Children, Parents, Restaurateurs Have Stake in Healthier Kids’ Meals

Anzman-Frasca, assistant professor of pediatrics, and her research team surveyed parents and children dining at participating fast food and sit-down restaurants, as well as executives of restaurant chains.

“Incorporating the perspectives of parents, children and executives allows us to gain insight and develop future interventions,” says Anzman-Frasca, lead author of the study.

Previous analysis of menu offerings at chain restaurants identified most meals marketed for children as deficient in fruits, vegetables, whole grains, vitamin A, vitamin C, calcium, iron and fiber. Likewise, the majority of kids’ meals at quick- and full-service restaurants in the United States fails to meet recommendations for calories, total fat, saturated fat and sodium.

“For many families today, dining out is not a special occasion but instead is a regular part of daily life. At the same time, there is evidence that children’s calorie consumption is higher and diet quality lower on days they consume food from restaurants,” Anzman-Frasca says. “So health promotion efforts are warranted in these settings.”

The idea behind the new study was that interventions aiming to increase healthy eating in restaurants will be more effective if they fit with the views and realities of both families and restaurant personnel.

For the study, parent-child pairs dining at one of two participating quick-service restaurants or one of two participating full-service restaurants were recruited.

Fifty-nine parents and 58 children answered surveys. Just 8 percent of children’s meals ordered were those meeting national Kids LiveWell criteria for healthier kids’ meals. Kids LiveWell is a program involving more than 42,000 restaurant locations that have committed to providing families with healthy menu choices when dining out.

When parents were asked whether the Kids LiveWell meal options appealed to their child, 7 percent said no, 14 percent said yes, 37 percent indicated they did not know and 42 percent did not know what Kids LiveWell meals were.

Of the children surveyed, 76 percent reported that they had visited the restaurant before, 64 percent placed their usual order, and 48 percent knew what they would order before arriving at the restaurant.

Ninety-five percent of children had positive responses regarding the taste of their meal and 48 percent planned to order the same item again.

“It’s really tough to change people’s habits in restaurants. We saw in the current study that half of children already knew what they wanted before they came in the door. One possible solution is to shift the restaurant environment in ways that fit with the way people naturally make decisions,” says Anzman-Frasca.

One example of such a strategy is having healthy defaults.

“If a meal comes with a certain side dish by default, we’re very likely to accept that side dish instead of going out of our way to request something else. This technique works in many areas of our lives, not just food selection,” Anzman-Frasca says.

To further inform future restaurant interventions, researchers conducted phone interviews with two executives from large chains and two executives from small chains.

“We believe that it is very important to speak with restaurateurs when conducting research in this area. You can develop a program with great potential to promote healthier eating among children in restaurants, but if the program is not feasible or acceptable from the restaurant perspective, it will not be implemented successfully or sustained,” Anzman-Frasca says. “Restaurateurs understandably have their own priorities and constraints, and our goal was to uncover approaches that are likely to be acceptable to them as well as families.”

Executives’ views revealed greater demand for kids’ meals at full-service restaurants compared to quick-service restaurants. The executives also said that meal offerings must be readily accepted by children to make it worth the effort.

According to the executives, parents view dining out as a special occasion, allowing their children to eat items that are not necessarily available to them every day; thus, healthy options were less popular. Some areas of common ground between families and restaurant executives were uncovered, including the importance of taste and familiarity.

The article, “Healthier Children’s Meals in Restaurants: An Exploratory Study to Inform Approaches That Are Acceptable Across Stakeholders,” was published in the Journal of Nutrition Education and Behavior. The publication also produced an audio podcast with Anzman-Frasca about her research.

The research was funded by the Centers for Disease Control and Prevention through a Small Business Innovation Research Program grant. The work was led by Healthy Dining (the principal investigator on the grant) and the organization ChildObesity180 at Tufts University, which received the subcontract focused on research Anzman-Frasca led.

Anzman-Frasca, who has been a Jacobs School of Medicine and Biomedical Sciences faculty member since 2015, was employed by ChildObesity180 and the Friedman School of Nutrition Science and Policy at Tufts University when the study began.

Co-authors are:

• Sara C. Folta, PhD, Tufts University
• Meaghan E. Glenn, MS, MPH, Abt Associates
• Anita Jones-Mueller, MPH, Accents on Health Inc. (doing business as Healthy Dining)
• Nanette V. Lopez, PhD, University of Southern California
• Vanessa M. Lynskey, MPH, ChildObesity180
• Anjali A. Patel, MPH, RD, Accents on Health Inc. (doing business as Healthy Dining)
  
• Lisa L. Tse, MPH, Columbia University