Healthy menu changes and healthy meal promotions in restaurants: evaluating consumer responses and industry trends over the past decade
Abstract: In recent
years, as parents have become more time-constrained, and American families acquire much
more of their food away from home, the health of our next generation depends on having
more nutritious food offerings in restaurants. Children's meals from restaurants are
higher in calories, saturated fat, sodium, and added sugars than meals prepared at home.
Restaurant meals are also ... read moreprevalent in the diets of American children, with 34% of
children estimated to eat fast food meals on a given day. Recent changes in the
prevalence of healthy side and beverage options on children's restaurant menus have been
noted, but trends in the availability of healthy sides and beverages over time are
poorly understood. While some evidence suggests that the nutritional quality of
children's meal orders improves after healthy menu changes, there is a limited
understanding of the differences in how children respond to healthy children's menus.
Moreover, it is unclear if promotional campaigns aimed at improving the quality of
children's meal orders will also positively impact what their parents order either via
priming or parents' desire to serve as a role model. The objective of this dissertation
was to evaluate 1) meal orders after a healthier children's menu change within a
regional restaurant chain, 2) parent orders in a national quick-service restaurant after
the implementation of a community campaign aimed at promoting healthier orders for their
children, and 3) healthy side and beverage menu changes across a sample of national
restaurant chains from 2004 to 2015. In Aim 1, we utilized latent class analysis to
evaluate individual differences in the patterns of child meal orders from a regional
restaurant chain with a new, healthier children's menu. Linear mixed models were used to
evaluate differences in the calorie content of orders in each class. We uncovered six
distinct classes of ordering patterns. Most orders (57.9%) were in classes that were
consistent with the healthier menu and were more likely to meet calorie recommendations.
Ordering patterns comprised of less healthy items also emerged, and included individuals
who made substitutions for healthier items or added less healthy items to their meals.
Aim 2 evaluated using a randomized controlled design the potential spillover effects of
a community campaign aimed at promoting healthier orders for children.
Difference-in-differences analyses were conducted to evaluate differences in the
calories of parent orders overall (n=1533) and by subgroups specific to the campaign's
intended audience. We found no significant differences in the change in calories ordered
by parents from before to after the campaign in the intervention community compared to
the control in all analyses. Aim 3 described the availability on the menu of healthy
sides and beverages over the past 11 years in a subset of quick service restaurants
(QSRs) at the national level, along with co-occurring policy trends. The percentage of
meal bundles with healthy sides increased from 25.0 to 82.5% between 2004 and 2015;
meals bundles with healthy beverages increased from 50.0 to 75.0% during that same time.
Healthy menu changes coincided with periods of high policy activity and occurred
initially in the largest QSR chains in or prior to 2004. This research indicates side
and beverage options on the leading QSR menus have become healthier over time. Yet the
potential for differential responses to healthier menus suggests the need to consider
which children are ordering these items and in which contexts. The absence of spillover
from the campaign aimed at improving children's menu orders indicates that to also
influence parent orders, strategies that explicitly ask them to consider their own
ordering habits as part of interventions targeting children's meals in restaurants may
need to be considered. Future research and interventions should examine multiple levels
of influence on the nutrition quality of children's restaurant
Thesis (Ph.D.)--Tufts University, 2017.
Submitted to the Dept. of Food Policy & Applied Nutrition.
Advisor: Christina Economos.
Committee: Stephanie Anzman-Frasca, Sara Folta, and Parke Wilde.
Keywords: Nutrition, and Public health.read less