Research ArticleAssessing the Availability of Healthier Children's Meals at Leading Quick-Service and Full-Service Restaurants
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
References (35)
- et al.
Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level
J Acad Nutr Diet
(2013) - et al.
Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States
J Am Diet Assoc
(2010) - et al.
US adolescents and MyPyramid: associations between fast-food consumption and lower likelihood of meeting recommendations
J Am Diet Assoc
(2009) - et al.
Where are kids getting their empty calories? Stores, schools, and fast-food restaurants each played an important role in empty calorie intake among US children during 2009-2010
J Acad Nutr Diet
(2014) - et al.
Energy intake from restaurants: demographics and socioeconomics, 2003–2008
Am J Prev Med
(2012) - et al.
Calorie changes in chain restaurant menu items: implications for obesity and evaluations of menu labeling
Am J Prev Med
(2015) - et al.
Calorie changes in large chain restaurants: declines in new menu items but room for improvement
Am J Prev Med
(2016) - et al.
Nutritional value of meals at full-service restaurant chains
J Nutr Educ Behav
(2014) - et al.
The impact of menu labeling on fast-food purchases for children and parents
Am J Prev Med
(2011) - et al.
Slim by design: Menu strategies for promoting high-margin, healthy foods
Int J Hosp Manag
(2014)
The public health implications of fast-food menu labeling
Am J Prev Med
Vital signs: fruit and vegetable intake among children—United States, 2003–2010
MMWR Morb Mortal Wkly Rep
Fast food restaurant use among adolescents: associations with nutrient intake, food choices and behavioral and psychosocial variables
Int J Obes Relat Metab Disord
Poor nutrition on the menu: children's meals at America's top chain restaurants
Child Obes
Fast-food and full-service restaurant consumption among children and adolescents: effect on energy, beverage, and nutrient intake
JAMA Pediatr
Vital signs: sodium intake among US school-aged children—2009–2010
MMWR Morb Mortal Wkly Rep
Scientific Report of the 2015 Dietary Guidelines Advisory Committee
Cited by (26)
Evaluation of Short-Term Changes in Fast-Food Restaurant Online Kids’ Meal Beverage Offerings Following a State-Level Healthy Beverage Default Policy
2023, Current Developments in NutritionPosition of the Society for Nutrition Education and Behavior: Healthful Food for Children is the Same as Adults
2022, Journal of Nutrition Education and BehaviorCitation Excerpt :However, it does not appear that US restaurants are fully committed to meeting these guidelines. Studies examining the kilocalorie and macro- and micronutrient content of menu offerings demonstrate that restaurants may offer children's meal combinations that are fewer than 600 kcals, but the macro- and micronutrient content have not changed significantly with fat, saturated fat, and sodium exceeding national recommendations.62,65–67 Restaurants participating in the Kids LiveWell program have shown no substantial changes in kids’ meals across multiple years.62,68
Switching up sides: Using choice architecture to alter children's menus in restaurants
2022, AppetiteCitation Excerpt :Interventions aimed at improving children's intake of fruits and vegetables in restaurants, predominantly using information-based strategies, have been enacted; however, few show substantial impacts (Espino et al., 2015; Glanz & Hoelscher, 2004). Recently, demand for healthy children's meals has increased (Center for Science in the Public Interest (CSPI), 2013), which has led some restaurants to provide fruit and vegetable side dishes as options on children's menus; however, these options are not widely selected (Glanz et al., 2007; Mueller et al., 2019; Sliwa et al., 2016). The field of behavioral economics offers potential strategies to make healthy choices easier, simply by altering the choice architecture in the restaurant setting (Cravener et al., 2015; Guthrie, 2017; Thaler, 2008).
Does a vegetable-first, optimal default strategy improve children's vegetable intake? A restaurant-based study
2019, Food Quality and PreferenceCitation Excerpt :Currently, the Kids LiveWell Program has over 150 participating restaurants and restaurant chains across the country (NRA, 2016). Many restaurants now offer more healthful side options with children’s meals (Anzman-Frasca et al., 2014; Wootan, 2012), however, changes that make a more substantive impact on diet quality have been minimal and slow-going (Anzman-Frasca et al., 2014; Sliwa, Anzman-Frasca, Lynskey, Washburn, & Economos, 2016; Wootan, 2012). Overall, from 2008 to 2012 there was only a 2% increase in the number of children’s meals meeting standards for calories, fat, and sodium (Center for Science in the Public Interest, 2013).
Healthier Children's Meals in Restaurants: An Exploratory Study to Inform Approaches That Are Acceptable Across Stakeholders
2017, Journal of Nutrition Education and Behavior
Conflict of Interest Disclosure: The authors' conflict of interest disclosures can be found online with this article on www.jneb.org.