Abstract
BackgroundChildren consume restaurant-prepared foods at high rates, suggesting that interventions and policies targeting consumption of these foods have the potential to improve diet quality and attenuate excess energy intake. One approach to encouraging healthier dietary intake in restaurants is to offer fruits and vegetables (FV) as side dishes, as opposed to traditional, energy-dense accompaniments like French fries. The aims of the current study were to examine: children's views about healthier side dishes at restaurants; current side dish offerings on children's menus at leading restaurants; and potential energy reductions when substituting FV side dishes in place of French fries.MethodsTo investigate children’s attitudes, a survey was administered to a nationally representative sample of U.S. 8- to 18-year-olds (n = 1178). To examine current side dish offerings, children's menus from leading quick service (QSR; n = 10) and full service restaurant chains (FSR; n = 10) were analyzed. Energy reductions that could result from substituting commonly-offered FV side dishes for French fries were estimated using nutrition information corresponding to the children's menu items.ResultsTwo-thirds of children reported that they would not feel negatively about receiving FV sides instead of French fries with kids' meals. Liking/taste was the most common reason that children gave to explain their attitudes about FV side dishes. Nearly all restaurants offered at least 1 FV side dish option, but at most restaurants (60% of QSR; 70% of FSR), FV sides were never served by default. Substituting FV side dishes for French fries yielded an average estimated energy reduction of at least 170 calories.ConclusionsResults highlight some healthy trends in the restaurant context, including the majority of children reporting non-negative attitudes about FV side dishes and the consistent availability of FV side dish options at leading QSR and FSR. Yet the minority of restaurants offer these FV sides by default. Promoting creative, appealing FV side dishes can result in healthier, less energy-dense meals for children. Substituting or displacing energy-dense default side dishes with such FV dishes show promise as part of continued, comprehensive efforts to increase the healthfulness of meals consumed by children in restaurant settings.
Highlights
Children consume restaurant-prepared foods at high rates, suggesting that interventions and policies targeting consumption of these foods have the potential to improve diet quality and attenuate excess energy intake
Sixty-seven percent of children reported eating take-out from restaurants at least a few times per month, and 19.4% reported eating take-out weekly. When asked what they do when they eat at a restaurant and there is too much food, the majority of children reported taking it home (69%); the most common answers were leaving the food on their plate (12%) and trying to finish it anyway (9%)
While the current results suggest that many children would accept fruits and vegetables (FV) side dishes, they highlight that tailored strategies may be warranted to promote FV acceptance in certain subgroups: namely, boys, children eating at restaurants less frequently, and children eating takeout more frequently
Summary
Children consume restaurant-prepared foods at high rates, suggesting that interventions and policies targeting consumption of these foods have the potential to improve diet quality and attenuate excess energy intake. A report released in 2013 showed that 91% of children’s meals at the top 50 restaurant chains did not meet the National Restaurant Association’s Kids LiveWell nutrition standards [8], and with regards to energy content 50% of children's meals did not meet the Kids LiveWell criterion of 600 calories or less. These findings justify efforts to decrease the energy content of children's meals, as the appropriate energy content of a meal for a sedentary child ranges from 400–667 calories, depending on their age and sex [9]
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