KIMEHS—Proposal of an Index for Qualitative Evaluation of Children’s Menus—A Pilot Study

Abstract

Considering the importance of the food environments for health promotion, and the lack of simple, easy to use, low-cost measures of the quality of meals, the authors developed a qualitative menu index (KIMEHS—Kids’ Menu Healthy Score), tailored to children’s menu evaluation. Development of the tool was based on the Mediterranean food pattern. It includes 18 components, divided into seven main groups that reflect key aspects of menu quality, including protein source, side dishes, vegetables, dessert and beverages, and also allergens and nutritional information. The index was analysed for content and construct validity, as well as inter-rater reliability, and was applied to a sample of menus from restaurants in shopping centres in the Lisbon region. Possible index point ranges from −17 to 17, with a higher score indicating greater compliance with the recommendations. A value of 5.5 is obtained if all KIMEHS items are available, considering healthy and non-healthy options. The inter-rater reliability was assessed and values above 0.80 were obtained for Alpha Cronbach, as well as agreement % rate >75%. Agreement percentage is above 75% for all the components. Evaluated restaurants scored from −14 to 7, with an average KIMEHS of −6.15. Only four restaurants scored positive values, ranging from 0.25 to 7. KIMEHS was considered to be an adequate index to evaluate children’s menus, from the menu information displayed on restaurant websites and/or on restaurant displays or table menus. It is a simple, low-cost tool that may be used as a reference for health professionals as an objective measure to evaluate the food environment. Stakeholders could also be involved in their own assessment to help educate consumers about healthy food choices, strengthening the efforts to promote an adequate food pattern and health, contributing to the fight against obesity.

Children’s menus in shopping centre restaurants: a multicentric study

“…The KIMEHS (Rocha and Viegas, 2020) was calculated globally and for each country. Results are presented in Table 3.…”

“…Positive points are attributed to healthy options on the menu, while non-healthy choices are negatively scored. Menus ranging from À17 to 0.5 are unhealthy; from 0.5 to 5.5 moderately unhealthy; from 5.5 to 11.5 are classified as going healthy; from 11.5 to 13.5 moderately healthy and from 13.5 to 17 are healthy (see Figure 1) (Rocha and Viegas, 2020).…”

Quality of kids’ meals in fast-food restaurants: the nutritional content is not enough for an informed choice

“…This study has some limitations, namely the fact that sugary drinks, sweet desserts, and sauces, also available in children's menus, were not included in the quantification of the nutritional value, which underestimates the meals' energetic value. The results of this study point out the need for a more simplified and explicit visual scale/score of meal quality, to be read and understood by consumers, that goes beyond the nutritional content [29]. This could allow consumers and parents in particular to make more informed decisions.…”

The Nutritional Quality of Kids’ Menus from Cafés and Restaurants: An Australian Cross-Sectional Study

“…KIMEHS is a validated tool designed to assess the nutritional quality of Kids' Menus obtained from restaurant websites, in-store display menus, or table menus [33]. Based on adherence to the Mediterranean dietary pattern, which is widely recognised as being healthy due to the high intake of plant-based foods [34,35], the KIMEHS assesses the presence of major food groups, including vegetables, pulses, cereals, meat, fish and eggs, fruit, and water.…”

“…Each Kids' Menu was evaluated using the KIMEHS tool [33], which applies positive points for healthy options and negative scores for non-healthy options. The magnitude of the attributed points is proportional to the impact that the food option has on menu quality and health [33]. A total KIMEHS score is calculated across the whole menu, with a possible range from −17 to 17.…”