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Family dynamics at mealtimes have changed. With both parents working, home-made food and regular mealtimes are becoming a thing of the past. Americans are consuming more food prepared away from home and it is this fact that caught the attention of Erin Gilgan, a recent online Master of Public Health (MPH) graduate and Student of the Year awardee from the University of Liverpool.

The United States is facing an obesity epidemic, with more than two-thirds of adults and one-third of children having unhealthy weights and an increased risk of associated chronic diseases¹. This equates to an estimated $147-190 billion dollar spend in terms of private and public healthcare costs associated with obesity².

Focusing on food consumed away from home

University of Liverpool MPH graduate Erin Gilgan is passionate about nutrition and well-being. She performs a significant role with Nestlé Professional as the global Nutrition, Health & Wellness Champion. Now based in Switzerland, Erin studied her MPH online while living in the USA. It was during her time in America that she became aware of the potential impact that ‘food consumed away from home’ was having on diet and health in a population with high obesity rates.

“Restaurants pride themselves on serving their customers good food whereas consumers in a culture of convenience now rely on restaurants to provide a core part of the American diet. According to the National Health and Nutrition Examination Survey (2013) some age groups derive up to 26.3% of their energy from restaurant food³. Diets high in ‘away-from-home food’ are associated with increased energy consumption,” she said.

Erin chose to research this issue for her MPH dissertation. She set out to explore industry professionals’ perspectives on how restaurants contribute to the US food supply, obesity, and elevated risk for lower socioeconomic groups. Her aim was to identify opportunities to engage and support the industry to promote healthier eating patterns.

Online MPH research interviews

As part of her research, Erin interviewed 10 restaurant industry professionals who influence menu offerings – including chefs, operations and marketing executives, senior managers and owners from major restaurant chains and independently owned establishments in the northeast Ohio region of the United States. She explored their awareness of the impact they had on the diet and nutritional intake of their customers.

Erin discovered that participants were generally aware of obesity as a public health concern, but that there were mixed responses regarding their own perceived responsibility in contributing to or addressing the epidemic. Overall, the majority of participants’ perspectives on how the restaurant industry might contribute to food environments, local food supply and health inequalities were limited due to a general lack of awareness. The findings were considered within a social ecological model showing opportunities for restaurants to make improvements within their establishments to promote nutritious menus, but equally importantly there were factors beyond their walls that challenged their ability to change. “This highlights the complexity of the public health challenge and need for a multi-sector approach to address it,” said Erin.

Online MPH research findings

Erin identified three emerging themes: the role of the restaurant, the knowledge gap – both for consumers to be able to achieve a healthy, balanced diet and for restaurant professionals to provide such a diet – and requirements for supporting consumers to make healthy choices when dining away from home. She investigated these themes by conducting a series of qualitative interviews. The results indicated that participants felt that both individual and interpersonal factors resulted in a reliance on restaurant foods by consumers. In addition, the environment within restaurants may make it difficult for consumers to make healthy choices, and broader environmental factors like food supply and regulations challenged the industry to make healthy choices more accessible.

Collaboration to combat obesity

While Erin is in the unique position to be able to apply her learning and research directly to her role at Nestlé Professional, she believes that more can be achieved. “This topic is generally underexplored and there is a need for more research in this area,” said Erin. “Recognising that there are several factors that influence health at the community level – such as neighbourhood safety, access to transportation, healthy food and other social determinants of health – research may also consider the role of collaboration between industries, stakeholders and private/public sectors”.

Erin believes that the need to raise awareness of the impact restaurants may have on nutrition and public health also highlights the need for more leadership and guidance within the restaurant industry, including industry associations, educational institutions or even larger restaurant groups. “Adjacent to this notion, is the need for more nutrition and health education for food providers – for example, by including more nutrition education in culinary and hospitality schools – as well as, stronger curricula in schools for younger generations and community programmes to support families,” she said.

Erin Gilgan spoke on the impact and role of restaurants and ‘out-of-home foods’ on diet quality at the World Chefs Congress & Expo in 2016.

¹ Ogden, C.L., Carroll, M.D., Kit, B.K. and Flegal, K.M. (2014) 'Prevalence of childhood and adult obesity in the United States, 2011-2012', The Journal of the American Medical Association, 311(8), pp. 806-14 [Online]. DOI: 10.1001/jama.2014.732.

² Hammond, R.A. and Levine, R. (2010) 'The economic impact of obesity in the United States', Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 3, pp. 285-95 [Online]. DOI: 10.2147/DMSOTT.S7384.

³ Drewnowski, A. and Rehm, C.D. (2013) 'Energy intakes of US children and adults by food purchase location and by specific food source', Nutrition Journal, 12(1), pp. 59-69 [Online]. Available at:

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