Chain restaurants are not known for serving up healthy kids’ meals. Most entrees on a kids’ menu are either fried, breaded or doused in cheese. Fresh fruits and vegetables are rare side dish options, and French fries abound. 
Looking at nutritional content alone, some drinks could easily be mistaken for candy. For example, one serving of “Sharks in the Water” — a blue raspberry soft drink sold at Friendly’s — has more than an entire day’s worth of added sugar.
With options like these, it isn’t surprising that kids who eat more restaurant food have worse diets than other children.
In recent years, restaurants have vowed to change up the menu and offer healthier choices for kids. But our analysis of the nutritional content of more than 4,000 children’s menu items from across the country shows that, despite the promises, kids’ plates still look much the same.
Promises to change
Despite the health risks, kids eat at restaurants all of the time. In fact, kids eat restaurant food nearly as much as they eat at home.
This is due, in part, to the amount of money restaurants spend encouraging kids to buy their products. Restaurants advertise directly to kids by offering action figures from the movie “Frozen” or Hot Wheels cars. They host birthday parties in indoor play areas. Dora the Explorer, Lebron James and Michael Phelps promote restaurant food on billboards and through television advertisements and social media campaigns.
Each year, the restaurant industry spends nearly one-quarter of its advertising budget on tactics that directly target children. This spending seems to have paid off: one-third of kids and over 40 percent of teens eat fast food each day.
There is increasing political pressure on restaurants to offer healthy kids’ meals. Michelle Obama was one of the first prominent political leaders to demand change, as part of her Let’s Move! campaign. In 2010, the first lady petitioned for healthier kids’ food in a speech to the National Restaurant Association (NRA), the nation’s largest food service trade organization. She asked that these healthy options be heavily promoted and easy for parents to find amid the macaroni and cheeses, chicken fingers and grilled cheese sandwiches that have dominated children’s menus for decades. A self-professed “fry lover,” the first lady even pushed restaurants to offer healthier defaults. For example, restaurants could automatically include fruit and vegetable side dishes with kids’ meals and serve French fries only when specifically requested.
The NRA quickly responded to this call to action by creating Kids LiveWell. Kids LiveWell sets nutrition standards for kids’ meals that restaurants can voluntarily adopt. To participate, restaurants must offer at least one kids’ meal and one other item that meet the program’s nutritional goals. For example, a piece of grilled chicken served with broccoli would likely meet these requirements, while fried chicken with French fries would not.
Kids LiveWell is incredibly popular. More than 150 restaurant chains in over 42,000 locations have joined since the program launched in 2011. Participating restaurants are included in a web application designed for parents, called Healthy Dining Finder. Meals meeting the Kids LiveWell criteria are designated with an icon on restaurant menus. Program participants have received significant media attention, with the NRA issuing dozens of press releases since the program began.
This isn’t the only industry pledge to make kids’ meals healthier. In 2014, Subway joined the Partnership for a Healthier America, promising to offer apple slices and to introduce healthier beverages, like low-fat milk and water, to kids’ menus. In March 2012, McDonald’s, a restaurant not participating in Kids LiveWell, reduced the size of French fries and added fruit and low-fat dairy options to Happy Meals. The following year, they promised to drop soda from kids’ menus. Restaurants like Wendy’s, Panera Bread and Applebee’s have since followed suit.
Counting calories
These promises beg the question: Has anything changed? To answer this, we looked at changes in the average nutritional content of kids’ menu items from the nation’s 45 top-earning chain restaurants. Details about these items were pulled from the nutrition information database MenuStat, which collates nutrient data from menus posted on chain restaurant websites and has been updated each year since 2012.
Despite industry promises to offer healthier kids’ menu options, between 2012 and 2015, our analysis found the amount of calories, salt and saturated fat in kids’ menu items has not budged.
We looked at the nutritional content of kids’ menus in the 45 top-earning chain restaurants from 2012 to 2015. Despite industry promises, calories in kids’ beverages, entrees, side dishes and desserts offered on menus has not budged.
The 15 top-earning Kids LiveWell participants showed similarly dismal results. Compared to 30 restaurants not affiliated with the initiative, the top participating restaurants made no improvements to calories, salt or saturated fat in kids’ entrees, side dishes or desserts in the first three years of the program.
We found that, in 2015, when combined, the average beverage, entrée, side dish and dessert contained nearly twice the recommended calories for a single meal and more than half the daily salt limit.
At first glance, it might seem like beverage options have improved. The proportion of sugary soda on kids’ menus declined over time, from 30 percent of kids’ beverages in 2012 to 23 percent in 2015. But when sodas were removed from kids’ menus, they were simply replaced with other high-sugar drinks like flavored milks, sports drinks and sweetened teas.
We also looked at beverages on kids’ menus in the 45 top-earning chain restaurants from 2012 to 2015. The proportion of sugary drinks stayed much the same.
Because restaurants are swapping one high-sugar drink for another, the proportion of sugary drinks on kids’ menus has not changed at all over time. Since 2012, sugary drinks have consistently made up 80 percent of beverage offerings on kids’ restaurant menus.
The bottom line
Food companies have a history of creating voluntary programs to avoid nutrition-related regulation. However, these often have little meaningful impact on health.
For example, the Children’s Food and Beverage Advertising Initiative is an industry self-regulatory program designed to reduce food marketing for unhealthy products to kids. Although companies have followed their pledges, the nutrition criteria bar is so low — high-sugar snacks like Gushers and Fruit Roll-Ups are just two examples of “healthy” products — that these actions have not had a meaningful impact.
The Kids LiveWell program, though well-intentioned, seems destined for the same fate. A kids’ menu from Applebee’s — one of the early restaurants to join Kids LiveWell — reveals one grilled chicken entree alongside chicken tenders, a corn dog, mini cheeseburgers and macaroni and cheese. It’s hard to imagine the grilled chicken standing a chance.
Voluntary initiatives were a reasonable first step, but our analysis shows they have not had a meaningful impact on kids’ meal offerings. So what else needs to be done to ensure our children get the nutrients they need?
The restaurant industry can improve Kids LiveWell by adding standards for healthy beverages, so the vast majority of beverages offered on kids’ menus are healthy options like unsweetened water or seltzer. Kids LiveWell should also require that a much larger percentage of kids’ menu items meet the program’s nutritional criteria. For example, if more than half of entrees on the kids’ menu looked like the grilled chicken, kids might be more likely to choose the healthy option.
Although big chain restaurants have a long way to go, some smaller restaurants have made promising changes. When the Silver Diner increased the number of kids’ meals meeting the Kids LiveWell standards, offered fruit and vegetable sides by default and removed French fries and soda from their menus, kids’ orders of healthy meals and sides went up, and orders of French fries and soda declined.
We believe these types of changes should be voluntarily adopted by restaurants or mandated by state and local governments. For example, the cities of Davis, Stockton and Perris, California have issued “healthy-by-default” ordinances, which require restaurants to offer healthy beverages automatically with kids’ meals, although parents can still request sugary drinks if they want to. New York City recently introduced a “Healthy Happy Meal” bill, which sets nutritional standards for fast food meals marketed to kids, including requirements for fruits, vegetables and whole grains, as well as limits on added sugar and salt.
Other policies — such as taxes on sugary drinks and other foods high in calories, sugar and salt — could encourage restaurants to revamp their kids’ menus, or may at least curb consumption of less healthful options.
Increased pressure from parents can also help move the needle. Advocates and parents can help hold the restaurant industry accountable to their voluntary pledges to ensure meaningful progress towards healthier kids’ meals.
Going out to eat was once viewed as an occasional treat, but is now so commonplace it accounts for nearly half of all food spending. Kids deserve tasty, nutritious meals to help them grow, play and learn, and restaurants can play an important role in making that happen.
Alyssa Moran, Sc.D. candidate in the Department of Nutrition at the Harvard School of Public Health, Harvard University and Christina Roberto, Assistant Professor of Social and Behavioral Sciences and Nutrition, University of Pennsylvania
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