Researchers in Spain created a new checklist to measure how easy it is to eat healthy food at restaurants. They adapted an American tool to fit Spanish restaurants and Mediterranean food culture. The checklist looks at things like what foods are available, their prices, and how they’re advertised. Scientists tested it in 57 restaurants across different neighborhoods and found it works really well at telling the difference between healthy and unhealthy restaurant environments. This tool could help cities and health officials understand which restaurants make it easier or harder for people to make good food choices.

The Quick Take

  • What they studied: Can a checklist tool designed in America work in Spain to measure how healthy the food environment is in restaurants?
  • Who participated: 57 restaurants in Alicante, Spain, including sit-down restaurants, cafes, and fast-food places, located in neighborhoods with different income levels. Two different raters evaluated each restaurant.
  • Key finding: The adapted checklist worked very well—when two different people used it, they got almost identical results (over 80% agreement). The tool successfully spotted differences between restaurant types and between wealthy and less wealthy neighborhoods.
  • What it means for you: This tool could help your city identify which restaurants make it easier to eat healthy. It may eventually lead to better restaurant policies and healthier food options in your community, though individual restaurant choices still depend on many factors.

The Research Details

Researchers took an existing American restaurant evaluation tool called NEMS-R and carefully adapted it for Spain. They translated it into Spanish, had experts review it, and tested it with real restaurants. The process included translation, back-translation to check accuracy, expert feedback, and small-scale testing before the main study. In the main study, two trained raters independently evaluated 57 restaurants in five different neighborhoods in Alicante between November and December 2023. One rater came back 30 days later to evaluate the same restaurants again to check if results were consistent over time.

Restaurant food environments are different in Spain compared to the United States because of different food cultures, eating habits, and Mediterranean dietary traditions. Using an American tool without changes wouldn’t work well. Creating a Spanish version that reflects local restaurant types and food practices makes the results more accurate and useful for Spanish public health efforts.

This study shows strong reliability—when two different people used the tool, they almost always agreed (kappa values over 0.80, which is considered ‘almost perfect’). The tool also showed it could distinguish between different types of restaurants and neighborhoods, suggesting it measures what it’s supposed to measure. The study was published in a peer-reviewed public health journal, adding credibility to the findings.

What the Results Show

The NEMS-R-MED checklist proved to be both reliable and valid for Spanish restaurants. When two different raters evaluated the same restaurants, they got nearly identical results for most items on the checklist, with agreement levels above 80%. This means the tool is consistent and objective—different people using it will reach similar conclusions. The checklist successfully identified meaningful differences between restaurant types: sit-down restaurants, bar-cafeterias, and fast-food establishments scored differently on the assessment. This shows the tool can distinguish between different restaurant environments. The checklist also revealed differences across neighborhoods with different income levels, particularly in measuring barriers to healthy eating. Wealthier neighborhoods showed different restaurant food environments compared to less wealthy neighborhoods.

The statistical analysis (factor analysis) showed that the different questions on the checklist measured distinct concepts, which is what researchers expected. The tool’s ability to discriminate between restaurant types and neighborhood socioeconomic levels suggests it captures real differences in food environments. These secondary findings strengthen confidence that the tool is measuring actual, meaningful differences rather than random variation.

The original NEMS-R tool was developed and validated in the United States but had never been adapted for Spain. This study fills that gap by creating a Spanish version that respects local food culture and restaurant types. The strong reliability and validity results suggest that the adaptation process worked well and that the tool can be effectively used in Mediterranean contexts, potentially opening the door for similar adaptations in other countries with different food cultures.

The study only included restaurants in Alicante, a specific region in Spain, so results may not apply to all Spanish restaurants or other Mediterranean countries. The sample of 57 restaurants is relatively small, which limits how broadly we can apply the findings. The study was conducted in just two months (November-December), so seasonal variations in restaurant menus weren’t captured. The study doesn’t measure whether having a better food environment actually leads to people eating healthier—it only measures the environment itself.

The Bottom Line

Public health officials and city planners in Spain and similar Mediterranean regions should consider using this NEMS-R-MED tool to assess restaurant food environments. The tool appears reliable and valid for identifying which restaurants and neighborhoods have healthier or less healthy food options. However, this is one step in a larger effort—the tool should be combined with other strategies to improve restaurant food environments. Confidence level: Moderate to High for using this tool in Spanish Mediterranean contexts.

City health departments, public health researchers, restaurant policy makers, and nutrition advocates in Spain and Mediterranean countries should care about this research. Restaurant owners might use it for self-assessment. General consumers may benefit indirectly if cities use this tool to improve restaurant environments. This research is less directly relevant to individual diet choices and more relevant to community-level food policy.

The tool itself works immediately—it can assess restaurants right away. However, seeing actual changes in restaurant food environments and community health would take months to years, depending on how cities use the information and implement policies based on the findings.

Want to Apply This Research?

  • Track which restaurants in your area have been evaluated with NEMS-R-MED scores and monitor how their healthy food options change over time. Users could rate their own restaurant experiences and compare them to official NEMS-R-MED assessments.
  • The app could show users which nearby restaurants scored highest on the NEMS-R-MED assessment, helping them choose restaurants with better healthy food environments. Users could set goals to eat at higher-scoring restaurants more frequently.
  • Long-term tracking could include periodic updates of NEMS-R-MED scores for local restaurants, allowing users to see if their community’s restaurant food environments are improving over time. The app could alert users when new restaurants open or when existing restaurants improve their healthy food options.

This research describes a tool for measuring restaurant food environments and does not provide medical advice or dietary recommendations for individuals. The NEMS-R-MED tool assesses the availability of healthy options but does not guarantee that eating at restaurants with higher scores will improve your health. Individual dietary needs vary, and you should consult with a healthcare provider or registered dietitian for personalized nutrition advice. This study was conducted in Spain and may not apply to all regions or restaurant types. The tool measures environment, not actual food quality or nutritional content of specific dishes.