Objective: To examine changes in children's meal orders, price, and revenue following the implementation of a healthier children's menu in a full-service restaurant chain. Methods: In April 2012, the healthier menu was implemented, featuring more meals meeting nutrition standards, healthy side dishes by default, and removal of French fries and soda (which could be substituted). Orders (n 5 352,192) were analyzed before (September 2011 to March 2012; PRE) and after (September 2012 to March 2013; POST) implementation. Results: Children's meal prices increased by $0.79 for breakfasts and $0.19 for non-breakfast meals from PRE to POST. Revenue continued to increase post-implementation. Orders of healthy meals, strawberry and vegetable sides, milk, and juice increased, and orders of French fries and soda decreased (P < 0.0001). Orders at POST were more likely to include healthy sides (P < 0.0001) and substitutions (P < 0.0001) and less likely to include a la carte sides (P < 0.0001) and desserts (P < 0.01), versus PRE. Total calories ordered by children accepting all defaults decreased (684.2 vs. 621.2; P < 0.0001) and did not change for those not accepting defaults (935.0 vs. 942.9; P 5 0.57). Conclusions: Healthy children's menu modifications were accompanied by healthier ordering patterns, without removing choice or reducing revenue, suggesting that they can improve child nutrition while restaurants remain competitive.
In a previous study we showed that customers ordered healthier food following the April 2012 implementation of a healthier children's menu at Silver Diner, a regional restaurant chain. In this study we used newly available data to assess orders of children's menu items both one and two years after our last assessment. Previous assessments took place in September 2011-March 2012 and in September 2012-March 2013, before and after implementation of the new menu, respectively. Orders were abstracted from the restaurant's central database. We found that the overarching changes from the previous study were sustained during the two follow-up periods, with some small fluctuations (for example, the prevalence of healthy side dish orders changed from 38 percent of children's meals ordered to 74 percent, then 76 percent, and then 75 percent in the successive study periods). Ordering patterns at follow-up remained healthier than before the menu change and in some cases continued to improve. Similar interventions have the potential to promote sustainable healthier ordering patterns and inform policy.
Parent education about calorie recommendations for children could improve understanding and use of menu labelling information in restaurants. Targeted strategies are recommended to ensure that such efforts address, rather than exacerbate, health disparities.
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