Healthy Menu Items Research Articles

Food Is Medicine for Individuals Affected by Homelessness: Findings from a Participatory Soup Kitchen Menu Redesign.

Health disparities among people experiencing homelessness are likely exacerbated by limited access to healthy, fresh, and minimally processed foods. Soup kitchens and shelters serve as essential food safety nets for preventing hunger in this population, and community interest is growing in the potential of "food is medicine" interventions to improve the mental and physical wellbeing of people who receive meals from these providers. This study describes our two-phase approach to first identify and prioritize nutrition needs within an urban soup kitchen community and then test and implement new recipes and menu guidelines to help the standard soup kitchen menu better align with those priorities. We began by first conducting a nutrition needs assessment, including a collection of intercept surveys from a convenience sample of soup kitchen guests to better understand their nutrition-related health needs, dental issues, food preferences, and menu satisfaction (n = 112), as well as a nutrition analysis of the standard menu based on seven randomly selected meals. Most respondents reported at least one chronic health condition, with depressive disorders (50.9%) and cardiovascular diseases (49.1%) being the most common. Nearly all guests requested more fruits and vegetables at mealtimes, and results from the menu analysis revealed opportunities to lower meal contents of sodium, saturated fat, and added sugars and to raise micronutrient, fiber, and omega-3 content. We then applied these nutrition needs assessment findings to inform the second phase of the project. This phase included the identification of new food inventory items to help support cardiovascular and mental health-related nutrition needs, taste test sampling of new healthy menu items with soup kitchen guests, and hands-on culinary medicine training to kitchen staff on newly-developed "food is medicine" guidelines to support menu transformation. All taste tests of new menu items received over 75% approval, which exceeded satisfaction ratings of the standard menu collected during the phase 1 needs assessment. Findings from this community-based participatory research project confirm the great potential for hunger safety net providers to support critical nutrition needs within this vulnerable population through strategic menu changes. However, more research is needed on the longitudinal impacts of such changes on health indicators over time.

The numerical stroop effect on consumer preference to order healthy food

This article explores an alternative strategy to subtly nudge decisions in preference for healthy menu items – managing calorie presentation to create a Numerical Stroop Effect drawing upon the numerical magnitude representation theory. Across two experiments, the research finds that incongruent (vs. congruent) numerical magnitude representation of food calories (e.g., small 7 and large 5) increases consumers' preference to order healthy items. The study reveals the effect’s underlying mechanism through perceived healthiness along with the boundary factors of consumers’ health consciousness and time pressure. Specifically, low health-conscious consumers show a preference to order healthy items when exposed to incongruent magnitude representation of food calories, particularly when they experience high time pressure. The research contributes to the hospitality literature with an in-depth understanding of the less explored effect of numerical magnitude representation. This research also provides an easily implementable menu strategy to influence consumers’ dining preferences for healthier alternatives.

Evaluating the outcomes and implementation determinants of interventions co-developed using human-centered design to promote healthy eating in restaurants: an application of the consolidated framework for implementation research.

Restaurants are an emerging yet underutilized setting to facilitate healthier eating, particularly among minoritized communities that disproportionately experience health inequities. The present study aimed to examine outcomes from interventions co-developed using Human-Centered Design (HCD) in two Latin American restaurants, including sales of healthier menu items (HMI) and the consumer nutrition environment. In addition, we aimed to assess implementation outcomes (acceptability, fidelity, and sustainability) and elucidate the determinants for implementation using the Consolidated Framework for Implementation Research. This study used a mixed-methods, longitudinal design. Data were collected pre-, during, and post-intervention testing. Intervention outcomes were examined through daily sales data and the Nutrition Environment Measures Survey for Restaurants (NEMS-R). Changes in HMI sales were analyzed using interrupted time series. Implementation outcomes and determinants were assessed through site visits [observations, interviews with staff (n = 19) and customers (n = 31)], social media monitoring, and post-implementation key informant interviews with owners and staff. Qualitative data were analyzed iteratively by two independent researchers using codes developed a priori based on CFIR. The HCD-tailored interventions had different outcomes. In restaurant one (R1), where new HMI were introduced, we found an increase in HMI sales and improvements in NEMS-R scores. In restaurant two, where existing HMI were promoted, we found no significant changes in HMI sales and NEMS-R scores. Acceptance was high among customers and staff, but fidelity and sustainability differed by restaurant (high in R1, low in R2). Barriers and facilitators for implementation were found across all CFIR constructs, varying by restaurant and intervention. Most relevant constructs were found in the inner setting (restaurant structure, implementation climate), individual characteristics, and process (HCD application). The influence of outer setting constructs (policy, peer pressure) was limited due to lack of awareness. Our findings provide insights for interventions developed in challenging and constantly changing settings, as in the case of restaurants. This research expands the application of CFIR to complex and dynamic community-based settings and interventions developed using HCD. This is a significant innovation for the field of public health nutrition and informs future interventions in similarly dynamic and understudied settings.

Assessing the Implementation Outcomes of Interventions to Promote Healthy Eating in Latin American Restaurants

ObjectivesFood away from home is of increasing importance to the nutritional quality of diets, but little attention has been paid to improving the quality of Latino-serving restaurants. This paper aims to assess implementation outcomes of interventions co-developed in two Latin American restaurants (LARs) using Human-Centered Design (HCD) and implementation science as the conceptual frameworks. MethodsInterventions to increase the existence and use of healthy menu items (HMI) were developed previously in collaboration with owners and staff of two LARs in New York City. Using HCD, the perspectives of these individuals were included in a problem-solving approach to improve both the health and profitability of menu items. Key informant interviews with these individuals (n = 3 per restaurant) were conducted to obtain qualitative insights on the acceptability, adoption, feasibility, and sustainability of these interventions, all key outcomes for successful implementation. ResultsThe use of HCD resulted in high acceptability among owners, but not staff. Although owners and chefs in both LARs were included in the initial HCD planning process, chefs did not feel included in follow-up planning, resulting in low acceptability. Adoption was high for all roles in both LARs. Feasibility and sustainability were high in one restaurant, but not the other. While the new HMI was sustained in the first restaurant, efforts to promote them in the second restaurant with a social media campaign were hindered by the substantial time and resources required by this activity. ConclusionsHCD helped pinpoint the specific need of each LAR and offered a way to co-develop tailored interventions to address these needs, resulting in high owner acceptability and initial adoption. The mixed results found among staff show that power dynamics among different stakeholders can influence the success of healthy eating interventions. Owners are a key stakeholder for adoption, which overrides acceptability. The mixed results by intervention regarding feasibility and sustainability revealed that activities to promote HMI, such as a social media campaign, should consider the high operational burden and resource constraints of independently-owned LARs. More work is needed to improve the feasibility of these interventions. Funding SourcesNIH/NHLBI and Tulane University.

Fast Food Restoranlarını Tercih Eden Tüketiciler Üzerine Bir Araştırma

Products consumed by society vary according to needs, preferences and purchasing power. Consumers prefer fast food products for different reasons. These differences ensure that the food and beverage industry have a dynamic and competitive structure. The increasing number of consumers and changing customer demands / desires can cause changes in consumer perception. Questionnaire form was used to obtain data in the study and data were obtained from 406 participants. The data obtained were analyzed with the help of SPSS. As a result of the research, some differences were determined between importance and satisfaction in some criteria. The criteria for which the perceived value decreases consist of cleaning / hygiene, the taste of the product, the quality of the product, the service speed, the quality of the service, the variety of the menu and the price. The criteria for which the perceived value does not change much are nonfood and beverage services, the location / location of the restaurant, name / brand and ambiance. In addition, 70% of the participants stated that healthier menu items should be included, and 62% stated that the nutritional values of the products should be shown.

Five-star prices, appealing healthy item descriptions? Expensive restaurants' descriptive menu language.

Objective: Prior research shows that America's top-selling inexpensive casual dining restaurants use less appealing language to describe healthy menu items than standard items. This may suggest to diners that healthy options are less tasty and enjoyable. The present research asked whether expensive restaurants also use less appealing language to describe healthy items, or whether healthy items are described with equally appealing language as standard items in high status dining contexts. Method: Using Yelp, the name and description of every food item were recorded from the menus of 160 top-rated expensive restaurants across 8 U.S. cities (Nitems = 3,295; Nwords = 32,516). Healthy menu items were defined as salads and side vegetables, and standard items as all other dishes (excluding desserts), with high interrater reliability (K = .89). Descriptive words were categorized into 22 predefined themes, and log likelihood analyses compared normalized theme frequencies from standard item and healthy item descriptions. Results: Healthy items were described with 4.8-times fewer American region words, 2.7-times fewer exciting words, 1.4-times fewer tasty words, and significantly fewer portion size, spicy, artisanal, and foreign region words. Unlike inexpensive restaurants, however, expensive restaurants did not use any health-focused themes to promote healthy items and used several appealing themes more frequently in healthy item descriptions. Conclusions: Like inexpensive restaurants, expensive American restaurants described healthy items as less appealing and less authentically American than standard foods, but to a lesser extent. Implications for ordering behavior and solutions for improving the appeal of healthy menu items are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The US Chain Restaurant Industry Must Transform Its Business Model to Market Healthy Menu Items to Americans to Reduce Obesity and Chronic Disease Risks

The US Chain Restaurant Industry Must Transform Its Business Model to Market Healthy Menu Items to Americans to Reduce Obesity and Chronic Disease Risks

Trends in the Nutrition Profile of Menu Items at Large Burger Chain Restaurants

Fast food restaurants, including top burger chains, have reduced calorie content of some menu items in recent years. However, the extent to which the nutrition profile of restaurant menus is changing over time is unknown. Data from 2,472 food items on the menus of 14 top-earning burger fast food chain restaurants in the U.S., available from 2012 to 2016, were obtained from the MenuStat project and analyzed in 2019. Nutrition Profile Index scores were estimated and used to categorize foods as healthy (≥64 of 100). Generalized linear models examined mean scores and the proportion of healthy menu items among items offered in all years (2012-2016) and items offered in 2012 only compared with items newly introduced in subsequent years. Overall, <20% of menu items were classified as healthy with no change from 2012 to 2016 (p=0.91). Mean Nutrition Profile Index score was relatively constant across the study period among all food items (≈50 points, p=0.58) and children's menu items (≈56 points, p=0.73). The only notable change in Nutrition Profile Index score or in proportion of healthy items was in the direction of menu items becoming less healthy. At large chain burger restaurants, most items were unhealthy, and the overall nutrition profile of menus remained unchanged from 2012 to 2016. Future research should examine the nutrition profile of restaurant menus in a larger, more diverse sample of restaurants over a longer timeframe and examine whether results are robust when other measures of nutritional quality are used.

Children's Intake of Food from Non-Fast-Food Outlets and Child-Specific Menus: A Survey of Parents.

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.

How do social norms affect customers’ food selections at restaurants? Investigating social norms misalignment using polynomial regression with response surface analysis

ABSTRACT This study investigated the effects of perceived social norms on customers’ intentions to choose healthy menu items at restaurants. Specifically, injunctive norms and descriptive norms were examined, and the effects of misalignment of these social norms were explored on those intentions. To remedy problems associated with a more traditional analytical technique often used in misalignment studies, polynomial regression with response surface analysis was employed. Results revealed that when people perceived that most others eat healthy and approve of healthy eating, they were more likely to have intentions to choose healthy menu items. However, the conflict between perceived injunctive and descriptive norms weakened such intentions. This study expanded the literature on the role of social norms in changing behavioral intentions by investigating the roles of these two social norms, as well as the conflict between the two norms related to choosing healthy menu items by employing a new analytical technique.

A cross-sectional description of mobile food vendors and the foods they serve: potential partners in delivering healthier food-away-from-home choices

BackgroundFood away from home (FAFH) in the US is associated with adverse health outcomes, and food dollars spent on FAFH continues to increase. FAFH studies have typically focused on restaurants and carryout establishments, but mobile food vendors – popularly known in the US as food trucks – have become more numerous and are an understudied segment of FAFH. The objective of this study was to assess mobile food vendors, their attitudes toward health and nutrition, and the foods they serve.MethodsThis was a cross-sectional study of 41 mobile food vendors in Michigan, US. The survey contained questions about food and nutrition attitudes, such as barriers to putting healthy items on menus and perceived agreement with healthy food preparation practices. Participants were classified into a healthy and a less healthy attitude group based on whether they believed healthy menu items could be successful or not. In addition, participant menus were collected and analyzed according to whether menu items were healthy, moderately healthy, or unhealthy. Descriptive, univariate, and bivariate analyses were conducted.ResultsTwo-thirds of the participants felt that healthy menu items could be successful, and yet taste and value were the most important menu item success factors, each rated as important by 100% of the participants. Low consumer demand was the biggest barrier to putting healthy items on the menu (76%) whereas lack of chef interest (29%) and need for special training (24%) were the smallest. 72% of the vendors offered at least one healthy menu item, but only 20% of all reviewed menu items were healthy overall. There was no difference in the proportion of menu items that were healthy when comparing those with healthy attitudes (23% of menu items healthy) to those less healthy attitudes (17% of menu items healthy, p = 0.349).ConclusionsMobile food vendors had positive views about putting healthy items on menus. However, a low proportion of menu items were classified as healthy. This suggests that mobile food vendors are promising potential public health partners in improving the health profile of FAFH, but that education of vendors is needed to ensure the success of healthier items.

Relationships among behavioral beliefs, past behaviors, attitudes and behavioral intentions toward healthy menu selection.

BACKGROUND/OBJECTIVESObesity is a serious concern worldwide, for which the restaurant industry holds partial responsibility. This study was conducted to estimate restaurant consumers' intention to select healthy menu items and to examine the relationships among behavioral beliefs, past behaviors, attitudes and behavioral intentions, which are known to be major determinants of consumer behaviors.SUBJECTS/METHODSAn online, self-administered survey was distributed for data collection. The study sample consisted of customers who reported having visited casual dining restaurants in the last three months at the time of the survey. Structural equation modeling was used to verify the fit of the proposed research model.RESULTSStructural equation modeling revealed that the proposed model supports the sequential, mediated (indirect) relationships among behavioral beliefs, past behaviors, attitudes and behavioral intentions toward healthy menu selection.CONCLUSIONThis study contributes to the available literature regarding obesity by adding past behaviors, one of the most influential variables involved in prediction of future behaviors of consumers, to the TPB model, enabling a better understanding of restaurant consumers' rational decision process regarding healthy menu choices. The results of this study provide practical implications for restaurant practitioners and government agencies regarding ways to promote healthy menus.

STRIVE, San Diego! Methodology of a Community-Based Participatory Intervention to Enhance Healthy Dining at Asian and Pacific Islander Restaurants

ObjectiveAsian American, Native Hawaiian, and Pacific Islander (AANHPI) populations have elevated prevalence of dietary-related chronic conditions; however, culturally relevant dietary interventions are lacking. This article describes the methodology for a community-based participatory intervention. Strategies to Reach and Implement the Vision of Health Equity, San Diego! aims to increase access to healthy food in AANHPI restaurants, grocery stores, and farmers' markets. DesignTime series quasi-experimental study design. Dietitians, health promotion specialists, and community partners collaborated with restaurant owners and chefs to develop culturally tailored approaches without compromising traditional flavors. SettingAANHPI restaurants in San Diego County, CA. ParticipantsTwenty restaurants and 600 diners are anticipated and will be sampled at 3 intervals for a total of 1,800 diners. InterventionWe describe the community-based interventions within restaurants, including (1) analyzing and modifying selected recipes to create and promote healthier dishes; (2) providing nutrition labels on selected food items; (3) marketing healthy menu items through food tastings, signage, and social media promotion; and (4) offering low-sodium soy sauce and other condiments. Main Outcome MeasuresTemporal changes in availability of healthful options, and the frequency of healthy dining choices. AnalysisProgram evaluation consists of assessment of the nutritional environment in 20 participating restaurants and surveys of customers' opinions and behaviors at baseline and at 3 and 12 months postintervention. Fifteen restaurants have been recruited to date.

Heuristic evaluation of healthy menus: examining the effect of brand image congruity

PurposeThis study aims to investigate how restaurant customers’ heuristic judgment, originating from their perceived level of congruity between restaurant brand image regarding healthfulness and healthy menu products, can affect their information processing in terms of their perceived nutritional information credibility and, furthermore, how these effects influence customers’ attitude toward the menu in terms of healthiness.Design/methodology/approachA Web-based survey was developed and distributed to randomly selected respondents in the USA, and in total, 320 responses were used for the data analyses. Structural equation modeling (SEM) was used to examine the relationship among three constructs: perceived brand–product congruity, perceived nutritional information credibility and nutrition attitude toward the healthy menu item being promoted. To assess the mediating role of perceived information credibility, an analytical procedure proposed by (Baron and Kenny 1986) was used. Finally, to investigate the moderating effect of the health involvement, multiple group analyses were executed.FindingsThe study results suggested that the synchronization between healthful brand image of the restaurant and the promoted menu item is important for ensuring customers’ perceptions of information credibility regarding the menu item healthiness and for eliciting customers’ positive nutrition attitudes toward the menu item. Also, positive nutrition attitudes toward a menu item can be increased by improving perceived information credibility. Depending on an individual’s level of health involvement, the relationships between the three proposed constructs vary.Originality/valueThis paper includes a theoretical model that explains customers’ heuristic evaluation of a healthy menu product by assessing the influence of brand image congruity in terms of healthy menu promotion.

Stress and food choices: Examining gender differences and the time horizon framing effect

The number of people facing daily stress is on the rise in the United States. Further, there is increasing evidence of stress induced obesity and other food-related health risks. This study tested the effects of self-reported stress on choosing indulgent and healthy food options in the context of menu promotions at restaurants. The study proposed that time horizon message framing (expansive vs. limited) on restaurant menus influences the effectiveness of advertising messages aimed at preventing unhealthy food choices and promoting healthy choices. Further, this study examined gender differences in stress induced eating. The current findings shed new light on time horizon message framing, which encourages stressed consumers to make healthy choices. The results showed that food choices can be altered using time horizon messages. That is, stressed individuals tend to choose healthier options when the message is framed in terms of expansive time and more indulgent food than when the message is focused on a limited time frame. Restaurant managers are advised to establish creative marketing strategies to spur interest in healthy menu items and emphasize the benefits of healthy food items.

Eating Well While Dining Out: Collaborating with Local Restaurants to Promote Heart Healthy Menu Items

Eating Well While Dining Out: Collaborating with Local Restaurants to Promote Heart Healthy Menu Items

Eating Well While Dining Out: Collaborating with Local Restaurants to Promote Heart Healthy Menu Items

ABSTRACTBackground: Because Americans commonly consume restaurant foods with poor dietary quality, effective interventions are needed to improve food choices at restaurants. Purpose: The purpose of this study was to design and evaluate a restaurant-based intervention to help customers select and restaurants promote heart healthy menu items with healthful fats and high-quality carbohydrates. Methods: The intervention included table tents outlining 10 heart healthy eating tips, coupons promoting healthy menu items, an information brochure, and link to study website. Pre- and postintervention surveys were completed by restaurant managers and customers completed a brief “intercept” survey. Results: Managers (n = 10) reported that the table tents and coupons were well received, and several noted improved personal nutrition knowledge. Overall, 4214 coupons were distributed with 1244 (30%) redeemed. Of 300 customers surveyed, 126 (42%) noticed the table tents and, of these, 115 (91%) considered the nutrition information helpful, 42 (33%) indicated that the information influenced menu items purchased, and 91 (72%) reported that the information will influence what they order in the future. Discussion: The intervention was well received by restaurant managers and positively influenced menu item selection by many customers. Translation to Health Education Practice: Further research is needed to assess effective strategies for scaling up and sustaining this intervention approach.

Socioeconomic and Demographic Determinants of the Nutritional Content of National School Lunch Program Entrée Selections

New National School Lunch Program (NSLP) guidelines aim to reduce sodium and saturated fats, limit calories, and eliminate trans‐fat and whole milk. This paper provides a novel approach to understanding how the healthfulness of NSLP participants’ entrée selections varies across socioeconomic and demographic groups. Unlike previous studies that rely on dietary recalls, we use a mixed logit model to examine students’ entrée choices in a school cafeteria. We estimate the likelihood that an entrée is selected from the available lunch choices as a function of the entrée's nutrients (fat, carbohydrate, protein, and sodium) and entrée's taste profile characteristics (e.g., Mexican, Pizza‐like), as well as the student's socio‐economic and demographic characteristics. Using these estimates, we examine how changing the nutritional content of an offering impacts the probability of selecting each of the offerings. Free lunch recipients are more likely to choose entrées higher in fat but lower in sodium than other students. Full‐price lunch recipients are the most responsive to changes in nutritional content of the offerings and are most likely to respond to changes in the nutritional content of the offered entrées by substituting a lunch brought from home for the school‐purchased lunch. Replacing less healthy menu items with popular but healthier items reduces the selection of total calories, calories from fat, and sodium by approximately 4%, 18%, and 8%, respectively, over the study period. The new guidelines should be effective at improving the nutrition of school‐age children, and potentially reducing childhood obesity, provided NSLP participation does not decline appreciably.

A thousand ways to say 'Delicious!'—Categorizing expressions of deliciousness from restaurant reviews on the social network site Yelp

This study explored expressions of deliciousness—one of the main reasons people make specific food choices over others—from restaurant reviews on Yelp, a popular social network site. Through qualitative content analysis of 205 reviews from 41 food establishments in Hawaii, we found 8 main categories of expressions of deliciousness. These eight main categories created by both concept-driven and data-driven strategies are Sense, Culinary Affair, Matter of Heart, Health, Testimonial and Endorsement, Personal Signature, Consumer, and Restaurant. Each main category was further subcategorized. This meaningful categorization might contribute to healthier eating by helping policy makers and food companies craft effective strategies for healthy eating schemes, healthy menu items, or healthy food products. Marketers of any food product can also increase their market share by utilizing these categories, subcategories, and their underlying concepts in the planning stage. Detailed examples of nudging and social marketing campaigns inspired by our findings were provided. Moreover, social network sites can better serve health conscious and hedonic consumers by personalization through improved algorithms inspired by these categories.

Understanding healthy eating behaviors at casual dining restaurants using the extended theory of planned behavior

This study examined the effects of customers’ psychological factors on their healthy eating behaviors (e.g., selecting low-calorie menu items) at restaurants within an extended version of the theory of planned behavior (TPB), which consists of attitudes, subjective norms, perceived behavioral control, and behavioral intentions. This extension was implemented by incorporating two new constructs (prototype and willingness) and subdividing the original TPB constructs of attitudes (affective and cognitive attitudes) and social norms (injunctive and descriptive norms). Data were collected using on-line surveys. Structural equation modeling revealed that healthful menu item selection was better predicted by the willingness-based reactive decision-making process than by the intention-based rational process. Results also indicated that affective attitude and injunctive norms had stronger and more consistent effects on behavioral intentions and willingness to choose healthful menu items than did cognitive attitude and descriptive norms. Prototype image had a positive effect on behavioral willingness. By extending the existing theory, this study makes contribution by remedying the shortcomings of the original theory and providing practical implications to encourage people to select healthy menu items.