 menu-items from Canadian fast-food and sit-down chain restaurants which was created in 
       2010. There was wide variation in calorie levels within each restaurant and food category; 
       furthermore, portion size, as opposed to calorie density, was the most important driver of this 
       variation. Sodium levels in menu items often exceed daily recommendations and despite reported 
       efforts by the restaurant sector to improve, as of 2013, reductions were minimal. 
          Objective 2 used an online, national consumer survey to test three menu-labelling 
       treatments (calories; calories and sodium; and calories, sodium and serving size labelling). The 
       effect of labelling on consumer choice varied depending on the restaurant setting, however, 
       overall, labelling sodium in addition to calories led consumers to choose meals with significantly 
       less sodium. There was no additional benefit from adding serving size information.  
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          Objective 3 was examined in a quasi-experimental, population-level nutrition 
       labelling/education intervention study in a campus cafeteria. Results showed that this 
       intervention could modestly increase fruit and vegetable consumption, and decrease sugar-
       sweetened beverage consumption among University students.  
          Overall, this thesis provides food supply and consumer data to inform public health 
       policy debates around issues concerning food consumed outside-the-home. 
                     
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                         Dedication 
                              
                     This thesis is dedicated to my Mom,  
                  who told me what a PhD was when I was twelve,  
                     and then encouraged me to do one. 
                              
                              
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