Research Article
Assessing the Availability of Healthier Children's Meals at Leading Quick-Service and Full-Service Restaurants

https://doi.org/10.1016/j.jneb.2016.01.004Get rights and content

Abstract

Objective

To compare the calorie, fat, saturated fat, and sodium content of available children's meal combinations in leading restaurants with national recommendations.

Design

Cross-sectional.

Setting

Children's menu offerings and corresponding nutrition information were collected (May, 2014) from Web sites of the top 10 quick-service (QSR) and top 10 full-service (FSR) restaurant chains that offered a children's menu and provided nutrition information.

Variables Measured

Total calories (kcal), percent calories from fat and saturated fat, and total sodium (mg) were calculated for children's meal combinations (QSR N = 1,363; FSR N = 6,654). Combinations with ≤ 600 kcal, ≤ 35% kcal from fat, ≤ 10% kcal from saturated fat, ≤ 770 mg sodium, and those that met all 4 of these criteria were identified.

Analysis

Frequencies by restaurant segment.

Results

The majority of QSR (72%) and FSR (63%) meal combinations had ≤ 600 kcal. Only 31.9% of combinations at QSRs and 21.7% at FSRs met all 4 criteria. In both segments the calorie target was most frequently met, and the sodium target the least.

Conclusions and Implications

Children's meal combinations with ≤ 600 kcal are available at leading restaurant chains, but many meals fail to meet current national recommendations for fat, saturated fat, and sodium. Menu labeling legislation may address caloric content but implications for other nutrients remain unclear.

Introduction

Most American children consume nutritionally poor diets that exceed recommendations for calories, solid fats, sodium, and added sugars, while falling short of recommended intakes of fruits, vegetables, and low-fat dairy.1, 2, 3 Restaurant meals tend to be higher in calories and lower in nutritional quality than foods prepared at home.4, 5, 6, 7 Accordingly, consumption of foods from quick-service restaurants (QSRs) and full-service restaurants (FSRs) has been associated with higher energy and sodium intake and lower diet quality.7, 8 An analysis of National Health and Nutrition Examination Survey dietary recall data suggested that QSRs contribute over a third (35%) of children's intake of solid fats and added sugars.9 Because restaurants have become normative eating contexts for many children,10 improving the nutritional profile of foods available to children in restaurants is a strategy to improve children's overall diet quality. To this end, the 2015 Dietary Guidelines Advisory Committee encouraged restaurants to modify their offerings to improve their nutrient profiles and help Americans reduce intakes of calories, saturated fat, and sodium.11

Recent industry trends and research findings suggest that some restaurants are introducing healthier items to children's menus. For the past 6 years, healthier children's dishes have been among the top 10 food trends in the National Restaurant Association's annual survey of chefs.12, 13, 14, 15, 16, 17 The National Restaurant Association introduced the voluntary Kids LiveWell program in 2011, with the stated goal of helping parents and children make healthier choices when dining at restaurants.18 The > 42,000 restaurant locations participating in this program offer at least 1 meal and 1 side dish that meet specific nutrition criteria; furthermore, full meals must include at least 2 sources, and sides must include at least 1 of the following food groups: fruits, vegetables, lower-fat dairy, whole grains, and lean protein.18 On the research side, a study comparing menu items at 66 of the 100 largest restaurant chains found that overall, new menu items introduced in 2013 and 2014 contained significantly fewer calories than did menu items available in 2012.19, 20 These shifts may represent voluntary changes in anticipation of federal menu-labeling legislation, which is scheduled to go into effect by December 1, 2016.21 Improvements in single menu items are encouraging. Because many restaurants sell children's meals, the caloric content of the overall bundle also must be considered.

To expand upon existing research, this study describes the availability of healthier children's meals at leading QSRs and FSRs in 2014 by calculating children's meal combinations and determining the extent to which these meals align with national recommendations for calories, fat, saturated fat, and sodium.18, 22, 23 This focus was selected because (1) all 4 are overconsumed, (2) nutrition information was widely available for these components across leading restaurants, and (3) clear national recommendations for their intake are available.3, 22 Understanding the availability of healthier children's meals in the format in which they are presented in many restaurants is a critical first step toward accelerating improvements in supply and increasing children's exposure to healthier foods in these settings.

Section snippets

Data Collection

Using the 2014 Nation's Restaurant News Top 100 Report,24 the 10 leading QSRs and FSRs by sales were identified that met the following inclusion criteria: (1) offer a distinct children's menu, (2) make nutrition information publicly available online for children's menu items, and (3) provide at minimum calorie information for all children's entrées. Children's meals were defined as entrées advertised in a child-focused section of the online menu, plus any sides, beverages, or desserts offered

QSRs: Segment Summary

At all 10 QSRs, children's meal combinations included an entrée, at least 1 side dish, and a beverage. Two QSRs offered 2 sides with each kids' meal and 1 included a dessert by default with all but 1 meal combination. The QSR children's menus featured an average of 17 ± 10 items (range, 6–42 items). Average children's meal combination across QSRs had 506 ± 107 kcal (range, 200–1080 kcal) (Table 1), 30.9% calories from fat, 17.4 ± 6.2 g of fat (range, 1.5–49.0 g), 9.1% of calories from saturated

Discussion

Industry trends12, 13, 14, 15, 16, 17 and recent research19, 20, 28 have illustrated the potential for healthier options to become more prevalent in restaurants. The current findings present encouraging information about the availability of lower-calorie kids' meals at QSRs and FSRs. However, the consistently low availability of meals meeting all 4 nutrition criteria of interest and varied availability of these meals across restaurant chains suggest that healthier children's meals are not

Implications for Research and Practice

Overall, these results highlight the feasibility of offering healthier children's meals in restaurants,12, 13, 14, 15, 16, 17, 19 as well as room for further improvement in overall nutritional quality in the average children's meal. Nutrition professionals can empower parents to use nutrition information to select restaurants that offer a larger proportion of healthier children's meals. In addition, characteristics of meals meeting nutritional criteria offer insights into ways to improve the

Acknowledgments

This study was funded by the Robert Wood Johnson Foundation and The JPB Foundation. The authors thank Rachel Banner, Natalie Bishop, Clarissa Brown, and Grace Chan for attentive data entry and coding; Kathleen Smith for support with data cleaning; and Benjamin Barrington for providing Excel troubleshooting support. This article was written by Sarah Sliwa in her private capacity. No official support or endorsement by the Centers for Disease Control and Prevention, Department of Health and Human

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    Conflict of Interest Disclosure: The authors' conflict of interest disclosures can be found online with this article on www.jneb.org.

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