New research from ChildObesity180 at Tufts University Friedman School is challenging conventional wisdom about the viability of offering healthy children’s meals in restaurants.

Restaurants’ role in addressing childhood obesity

Americans, including children, eat frequently in restaurants. In fact, approximately one-third of American children eat fast food on any given day. A typical restaurant kids’ menu might include high-calorie foods like pizza, macaroni and cheese, and chicken nuggets, served with a side of salty French fries and a sugary drink like soda or lemonade. Given how frequently children dine in restaurants and the typical food choices available to them, restaurants have an important role to play in addressing childhood obesity.

Studying one restaurant chain’s new, healthier children’s menu

In 2012, the Silver Diner, a regional restaurant chain primarily located in the Baltimore-Washington, DC metropolitan area, revamped its children’s menu to offer healthier items. The new menu had significantly more kids’ meals that met broadly-accepted nutrition standards, and all kids’ entrees were automatically paired with healthy side dishes like strawberries, mixed vegetables, and side salads. The restaurant also removed French fries and sugary soft drinks from the children’s menu, although those items could be substituted at no additional charge.

ChildObesity180 researchers examined outcomes before and shortly after the menu overhaul, examining changes in children’s orders as well as restaurant revenue. This study was the first to look at both child meal orders and revenue following healthy menu changes.

Initial findings suggest the healthier menu was a success

The result, as reported in the May 2015 issue of the journal Obesity, was a win-win for customers and the restaurant chain: orders of healthier items increased, and restaurant revenue continued to grow. After the menu changes, nearly half (46%) of children’s entrées ordered were from the healthier kids’ meal options, versus a mere 3% of entrées ordered before the changes. The proportion of kids’ meal orders that included at least one healthy side also increased dramatically—from 26% before the changes to 70% after.

Strawberries were the most popular healthy side dish, accounting for 63% of the side dishes served with kids’ entrees after the menu was changed. Milk and juice orders also increased after the menu changes, and soda orders decreased.

“Given how frequently kids go to restaurants, and evidence that this can be linked with consuming excess calories, offering and promoting healthier menu options could play a role in reversing the childhood obesity epidemic,” said Stephanie Anzman-Frasca, PhD, Assistant Professor at the University at Buffalo and lead author of the paper.

Two years later, more positive news for the business and its customers

Wondering whether these changes would be sustained over time, the researchers examined ordering and revenue data again more than two years after the healthier children’s menu was rolled out. The results, published in the November 2015 issue of Health Affairs, were encouraging.

The new research showed that the healthy changes in orders of children’s items were largely maintained, and in some cases continued to improve. For example, across the two-year follow-up period, orders of fruit and vegetable side dishes held steady, while soda orders continued to decrease.

Moreover, results continued to show that including more healthy options on the kids’ menu did not hurt overall restaurant revenue and may have even supported continued growth. Total annual revenue across all Silver Diner restaurant locations grew by 5.3% from 2013 to 2014, exceeding the average revenue growth in leading family dining chains for the same period.

Everyone has a role to play in addressing childhood obesity

That’s good news for the restaurant industry, which is poised to play an important role in addressing the high rates of obesity among children in the US. “Restaurants should be commended for their progress to date, but no single step will reverse the childhood obesity epidemic and there is still much work to do,” said Christina Economos, PhD, Director of ChildObesity180, Associate Professor at Tufts University Friedman School, and the study’s senior author. “Everyone has a role to play in providing healthier meals for kids. Restaurants can increase the availability of healthy, appealing options on children’s menus. Parents can educate and guide their children toward healthy choices, and speak up to demand healthy meals where they don’t exist. We need to combine more nutritious children’s meal offerings with stronger education to drive both supply and demand to support healthier choices.”

This research was funded by The JPB Foundation and the Robert Wood Johnson Foundation. No financial support was received from Silver Diner.

To learn more about this research, visit www.childobesity180.org/healthymeals