Search Results (13)

Background/Objectives: Despite evidence on the association between marketing unhealthy foods to children (M2K) and negative health outcomes, M2K remains widespread in Canada. To support mandatory restrictions, Health Canada has prioritized a monitoring strategy to assess the current state of M2K, identify gaps, and establish a baseline for future policy evaluation. This study aimed to support this initiative by updating the University of Toronto (UofT) Food Classification List and evaluating the proportion of foods and beverages in the Canadian grocery and restaurant food supply that would be permitted or restricted from M2K under Health Canada’s proposed nutrient profile model. Methods: Grocery items from the UofT Food Label Information Price 2020 (n = 24,949) and restaurant menu items from Menu-Food Label Information Price 2020 (n = 14,286) databases were evaluated using Health Canada’s M2K nutrient profile model, which assesses foods solely based on thresholds for added sodium, sugars, and saturated fat. The proportion of items permitted for or restricted from M2K was determined overall and by food and menu categories for grocery and restaurant items, respectively. Results: The updated UofT List contained n = 24,494 grocery items and n = 14,286 menu items. Overall, 83% (n = 32,664/39,235) of foods and beverages in the 2020 Canadian food supply would be restricted from M2K. Among grocery items, 23% (n = 5630) would be permitted and 77% (n = 19,202) would be restricted from M2K. Among restaurant items, only 6% (n = 837) would be permitted and 94% (n = 13,442) restricted. Conclusions: The updated UofT List supports Health Canada’s monitoring strategy and highlights the large proportion of unhealthy products in the Canadian food supply that are currently still permitted for M2K. While Health Canada’s M2K nutrient profile model is stringent, gaps remain that could allow continued M2K exposure under the current proposed policy. Ongoing monitoring and policy refinement are essential to effectively protect children from M2K and its harmful effects. Full article

Introduction: The food environment is an important determinant of children’s eating behavior. Improving the environment to encourage healthier choices is crucial to prevent obesity, especially in restaurants where the majority of kids’ menus are unhealthy. This study explored the perceptions, attitudes, motivations, influencing factors, and opportunities of restaurant owners, managers, and chefs for implementing healthier kids’ menus in Dutch restaurants. Method: We used a mixed methods design in two consecutive study parts. Part I consisted of an online unstandardized questionnaire that was completed by 44 restaurant owners, 26 chefs, 18 managers, and 6 other restaurant employees (n = 94). This was followed by semi-structured interviews with 3 restaurant owners, 2 chefs, and 1 manager, to gather exploratory information in Part II (n = 6). The quantitative data were categorized into three groups: restaurants without kids’ menus (n = 18), restaurants with unhealthy kids’ menus (n = 24), and restaurants with (partially) healthy kids’ menus (n = 52). Group differences were assessed using the Kruskal–Wallis test. We used thematic analysis for the interviews. Results: Parts I and II showed that the restaurant sector is aware of the need, and willing and motivated to offer healthier kids’ menus. Nevertheless, the concerns about food waste, the unhealthy demand from children and parents, and seeing eating out as a free pass to consume unhealthy meals by children and parents were important factors limiting the implementation of healthier kids’ menus. Discussion: We discussed potential solutions to enhance demand and acceptance of healthier kids’ menus, such as attractive names, storytelling, offering children’s portions based on adult menus, and using participatory approaches in which parents, children, and chefs co-create meal composition. Full article

Background/Objectives: Sugar-sweetened beverage (SSB) consumption is associated with child obesity, an understudied issue in the southern United States, where obesity rates are the highest in the country. We examined the factors associated with high SSB intakes among children aged 2–12 years in two major cities in Louisiana, New Orleans and Baton Rouge. Methods: We conducted a cross-sectional study using an online survey. The sample consisted of caregivers of children aged 2–12 years who eat restaurant meals (either dine-in, delivery, or take-out) at least once a month and reside in or near New Orleans or Baton Rouge, LA. Multivariable logistic regression was used to examine factors associated with high child SSB intake frequency (≥4 times/week), including restaurant use, caregiver attitudes towards SSB, and their demographics (n = 1006). Results: Most caregivers reported weekly child SSB consumption (74.6% ≥ 1×/week; 38.1% ≥ 4+/week) and restaurant use (58.8% ≥ 1×/week). High SSB frequency (≥4+/week) was associated with a higher frequency of restaurant use, lower caregiver education, agreement with the statement that SSBs are an important part of family meals, and disagreement with the statement that restaurants should not offer SSBs with children’s meals (p < 0.05). Conclusions: Our results revealed a high frequency of SSB consumption among children who dine at restaurants monthly, with significant associations observed between SSB intake, restaurant meals, and pro-SSB attitudes. These findings may support the need for regulations, such as healthy default beverage policies for children’s menus, to potentially reduce SSB intake and shift social norms, particularly in regions with high childhood obesity rates like Louisiana and the southern USA. Full article

Objectives: To evaluate the offer of children’s menus offered in fast food restaurants present in the Uber Eats delivery application through the Kids Menu Healthy Score ‘KIMEHS’ in Greater Santiago. Methods: Observational, descriptive, cross-sectional. Research in fast food restaurants present in the Uber Eats delivery app. A total of 858 restaurants were selected. The KIMEHS was used to assess menu quality. KIMEHS index and descriptive statistics were calculated. Results: 558 restaurants were evaluated through the app; 57 offered children’s menus, yielding 114 children’s menu options from 18 different municipalities. The common offer was based on fried and/or processed lean meat accompanied by French fries in 71%. Moreover, 99% of the menus assessed obtained the minimum score in the KIMEHS placing them in the ‘not healthy at all’ category. When associations were made between foods and the lowest KIMEHS score quartile, the presence of chips had the strongest association (OR; 40.36: CI95% 11.43–201.08). Conclusions: Most restaurants offer a children’s menu of low nutritional quality and poor balance, where their dishes are commonly based on fried and processed products, pointing to the urgent need for legislation on guidelines to be applied on the different actors influencing the food offered to children. Full article

The Childhood Obesity Plan aimed to reduce sugar and energy in foods through a voluntary sugar-reduction programme. Our primary objective was to determine whether this implementation strategy had been successful, focusing on the out-of-home sector. We used a repeated cross-sectional design to evaluate nutritional changes in desserts served by leading chain restaurants. We extracted nutrition information from online menus in autumn/winter 2020, for comparison with baseline (2017) and interim (2018) values extracted from third-party datasets. We assessed compliance with the 20% sugar-reduction target and category-specific energy targets by product category and for pooled desserts. Overall, sugar/portion and energy/portion decreased by 11% and 4%, respectively. Policy targets were achieved in one of five categories (ice-cream: −38% sugar, p < 0.001; −30% energy, p < 0.001). Secondary outcomes were analysed for subgroups with the necessary data. Few chains significantly reduced sugar and/or energy across their dessert range. Energy/portion was positively associated with portion weight and sugar/portion but not with sugar/100 g. More than half of adults’ desserts contained excessive sugar and/or saturated fat compared with dietary guidelines. Children’s desserts less frequently exceeded guidelines. These results demonstrate that voluntary measures can drive substantial change when technical, commercial, and operational barriers can be overcome. Full article

Australian families increasingly rely on eating foods from outside the home, which increases intake of energy-dense nutrient-poor foods. ‘Kids’ Menus’ are designed to appeal to families and typically lack healthy options. However, the nutritional quality of Kids’ Menus from cafes and full-service restaurants (as opposed to fast-food outlets) has not been investigated in Australia. The aim of this study was to evaluate the nutritional quality of Kids’ Menus in restaurants and cafés in metropolitan Perth, Western Australia. All 787 cafes and restaurants located within the East Metropolitan Health Service area were contacted and 33% had a separate Kids’ Menu. The validated Kids’ Menu Healthy Score (KIMEHS) was used to assess the nutritional quality of the Kids’ Menus. Almost all Kids’ Menus (99%) were rated ‘unhealthy’ using KIMEHS. The mean KIMEHS score for all restaurants and cafés was −8.5 (range −14.5 to +3.5) which was lower (i.e., more unhealthy) than the mean KIMEHS score for the top 10 most frequented chain fast-food outlets (mean −3.5, range −6.5 to +3). The findings highlight the need for additional supports to make improvements in the nutritional quality of Kids’ Menus. Local Government Public Health Plans provide an opportunity for policy interventions, using locally relevant tools to guide decision making. Full article

Considering the importance of the food environments for health promotion, and the lack of simple, easy to use, low-cost measures of the quality of meals, the authors developed a qualitative menu index (KIMEHS—Kids’ Menu Healthy Score), tailored to children’s menu evaluation. Development of the tool was based on the Mediterranean food pattern. It includes 18 components, divided into seven main groups that reflect key aspects of menu quality, including protein source, side dishes, vegetables, dessert and beverages, and also allergens and nutritional information. The index was analysed for content and construct validity, as well as inter-rater reliability, and was applied to a sample of menus from restaurants in shopping centres in the Lisbon region. Possible index point ranges from −17 to 17, with a higher score indicating greater compliance with the recommendations. A value of 5.5 is obtained if all KIMEHS items are available, considering healthy and non-healthy options. The inter-rater reliability was assessed and values above 0.80 were obtained for Alpha Cronbach, as well as agreement % rate >75%. Agreement percentage is above 75% for all the components. Evaluated restaurants scored from −14 to 7, with an average KIMEHS of −6.15. Only four restaurants scored positive values, ranging from 0.25 to 7. KIMEHS was considered to be an adequate index to evaluate children’s menus, from the menu information displayed on restaurant websites and/or on restaurant displays or table menus. It is a simple, low-cost tool that may be used as a reference for health professionals as an objective measure to evaluate the food environment. Stakeholders could also be involved in their own assessment to help educate consumers about healthy food choices, strengthening the efforts to promote an adequate food pattern and health, contributing to the fight against obesity. Full article

This study evaluated orders of adult menu items designated as healthier at the Silver Diner, a regional full-service restaurant chain serving over 4 million customers annually. This restaurant implemented a healthier children’s menu in April 2012. Orders of adult menu items were abstracted from before (September 2011–March 2012; PRE; n = 1,801,647) and after (September 2012–March 2013; POST; n = 1,793,582) the healthier children’s menu was introduced. Entrées, appetizers, and sides listed as healthier options on the menu were coded as healthier. PRE to POST changes in the percentage of orders of healthier items, soda, and dessert were evaluated using McNemar tests of paired proportions. Orders of healthier entrées, appetizers, and sides on the adult menu increased PRE to POST (8.9% to 10.4%, 25.5% to 27.5%, and 7.3% to 9.3%, respectively), and soda and dessert orders decreased (23.2% to 21.7% and 29.0% to 28.3%, respectively). All shifts were statistically significant (p < 0.0001). Our findings demonstrate improvements in orders of healthier adult menu options during the same time frame as a healthy children’s menu change. Future research can help elucidate mechanisms to inform future health promotion efforts in restaurants in ways that have the potential to impact both adults and children. Full article

Children regularly consume foods from quick service restaurants (QSRs) in the United States, but little is known about how ordering decisions are made and the impact on selection and consumption. A total of n = 218 parents dining with a child (ages 4–16 years) inside a participating QSR completed interviews and demographic surveys and provided their child’s leftover foods at the end of the meal. Children’s meal consumption was measured using plate-waste methodology. The majority of children selected their meal without parental involvement (80%) and decided what to order prior to entering the QSR (63%). Using mixed-model analysis of variance, children selected and consumed significantly fewer calories and less total fat and sodium when a parent ordered the meal compared with when the child ordered the meal alone. There were no significant differences in selection or consumption when a parent and child ordered the meal together. Approximately one-third of the children consumed foods that were shared. In conclusion, because children primarily select foods without parental involvement and prior to entering QSRs, innovative strategies are needed to influence ordering decisions inside QSRs toward healthier options. Additionally, because food is frequently shared, policies that only focus on children’s menus may not be as effective in impacting children’s dietary intake. Full article

International data indicate that children and adolescents obtain around one third of their daily food intake from products consumed outside their home. Food products from restaurants are usually higher in calories and lower in nutritional value than those prepared home. We evaluated the nutritional quality in kids’ meals from three fast food chains and two movie theaters and compared them with nutritional recommendations for Mexican school-age population. Results showed that the menu options marketed for school-age children have higher caloric contributions than those recommended, in addition to a deficient nutritional quality. The contribution of caloric and of almost all macronutrients for all mealtimes is not only high but even above 100% or 200% of the mean recommended daily intake (reaching to more than 400% of the recommendations of carbohydrates and lipids of preschool age group). In particular, the snack main dish (popcorn), provides over 100% of the mean energy intake recommendations for the three school age groups and for preschool age group, this contribution could reach to 270%. Therefore, regulations regarding nutritional recommendations should exist for these types of commercialized food products for school-age children, along with mandatory and clear labeling that allows consumers to be able to make better choices for their kids. Full article

Eating out-of-home is associated with higher energy intakes in children. The continued high prevalence of childhood obesity requires a greater understanding of child menu options and eating out frequency to inform appropriate regulatory initiatives. The majority of studies to date have focused on menus from fast-food outlets with few focused on non-fast-food outlets. This study aimed to describe parents’ reports of their child(ren)’s (aged up to 6 years) frequency of consuming foods at non-fast-food outlets, observations of child menus at these outlets, and their purchasing behaviours and future preferences regarding these menus; and if their responses were influenced by sociodemographic characteristics. Ninety-five parents completed a 15-item cross-sectional survey. Overall, children from 54% of families consumed food from non-fast-food outlets at least monthly. Of the 87 parents who reported that their child eats at a non-fast-food restaurant, 71 had children who ordered from child menus every time (7%, n = 5), often (29%, n = 22), sometimes (42%, n = 32) or rarely (16%, n = 12), with a further 7% (n = 5) never ordering from these menus. All parents indicated that they would like to see a higher proportion of healthy child menu items than is currently offered. Parents’ responses were not influenced by sociodemographic characteristics. Parents’ views support implementation of initiatives to increase availability of healthy options on child menus at non-fast-food outlets. Full article

Evidence indicates that restaurant-based interventions have the potential to promote healthier purchasing and improve the nutrients consumed. This study adds to this body of research by reporting the results of a trial focused on promoting the sale of healthy child menu items in independently owned restaurants. Eight pair-matched restaurants that met the eligibility criteria were randomized to a menu-only versus a menu-plus intervention condition. Both of the conditions implemented new healthy child menu items and received support for implementation for eight weeks. The menu-plus condition also conducted a marketing campaign involving employee trainings and promotional materials. Process evaluation data captured intervention implementation. Sales of new and existing child menu items were tracked for 16 weeks. Results indicated that the interventions were implemented with moderate to high fidelity depending on the component. Sales of new healthy child menu items occurred immediately, but decreased during the post-intervention period in both conditions. Sales of existing child menu items demonstrated a time by condition effect with restaurants in the menu-plus condition observing significant decreases and menu-only restaurants observing significant increases in sales of existing child menu items. Additional efforts are needed to inform sustainable methods for improving access to healthy foods and beverages in restaurants. Full article

Energy intakes from fast food restaurants (FFRs) have declined among US children. Less is known about the corresponding trends for FFR-sourced solid fats, added sugars, and sodium, and food groups of interest, such as fruit and sugar-sweetened beverages (SSBs). Using data from a single 24-h dietary recall among 12,378 children aged 4–19 years from four consecutive cycles of the nationally-representative National Health and Nutrition Examination Survey (NHANES), 2003–2010 a custom algorithm segmented FFRs into burger, pizza, sandwich, Mexican cuisine, chicken, Asian cuisine, fish restaurants, and coffee shops. There was a significant population-wide decline in FFR-sourced solid fats (−32 kcal/day, p-trend < 0.001), added sugars (−16 kcal/day; p-trend < 0.001), SSBs (−0.12 servings (12 fluid ounces or 355 mL)/day; p-trend < 0.001), and sodium (−166 mg/day; p-trend < 0.001). Declines were observed when restricted to fast food consumers alone. Sharp declines were observed for pizza restaurants; added sugars, solid fats, and SSBs declined significantly from burger restaurants. Fruit did not change for fast food restaurants overall. Temporal analyses of fast food consumption trends by restaurant type allow for more precise monitoring of the quality of children’s diets than can be obtained from analyses of menu offerings. Such analyses can inform public health interventions and policy measures. Full article