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Do Healthier Meals Cost More?

Huang, Yue, MS; Houser, Robert F., PhD; Roberts, Susan B., PhD; Lichtenstein, Alice H., DSc

doi: 10.1097/NT.0000000000000278
Food and Nutrition

One barrier to achieving healthier eating patterns is the perceived higher cost of healthier food. The objective of this cross-sectional study was to investigate the potential association between cost and the nutrition quality among entrées from casual dining restaurants.

Nutrition and price information were collected from 11 restaurants in Boston metropolitan area. A nutrition quality metric (Estimated Nutrition Score [ENS]) was developed based on the 2015-2020 Dietary Guidelines for Americans to allow comparisons between more healthy and less healthy entrées. Associations between entrée price and ENS were assessed as continuous variables and dichotomized based on median ENS, availability of “small,” “half,” and “light” options, and with or without calories as a component of the score.

Of the 11 restaurant chains meeting the inclusion criteria, the association between ENS and price was significant for 6. Of those 6, more healthy options were less expensive at 4 restaurants, and more healthy options were more expensive at 2 restaurants. Eliminating small, half, and light options from the analyses resulted in a null association for 1 restaurant in the former category. Eliminating calories from the score resulted in loss of a significant association between price and ENS for all 6 restaurants, whereas for 2 additional restaurants, significant negative relationships were detected.

There was no consistent association between ENS and entrée price in the sample assessed. Hence, within the category of restaurants evaluated, customers can often choose healthier entrées that are priced less than or equal to less healthy entrées.

Yue Huang, MS, is a research scholar at the Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.

Robert F. Houser, PhD, is an assistant professor and statistical programmer/analyst at the Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.

Susan B. Roberts, PhD, is a senior scientist and director of the Energy Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. She is also a Professor of Nutrition and Professor of Psychiatry at Tufts University, Boston, Massachusetts.

Alice H. Lichtenstein, DSc, is a senior scientist and director of the Cardiovascular Nutrition Laboratory at the Human Nutrition Research Center on Aging, as well as a Stanley N. Gershoff Professor of Nutrition Science and Policy at the Friedman School, Tufts University, Boston, Massachusetts.

The authors have no conflicts of interest to disclose.

Correspondence: Yue Huang, MS, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Room 275 Boston, MA 02111 (

Author contributions: A.H.L. and Y.H. conceived and oversaw this research project; A.H.L., S.B.R., and R.F.H. provided expertise on research methods and design of the nutrition score; R.F.H. provided critical statistical support; Y.H. led data collection, analysis, and writing of the initial draft. All authors have reviewed and commented on subsequent drafts of the manuscript.

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