The song is effectively a medley of three distinct pieces fused into one. "Italian Restaurant" begins as a gentle, melodic piano ballad, depicting, in the first person, a scene of two old classmates reuniting in an Italian restaurant. This segues into a triumphant and uptempo jazz-influenced section as the classmates catch up with each other's lives and begin to reminisce. Clarinet, trombone, tuba and saxophone solos then lead into a rock and roll section (which Joel calls "The Ballad of Brenda and Eddie"). This section tells a story, in the third person, about high school sweethearts who were an "it" couple, who marry young and quickly divorce. The tempo then slows as the song transitions back to the style of the first section and the two-part fondly, with one character remarking "I'll meet you anytime you want / At our Italian restaurant."

