With increased scrutiny over the past decade by the mass media and several legislative efforts by local governments, you might think fast food has come a long way nutritionally. But has it really?

You can now find some healthier choices on fast food menus such as oatmeal with fruit, fruit smoothies, side salads and grilled chicken sandwiches. However, a study led by Katherine W. Bauer, assistant professor in Temple University's Department of Public Health and Center for Obesity Research and Education, found that the average calorie content of foods offered by eight of the major U.S. fast food restaurants changed very little between 1997 and 2010.

In the study, results of which will be published in the November issue of the American Journal of Preventive Medicine, researchers analyzed menu offerings and nutrient composition information from leading fast food restaurant chains in the U.S. using archival versions of the University of Minnesota Nutrition Coordinating Center's Food and Nutrient Database. McDonald's, Burger King, Wendy's, Taco Bell, KFC, Arby's, Jack in the Box and Dairy Queen were chosen because they had been in the database since 1997, each has defined set of offerings on the menu and all standard menu items are included in the database.

One striking finding was a 53 percent increase in the total number of offerings - 679 to 1036 items - over 14 years across the restaurants. Specific fast-growing additions to the menus include the number of entree salads, which increased from 11 to 51, and sweetened teas, which went from zero to 35.

The study authors did not find any large changes in the median calorie content of entrees and drinks. A gradual increase in calories was found in condiments and desserts. Meanwhile, a decrease in the median calories of side items was observed - from 264 to 219 - which may be due to the addition of lower-calorie side salads and some restaurants limiting the portion sizes of side items like French fries.

In the last years examined, 2009 and 2010, lunch and dinner entrees had 453 calories on average per item while side items had 263 calories on average.

"You might order a lower-calorie entree, but then you get a drink, fries and a dessert," said Bauer. "Calories can add up very quickly. A salad can be low calorie, but not when it includes fried chicken and ranch dressing. Sweetened teas are just empty calories."

Eating fast food becomes a concern when someone eats too much of it too often. Studies have consistently found associations between fast food intake and excess weight and weight gain among adults. A recent survey of adults found that 80 percent purchased fast food in the past month and 28 percent consumed it two or more times a week. On a typical day, nearly 40 percent of teens consume fast food.

"We're not saying you shouldn't ever eat fast food, but you need to think about things like portion size, preparation method, condiments and the total caloric content of your meal," said Bauer.

In the near future, consumers will be able to see calories for all food items posted at restaurants and food vendors with more than 20 locations, as mandated by the Patient Protection and Affordable Care Act of 2010. McDonalds recently began posting calories on its menus.

"Using this study as a start, we'll be able to see if being required to post the calorie content of menu items - the primary aim of which is to inform consumers - prompts any changes by the fast food industry," said Bauer. "While some localities such as Philadelphia and New York City already require menu labeling, when the effort is rolled out nation-wide fast food restaurants may modify the calorie content of the foods they sell so consumers can see a smaller number on the menu board.

"Without massive changes by the fast food industry in the caloric content of food, the key is for consumers to try to educate themselves about calories and be aware that just because a restaurant promotes healthful options, does not mean that overall the foods sold are lower calorie," she said. "Over time, with increased exposure to calorie information on menus, people may start to understand how many calories they should consume each day."