taurants indicated that the top concerns when altering menus are how the changes will attract or maintain the customer base and how the changes will affect sales and profits (Glanz et al., 2007).

To develop and supply the exact ingredient or product they desire, large chains go through a product development process that is similar to that used to develop packaged foods for retail sale. In fact, large chains often establish relationships with food processors and suppliers to help develop and manufacture menu items (Connor and Schiek, 1997). For large chains, food processors may even develop proprietary recipes and produce standardized products exclusively for one company (Cobe, 2008). Because consumers expect menu items to have the same tastes, textures, nutrient content, and portion sizes regardless of the location at which they are purchased, chain restaurants work with their contracted manufacturers to create ingredient and preparation specifications to ensure a standard product (Walker and Lundberg, 2005).

Introducing or changing menu items may be a challenging and time-consuming process regardless of the size of the restaurant/foodservice operation. Changes require efforts to ensure a sufficient supply of ingredients, revisions to printed menus or menu boards, and training for many food preparers with varied education and skill levels. Because of the costs of changing menus and menu items, restaurant/foodservice operations are unlikely to make changes to reduce the sodium content of their offerings unless such items are expected to generate profits (Glanz et al., 2007).

Some menu planners may believe that lower-sodium foods will be unsuccessful. A survey of more than 400 chefs found that only 39 percent believed that foods would taste good if they were designed to meet Dietary Guidelines for Americans recommendations (Reichler and Dalton, 1998). Along the same lines, a survey of menu developers from chains showed that these personnel believe that most customers are seeking an indulgent experience when they consume foods away from home and that the demand for more healthful foods is low. Even for menu planners who are interested in creating more healthful options, fat, calorie, and fruit and vegetable content are more top-of-mind issues than sodium content (Glanz et al., 2007). While redesigning menus and menu items to lower calories or include more fruits and vegetables may have the added benefit of reducing sodium content, this may not be the case for all items. In some cases, sodium content may not be reduced to the same extent or may even increase in the absence of menu planners who are concerned and knowledgeable about its health implications.