Improving Children’s Menus in Community Restaurants: Best Food for Families, Infants, and Toddlers (Best Food FITS) Intervention, South Central Texas, 2010–2014

Abstract

BackgroundApproximately 32% of US children are overweight or obese. Restaurant and fast food meals contribute 18% of daily calories for children and adolescents aged 2 to 18 years. Changing children’s menus may improve their diets. This case study describes Best Food for Families, Infants, and Toddlers (Best Food FITS), a community-based intervention designed to address childhood obesity. The objective of this study was to improve San Marcos children’s access to healthy diets through partnerships with local restaurants, removing sugar-sweetened beverages, decreasing the number of energy-dense entrées, and increasing fruit and vegetable offerings on restaurant menus.Community ContextSan Marcos, Texas, the fastest growing US city, has more restaurants and fewer grocery stores than other Texas cities. San Marcos’s population is diverse; 37.8% of residents and 70.3% of children are Hispanic. Overweight and obesity rates among school children exceed 50%; 40.3% of children live below the poverty level. MethodsThis project received funding from the Texas Department of State Health Services Nutrition, Physical Activity, and Obesity Prevention Program to develop Best Food FITS. The case study consisted of developing a brand, engaging community stakeholders, reviewing existing children’s menus in local restaurants, administering owner–manager surveys, collaborating with restaurants to improve menus, and assessing the process and outcomes of the intervention.OutcomeBest Food FITS regularly participated in citywide health events and funded the construction of a teaching kitchen in a new community building where regular nutrition classes are held. Sixteen independent restaurants and 1 chain restaurant implemented new menus.InterpretationImproving menus in restaurants can be a simple step toward changing children’s food habits. The approach taken in this case study can be adapted to other communities. Minimal funding would be needed to facilitate development of promotional items to support brand recognition.

A restaurant-based intervention to promote sales of healthy children’s menu items: the Kids’ Choice Restaurant Program cluster randomized trial

“…Similar to a previous study [ 49 ], restaurants randomized to the menu-plus intervention condition are engaged in a more collaborative process of: (a) identifying healthy children’s menu items that may fit better with their existing adult and children’s menus (if available); (b) implementing a healthy children’s menu campaign that includes a printed children’s menu with copy and design elements that influence ordering behavior [ 50 ], a banner and table tents; and (c) kitchen staff and server training to prepare and promote the new healthy children’s menu items (see Table 1 ). Regarding the menu items, to maximize the sales of new children’s menu items, decisions about what items to include, their recipes, prices, etc., are made over three to four meetings with the restaurant manager/owner.…”

“…Outside banners are used to draw dining parties with children into the restaurants. Table tents and banners are used to promote the menu items, similar to previous research [ 49 ]. The materials are designed to appeal to both children and adults given the increased autonomy children exhibit in restaurant ordering, compared with other food-related decisions [ 42 ].…”

Alimentación saludable y oferta de restaurantes. Una revisión de la evidencia reciente en la literatura

“…According to the articles, low calorie dishes may be included in restaurants' menus through modifying cooking methods 4,20,22,24 , reducing portion size 4,17,19,20,[22][23][24] or adding appetizers with lower calories 4,18,23,24 . Likewise, sugar reduction in meals offered in these establishments was discussed 4,17,20,22,26,27 . On the other hand, reduction of sodium and saturated fat was mentioned repeatedly due to the high prevalence of cardiovascular disease in the population 4,20,24,[27][28][29] .…”

“…To illustrate this, Newson et al 4 asserted that healthy choices are often linked to the perception of less taste, less satiety and higher price. Given this trend, several establishments assume that providing this type of food will harm their profits 22,34 , even more so if foods with lower nutritional quality have a higher profit margin 25,26 . In fact, one study indicated a potential conflict between health promotion and profit generation in food outlets 35 .…”

Progress Evaluation for the Restaurant Industry Assessed by a Voluntary Marketing-Mix and Choice-Architecture Framework That Offers Strategies to Nudge American Customers toward Healthy Food Environments, 2006–2017

“…However, a rural [ 64 ] and urban [ 65 ] study demonstrated that portions could be reduced if technical assistance and public recognition were offered to promote healthy restaurant programs. The fourth study was conducted in an urban city of Texas, and 12 of 17 restaurants reported using the healthy children’s menus two years after the intervention had ended [ 66 ].…”