Americans spend millions of dollars a year eating and drinking at fast food establishments. The coronavirus pandemic did not stop the trend. In fact, drive-thru orders surged in 2020. By December, about 44% of all off-premise orders in the industry were via drive-thru, with the volume increasing 22% compared to December 2019, according to NPD Group, a marketing research company.

The biggest chain in terms of sales, according to QSR magazine figures, is McDonald’s, where people spent $40.4 billion in 2019, followed by Starbucks with $21.6 billion, and Chick-Fil-A with $11.0 billion.

Fast food is popular because it’s cheap, readily available, filling, and, well … fast. But its popularity does not guarantee that it is healthy, too. Most people who go to fast-food restaurants are aware that they are not likely to get a super healthy, or even mildly healthy, meal — and some choices are worse than others.

To identify the unhealthiest food at every major fast-food chain in the U.S., 24/7 Tempo reviewed the nutritional contents of every item on their menus. We compiled a universe of over 150 items with the most calories. We then created an index of five measures, weighted equally: calories, fat, trans fat, salt, and sugar. Only food items intended for single individuals were considered.

More than one in three people in the United States eat at a fast food restaurant on a given day, according to the National Center for Health Statistics. And adults between 20 and 39 years old are most likely to choose fast food over other options.

Perhaps it’s no surprise also that the biggest health issues in the country — including obesity, heart disease, cancer, and diabetes — are all associated with poor nutrition, according to the Centers for Disease Control and Prevention.

Many of the least healthy items on fast food menus contain nearly half of the entire daily recommended intake of calories, as per the U.S. Health Department’s dietary guidelines, and often almost the entire recommended amount for salt and sugar. The recommended amount of sodium is less than 2,300 milligrams per day, and even less for people who are younger than 14.

How much fat a person should consume in a day depends on how many calories the person needs. In a diet of about 2,000 calories a day, the American Heart Association recommends aiming for about 13 grams of saturated fat, which often comes from meat and cheese. Both are a staple in fast foods.

Many fast-food restaurants offer healthy options like salads. But the word “salad” in a menu item can be deceiving — these are 40+ salads that are worse than a slice of cheese pizza.

Click here to see the unhealthiest items in the most popular fast food chains.

To identify the unhealthiest food at every major fast-food chain in the U.S., 24/7 Tempo reviewed the nutritional contents of every item on their menus. We compiled a universe of over 150 items with the most calories.

We then created an index of five measures, weighted equally: calories, fat, trans fat, salt, and sugar. 

Only food items intended for single individuals were considered. For example, McDonald’s 40-piece Chicken McNuggets was excluded. Meals that contain more than one item were also excluded.

Among food items that were very similar, the item that scored the worst on the index was selected. For example, the eight unhealthiest items at Sonic Drive-In were all drinks — either a shake or a blast. We selected the one with the worst score and listed the second worst item in a different category as the second unhealthiest food at that restaurant. 

The items on our list are not necessarily the most popular menu item the fast-food chain offers, and their availability may vary from region to region.