Healthful vs. Unhealthful Plant-Based Restaurant Meals

<i>Background:</i> Vegan/vegetarian (VEG) restaurants and VEG options in omnivore (OMNI) restaurants may serve unhealthful plant-based food that may be more harmful than a typical American diet. <i>Methods:</i> A sample of 561 restaurants with online menus were analyzed over a 3-year period. Each plant-based menu entrée was counted, up to a maximum of ten entrées per restaurant, meaning that a restaurant customer could select from ten or more healthful plant-based choices. Entrées containing refined grains (e.g., white rice and refined flour), saturated fat (e.g., palm oil and coconut oil), or deep-fried foods were counted as zero. <i>Results:</i> We evaluated 278 VEG and 283 OMNI restaurants. A full menu (10 or more plant-based entrées) was available in 59% of the VEG, but only 16% of the OMNI (<i>p</i> < 0.0001). Zero healthful options occurred in 27% of OMNI, but only 14% of VEG (<i>p</i> = 0.0002). The mean healthy entrée count for all restaurants was 3.2, meaning that, on average, there were only about three healthful plant-based choices of entrées on the menu, significantly more in VEG (4.0 vs. 2.4 <i>p</i> < 0.0001). The most common entrée reduction was for refined grains (e.g., white flour in veggie-burger buns or white rice in Asian entrées, n = 1408), followed by fried items (n = 768) and saturated fat (n = 318). VEG restaurants had a significantly higher frequency of adequate VEG options (≥7 options, 24% vs. 13%, <i>p</i> = 0.0005). <i>Conclusions:</i> Restaurants listed as VEG have a slightly higher number of healthful entrées than OMNI restaurants, which offer more limited vegan/vegetarian options. Given the published relationship between unhealthful dietary patterns, chronic illness, and mortality, we propose that detailed nutrition facts be publicly available for every restaurant.