Healthy children's menu items tied to healthier ordering patterns, sustained restaurant revenue

"Children and families in the U.S. often eat meals away from home making it even more important for restaurants to provide menu options that have the potential to promote health and improve nutrition," says Amanda Staiano, PhD, MPP, Public Affairs Chair of The Obesity Society and Assistant Professor at Pennington Biomedical Research Center in Baton Rouge, LA. "This research is contrary to some of the current claims that patrons will reject healthier menus thus having a negative impact on sales."

To conduct the study, Tufts University researchers led by Stephanie Anzman-Frasca, PhD, investigated the purchasing patterns of children's meals before and after a regional restaurant chain implemented healthier children's menu items in its 13 standard locations. The healthier menu featured a greater number of children's meals eligible for the National Restaurant Association's Kids LiveWell program, which is designed to decrease the caloric content and increase the micronutrient content of children's meals in restaurants.

In addition to increasing the availability of healthier children's meals, the restaurant chain shifted the menu's structure so healthier options like salad and fruit were offered by default in place of traditional side dish items like French fries. Children could swap their healthier side dish for free upon request, but the restaurateurs hoped that by replacing the default side dish with something healthier (e.g., salad, vegetables or strawberries), children's nutritional intake could improve.

"Research has demonstrated that individuals are likely to accept default options," says Dr. Anzman-Frasca. "Our research suggests that by decreasing the automatic availability of energy-dense items like French fries and replacing them with healthier items such as strawberries, children's dietary choices in restaurants can improve."

The researchers based their analysis on aggregate data of more than 350,000 children's meals provided by the restaurant, including a random subsample of individual receipts. The researchers noted encouraging differences before and after the implementation of the new menu, such as increases in healthy entrées ordered (from 3% to 46%) and at least one healthy side dish ordered (from 25% to 70%). There was also a decrease in French fries ordered from 57% to 22%. While the researchers noted no differences in total calories ordered on average, they found that when children kept the default side dish in their order, meals had about 60 fewer calories after the new menu was instated.

In addition, researchers found that while costs for the healthier menu items were slightly higher (+$0.79 for breakfast and +$0.19 for non-breakfast meals), overall revenue continued to grow for the restaurant after the adjustment to the menu, with growth exceeding that of leading family dining chains (+11% from 2010-2011, +5% from 2011-2012, +5.1% from 2012-2013). According to the paper, "this is consistent with the idea that healthy menu modifications are good for business."

"This research adds evidence to the strategy of changing children's menu defaults as a means to lower the calorie content of children's meals and add more diverse food choices without necessarily sacrificing sales or choice," continues Dr. Staiano. "Restaurateurs interested in improving their menus may find this a useful case study."

This study did not evaluate the effect of intervention on actual consumption of food, which is critical to determine the actual impact on health. The study authors recommend future research to "explore the impacts of healthy menu modifications over time in different subgroups, including frequent consumers of restaurant foods" and "examine the number of calories ordered and consumed by children in response to different menu configurations."