Dining Out: What do Dietitians Need to Know to Keep Clients Menu- Savvy?

It can be difficult to know what is *actually* on the menu when dining out. With changing rules, regulations, and trends, what can dietitians do to keep clients menu-savvy?



When discussing dining out with a client, it’s like that old saying about teaching a man to fish. You can catch the fish for him, or you can teach him how to fish so he has the skills to feed himself. When it comes to dining out, what are the best strategies and skills clients need to navigate tricky menus?


Especially for clients with sensitivities and allergies, it is important that clients learn what to look for on menus and how to ask questions about ingredients as needed. As Peter Drucker said, “Making good decisions is a crucial skill at every level.” From the dietitian’s office to dining out, educating clients and empowering them to make healthy choices on their own is key.


Incorporating Eating Out into a Healthy Meal Plan


It is possible to incorporate healthy eating patterns and eating out into the same meal plan. Many people think they have to choose one or the other. Just like food, it is helpful to think of eating out not as “good” or “bad”, but in terms of whether it is productive as part of the whole meal plan.


Menu Limitations

Nutrition information differs by establishment. Some restaurants make information available online, directly on their menus, or on the order boards or drive-through signs. When in doubt, it’s okay, even encouraged, to ask a restaurant associate what is available or if there are alternatives to listed items.


Menus are not required to make nutrition information available if the restaurant has fewer than 20 locations. Since hole-in-the-wall places are sometimes the tastiest, and can offer uniqueness and variety to the diet.


At restaurants where nutrition facts aren’t readily available, considering utilizing the following tips and tricks:







Items that vary daily, weekly, or with the seasons may not have nutrition information available. Some of these exceptions may include:

  • Daily specials

  • Custom orders

  • Condiments

What nutrition information is most important?


While the answer to this question will be different for everyone, most people will find the following values relevant to their eating goals. The key to being menu-savvy is to practice moderation. Nutrients like saturated fat and sodium are often consumed in excessive amounts.


General Tips


Watch the Wording

Choose options that are grilled, broiled or steamed instead of fried, breaded, or smothered. Many times, restaurants are willing to substitute grilled chicken for other types of meat in a dish.


It’s Okay to Ask

Give yourself permission to ask questions about the menu. Contrary to popular belief, it isn’t set in stone. Ask for help, for other options, for individualized resources--whatever it is, let yourself ask the questions you feel you need answers to. Many times, restaurants will be happy to accommodate loyal customers and are happy to increase business to local community members with special dietary needs.


Calories

Listing of calories is a commonplace occurrence on modern menus. If you can’t find them directly on the menu, try looking at the order boards or online.


Calories aren’t a definitive measure of whether a food is healthy or not, but they can give clues about the content of the menu items. For example, a salad full of nutrient-rich ingredients may be the same number of calories as a burger full of fried foods and saturated fat. Each offers nutrients along with the calories, but the salad is likely more nutrient-rich.


Remember -- calories aren’t the enemy. They can be a helpful indicator when it comes to choosing food. However, I don’t recommend picking a menu item just because it has the lowest calories.


Instead, I recommend finding a few options you enjoy and then looking at the calorie counts and thinking of your health goals. Being mindful of your choices can help you incorporate calories into the decision. Picking an item you enjoy eating is just as important as making a healthy decision.


Salt/Sodium


Items lower in sodium are usually labeled with a “heart healthy” mark. Cutting back on salt is a key part of reducing hypertension, so this may be extra important for patients at risk for heart disease. Salt is used heavily in restaurant meals as a flavor enhancer.


Tips for reducing salt content include:

  • Ask that food be prepared without salt, MSG, or ingredients that contain salt

  • Know which cooking styles or labels hint at higher salt content (i.e. pickled, smoked, cured, soy sauce, broth, dressing)

  • Avoid using the salt-shaker, especially using it before tasting foods

  • Limit condiments like mustard, ketchup, pickles, and sauces

  • Choose fruits and vegetables (ask for them unsalted) instead of high-salt appetizers or sides

Carbohydrates

Just like calories, carbs aren’t the enemy! A balanced diet needs carbohydrates to be balanced. It is important to look at the quality of the carbs and to opt for nutrient-dense choices when possible.


The Academy of Nutrition and Dietetics recommends choosing whole grains when you can, such as:

  • Brown rice

  • Whole wheat pasta

  • Whole grain bread


Ask if they can switch out white bread for wheat or other refined grains for whole grains. Some places even wrap burgers in lettuce now and call it “protein style”. Explore your options.


Nutrient Levels

Restaurants will sometimes highlight items if they are high in nutrients. While not always featured on the menu, you can do research before frequenting the storefront to find out the nutrient value of the food item.



Many establishments are hiring dietitians to craft specialized dishes or emphasize healthy “dietitian’s choice” meals. Use these experts to your advantage, and don’t be afraid to contact the manufacturers for more details about their dishes.


Saturated Fat

Saturated fat can show up in many menu items, especially animal products and condiments. Beware of baked goods, fatty meats, processed meats, and fats and oils that are solid at room temperature. These include foods such as:

  • Baked Goods, Breads, and Desserts - White chocolate, toffee, cakes, puddings, biscuits, pastries, pies

  • Fatty meats - Lamb chops, fatty beef, pork, poultry with skin,

  • Processed meats - Sausages, burgers, bacon, kebabs

  • Animal fats - Butter, lard, ghee, goose fat, suet

  • Plant-based fats - Margarine, coconut and palm oils, coconut cream


You don’t necessarily need to avoid these items, just be sure to eat them in moderation. While plant-based options may contain less saturated fat at first glance, know that prepared dishes often have added ingredients and about the same number of calories as their animal-based counterparts.


Dietary Fiber

Fiber is an extremely important aspect of the diet. In fact, the most recent national guidelines identify dietary fiber intake as a public health concern.


While some establishments may highlight dishes that are “high fiber” or advertise the benefits of a new health-centric dish, it’s not common to see fiber as the focus of menus. Here are some tips for locating high-fiber dishes on the menu:



Added Sugars Allergens & Other


Is it made with real anything? Be sure to see if lemonade, beverages, and other menu items are flavored with “artificial and/or natural flavors” -- these terms aren’t necessarily regulated. It’s always better to opt for water if you’re not sure.

Generally, restaurants will want to advertise if their item is made with real ingredients. This appeals to their more health-conscious customers and helps them to build trust with their consumer audience. Look for these options as they will likely contain less artificial ingredients.


Allergens

When dining out with food allergies or sensitivities, I recommend looking for icons indicating whether a dish is gluten/dairy/soy, etc. -free. It’s also important to ask whether the establishment can guarantee there is no risk of cross-contamination.


If you have doubts, ask questions. I suggest joining an online community with similar dietary challenges and opportunities and asking the advice of people who have been where you are. Many places are becoming more allergen-free and offering expanded options to those with food allergies.


Other

Look for the symbols, icons, and other pictures that indicate vegetarian options, heart-healthy choices etc. These often cater to populations looking to avoid certain ingredients while maximizing others.

For example, a heart healthy option might have less sodium and saturated fat compared to other items on the menu. Dairy-free and gluten-free options may be free of refined ingredients or contain lower fat alternatives. Icons can help you identify alternate options for eating.



Three Questions to Consider

It may seem overwhelming to consider all the menu items -- both for the client and the dietitian.


The key practice is to focus on three questions:

  1. Does this food fit my health needs? Does it meet my nutrition needs?

  2. Does this food make sense for my eating style? Is the restaurant kid-friendly, with healthy choices for younger diners?

  3. Do I genuinely enjoy eating or trying this type of food? Am I choosing a healthier option because I like it or just because it is “healthy”?


The answers to these questions can help guide the consumer to choose menu items that are right for them individually. For example, in some rare cases, clients may require more sodium for their health. Others may need less sodium to manage their health condition. This can make a high sodium option more healthful for one person and less healthful for another person.


These questions help to provide a framework for healthy choices when dining out. It’s important to keep health goals realistic and to help clients identify healthy choices for them individually. Acknowledge the challenges and small wins that come along with gaining these skills.



To-Do Before Browsing the Menu

The following are healthful actions to take before the server asks for your order:

  • Ask if there are options that allow you to “build your own _____” so you can customize your order.

  • Order water as your beverage of choice.

  • Have a response practiced and ready for pushy friends or family.

  • Know that the servers don’t have every ingredient memorized, and it’s always worth it to double check for allergens and any other ingredients you’re curious about.

  • Ask if anyone would like to split a meal with you. Portion sizes can sometimes be double (or more) of a regular serving. You’ll be helping your other-half eat healthier as well.

  • Don’t go out hungry. It’s okay to eat a little before a date or other outing if it’s in the effort of helping you make healthier decisions while you are at the eating location. Sometimes it can take upwards of an hour to be seated at a popular place. Be sure to fuel properly beforehand to avoid a dining binge during the main meal.


A common concern I get when I consult with dietitians is that clients feel overwhelmed at the thought of eating out AND making healthy choices at the same time.


My advice? Control what you can control, and use your resources for the rest. Don’t forget you're not alone, as a client or as a dietitian, and finding a community going through the same changes can make all the difference.


Very rarely are you the first person to have experienced this. That being said, your concerns are also unique and valid in their own right. Refer to your resources often, and don’t be surprised when you will find that others have often done the work for you by finding healthier or allergen-free versions of the processed foods you thought you couldn’t live without.


A Little Research Goes a Long Way


Look up the nutrition facts and item ingredients online before you eat out. A lot of places now offer filtering tools to help you in your efforts to avoid certain ingredients.


One of my absolute favorite resources is the EatWell Guide. It’s a database with over 25,000 restaurants, farms, and markets that offer local, sustainable, and organic food options. I’ve used it from San Francisco to New York, and it always helps me expand my options and find great new places to eat.




Menu-Savvy Skills for Dietitians to Teach Their Clients

For the majority of clients, dietitians can use these five easy tips to encourage their clients to eat out in healthful ways:

  1. Clue in on the information. Calories, salt, sugar, and saturated fats are generally the most telling nutrient numbers to look at.

  2. Consider asking for fruits and vegetables on the side. It’s easy to fill up on high-calorie and high saturated fat appetizers such as fries, dips, onion rings, and anything “smothered”. Fruit and vegetables help to leave room for the main dish while also providing some balanced calories to the meal.

  3. Get two meals out of one (save half for later). America has some of the most outrageous portion sizes on the planet. “Small” meals are often much larger than they should be. Don’t feel pressured to finish an entire meal in one sitting. Take half of it home, and BONUS -- your leftovers can become tomorrow’s lunch. See? A balanced eating plan can save you time and money.

  4. Opt for optimal hydration. Sodas, sports drinks, sweet teas, coffees, and lemonades are all common high-calorie culprits. The worst offender? Fruit drinks seldom contain actual fruit, and they contain around 240 calories per 12 ounces on average. Your best bet? Unsweetened tea or plain water.

  5. Order the entrée, but consider asking for (or skipping) the following on the sides: toppings, sauces, dressings, and dips. Sauces can contain many hidden ingredients. Sugar, salt, saturated fat, and more. Next time you dine out, ask for sauces on the side. At the very least, this will allow for a more metered approach to eating and moderation of added ingredients (instead of asking for more sauces throughout the meal). It’s important to make sure that you still eat a balanced meal.



The Bottom Line

Eating out and eating healthy IS possible once you get the hang of it, but it all starts with understanding the foundation of a healthy meal, knowing the importance of healthy ingredients and obtaining special skills that contribute to your personal sense of balance.


References


Academy of Nutrition and Dietetics staff registered dietitian nutritionists. Smart Tips for Reading Menus While Eating Out. Eatright.org. Published March 2020.


Academy of Nutrition and Dietetics. 7 tips for Healthy Dining Out. Eatright.org. Published January 3, 2019.


American Heart Association. Saturated Fat. Heart.org. Accessed March 2021.


Heart UK. Saturated fat. Heartuk.org.uk. Accessed March 2021.


Klemm S. 9 Ways to Deal with Dietary Restrictions at Holiday Meals. Eatright.org. Published November 19, 2018.


Mayo Clinic Staff. DASH diet: Tips for dining out. Mayoclinic.org. Published May 8, 2019.


O’Neil C. Dining Out with Kids. Eatright.org. Published January 30, 2019.


United States Department of Agriculture. Dietaryguidelines.gov. Published December 2020.