5/4/2016

Eating Out On‐The‐Go Richard Collins, MD “The Cooking Cardiologist” Susan Buckley, RDN, CDE

Eating Out On The Go • Eating out can be such a pleasure: Someone else chops the veggies, cooks the entree and brings it steaming hot to your table, while you enjoy time with friends or family. Then, THEY CLEAN UP!! • But when we eat out, we tend to overdo it. • While an occasional splurge is OK, if we're not smart about our menu choices, we may be hunting for a larger wardrobe and setting ourselves up for heart disease!

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The Stats • Asurvey from the National Restaurant Association revealed: • 9 in 10 consumers say they enjoy going to restaurants • 2 in 5 consumers say restaurants are an essential part of their lifestyle • 7 in 10 consumers say their favorite restaurant foods provide flavors that can’t easily be duplicated at home • Three fourths of consumers say going to a restaurant with family and friends is a better use of their leisure time than cooking and cleaning up

Eating Out On The Go • On average, Americans eat out about five times a week, according to the National Restaurant Association. • Because those meals are generally higher in calories and fat than what we make at home, they can create a recipe for weight gain. • More than 30% of children eat fast food on any given day. • Every meal away from home increases an adult's average daily calorie count by about 135 calories, according to the U.S. Department of Agriculture. • If we eat out five times a week (this includes pick‐up meals), we stand to gain up to 10 pounds a year.

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Eating On The Go • 2013 study at the Energy Metabolism Laboratory at USDA Human Nutrition Research Center on Aging at Tufts University • Calories of the 42 most frequently eaten meals from independent and small chain sit‐down restaurants in the Boston area were analyzed • Included popular cuisines like Mexican, Italian, Chinese, Thai, Greek and Vietnamese • The average meal had roughly 1,300 calories

Eating Out On The Go • Based on a recent study of the top 400 Chain Restaurants (by sales) published in the Cambridge University Press, it looks like eating out healthfully (at least at the most popular chain restaurants surveyed) is still a challenge. • But even where it’s hard to find a great choice, there are still some choices that are better than others.

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Xtreme Eating award: CSPI • Outback Steakhouse: Herb Roasted Prime Rib dinner, 16 oz. prime rib (1,400 calories) with loaded baked potato and blue cheese wedge salad: 2,400 calories, 71 grams of saturated fat 3,560 mg sodium • Cheesecake Factory: The Louisiana Chicken Pasta, 2,370 calories, plus 80 grams of saturated fat and 2,370 milligrams of sodium • SONIC: Pineapple Upside Down Master Blast: 2,020 calories, 61 grams of saturated fat and 4½ grams of trans fat, and it comes with 29 teaspoons of added sugar

Key findings

• Appetizers had more calories, fat and sodium than all other item types. • Children’s menu specialty beverages had more fat, saturated fat and carbohydrates than comparable regular menu beverages. • As few as 3% of entrees were within limits for sodium, fat and saturated fat. • Main entrées had significantly more calories, fat and saturated fat in family‐style restaurants than in fast‐food restaurants. • Restaurants that made nutrition information easily accessible on websites had significantly lower energy, fat and sodium contents across menu offerings than those providing information only upon request.

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Eating Out On The Go • Eating at a restaurant does not have to sabotage a healthy diet. • Use smart‐eating strategies: plan ahead, consider the menu and choose foods carefully to keep you on your plan. • Have a plan. Eat a light dinner if you ate a big lunch that day. Or if you know ahead of time that you're going to a restaurant, cut back on calories during other meals that day (but not TOO low!) • Get online before you go out and look at some nutrition information. • Knowing menu terms and cooking basics makes ordering easier, especially if you need to control calories, fat and other nutrients. Look for foods that are steamed, broiled, baked or grilled, and limit fried and sautéed items or foods described as "crispy," "rich" or "au gratin."

Eating Out On The Go • As a beverage choice, ask for water or unsweetened tea, or other drinks without added sugars. • Learn to order better – don’t be afraid to ask questions and get what you WANT! • Be careful where you eat. Much harder to get a healthy meal at some restaurants • No all‐you‐can‐eat buffets or steakhouses with enormous portions • Make friends with the waitperson. She/he can tell you about any dish. • Order Creatively. Soup, salad and a healthy appetizer can stand in for a full meal. Extra vegetables can replace French fries. • In a restaurant, start your meal with a salad or vegetable soup packed with veggies, to help control hunger and feel satisfied sooner.

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Eating Out On The Go • Choose main dishes that include vegetables, such as stir fries, kebobs, or pasta with a tomato sauce. • Order steamed, grilled, or broiled dishes instead of those that are fried or sautéed. • Choose a “small" or "medium" portion. This includes main dishes, side dishes, and beverages. • If main portions at a restaurant are larger than you want, try one of these strategies to keep from overeating:

Eating Out On The Go

– Order an appetizer‐sized portion or a side dish instead of an entrée. – Share a main dish with a friend, and get a veggie side dish – If you can chill the extra food right away, take leftovers home in a "doggy bag." – When your food is delivered, set aside or pack half of it to go immediately or ask for ½ to go from your wait staff – Resign from the "clean your plate club" ‐ when you've eaten enough, leave the rest.

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Eating Out On The Go • To keep your meal moderate in calories, fat, and sugars: – Ask for salad dressing to be served "on the side" so you can add only as much as you want. Dip your fork in the dressing. – Order foods that do not have creamy sauces or gravies – Add little or no butter to your food. – Choose fruits for dessert most often. • On long commutes or shopping trips, pack some fresh fruit, cut‐up vegetables, low‐fat string cheese sticks, or a handful of nuts to help you avoid stopping for sweet or fatty snacks.

Eating Out On The Go • Above all else, be assertive. • Dining out is no time to be a meek consumer, notes Michael F. Jacobson, Ph.D., executive director of the Center for Science in the Public Interest (CSPI) and coauthor of the book Restaurant Confidential. • “You need to be an assertive consumer by asking for changes on the menu,” he says. • For instance, if an item is fried, ask for it grilled. • If it comes with French fries, ask for a side of veggies instead. • Ask for a smaller portion of the meat and a larger portion of the salad; for salad instead of coleslaw; baked potato instead of fried. • “Just assume you can have the food prepared the way you want it,” says Dr. Jacobson. “Very often, the restaurant will cooperate.”

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Eating Out On The Go • Ask your waiter to “triple the vegetables, please.” • Often a side of vegetables in a restaurant is really like garnish —a carrot and a forkful of squash. • When ordering, ask for three or four times the normal serving of veggies, and offer to pay extra • So what if you pay an extra dollar or two –your health is more than worth it!

Eating Out On The Go • Ask how the food was prepared; don’t go by the menu. • For instance, cholesterol‐free does not mean fat‐free; the dish could still be filled with calorie‐dense oil. • Neither does “lite” necessarily mean light in calories or fat.

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Eating Out On The Go • Order from the “healthy, light, low fat” entrées on the menu. • Most chains will even list the calories and nutritional content of such foods. • Applebee’s, for instance, offers approved Weight Watchers options, Bennigan’s has its Health Club entrées (which it will serve in half portions), and Ruby Tuesday lists the nutritional information for its entire menu.

Eating Out On The Go • Beware of the low‐carb options. • Restaurant chains have jumped on the low‐carb bandwagon, offering numerous low‐carb options on their menu. • But low‐carb doesn’t mean low‐cal! • For instance, at Ruby Tuesday the Low‐Carb New Orleans Seafood packs 710 calories and 42 grams of fat —ouch! • A much better bet —the Low Carb Veggie Platter —leaves you with just 297 calories and 16 grams of fat.

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Eating Out On The Go • Try double appetizers. • If there is a nice selection of seafood‐ and vegetable‐based appetizers, consider skipping the entrée and having two appetizers for your meal. • Often, that is more than enough food to fill you up.

Eating Out On The Go • Order a salad before ordering anything else on the menu. • Scientists at Pennsylvania State University found that volunteers who ate a big veggie salad before the main course ate fewer calories overall than those who didn’t have a first‐ course salad

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Eating Out On The Go • But remember: Salads shouldn’t be too fatty. • This is a vegetable course — keep it tasty but healthy. • That means avoiding anything in a creamy sauce (coleslaw, pasta salads, and potato salads), and skipping the bacon bits, cheese, ham, egg and fried noodles. • Instead, load up on the raw vegetables, treat yourself to a few well‐drained marinated vegetables (artichoke hearts, red peppers, or mushrooms), and for a change, add in some fruit or nuts. • Indeed, fruits such as mango, kiwi, cantaloupe, and pear are often the secret ingredient in four‐star salads.

Eating Out On The Go • Watch the add‐ons to vegetable salads. • Even salads that are mostly raw vegetables are a problem if they’re loaded with cheese and meats. • Take the typical Caesar salad in most restaurants (the one topped with chicken or shrimp as well as plenty of cheese and mayo in the dressing). • Add in the fried croutons and the calories add up to a whopping 560, with 36 grams of fat, 6 of them saturated. • Italian antipasto salads also are a health challenge, with all their salami, spicy ham, and cheese. • Get the salad, but ask for vegetables only or vegetables with some fruit.

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Eating Out On The Go • Do the fork dip. • The best way to combine salad dressing with salad? • Get your dressing on the side, in a small bowl. • Dip your empty fork into the dressing, then skewer a forkful of salad. • You’ll be surprised at how this tastes just right, and how little dressing you’ll use. • Plus, your lettuce won’t wilt and drown in a sea of oil.

Salads Worse than a Big Mac • Big Mac: Calories: 550 Fat: 29 g Saturated Fat: 10 g Sodium: 770 mg • McDonald's new kale salad "Keep Calm, Caesar On" chicken salad contains "real parmesan" cheese petals and a "nutrient‐rich lettuce blend with baby kale." • The salad contains more than 730 calories, 53 grams of fat, and 1,400 milligrams of salt, according to McDonald's nutritional information.

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Eating Out On The Go • Check the menu before you leave home. • Most chains post their menus on their Web sites. • For instance, Ruby Tuesday’s Smart Eating menu tells you the restaurant only uses canola oil and even provides nutritional information on its salad bar. • You can decide before you ever hit the hostess stand what you’re going to order. • Conversely, if you don’t see anything that’s healthy, pick another restaurant. • www.dwlz.com/restaurants.html ‐ over 600 restaurants listed • www.healthydiningfinder.com –they show you what is healthy on the menu

Eating Out On The Go • Read between the lines. Any menu description that uses the words creamy, breaded, crisp, sauced, or stuffed is likely loaded with hidden fats —much of it saturated or even trans fats. • Other “beware of” words include: buttery, sautéed, pan‐ fried, au gratin, Newburg, Parmesan, cheese sauce, scalloped, and au lait, à la mode, or au fromage (with milk, ice cream, or cheese).

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Eating Out On The Go • Ask the waiter to skip the bread basket. • If you must have something to munch on while you wait for your order, ask for a plate of raw vegetables or ask them to bring your salad right away

Ever wonder how many calories are in those tempting baskets of warm bread, rolls, or tortillas chip baskets? They taste so delicious but those calories could turn your restaurant meal into a calorie disaster! Take a look: ½ basket of tortilla chips: 350 calories (This doesn’t include what you dip ‘em in!) 1 Cheddar Bay biscuit from Red Lobster: 150 calories 1 bag of tortilla chips from Chipotle: 570 calories 1 slice of carrot raisin bread from MiMi’s Cafe: 250 calories 1 breadstick from Olive Garden: 150 calories 1 biscuit from Bob Evans: 340 calories 1 biscuit from Cracker Barrel: 130 calories

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Tips to limit bread intake in restaurants • So you are sitting in a restaurant, cocktail in front of you, waiting for your food. The bread basket is calling your name. How do you handle this? • 1. Tell the waiter to remove the bread basket. This is most obvious and effective way to control your intake. • 2. Take one piece of bread –no butter or oil • 3. Keep the basket out of your reach • 4. If you love bread, take 1 –2 SMALL pieces and omit the starch (i.e. potato) with your meal. Omit the added fat to save 100 calories or more

Tips to limit break intake in restaurants • 5. Have a light snack before you go into the restaurant, so you will not be starving • 6. Ask for your salad immediately, so you will be less tempted to eat the bread • 7. Think about this bread situation ahead of time. Play the scenario in your head of you resisting the bread • 8. Enlist the support of your dining partner not to let you have bread. Perhaps you shouldn’t do this on your first Match.com date

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Eating Out On The Go • Skip the fancy drinks • If you must order an alcoholic drink, forget the margaritas, piña coladas, and other exotic mixed drinks. • They include sugary additions that only add calories. • Opt instead for a glass of wine, a light beer, a vodka and tonic or a simple martini (without the chocolate liquor, sour green apple schnapps, or triple sec).

Cocktails • So just how many calories are in your favorite cocktail? These calorie counts for popular alcoholic drinks are approximate, based on popular recipes, but may vary depending on ingredients and portions. • Pina Colada (6 oz): 378 calories • Mojito (8 oz): 214 calories • Cosmopolitan (4 oz): 200 calories • Chocolate martini: (2 oz each vodka, chocolate liqueur, cream, 1/2 oz creme de cacao, chocolate syrup): 438 • Margarita (8 oz): 280

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Cocktails • Champagne (5oz): 106‐120 • Coffee liqueur (3 ounces): 348 • Martini (2.5 oz): 160 • Godiva chocolate liqueur (3 oz): 310 • Port wine (3 oz):128 • Wine spritzer (5 oz): 100 • Bloody Mary (5 oz): 118 • Eggnog with rum (8 ounces): 370 • Red wine (5 oz):120 • Hot chocolate with peppermint • White wine (5 oz): 120 schnapps (8 oz): 380 • Beer (12 oz): 150‐198 • Hot buttered rum (8 oz): 292 • Light beer (12 oz): 95‐136 • Spiced cider with rum ( 8 oz):150 • Ultra‐light beer (12 oz): 64‐95 • Mulled wine (5 oz): 200

Effects of Alcohol on Your Waistline • It isn't just the beer that contributes to beer bellies. • It could also be the extra calories, fat and unhealthy eating choices that may come with moderate drinking. • A recent study found that men consume an additional 433 calories (equivalent to a McDonald's double cheeseburger) on days they drink a moderate amount of alcohol.

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Eating Out On The Go • Top a baked potato with veggies from the salad bar. • Or ask if they have salsa —the ultimate potato topper, both in terms of flavor and health. Just avoid the butter and sour cream.

Eating Out On The Go • Order fish • Just make sure it’s not fried. • When the CSPI evaluated food served at seafood chains and independent restaurants, researchers found low‐fat and low‐sodium options abounded. • Plus, you can order seafood so many different ways — steamed, baked, broiled, sautéed, blackened, or grilled. Nix any sauces, or ask for them on the side.

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Eating Out On The Go • Drink water throughout the meal • It will slow you down, help you enjoy the food more, and let the message get to your brain that you’re full —before your plate is empty. • Remember to put your fork down between bites –savor your food! Be mindful and ENJOY!

Eating Out On The Go • Skip the dessert. You can always have some sorbet or even a small piece of chocolate at home. • That is much better healthwise than the Triple Chocolate Meltdown or a mountain of ice cream topped by a second mountain of whipped cream • TGI Fridays: Tennessee Whiskey Cake: 1270 calories, 28 g saturated fat • TGI Fridays: Brownie Obsession®: 1240 calories, 32 g saturated fat

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Eating Out On The Go • Cheesecake Factory: • Carrot Cake: 1550 calories, 24 g saturated fat • Brownie Sundae Cheesecake: 1270 calories, 43 g saturated fat

Eating Out On The Go • Olive Garden Salmon Bruschetta: 1,100 calories, 54 g fat, 2,270 mg sodium, 78 g carbs • Chili’s Crispy Chicken Tacos: 1,480 calories, 67 g fat, 4,470 mg sodium, 155 g carbs • Denny’s Sticky Bun French Toast: 1,230 calories, 68 g fat, 115 g carbs • California Pizza Kitchen Moroccan‐Spiced Chicken Salad: 1,500 calories, 99 g fat, 1,380 mg sodium, 128 g carbs

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Eating Out On The Go • Applebee’s 4‐Cheese Mac & Cheese with Honey Pepper Chicken Tenders: 1,830 calories, 92 g fat, 4,300 mg sodium, 175 g carbs • IHOP’s Chicken Fajita Omelette: 1,140 calories, 77 g fat • P.F. Chang’s Stir‐Fried Eggplant: 1,010 calories, 88 g fat

Eating Out On The Go • What’s the most heart attack‐inducing dish you can get at a restaurant chain in America? • It isn’t KFC with its much‐talked‐about Double Down, or Burger King with its Triple Whopper, and it isn’t even TGIF with its heavily loaded nachos (1370 calories, 94 grams fat and 2210 mg sodium)

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Eating Out On The Go • The Heart Attack Grill in Las Vegas ‐ (“A Taste Worth Dying For”) • Menu features single through quadruple bypass burgers (one beef patty for each bypass), “flatliner fries” deep fried in pure lard, unfiltered cigarettes, and Jolt Cola • The Quadruple Bypass Burger packs an estimated 8,000 calories (which presumably doesn’t include a side of flatliner fries), and this, enough calories for four full days, is free to anyone who weighs over 350 pounds

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Eating Out On The Go • A daily customer and unofficial mascot for the Heart Attack Grill, a Las Vegas diner infamous for its calorie‐laden menu and waitresses in nurse garb, died of an apparent heart attack, the latest in a string of incidents that evoke the restaurant's ominous name. • 52‐year‐old John Alleman died after collapsing as he waited at a bus stop in front of the Fremont Street restaurant. • He had been a faithful patron since the restaurant opened in October 2011, owner Jon Basso said. He inspired a "Patient John" caricature on the Heart Attack Grill's menu, clothing line and merchandise. • In February 2012, a man was hospitalized with an apparent heart problem after chowing down a 6,000‐calorie Triple Bypass Burger. Two months later, a woman suffered from a similar medical problem while reportedly eating a Double Bypass Burger.

•Don’t Eat at the Heart Attack Grill!!!!!!!!!!!!!!!

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Calorie Information on Menus • The U.S. Food and Drug Administration has finalized two rules requiring that calorie information be listed on menus and menu boards in chain restaurants and similar retail food establishments and vending machines. • Applies to restaurants and similar retail food establishments if they are part of a chain of 20 or more locations • New laws will be in effect some time in 2017 • In New York City, menu label mandates began in 2008. There has not been a significant decrease in calories on orders

Eating Out On The Go • 6 tips to ordering Chinese

• 1. Ask for brown rice 2. Start your meal with wonton, egg drop, or hot‐and‐sour soup. 3. When it comes to entrées, order from the 'health' menu – nothing deep fried • 4. Make sure you order plenty of vegetables • 5. Take advantage of the bean curd (tofu). • 6. Plan to take home leftovers.

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Eating Out On The Go • 4 tips to ordering Italian • 1. Ask the waitperson not to bring the breadbasket. 2. If you want pasta, order a dish from the appetizer section of the menu, or share. 3. If it's on the menu, order simple grilled fish, chicken, beef, veal, pork, or shellfish. 4. For dessert, ask for fresh berries or fruit ice, if it's available, or a small plate of cookies to share.

Eating Out On The Go • 6 tips to ordering Mexican • 1. Ask the waitperson to take away the tortilla chips. 2. Order a healthy starter instead. 3. For an entrée, look to fajitas. 4. Order tacos or burritos without high‐fat sour cream. 5. As a side dish, go for rice and beans or just beans instead of Mexican rice. 6. Have dessert at home

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Eating Out On The Go • 5 tips to ordering fast food • 1. Opt for simple grilled fare, if you can find it. 2. A simple hamburger isn't bad either ‐‐ if you order the smallest one without cheese or mayonnaise. 3. Order a la carte. 4. Take advantage of the salads but watch for fried chicken and fatty dressings. 5. Have yogurt or cut up apples

Healthy Plate Try to keep the balanced plate in mind (½ vegetables, ¼ grain products and ¼ protein‐rich foods) when ordering. Most restaurant meals tend to be high in grain products and light on veggies. You can ask for menu changes to balance your meal. Restaurants typically are very accommodating to friendly requests for a customized order.

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Some Good Choices (except the sodium!) • Starbucks Chicken & Hummus Bistro Box Calories –270 Fat –8 grams Sodium –520 mg Carbohydrate –29 grams Fiber –6 grams Protein –16 grams • Applebee's Asiago Peppercorn Steak with Herb Potatoes and Seasonal Vegetables Calories –380 Fat –14 grams Sodium –1,520 mg Carbohydrate –25 grams Fiber –5 grams Protein –44 grams

Some Good Choices • Cheesecake Factory SkinnyLicious Grilled Chicken Calories –560 Fat –2 grams saturated Sodium –1,252 mg Carbohydrate –20 grams • Red Lobster LightHouse Rock Lobster with Fresh Broccoli and Garden Salad with Balsamic Vinaigrette Calories –305 Fat –10 grams Sodium –985 mg Carbohydrate –23 grams

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Resources • http://www.helpguide.org/articles/healthy‐eating/healthy‐ fast‐food.htm • www.healthydiningfinder.com • http://www.dwlz.com/restaurants.html (over 600 restaurants listed) • Apps: HealthyOut • Restaurant menu nutrition • Loseit

•Enjoy and Eat Mindfully

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