DISCUSSION
and
Conclusion

The sample of the population used in the study was not wholly representative of fast food eaters.

Interviewing only took place over the lunchtime period, and so the sample profile may have been very different if interviewing was able to be carried out in the evenings. The location of the outlets is also a source of bias. The centre of town was chosen because a range of outlets was found in a small area, offering the greataast choice to the consumer. However, the consumers using these outlets in town, at lunchtime, may be very different to those using outlets in a residential area, in the evening.

These limitations must therefore be considered when discussing the structure of the sample, and its eating habits.

Another limitation of the study was the lack of information regarding the nutrient content of the food items being offered to the consumer. Having written to 12 companies requesting information, only 6 replied - and even then, only 3 divulged any information - see Appendix (iii). These gave an analysis of the macro-nutreints, but analysis of the inicro- nutrients was extremely poor, and, to a large extent, non-existent. Therefore a conclusive look at the nutritional value of fast foods was not possible.

The large majority of consumers were found to be eating fast food weekly, with a quarter of respondents using the outlets daily. This reflects the findings of the Peckham study in 1987 (Carruthers 1987). These high numbers indicate that fast food is satisfying a very real need, and for those eating fast food daily, it is contributing significantly to their diets. With an average expenditure of £2.41 per person, it is not surprising that most of the daily eaters were in the higher income groups.

As seen in tables IX and X, there were definite groupings in relation to the site of interview. The younger age group were found mainly in the hamburger bars, as might be expected, and this may be due to advertising campaigns being specifically aimed at children, using cartoon figures, and offering free gifts when the outlet is used. This is somewhat concerning when the nutritional analysis of these products shows them to be high in fat and low in other nutrients.

The lower income group made up the highest proportion of consumers, although there were very few unemployed interviewees. The low proportion of the unemployed does not tally with the findings of the other studies (Carruthers 1987, Lobstein 1988), and may be due to the time and place of interview, which, as explained earlier, produced a bias sample.

The predominance of the lower income group could be due to the higher income groups using up-market restaurants more than fast food restaurants, which have a more down-market image. The lower income group was found most often in the hamburger bars, but also in the sandwich bar - and hence were consuming the cheaper forms of fast food. Although the nutritional quality of the food doesn't increase with cost, only the quantity increases, according to the analysis in table XV, the cheap and nutritious foods, such as baked potatoes were not available to the consumer in this area of central leeds. It is surprising that the sandwiches did not fair better when analysed, but this will depend very much on the type of filling chosen and the outlet's preparation of the food, so there is potential for these products to be of good nutritional quality. For example, Oliver's use butter and mayonnaise in all their sandwiches, whereas the outlet used in this survey may not.

Table XIV shows that 83% of the consumers using the hamburger bar rated the food as average or poor in terms of health. So why do they eat it? The answer to this question is shown in figure, 6, where 23% of the consumer had chosen the outlet they were using because they 'Liked the taste'. This indicates a prefferce for a certain outlet, not in terms of nutrition, which leads to the understanding that the choice of food available within an outlet is more important than between outlets.

The range of food within a fast food outlet is, on the whole, limited, focusing on one food type, i.e. pizzas - and so to obtain a balanced meal in terms of nutrition is difficult - as shown by table VIII. Therefore, if the consumer's preference for one outlet is so strong, a choice of foods is essential.

The inclusion of salad bars in pizza houses, for example, has shown an attempt is being made to diversify the range of products available. Some manufacturers seem reluctant to make such changes. As mentioned at the beginning. Wimpy are hesitant about introducing salads into their outlets for economic reasons, and it is only rumoured that McDonalds will follow suit.

However, the recommendations for nutritional intakes were made for the whole day, and so each meal needn't necessarily be perfectly balanced. One meal's excesses can compensate for another's deficiencies. The problem is heightened by the fact that fast food is not labelled in anyway, making the task infinitely harder, if not impossible, for the average consumer.

In this survey, only half of the consumers were able to answer correctly the questions concerning the nutrient content of certain specified fast food items. interestingly most of the sample identified the food lowest in calories correctly, but conversely, the correct response rate for fat was very low. This may be due to the pizza containing more 'hidden' fat than chips, for example. The most incorrect answers were given from those using the hamburger bar, correlating with the poorer nutritional content of the food offered by these outlets.

To balance, fast food meal, which is often high in calories and fat, nutrient-rich foods would need to be bought, proving costly for those in the low income groups.

But why should the consumer have to worry about buying nutrient-rich foods to compensate for the cheap calories offered to them by the fast food outlets? It could be argued that industry has social responsibilities to make good nutrition available, to both those who explicitly seek it and to those who don't, to be more in line with recommendations (NACNE 1983, DHSS 1979). This is echoed in the NACNE report, which states that 'the public be given access to a variety of nutritionally suitable and palatable foods'. Wimpy themselves, conclude, in their fact sheet, that 'a healthy diet can easily be achieved by eating a varied selection of food in moderation : healthy eating =variety and moderation' (Capewell and Penn 1986).

Dietitians shoud be taking fast food seriously when it is having such an impact on the diets of a growing number of the population. More nutritional information should be available to, and sought after by, the profession, so that dietieians are more aware of the food being offered to their potential clients.

They should be working more closely with the industry to encourage the availability of healthier food choices - not simply by introducing completely new outlets such as Spud-U-Like or sandwich bars, but by improving the quality of food within existing outlets, as consumer loyalty appears to be a strong factor in consumer choice.

As dietitians, amongst others, strive to educate the public, in terms of nutrition, industry should be encouraged to reinforce the messages being conveyed. Nutritional information should be displayed on the food packaging in a uniform and inderstandable format, developed by the health professionals, government and industry together.

Further work is needed to obtain micro-nutrient analysis of fast food from the companies responsible for their production. This would enable more qualified conclusions to be made about the nutritional adequacy of fast food.

The availability of outlets is variable. Often, only one or two outlets are found in a single location. This is especially true of residential areas, and emphasises the need for a variety of foods to be offered in each outlet. A comprehensive survey of outlet location is needed to reveal the areas of greatest choice limitation.

CONCLUSION

A large proportion of the consumers interviewed in this study were found to be eating fast food at least weekly, with a quarter of respondents using outlets daily. This shows that fast food is contributing significantly to the diets of some individuals.

The lower income group, representing those who are most nutritionally vunerable, were found to be eating less nutritional forms of fast food, lending support to the stated hypothesis. However, the nutritional analyses of the products was limited and so it would be premature to make any firm conclusions regarding the nutritional adequacy of some fast foods.

The less nutritional forms of fast food were not found to be the cheapest necessarily, as it is the quality of food which increases with price, not quality. It is thefefore untrue to say, with respect to fast food, that food of reasonable nutritional value is not available to the nutritionally-vunerable consumers.

From the findings of this study, it can be concluded that the high amounts of fast food being eaten by a significant proportion of the population makes fast food a matter of importance for all those concerned with the nutritional status of the population as a whole.

I, Fiona Winter (née Carruthers), am a qualified state-registered dietirian.

I can confirm that during 1987 & 1988 I carried out two surveys of Fast Food Eaters, namely (Grazing in Peckham' (1987) and 'Who is under the Golden Arches?' (1988), and that the results contained in them are, to the best of my knowledge, correct as read.

Signed
Fiona E.C. Winter BSc(Hons) SRD
Community Dietitian


Tuesday, 26th July 1994