Eighty-five percent of menu items from the six highest selling fast-food restaurants in the USA are ultra-processed.

Objective: While fast-food is typically considered highly processed, an analysis to demonstrate this has yet to be conducted. Therefore, the objective of this research was to examine the menu items and ingredients from six fast-food restaurant menus using the NOVA classification.

Design: Cross-sectional study.

Setting: Data were collected from the top six highest selling US restaurants, per each food category, identified using the Quick Service and Fast Casual Restaurants (QSR) 2020 report.

Participants: A total of 740 menu items were identified and classified according to their degree of processing based on ingredient lists using the NOVA classification: minimally processed (MPF), culinary processed ingredient (CPF), processed (PRF) or ultra-processed (UPF). In addition, individual ingredients that appeared on at least three menus were classified into NOVA groups, and the twenty most common ingredients were identified based on frequency of appearance in ingredient lists.

Results: Across all menus, 85 % (range: 70-94 %) of items were UPF with only 11 % (range: 6-25 %) being MPF (P < 0·001). Additionally, 46 % of the ingredients that appeared on at least three menus were ultra-processed ingredients. Three ultra-processed ingredients appeared on all six menus: natural flavours, xanthan gum and citric acid.

Conclusions: These findings show that the vast majority of menu items from major fast-food restaurants are UPF, and there are few options for MPF. Fast-food companies should consider reformulation or the addition of MPF to the menu to increase healthful food options for their patrons.