Background: An increase in energy dense meals eaten outside the home has been identified as a contributing factor in the rise in obesity over the last 25 years (WHO, 2003). Initiatives that clearly signpost healthier restaurant meal choices that are lower in energy and fat may offer a valuable customer service with potentially important public health, as well as commercial, benefits. The aim of this study was to investigate whether a traffic light labelled menu with healthier choices for two main courses was an acceptable and effective means of encouraging healthier food choices in a table service restaurant. Methods: A menu was developed for an independent table service restaurant to offer ‘standard’ and ‘healthier’ (lower in fat and energy) alternatives for two main courses: one meat and one fish dish. Both sets of dishes were nutritionally analysed and colour coded on the menu in accordance with Food Standard's Agency traffic light signposting guidelines and energy information (FSA, 2009). Over a 2-week period, the choice of dishes made by customers using the menu and their views about whether they liked the initiative, found it useful and whether they would use it in future were surveyed using a questionnaire given after the meal. Practical and commercial issues around preparation, analysis and cost of implementing the menu were assessed in a qualitative interview with the head chef (also the restaurant owner). Results: Seventy surveys were returned from customers [66% female, mean age 42 years (age range 16–65+ years)] over the 2-week period. Of those ordering from the separate menu, almost half (46%) chose the healthy alternative. The concept of a healthy alternatives menu was popular, with 90% (n = 60) of customers who returned a survey stating they either did order or would consider ordering a healthy alternative when eating out. Of 24 customer comments, 25% stated they considered eating out a time to indulge. Women were more strongly in favour than men of the concept of healthy alternatives and of having nutritional information on a menu. Customers who ate out frequently were more likely to order a healthy alternative (rho = 0.249, P = 0.044). Interestingly, choosing a healthy main course increased the likelihood of ordering dessert (rho = 0.459, P = 0.000), thus potentially negating any energy and fat savings. Seventy percent (n = 39) of customers returning the survey said they would like to see healthy alternatives provided in other restaurants. Feedback from the restaurant staff suggested they were broadly in favour of the initiative as a valuable customer service but felt that analysing recipes for a rotating menu in an independent restaurant was both time consuming and costly. Discussion: A traffic light labelled menu with energy information appears to be popular and effective in signposting some customers towards healthier alternatives in a table service restaurant. The finding that the provision of this information on menus was particularly popular with women is supported by other studies (Mackison et al., 2009) and suggests a value of finding ways to increase the appeal to men. The finding that choosing a healthy main course option increased the likelihood of ordering dessert also mirrors previous research. Although exposure to nutritional information on menus may cause customers to eat less at one time point, they may over-compensate for this in subsequent eating occasions (Roberto et al., 2010). This suggests a potential value of information on overall energy balance alongside nutritional signposting information. Such initiatives may be feasible and even commercially beneficial for independent restaurants over the long term, although motivators may be needed to incentivise them alongside tools to support the development and traffic light coding of healthy recipes. Conclusions: A menu signposting healthy alternatives in an independent table service restaurant appears to be popular with customers, effective at encouraging healthier food choices and acceptable to a commercial restaurant especially if there is practical support for implementation.
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