Fast food gets a bad rap. The industry is actively cutting back on calories, sodium, trans fats, high fructose corn syrup, and other ingredient components that are detrimental to nutrition, but consumers and watchdogs alike are still quick to point fingers when the nation’s health woes come under debate.

Of course, the industry isn’t blameless. Until recently, large portion sizes and indulgent ingredients were the name of the game. And health data over the past four decades show alarming trends: The percentage of overweight adults ages 20–74 rose from 47.4 in 1970 to 68.5 in 2010, while the percentage of obese adults more than doubled from 15.1 percent to 35.3 percent, according to the Centers for Disease Control’s (CDC) “Health, United States, 2012” report. In addition, heart disease continues to be the No. 1 killer of American men and women, despite significant declines over the years reflected in the CDC report.

Statistics like these have made consumers more conscious of what they eat, especially when they eat out, and restaurants have changed with the times.

“I think the industry has done a good job, but we can’t rest on our merits,” says Joy Dubost, director of nutrition and healthy living at the National Restaurant Association (NRA).

Pointing to research published in the Nutrition Journal in 2013, Dubost says that “burgers coming from quick-serve restaurants only contribute … up to 2 percent of calories in the diet at its highest point. That’s for the age group of 12–19-year-olds. So that’s pretty low.” The ever-popular french fry contributes even less, she says.

But in an industry landscape that’s moving in the direction of better-for-you foods, traditional quick serves still have room for improvement, especially in their most classic offerings. Here, we examine five of the most popular menu items—burgers, fries, pizza, sandwiches, and chicken—and what can be done to improve their nutritional profile.

Burgers

Perhaps the most ubiquitous menu item in quick-service restaurants, the burger is a mainstay of the American diet, and it isn’t going away. While fast casuals and better-burger joints have enhanced the burger’s image with premium ingredients and better sourcing practices, operators are still struggling to figure out a successful way to make the burger healthier.

“In terms of the nutritional culprits, it’s really the calories and saturated fats that can add up very quickly in a burger,” says Nicole Ring, director of nutrition at Healthy Dining, an organization that offers nutritional analysis and menu development assistance to the restaurant industry and maintains an online resource guide for consumers. “We’ve seen, when we do nutritional analysis at quick-serve restaurants, the bun alone can have upward of 300 calories. That’s before you’ve added any of the protein and the toppings.” Many restaurants will also add butters to enhance the flavor of a bun, which can be a hidden source of extra calories and fat, she adds.

At fast-casual chain Mooyah Burgers, Fries & Shakes, founder Rich Hicks tackles the problem of a highly caloric burger bun with a staple menu item known as the Iceburger. Wrapped in lettuce rather than sandwiched between bread, the Iceburger eliminates as many as 200 calories and 4.5 grams of fat when compared with the brand’s white and wheat buns.

“We’re seeing an uptick in the Iceburger,” Hicks says. “It’s something our customers really want because it addresses a lot of dietary needs.”

A few Mooyah locations also serve smaller buns, at 2 ounces instead of 2.5 for regular white and 2.7 for regular wheat. The smaller buns have only 140 calories. The brand also goes beyond beef, offering both a turkey patty and a black-bean veggie patty. Hicks says he sees more turkey burgers carving into beef purchases year over year at the chain, and the popularity of the veggie burger has risen, too. While the turkey and veggie patties may not be significantly lower in calories compared with Mooyah’s beef patty, both have less fat—the veggie burger has less than half of the beef patty’s 18 grams of fat.

“I think [quick-service restaurants] have a big problem with what they’re putting between the bun,” says Jayne Hurley, a registered dietitian with the Center for Science in the Public Interest (CSPI), a nonprofit advocacy group that focuses on improving the health and safety of food. “The problem with lean ground beef is that a 3-ounce cooked patty is going to have a third of a day’s saturated fat.”

McDonald’s 2.9-ounce beef patty, the size (after cooking) offered on Quarter Pounder burgers, has 16 grams of fat, accounting for 25 percent of a daily serving, and 7 grams of saturated fat, accounting for 35 percent.

“Restaurants may be hesitant to provide a leaner cut of meat because … that fat is going to provide a really nice mouthfeel and taste,” NRA’s Dubost says. However, that doesn’t mean there aren’t opportunities for improvement in the meat. Dubost suggests chains consider beef patties that are at least 93 percent lean.

Fries

Frequently acting as the burger’s sidekick, the french fry has the ability to drive up calories, fat, and sodium. But Dubost says they aren’t as bad as one would think.

“Frankly, french fries get a bad reputation,” she says. “Potatoes in general, even if they’re prepared fried, are the best source of potassium of all the vegetables, and Americans don’t consume enough potassium in their diet. They’re also high in fiber.”

That said, there are still things quick-serve owners and operators can do to lighten the load of this staple side dish. Looking at fresh versus frozen or pre-cut potatoes is one place to start, Ring says. “A lot of pre-packaged frozen fries have a coating added to the potato, so there’s likely extra fat, sodium, and carbohydrates depending on what’s in the coating,” she says.

Some fast-casual concepts, like Five Guys Burgers & Fries, are offering hand-cut fries as a healthier, more premium version of the side dish.

“Leaving the skin on adds to the nutritional value,” says Don Odiorne, vice president of foodservice for the Idaho Potato Commission. “The cost is worth it if you want to make [fries] a signature item and if you can charge a little more to cover the labor costs. It is not unusual at a Five Guys or Cheeseburger Bobby’s, for example, to dedicate one to two people full-time to cutting, blanching, storing, and finish frying.”

But Odiorne says he wouldn’t always bet against pre-cut, pre-packed potatoes. In fact, he says, some suppliers offer fries with a coating intended to help the potato absorb less oil during frying.

Less oil absorption is reported to be the trick to Burger King’s game-changing Satisfries. The new alternative offers 30 percent less fat and 20 percent fewer calories than the brand’s normal fries; compared with McDonald’s fries, they have 40 percent less fat and 30 percent fewer calories. As the first mainstay quick serve to focus on the french fry so intently, Burger King set out to prove that change is possible.

Pizza

While pizza has the potential to be healthy, there is arguably less innovation in the segment in regards to nutrition.

Dubost says it’s often hard to control pizza’s nutrition. “Pizza can be a very healthy dish to have, but portion size can be hard to control because people will just eat so much of it,” she says.

There are, however, ways to improve the nutrition of individual ingredients. CSPI’s Hurley says crust should be of particular concern to those who are serious about offering healthier options. She says a thinner crust is the way to go.

At Pizza Hut, a slice of a 12-inch cheese Pan Pizza has 240 calories, 10 grams of fat, and 540 milligrams of sodium. A slice from a 12-inch cheese Thin ’N Crispy pizza has 190 calories and 8 grams of fat, but 580 milligrams of sodium, perhaps to enhance taste. The brand’s new Hand-Tossed Style Pizza, arguably inspired by the growing list of fast-casual options available, has 220 calories, 8 grams of fat, and only 480 milligrams of sodium per slice.

At Domino’s, the stats are similar: A small Crunchy Thin Crust has 330 less calories than its small Hand Tossed Crust, and the thin crust option has only 85 milligrams of sodium, compared with 930 milligrams in the latter option. The brand also offers a gluten-free crust as a healthier alternative.

Healthy Dining’s Ring says quick serves could learn a lot about different flour from their fast-casual counterparts. “We work with a pizza chain, RedBrick Pizza, that puts wheatberries in its crust to offer more nutritional impact,” she says. It wouldn’t be too far-fetched for Domino’s, Pizza Hut, and the like to offer something similar, she adds.

In fact, Domino’s already has a model for healthier pizza within its system—the company’s Smart Slice pizza, which is offered to schools, has 24 grams of whole grain per serving and 35 percent less sodium than its traditional pizza. It’s also made with pepperonis that have 33 percent less fat and 50 percent less sodium than its traditional pepperonis, and the lite Mozzarella has half the fat of the brand’s regular Mozzarella.

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Sandwiches

Much like the burger, the sandwich has several components that can be tweaked to offer consumers a bevvy of nutritional value—there’s the bread, proteins, cheeses, vegetables, and condiments. One of the most customizable quick-serve staples, the sandwich had seen a fair amount of innovation and heightened attention to quality ingredients.

As the category leader, Subway has positioned itself as a healthful alternative to other fast-food options through careful marketing and its iconic spokesman, Jared Fogle. And company executives have put their money where their mouth is, continually working to improve Subway’s nutrition.

“Back in 2009, we were looking at nutritional parameters, and there was a lot of talk about sodium in the diet,” says Lanette Kovachi, Subway’s corporate dietitian. “We thought we could do more to make our sodium levels more responsible.”

Since then, the chain has cut sodium in its sauces, turkey, ham, roast beef, and bread, accounting for a 30 percent decrease across its entire menu, Kovachi says. The changes make Subway a more ideal choice for those seeking a heart-healthy diet.

“We know definitively that sodium increases blood pressure … particularly as one ages and in certain populations. If you have higher blood pressure, that’s a risk factor for heart disease,” NRA’s Dubost says. “The controversy revolves around if a high-sodium diet drives up the risk of heart disease, and that’s where the evidence hasn’t been as clear. Nonetheless, blood pressure has been an issue in this country.”

Kovachi says Subway’s commitment to nutrition often means months, sometimes years, of recipe and product testing because the chain can’t compromise flavor. “Of course, bread has the biggest impact on our nutrition, so if we can do something positive to the bread, we can do something positive to the sandwiches,” she says. In 2011, the brand fortified all of its bread varieties with calcium and vitamin D, and a 6-inch piece of bread offers as much calcium as a glass of milk.

“For us, it’s extremely important that we’re ahead of the nutrition trends. It never stops—we’re always looking at ways to improve the products,” Kovachi says. “We also always want to have choices for our customers, including those more indulgent choices.”

CSPI’s Hurley says portion size plays a big role in how healthy a sandwich can be. “Sometimes this means you’re consuming more calories than you would in a burger,” she says. “If you’re talking about a fast-casual place like Panera or Au Bon Pain, those kinds of places have a problem with the size of their sandwiches.”

When compared with Subway’s 6-inch Turkey Breast sandwich, Panera’s Smoked Turkey Breast on Country Bread has almost double the calories—430 to Subway’s 217. Au Bon Pain’s Turkey and Swiss sandwich weighs in at 740 calories.

“Half portions for sandwiches are really ideal from some chains because they can just be so large,” Healthy Dining’s Ring says. “You can have those with a salad and light dressing, and it becomes a much better option.” Both Panera and Au Bon Pain offer half-sandwich portions.

Ring says there is still room in the segment to add new sauces, vegetables, and even fruits. “We’re seeing a lot of restaurants get creative and use hummus as a spread instead of mayo,” she says. “Some other unique ingredients we’ve seen include thinly sliced sweet potatoes and thinly sliced green apple.” For its part, Subway recently ensured all of its restaurants offer spinach year-round and avocados during the summer.

Chicken

Chicken, when pared down to its poultry essence, is a healthy, lean protein source. But when seasoned and battered and fried, not so much.

“Obviously, if you’re not going to fry, and you’re going to bake, grill, or boil, it’s going to drive down calories,” Dubost says. “With fried chicken, the breading can drive up fat and sodium, and not all chicken is heavily breaded. That’s one thing you could be mindful of.”

Sodium is a key area of concern because many chains offer poultry that’s been injected with salt water to increase food safety, Dubost says. The Food and Drug Administration suggests that one’s daily intake of sodium should be no more than 2,400 milligrams.

At KFC, which boasts a variety of fried chicken options seasoned with a secret combination of herbs and spices, a single Original Recipe chicken breast can account for nearly half a day’s sodium intake, at 1,080 milligrams. The same cut of meat in the brand’s Extra Crispy recipe has 1,140 milligrams of sodium, along with 8 more grams of fat. Comparatively, a breast from the KY Grilled Chicken Bucket has only 730 milligrams of sodium, two-thirds less fat than the Original Recipe, and 6 more grams of protein—proof that it is possible to offer a healthier grilled option at even the most traditional of fried chicken chains.

Beyond decreasing sodium and offering different preparation methods, there are other small changes those in the chicken segment can make to improve the overall quality of offerings, experts say. Chick-fil-A is one example of a brand flying under the radar with its attention to nutritional detail. The brand worked to remove dyes from various menu items and is testing a new type of peanut oil without tert-Butylhydroquinone, a form of butane used as a preservative in foodservice.

“We have a good long-term relationship with [our suppliers],” says Jodie Worrell, senior nutrition consultant at Chick-fil-A. “When I’m working on something, I turn to them, tell them what we’re looking for, and they will help us develop it.”

Worrell adds sodium reduction to the list of important initiatives Chick-fil-A has tackled over the years.

The brand also places an emphasis on its grilled chicken options, which rolled out as a sandwich option in 1989. The Chargrilled Chicken Sandwich has 310 calories, 3.5 grams of fat, and 830 milligrams of sodium. “It’s really part of our long-term menu strategy of creating a menu of craveable food that’s increasingly healthy, natural, and sustainable,” says Brian Kolodziej, senior manager of culinary. In 2004, he says, Chick-fil-A switched its bun to a golden wheatberry version for added nutrition, and he and his team continue to work with suppliers and menu developers on various initiatives.

The NRA’s Dubost says an inclusive process for change can yield success like Chick-fil-A’s. “We have to continue to improve by working with suppliers, working with chefs, working with nutritionists and food scientists to provide food that’s healthy but also tasty enough that consumers crave them,” she says.