Assessing Healthful Food Choices and Nutritional Information on Kid’s Restaurant Menus Anthony Randles, Anita Gust, and Gary Liguori North Dakota State University Department of Health, Nutrition and Exercise Sciences Fargo, ND (
[email protected])
Abstract Introduction: Child-related obesity is a public health concern closely tied to nutrition quality. This study was designed to examine kids’ restaurant menus to determine the level of promoting and offering healthy choices. Methods: The Nutrition Environment Measures Survey- Restaurant (NEMS-R) was used in 128 restaurants throughout Fargo, North Dakota (75% of total Kid’s menu restaurants) between April and August, 2009. Researchers went to each restaurant individually and applied the NEMS-R to each product available. The time to assess each restaurant individually ranged from 20 to 30 minutes. All restaurants were surveyed Monday – Saturday and during regular business hours. The NEMS-R assessed the overall level of promoting and offering nutritional information or healthy food choices for children at fast food and full service restaurants. Results: Nutritional information was available in 30% of restaurants surveyed, yet 47% did offer healthy entrees, defined by NEMS as ‘baked’, ‘broiled’, or ‘grilled’. Healthy side items were offered at 48% of restaurants, with 9% of the “assigned” sides considered healthy. Healthy sides were offered by request only in 18%. Low fat (1%) or nonfat milk was available at 32% of restaurants, and 61% offered 100% fruit juice. However, 93% offered free refills on pop, yet no free refills on milk or juice. Eleven percent of kids’ menus routinely included a dessert, yet only 9% had any healthy desserts available (e.g. fruit). Discussion: Previous NEMS have focused on adult menus, with this being one of the first to address kids’ menus. These results indicate that kids’ menus are severely lacking in both information and healthy choices, which may be a prompt to encourage public policy change towards improving signage and offerings on kid’s menus. These types of changes may result in parents being able to make healthier food choices for their children leading to healthier children and adults in the future.
Introduction American families are eating out more now than ever before, consuming a significant portion of their calories from restaurants. As obesity and other diet-related diseases in children continue to rise, the role of restaurant meals has been at least partly implicated. One means of decreasing caloric intake from restaurant meals is to inform adults and children of the nutritional content, including calorie, fat, and sodium content in their menu items so they can make more informed choices. This study examined kid’s restaurant menus to determine if they are adequately promoting and/or offering healthful menu choices and providing appropriate nutritional information.
Methods All data for this project were collected in Fargo, ND Fast food restaurants (n = 63) and full service restaurants (n = 65) that offered children’s menus where surveyed from April 2009 to August 2009. Specialty eating establishments such as bakery’s, coffee shops, bars that restrict based on age, supper clubs and eating establishments located in supermarkets where excluded form this study. Procedures From pre-arranged lists of retail food outlets, surveyors used the Nutrition Environment Measures SurveyRestaurant (NEMS-R) survey for kids menu’s to conduct a detailed assessment of the kids menus from each restaurant that offered children’s menus in Fargo, ND. All site visits were conducted Monday through Saturday by two trained surveyors between the times of 8:30 AM – 11:30 AM and 1:30 PM -4:30 PM. These times are traditionally slow times for restaurants and which minimized any disruption to the normal flow of business. One surveyor recorded the data directly on to the NEMSR form while the other surveyed the area and asked the staff questions about nutritional information as needed. The average time to conduct a survey was approximately 10 minutes for fast food and 15 minutes for full service.
Categories: Specific barriers and facilitators to healthful eating were surveyed on kid’s restaurant menus and include: • Is nutritional information available in the store? • Is nutritional information provided on the kid’s menu (e.g. fat and calories)? • Are there any health entrées? • 100% fruit juice and low fat/fat free milk? • Are healthy sides offered? • Are there any healthy side substitutions? • Do any entrees that have assigned sides include an assigned healthy side? • Are there free refills on unhealthy drinks? • Is an unhealthy dessert automatically included in the kid’s meal • Are there any healthy desserts? Statistical Analyses All data were analyzed using Statistical Package for the Social Sciences (SPSS-version 17.0). Descriptive statistics were generated for all category items (table 1) and then generated separately for restaurant type (tables 2). Chi square was also utilized to compare differences between restaurant types.
Results
Discussion
Table1 shows the descriptive statistics for all restaurants surveyed.
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Table 1. All restaurants kid’s menu categories combined
Kid's Menu Categories Nutritional Information (NI) NI on kids menu Healthy Entrees 100% Fruit Juice Low Fat Milk Unhealthy Drink Refills Healthy Side Items Substitute Healthy for an Unhealthy Side Healthy Side Assigned
Number of Kid's Menus that had (%): 38 (30) 3(2) 60 (47) 78 (61) 41(32) 120 (94) 62 (48) 23 (18) 11 (9)
Unhealthy Dessert Automatically Included with Kid’s Meal
14 (11)
Healthy Desserts Offered on Menu Notes: N = 128
12 (9)
Table two shows the descriptive statistics between full service and fast food restaurants. Chi square showed that four of the eleven kid’s menu categories had a significant difference between fast food and full service restaurants: availability of nutritional information, 2 52% (FF) vs. 8% (FS): χ (1) = 30.608; p ≤ .001, φ= .489; low fat/fat free milk, 43% (FF) vs. 22% (FS): χ2 (1) = 6.679: p =. 010, φ= .228; unhealthy desserts automatically included with kid’s meal, 18% (FF) vs. 5% (FS): χ2 (1) = 5.419: p =.020, φ= .206; Healthy dessert options, 16% (FF) vs. 3% (FS): χ2 (1) = 6.166: p =.013, φ= .219.
Substitute Healthy for an Unhealthy Side Healthy Side Assigned Unhealthy Dessert Automatically Included Healthy Dessert
References: Bowman, S.A., Gortmaker, S.L., Ebbeling, C.B., Pereira, M.A., Ludwig, D.S., 2004. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics 113, 112–118. Bowman, S.A., & Vinyard, B.T., 2004. Fast-food consumption of U.S. adults: Impact on energy and nutrient intakes and overweight status. Journal of American College of Nutrition, 23, 163–168.
Table 2. Full service verse fast food
Kid's Menu Categories Nutritional Information (NI) NI on Kids Menu Healthy Entrees 100% Fruit Juice Low Fat Milk Unhealthy Drink Refills Healthy Side Items
This study describes the nutritional information in fast food and full-service restaurants in Fargo, ND. There was limited availability for kid’s menus at either type of establishment at the time of this study. This is consistent with Wooton, et al., (2006) where nutritional information was difficult to obtain, if available at all, at one of the largest fast food chains in America. A majority of kids menus surveyed offered some type of healthy entrees and/or healthy side items, however this was based on keys words (e.g. baked, grilled, broiled) instead of nutrient content. The current study also found that low-fat milk/fat free milk was rarely offered and that free refills of sugary drinks were quiet common among the restaurants surveyed. With the link to sugar concentrated beverages and obesity in children, restaurants should reconsider their stance on offering free refills of high sugared drinks, especially to children. Previous research has found that with every additional serving per day of a sugar concentrated beverage (e.g. soda pop), the risk of becoming obese increases by 50% (Ludwig, Peterson, & Gortmaker, 2001). When comparing the differences of fast food versus full service kid’s menus, fast food restaurants offered nutritional information, low fat/ fat free milk, and healthful dessert items more often than full service r e s t a u r a n t s . H o w e v e r, f a s t f o o d r e s t a u r a n t s automatically provided a dessert with a kids meal more often than full service restaurants. The results of this study suggest that all restaurant types should provide more healthy options and nutritional information so that parents are able to make a more informed decision for their children when dining out.
% full service (n=65) 8 2 52 65 22 91 47
%Fast food (n=63) 52 3 41 57 43 97 51
20 11
16 6
5 3
18 16
Burton, S.B., Creyer, E.H., Kees, J., & Huggins, K. (2006). Attacking the obesity epidemic: The Potential health benefits of providing nutrition information in restaurants. American Journal of Public Health, 96 (9), 1669-1675. Negrete, R. (2010). Kids' Menus: Bigger, Better, Boldly Flavored. Prepared Foods, 179(6), 15-22. Retrieved from EBSCO host on January 15th, 2011. Pereira, M.A., Kartashov, A.I., Ebbeling, C.B., et al., 2005. Fast-food habits, weight gain, and insulin resistance (The CARDIA Study): 15-year prospective analysis. Lancet 365, 36–42. Wooton, M.G., Osborn, M., & Malloy, C.J., (2006). Availability of point-of-purchase nutrition information at a fastfood restaurant. Preventative Medicine, 43, 458-459. Wooton, M.G., & Osborn, M. (2006) Availability of Nutrition Information from Chain Restaurants in the United States. American Journal of Preventative Medicine, 30(3), 266-268.
