Obesity increases a person's risk for developing chronic health problems such as hypertension, diabetes, cardiovascular disease, and stroke (1). Because most US adults are overweight or obese (2), weight management is essential for chronic disease prevention. Dramatic increases in the prevalence of obesity in the past 25 years are attributed to an environment that promotes excessive calorie intake, coupled with a sedentary lifestyle (3). Eating in restaurants contributes to this excess intake; Americans are 40% more likely to eat out at least 3 times per week now than they were in the 1980s (4), often eating large portions of calorie-dense foods (3).

Frequency of restaurant eating is positively associated with calorie and fat intake, along with body fat (3-6). Other studies show positive associations between frequency of eating fast food and body mass index (7-8). Little is known, however, about how restaurant eating affects weight management. We conducted a Medline search and found no studies that specifically addressed strategies used to manage weight or barriers to weight management when eating out. Studies have found that several factors influence restaurant eating behavior: taste, portion size, emotional needs, perceived value, and social interaction (9-17). These factors are often barriers to weight management when eating out.

The main objective of this study was to describe how often women and men use different strategies for managing weight when eating out (including fast food) and the magnitude of barriers to managing weight when eating out. Because sex differences occur in food choices and weight management behaviors (18-20), a secondary objective was to explore sex differences in the specific strategies used and the barriers encountered to increase our understanding of weight management in restaurant settings.

This descriptive survey study used a convenience sample recruited in the spring of 2006 during a campus-wide open house at the University of Texas at Austin, so the adults sampled for this study consisted primarily of parents of children of all ages (preschool to high school). The study was approved by the university's institutional review board, and all participants were provided with a cover letter that described the study.

The only inclusion criterion for the study was being at least 18 years old. To capture a variety of eating strategies used in restaurants, we included participants who were not dieting because many people who use strategies to manage weight may not be actively dieting. Adults who passed the display table for the study were asked to participate. Participants completed 3 questionnaires: background information, strategies for managing weight when eating at restaurants, and barriers to managing weight when eating at restaurants. A total of 156 adults completed the surveys. Participants received a pencil for participating.

We do not know the rate of nonresponse; we could not track people who declined to participate. We excluded participants only if 10% or more items were missing on either the strategies or barriers questionnaires, which resulted in a final sample of 146 participants. According to power analysis with an α of .05 for a 2-tailed test and a power of .80, a sample size of 146 would be adequate to detect a significant difference in an independent t test if a medium-to-large effect size was present (Cohen d > 0.48).

Of the 146 participants who completed the study, 56% were non-Hispanic white, 30% were Hispanic/Latino, and 3% were African American. The mean age of the sample was 38 (standard deviation [SD], 11) years, and 62% were women. Most of the sample was well educated (84% had at least some college).

Participants ate out an average of 3.5 (SD, 2.8) times per week, and men and women did not differ in frequency of eating out. Of the 41% of participants who reported eating in response to emotions, most (70%) were women. More than half (60%) of the participants reported that they watched what they ate to manage weight at least sometimes. Weight cycling occurred an average of 1 (SD, 1.5) time. We found no significant differences between men and women for educational level, ethnicity, frequency of managing weight by watching what you eat, eating in response to emotions, or number of times weight cycling occurred.

The top strategies for managing weight for both women and men were to avoid sugar-filled drinks, choose steamed vegetables, stop eating when full, and choose foods made with whole grains (Table 1). Strategies that were rarely used for both women and men were to have the bread or chip basket removed from the table, have a low-calorie snack before going out to eat, and ask the chef to prepare a menu item in a low-calorie or low-fat manner.

Of the 30 strategies, use of 6 differed significantly by sex (Table 1). Compared with men, women more frequently shared appetizers, substituted an appetizer for a meal, ate a salad for the main course, ordered salad dressing on the side, had half of the meal packaged to go, and shared a meal with a dining partner. All differences that we found to be significant with a t test retained significance when we used the Mann-Whitney U test, a nonparametric test.

The leading barriers for both women and men were that a busy lifestyle results in being overly hungry when eating out, restaurant food tastes good, and not wanting to waste food (Table 2). Factors that were not barriers were finding it hard to ask wait staff to package meal to take home, not wanting to take leftovers home, difficulty getting others to share an entrée or dessert, wanting to eat the same thing as dining companions, and eating out when not hungry to please others. The only barrier that was significantly different between men and women was difficulty in having the bread or chip basket removed from the table: women were more likely than men to perceive it to be a barrier.

Participants varied in how often they used different weight management strategies; numerous strategies were used regularly by some but not by others, which indicates that strategies for managing weight in restaurants should be individualized. Further research on factors that influence food choice and weight management behaviors in restaurant settings is needed to clarify how weight management can best be incorporated into restaurant eating. Additional research is also needed to establish the effectiveness of preventing weight gain when specific strategies for weight management in restaurants are used.

Women and men in this study had few significant differences in strategies used to manage weight in restaurants or in the barriers they encountered. Of the 6 differences in strategies, 5 involved reduced portion size and 1 involved eating salad as an entrée. One possible explanation is that American cultural standards include men eating heartily (24). Some people may view a hearty appetite and red meat consumption as masculine (25,26). Since eating out often occurs in social settings, some men may eat large portions of food or refuse to eat a salad as a main course so that they will be viewed as more masculine. Further study of sex differences in weight management strategies is needed with larger samples to validate the findings of this study and to clarify the differences.

One of the major barriers to weight management when eating out was that restaurant food tastes good. Taste influences restaurant selection and food choice (9,11), and palatability is associated with higher calorie intake (27). One possible way to address this barrier is to encourage people to be mindful as they eat, savoring each bite, maximizing the pleasure of eating while reducing the amount of food needed to be satisfied (28). Another barrier was not wanting to waste food. This barrier may be linked to the need to get the best value, which is determined by cost and portion size (3). Combined with excessively large portions endemic in many restaurants, not wanting to waste food can lead to overconsumption (29). If restaurants made nutrition information available on menus, including the portion sizes served, customers could weigh the cost of consumption in terms of calories and fat. Other approaches would be to provide restaurants with incentives to offer smaller portions or provide take-home containers concurrent with the meal.