For adolescents, Subway food may not be much healthier than McDonald's, UCLA study finds

Subway may promote itself as the "healthy" fast food restaurant, but it might not be a much healthier alternative than McDonald's for adolescents, according to new UCLA research.

In a study published May 6 in the Journal of Adolescent Health, the researchers found that adolescents who purchased Subway meals consumed nearly as many calories as they did at McDonald's. Meals from both restaurants are likely to contribute toward overeating and obesity, according to the researchers.

"Every day, millions of people eat at McDonald's and Subway, the two largest fast food chains in the world," said Dr. Lenard Lesser, who led the research while a Robert Wood Johnson Foundation Clinical Scholar in the department of family medicine at the David Geffen School of Medicine at UCLA and the UCLA Fielding School of Public Health. "With childhood obesity at record levels, we need to know the health impact of kids' choices at restaurants."
 
The researchers recruited 97 adolescents ages 12 to 21 to purchase meals at McDonald's and Subway restaurants at a shopping mall in Carson, Calif. The participants went to each restaurant on different weekdays between 3 p.m. and 5 p.m., and paid for the meals with their own money. Researchers used the participants' cash register receipts to record what each customer ate and estimated calorie counts from information on the chains' websites.

The researchers found that the participants bought meals containing an average of 1,038 calories at McDonald's and an average of 955 calories at Subway.
 
"We found that there was no statistically significant difference between the two restaurants, and that participants ate too many calories at both," said Lesser, who is now a researcher at the Palo Alto Medical Foundation Research Institute.
 
The Institute of Medicine recommends that school lunches not exceed 850 calories. An adolescent should consume an average of about 2,400 calories in a day.
 
Among the researchers' other findings: 

• The sandwiches purchased by participants contained an average of 784 calories at Subway versus 572 calories at McDonald's.
• Participants purchased sugary drinks averaging 61 calories at Subway, and 151 calories at McDonald's.
• Customers in the study purchased side items such as french fries and potato chips that added an average of 35 calories at Subway compared with 201 calories at McDonald's.
• Participants consumed 102 grams of carbohydrates at Subway; 128 grams at McDonald's.
• The meals contained an average of 36 grams of sugar at Subway; 54 grams at McDonald's.
• Meals contained an average of 41 grams of protein at subway; 32 grams at McDonald's.
• Sodium intake averaged 2,149 mg at Subway; 1,829 mg at McDonald's.  

"The nutrient profile at Subway was slightly healthier, but the food still contained three times the amount of salt that the Institute of Medicine recommends," Lesser said.

The authors suggested that the higher sodium content of the Subway meals likely came from the restaurant's processed meats. Processed meats in general are associated with obesity, cardiovascular disease and cancer.

The researchers noted some weaknesses in the study. They did not track the subjects' meals for the rest of the day, so it was unclear whether participants ate less at other times of the day to compensate for the excess calories. Also, participants were from a single suburb of Los Angeles and most were of Asian descent or of mixed race and ethnicity, so their purchase patterns may not be applicable to other populations.

Lesser recommends that McDonald's customers eliminate sugary drinks and french fries from their meals. "And if you go to Subway, opt for smaller subs, and ask for less meat and double the amount of veggies," he said.

Study co-authors are Chi-Hong Tseng of UCLA; Robert H. Brook and Deborah A. Cohen of RAND Corp.; Karen Kayekjian of Western University of Health Sciences; and Paz Velasquez of The Youth, Family, School and Community Partnership in Action. Brook is also associated with UCLA.

The study was funded by the Robert Wood Johnson Foundation Clinical Scholars Program.

The UCLA Department of Family Medicine(Link is external) provides comprehensive primary care to entire families from newborns to seniors. It provides low-risk obstetrical services and prenatal and inpatient care at UCLA Health - Santa Monica Medical Center, and outpatient care at the UCLA Family Health Center in Santa Monica and the Mid-Valley Family Health Center in Van Nuys, Calif. The department is a leader in family medicine education for both medical students and residents, and houses a significant research unit focusing on health care disparities among immigrant families and minority communities and other underserved populations in California.

The UCLA Fielding School of Public Health(Link is external) is dedicated to enhancing the public's health by conducting innovative research; training future leaders and health professionals; translating research into policy and practice; and serving local, national and international communities.

For more than three decades, the Robert Wood Johnson Foundation Clinical Scholars(Link is external) program has fostered the development of physicians who are leading the transformation of health care in the United States through positions in academic medicine, public health and other leadership roles. Through the program, future leaders learn to conduct innovative research and work with communities, organizations, practitioners and policymakers on issues important to the health and well-being of all Americans. This program is supported in part through collaboration with the U.S. Department of Veterans Affairs.

The RAND Corporation(Link is external) is a nonprofit institution that helps improve policy and decision-making through research and analysis.

The Palo Alto Medical Foundation for Health Care, Research and Education(Link is external) is a not-for-profit healthcare organization that is a pioneer in the multispecialty group practice of medicine. PAMF's 1,100 affiliated physicians and 4,300 employees serve approximately 800,000 patients at its medical centers and clinics in Alameda, San Mateo, Santa Clara and Santa Cruz counties. PAMF's Research Institute is recognized internationally as a center of excellence in health care services, health policy, health promotion, and outcomes research and training. It leverages its close connection with healthcare delivery and patient/community education arms, and the information resources, of PAMF to design, execute and rigorously evaluate new models of health promotion and health care using state-of-the-art research methods.