Fast food (patient information)

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 Editor in Chief: Atif Mohammad, MD

Overview
Fast food  is the term given to many items that can be prepared and served very quickly. While any meal with low preparation time can be considered to be fast food, typically the term refers to food sold in a restaurant or store with low quality preparation and served to the customer in a packaged form for take out/take away. The term "fast food" was recognized in a dictionary by Merriam-Webster in 1951.

Outlets may be stands or kiosks, which may provide no shelter or seating, or fast food restaurants (also known as quick service restaurants). Franchise operations which are part of restaurant chains have standardized foodstuffs shipped to each restaurant from central locations.

The capital requirements to start a fast-food restaurant are relatively small, particularly in areas with non-existent or poorly enforced health codes. Small, individually-owned fast-food restaurants have become common throughout the world. Fast food restaurants with higher sit-in ratios, where customers can sit and have their orders brought to them, are known as fast casual restaurants.

History
Although fast-food restaurants are often viewed as a representation of modern technology, the concept of "ready-cooked food to go" is as old as cities themselves; unique variations are historical in various cultures. Ancient Roman cities had bread-and-olive stands, East Asian cultures feature noodle shops. Flat bread and falafel are ubiquitous in the Middle East. Popular Indian "fast" food delicacies include Vada pav, Papri Chaat, Bhelpuri, Panipuri and Dahi Vada. In the French-speaking nations of West Africa, meanwhile, roadside stands in and around the larger cities continue to sell- as they have done for generations- a range of ready-to-eat, char-grilled meat sticks known locally as "brochettes" (not to be confused with the bread snack of the same name found in Europe).

United Kingdom
Fast food has existed in the UK since at least Roman Times, although the distinction between fast food items and fast casual restaurants has sometimes been blurred. Prior to the modern age, fast food in the UK has included meat pies and pastries as well as fried or battered items.

By the Medieval period it was not unknown for large cites or major towns to have 'pie shops' or cookhouses. Local pubs and taverns were also providers of 'rapid' if not fast food. As well as these fixed outlets, stalls selling cooked food were not uncommon. Cornish pasties and their descendants go back at least as far as the 13th century.

The content of pies varied, with poultry (such as chickens) or wildfowl commonly being used. Post WWII, turkey has been used more frequently in fast food.

In areas which had access to coastal or tidal waters, 'fast food' would frequently include local shellfish or seafood, (such as oysters or as in London eels), often this seafood would be cooked directly on the quay or close by. The development of trawler fishing in the mid nineteenth century would lead to the development of a British favorite fish and chips partly due to such activities.

Owing to differing availability of ingredients and tastes, until the Great War, British fast food had considerable regional variation. Sometimes the regionality of dish became part of the culture of its respective area.

A peculiarly British form of fast food is the sandwich, introduced by John Montagu, the 4th Earl of Sandwich c. 1762 when he wrapped dried meat in bread so as not to interrupt his work or his gambling (accounts vary). The sandwich has similarities in other cuisines and cultures such as the filled baguettes seen in France. Despite its wide appeal and consumption in the UK, it is only in recent years that the sandwich in its various forms has been considered to be fast food, initially being promoted as such by niche chains such as Subway and Pret-A-Manger.

As well as its native forms, the UK has adopted fast food from other cultures, such as Pizza (Italian), noodles (Chinese), Kebabs were adopted from Turkish defenders during the Crusades and various other forms of fast foods come from other parts of the British Commonwealth. and further afield. In some areas imported fast food has become part of both the local, and British culture in general. More recently healthier alternatives to conventional fast food have also emerged.

Recently on New Years Day 2008 a study was conducted worldwide counting the number of fast food restaurants per person. The UK has name claimed this title with Australia second and United States third. England alone accounted for 25% of all fast food.

United States
In 1867, Charles Feltman, a German butcher, opened up the first Coney Island hot dog stand in Brooklyn, New York, though the origin of the term is in dispute. The World's Columbian Exposition of 1893 (Chicago) and the St. Louis World's Fair of 1904 are credited with mass promotion of a number of portable foods, including the hot dog, the ice cream cone and iced tea.

The "diner" concept dates back to 1872, when Walter Scott of Providence, RI outfitted a horse-drawn lunch wagon with a simple kitchen so that he could bring hot dinners to workers.

The modern history of fast-food restaurants in the United States of America is often traced to 7 July 1912 with the opening of a fast food restaurant in New York City by Horn & Hardart. Their Automat was a cafeteria featuring prepared foods behind small glass windows and coin-operated slots. This was patterned after a Horn & Hardart Automat that had opened in Philadelphia in 1902. Numerous Automat restaurants were quickly built around the country to deal with the demand. Automats remained extremely popular throughout the 1920s and 1930s. The company also popularized the notion of “take-out” food, with their slogan “Less work for Mother”

As automobiles became popular and affordable following the First World War, drive-in restaurants were introduced. The American company White Castle, founded in 1921 by Billy Ingram and Walter Anderson in Wichita, Kansas in 1921, is generally credited with opening the second fast-food outlet and first hamburger chain, selling hamburgers for five cents apiece. Walter Anderson had built the first White Castle restaurant in Wichita in 1916, introducing the limited menu, high volume, low cost, high speed hamburger restaurant. Among its innovations, the company allowed customers to see the food being prepared. White Castle later added five holes to each beef patty to increase its surface area and speed cooking times. White Castle was successful from its inception and spawned numerous competitors.

Franchising was introduced in 1921 by A & W Root Beer, which franchised its distinctive syrup. Howard Johnson's first franchised the restaurant concept in the mid-1930s, formally standardizing menus, signage and advertising.

Curb service was introduced in the late 1920s and was mobilized in the 1940s when carhops strapped on roller skates.

McDonald's, the largest fast-food chain in the world and the brand most associated with the term "fast food," was founded as a barbecue drive-in in 1940 by Dick and Mac McDonald. After discovering that most of their profits came from hamburgers, the brothers closed their restaurant for three months and reopened it in 1948 as a walk-up stand offering a simple menu of hamburgers, French fries, shakes, coffee, and Coca-Cola, served in disposable paper wrapping. As a result, they were able to produce hamburgers and fries constantly, without waiting for customer orders, and could serve them immediately; hamburgers cost 15 cents, about half the price at a typical diner. Their streamlined production method, which they named the "Speedee Service System" was influenced by the production line innovations of Henry Ford. The McDonalds' stand was the milkshake machine company's biggest customer and a milkshake salesman named Ray Kroc traveled to California to discover the secret to their high-volume burger-and-shake operation. Kroc thought he could expand their concept, eventually buying the McDonalds' operation outright in 1961 with the goal of making cheap, ready-to-go hamburgers, french fries and milkshakes a nationwide business.

Kroc was the mastermind behind the rise of McDonald's as a national chain. The first part of his plan was to promote cleanliness in his restaurants. Kroc often took part at his own Des Plaines, Illinois, outlet by hosing down the garbage cans and scraping gum off the cement. Kroc also added great swaths of glass which enabled the customer to view the food preparation. This was very important to the American public which became quite germ conscious. A clean atmosphere was only part of Kroc's grander plan which separated McDonald's from the rest of the competition and attributed to their great success. Kroc envisioned making his restaurants appeal to families of suburbs.

"On The Go"
Fast-food outlets are take-away or take-out providers, often with a "drive-through" service which allows customers to order and pick up food from their cars; but most also have a seating area in which customers can eat the food on the premises.

The average American eats out more than five times a week [Arndt] and often, one or more of those five times is at a fast food restaurant.

Nearly from its inception, fast food has been designed to be eaten "on the go", often does not require traditional cutlery, and is eaten as a finger food. Common menu items at fast food outlets include fish and chips, sandwiches, pitas, hamburgers, fried chicken, french fries, chicken nuggets, tacos, pizza, hot dogs, and ice cream, although many fast-food restaurants offer "slower" foods like chili, mashed potatoes, and salads.

Filling Stations
Many petrol/gas stations have convenience stores which sell pre-packaged sandwiches, donuts, and hot food. Many gas stations in the United States also sell frozen foods and have microwaves on the premises in which to prepare them.

Street vendors and concessions
Traditional street food is available around the world, usually from small operators and independent vendors operating from a cart, table, or portable grill. Common examples include Vietnamese noodle vendors, Middle Eastern falafel stands and New York City hot dog carts. Commonly, street vendors provide a colorful and varying range of options designed to quickly captivate passers-by and attract as much attention as possible.

Depending on the locale, multiple street vendors may specialize in specific types of food characteristic of a given cultural or ethnic tradition. In some cultures, it is typical for street vendors to call out prices, sing or chant sales-pitches, play music, or engage in other forms of "street theatrics" in order to engage prospective customers. In some cases, this can garner more attention than the food itself; some vendors represent another form of tourist attraction.

Cuisine
Modern commercial fast food is often highly processed and prepared in an industrial fashion, i.e., on a large scale with standard ingredients and standardised cooking and production methods. It is usually rapidly served in cartons or bags or in a plastic wrapping, in a fashion which minimizes cost. In most fast food operations, menu items are generally made from processed ingredients prepared at a central supply facility and then shipped to individual outlets where they are reheated, cooked (usually by microwave or deep-frying) or assembled in a short amount of time. This process ensures a consistent level of product quality, and is key to being able to deliver the order quickly to the customer and eliminate labor and equipment costs in the individual stores.

Because of commercial emphasis on speed, uniformity and low cost, fast food products are often made with ingredients formulated to achieve a certain flavor or consistency and to preserve freshness.

Some items from McDonald's menu in particular include "chicken, hamburgers, French fries, Egg McMuffins ... premium salads, chicken sandwiches, yogurt parfaits, [and] fruit salads," [Adams]. 58 of the restaurant's menu items had "at least one serving of fruits and vegetables" and include the Fruit and Walnut Salad, Bacon and Ranch Salad, Cesar Salad, Minute Maid Orange and Apple Juices, and the Asain Salad [Adams].

Variants
Although fast food often brings to mind traditional American fast food such as hamburgers and fries, there are many other forms of fast food that enjoy widespread popularity in the West.

Chinese takeaways/takeout restaurants are particularly popular. They normally offer a wide variety of Asian food (not always Chinese), which has normally been fried. Most options are some form of noodles, rice, or meat. In some cases, the food is presented as a smorgasbord, sometimes self-service. The customer chooses the size of the container they wish to buy, and then is free to fill it with their choice of food. It is common to combine several options in one container, and some outlets charge by weight rather than by item. Many of these restaurants offer free delivery for purchases over a minimum amount.

Sushi has seen rapidly rising popularity in recent times. A form of fast food created in Japan (where obento is the Japanese equivalent of fast food), sushi is normally cold sticky rice served with raw fish. The most popular kind in the West is rolls of rice in nori (dried laver), with filling. The filling often includes fish, chicken or cucumber.

Pizza is a common fast food category in the United States, with chains such as Domino's Pizza, Sbarro's and Pizza Hut. Menus are more limited and standardized than in traditional pizzerias, and pizza delivery, often with a time commitment is offered.

Kebab houses are a form of fast food restaurant from the Middle East, especially Turkey and Lebanon. Meat is shaven from a rotisserie, and is served on a warmed tortilla with salad and a choice of sauce and dressing. These doner kebabs are distinct from shishkebabs served on sticks. Kebab shops are also found throughout the world especially Europe, but they generally are less common.

Fish and chip shops are a form of fast food popular in the United Kingdom, Australia and New Zealand. Fish is battered and then deep fried.

The Dutch have their own types of fast food. A Dutch fast-food meal often consists of a portion of french fries (called friet or patat) with a sauce and a meat product. The most common sauce to accompany French fries is mayonnaise, while others can be ketchup or spiced ketchup, peanut sauce or piccalilli. Sometimes the fries are served with combinations of sauces, most famously speciaal (special): mayonnaise, with (spiced) ketchup and chopped onions; and oorlog (literally "war"): mayonnaise and peanut sauce (sometimes also with ketchup and chopped onions). The meat product is usually a deep fried snack; this includes the frikandel (a deep fried skinless minced meat sausage), and the kroket (deep fried meat ragout covered in breadcrumbs).

Business


In the US alone, fast food sales were 157 billion dollars in 2008. In 2006, the global Fast food market grew by 4.8 %.It is projected to grow by 22 % by 2011. McDonalds has announced to open 1000 new restaurants worldwide. Likewise, Burger King has announced to open 300 new stores in Europe particularly in Russia in 2010. Yum Brands has announced to open 1000 more outlets in India by 2012. In a press release, McDonald’s announced a global sales increase of 3.8%, fueled by the U.S. 2.6%, Europe 5.2% and Asia/Pacific, Middle East and Africa 3.4% and serving 60 million customers per day worldwide over the year 2009 despite tough economic recession times. Currently, fast food restaurants are facing severe competition with fast food casual restaurants like Panera reported a 14.1 % increase in revenue over the first quarter of 2010 proving the point that better seating arrangements add to the business value of the franchise. .As of 2010,McDonald's has offered free Wi-fi services to its customers in approximately 11,000 outlets across US to compete with casual dining restaurants which have become very popular in today's world.

Globalization
In 2006, the global fast food market grew by 4.8% and reached a value of 102.4 billion and a volume of 80.3 billion transactions. In India alone the fast food industry is growing by 40% a year. Yums Brands is the parent company which oversees the business of KFC, Pizza Hut, Taco bell, A&W root beer(excluding Canada),Wings street and Long John Silver’s. It is the largest fast food restaurant company worldwide operating more than 36,000 stores worldwide. It has announced to open 1000 new outlets in India by 2012.

McDonald’s is located in 120 countries and operates 30,000 restaurants around the world. On January 31, 1990 McDonald’s opened a restaurant in Moscow, and broke opening day records for customers served. The Moscow restaurant is the busiest in the world. The largest McDonald’s in the world is located in Beijing China.

There are numerous other fast food restaurants located all over the world. Burger King has more than 11,100 restaurants in more than 70 countries. KFC is located in 109 countries and is operating 15,000 stores worldwide 800 of them located in China. Subway has 29,186 restaurants located in 86 countries, the first international location opened in December of 1984 in Bahrain. Pizza Hut is located in 26 countries, with 100 locations in China. Taco Bell has 278 restaurants located in 12 countries besides the United States.

Criticism
Fast-food chains have come under fire from consumer groups, such as the Center for Science in the Public Interest, a longtime fast-food critic over issues such as caloric content, trans fats and portion sizes. Some of the concerns have led to the rise of the Slow Food movement. This movement seeks to preserve local cuisines and ingredients, and directly opposes laws and habits that favor fast-food choices. Proponents of the slow food movement try to educate consumers about what its members considers the richer, more varied and more nourishing tastes of fresh, local ingredients that have been recently harvested.

Health issue
The major health risks related to obesity, increased salt intake and food poisoning.

Obesity
Obesity or being overweight can affect
 * Heart-High blood pressure,heart attack
 * Diabetes (high blood sugar levels) which itself affects heart,nerves, kidney,eyes and feet.
 * High cholesterol levels
 * Cancer
 * Stroke
 * Liver disease
 * Sleep disorders
 * Gynecological problems

Obesity is one of the top three leading causes of preventable deaths in the US. Fast food eating causes high calories, low fibers and high trans-fat intake. In 2006, Americans spent approximately 48% of their food dollars on food made outside of home as compared to 26% in 1970.Adults who eat fast food consume 250 more calories than those not eating at fast food restaurants. Likewise, children consume 155 more calories. Adults in USA consume 3900 calories which is 1600 calories more than the required 2300 calories intake/day for adults.

The director for Obesity program at Boston’s Children Hospital Dr. David Ludwig, MD claims that “"fast-food consumption has been shown to increase calorie intake, promote weight gain, and elevate risk for diabetes"

About one -quarter of Americans eat on fast food every day. A regular MacDonald’s meal comprising of a Big-Mac, fries and large Coke consists of 1350 calories.Currently; rates are higher in the South then the North with Colorado reporting to have smallest percentages of obesity rates Approximately 66 % of Americans are considered to be overweight or obese.

Trans-Fatty Acids (Trans-fat)
The trans-fat content is more in fast foods. Trans-fats are found in small amounts in various animal products such as beef, pork, lamb and the butterfat in butter and milk. These are formed during the processing of cooking oils and margarine which constitute ¾ of trans-fat in the American diet today.

Trans-fat generally increases the “Bad Cholesterol” content and decreases the “Good Cholesterol” in the body which increases the chances of getting heart disease, stroke and high blood sugar.

Major cities like New York and Boston have imposed a ban to limit the trans-fat content in foods served at fast food restaurants to be less than 0.5g per serving.A doughnut for breakfast contains 3.2 g of trans-fat and a large fries contains approximately 6 g of trans-fat which is much higher than recommended .Trans-fat content can cause increase in weight which can further lead to heart diseases and other diseases as mentioned above.

Major hospitals institutes like the Cleveland Clinic, Michigan Health and Hospital Association have already applied a trans-fat ban on food products being manufactured within the hospitals and also coming as stored packages.

Increased Salt Intake
Increase in salt intake leads to increase in blood pressure .Fast foods are generally more in salt content as compared to diets consisting of fruits and vegetables.Increased salt content in the diet leads to high blood pressure which can further lead to heart attack or stroke.Heart disease is currently one of the top 3 leading causes of death in America.

In a recent study published in the New England Journal of Medicine,it was reported that reduction of salt intake by 3 g/ day can reduce the number of new cases of heart disease (Coronary Heart Disease) by 60,000 to 120,000 and stroke by 30,000 to 60,000 and decrease the number of deaths to approximately by 40,000 to 90,000.Currently, approximately 100,000 deaths are considered to be due to increase salt intake.

Infections (Food Poisoning)
Besides the dangers of Trans fats, high calories, and low fiber, there is another health risk, food poisoning.Food poisoning leads to nausea,vomiting,diarrhea and pain in stomach.Different infections can occur due to uncooked hamburgers which leads to food poisoning.Sometimes, the meatpacking process before which the meat is cooked can get contaminated with infectious agents which can lead to food poisoning and other infections.

Health Care Costs
The overall medical care cost for someone who is obese is calculated to be $10,000 over a lifetime more than one who is not obese. It can easily be reduced to $2,300 dollars by reduction in 10% in weight.Health care costs annually $147 billion for overweight and obese Americans.

Recommendations
The American Heart Association's Nutrition Committee strongly advises that healthy Americans over age 2 limit their intake of trans fat to less than 1 percent of total calories. Based on current data, the American Heart Association recommends that consumers follow these tips:
 * Choose a diet rich in fruits, vegetables, whole-grain, high-fiber foods, and fat-free and low-fat dairy most often.
 * Keep total fat intake between 25 and 35 percent of calories, with most fats coming from sources of monounsaturated and polyunsaturated fats such as fish, nuts, seeds and vegetable oils most often.
 * Use naturally occurring, unhydrogenated vegetable oils such as canola, safflower, sunflower or olive oil most often.
 * Look for processed foods made with unhydrogenated oil rather than partially hydrogenated or hydrogenated vegetable oils or saturated fat.
 * Use soft margarine as a substitute for butter, and choose soft margarines (liquid or tub varieties) over harder stick forms. Look for ”0 g trans fat” on the Nutrition Facts label.
 * French fries, doughnuts, cookies, crackers, muffins, pies and cakes are examples of foods that are high in trans fat. Don't eat them often.
 * Limit the saturated fat in your diet. If you don't eat a lot of saturated fat, you won't be consuming a lot of trans fat.
 * Limit commercially fried foods and baked goods made with shortening or partially hydrogenated vegetable oils. Not only are these foods very high in fat, but that fat is also likely to be very hydrogenated, meaning a lot of trans fat.
 * Limited fried fast food. Commercial shortening and deep-frying fats will continue to be made by hydrogenation and will contain saturated fat and trans fat

Further information for heart healthy diet can be found on American Heart Association website http://www.americanheart.org

Similar dietary guidelines are recommended by the American Dietetic Association and Institute of Medicine.

http://www.eatright.org/

http://www.iom.edu/


 * Convenience food
 * Dieting
 * Fast food restaurant
 * Food groups
 * Fast Food Nation (film)
 * Restaurant
 * Slow Food
 * Super Size Me
 * Western pattern diet
 * Chew on this