Voluntary Kids' Meal Beverage Standards: Are They Sufficient to Ensure Healthier Restaurant Practices and Consumer Choices?

Phoebe Harpainter,Gail Woodward-Lopez,Anna C Martin,Danielle L Lee,Sridharshi C Hewawitharana,Wendi Gosliner,Lorrene D Ritchie

doi:10.3390/ijerph17155275

Abstract

Many quick-service restaurants (QSRs) instituted voluntary kids’ meal default beverage standards (standards) between 2013 to 2017. Little is known about impacts of standards on QSR drive-through practices and on customer choices. This study assessed differences in restaurant practices including kids’ meal beverages shown on menu boards, offered by cashiers, and selected by customers in QSRs with and without voluntary standards. Observations (n = 111) and customer surveys (n = 84) were conducted in 2018 at QSRs with standards (n = 70) and without (n = 41) in low-income California, U.S. neighborhoods. Kids’ meal beverages on menu boards (n = 149) and offered by cashiers (n = 185) at QSRs with and without standards were analyzed using multilevel logistic regression. Significantly more menu boards at QSRs with standards (n = 103) vs. without (n = 46) featured only milk, water or unsweetened juice (65.1% vs. 4.4%; p < 0.001). Most cashiers at QSRs with standards and QSRs without (53.1%, 62.5%) asked what drink the data collector wanted rather than first offering default beverages. A small sample of customer interviews found that customers at QSRs with standards most commonly ordered juice (37.0%); at QSRs without standards, soda (45.5%). Although menu boards showed healthier kids’ meal beverages at QSRs with standards than without, cashier behavior was inconsistent. Results suggest additional measures (legislation, implementation support, enforcement) may be needed to ensure optimal implementation.

Highlights

On an average day, a third of U.S children consume food and/or beverages from quick-service restaurants (QSRs), accounting for roughly 12% of their energy consumption [1]
Selected QSRs were separated into two categories: with or without standards, based on stated company pledges or standards previously described in the introduction, evaluation of restaurant websites and/or calls made to locations of the QSRs
Data collectors visited the QSRs in each county in the prescribed order, according to criteria described in the methods section

Summary

Introduction

A third of U.S children consume food and/or beverages from quick-service restaurants (QSRs), accounting for roughly 12% of their energy consumption [1]. Children’s restaurant meal consumption is associated with a higher intake of sugar-sweetened beverages (SSBs) [2]. Among California children aged 2–5, drinking soda or other SSBs is more prevalent among low-income than higher-income children [4]. QSRs are statistically significantly more prevalent in low-income areas and account for a high proportion of kids’ meal sales [5,6]. Instituting healthy default beverage (HDB) policies for kids’ meals (bundled meals for children with a beverage included, sold at a single price) at food retailers is considered one of the top five strategies to reduce SSB consumption and increase water access and consumption among young children [7]

Methods

Results

Discussion

Conclusion