If a restaurant chain dared to revamp its children’s menu – reducing the calorie count, stripping off the soda pop and offering a salad, mixed vegetables or strawberries as sides instead of french fries – how would kids react? How would parents react? Could the chain still turn a profit?
This is what Stephanie Anzman-Frasca and her colleagues at ChildObesity 180 and the Tufts University Freidman School of Nutrition Science and Policy wondered a few years ago, after the Rockville, Md.-based Silver Diner made such a switch. They worked with the small chain on two studies after the switches were made. More sugary and fattening foods went off the kids' menu but still were made available if requested.
“There’s evidence emerging that children would be open to healthier options and that liking and accepting those options increases with repeated exposure to those options,” said Anzman-Frasca, 31, who in September became an assistant professor in the Department of Pediatrics at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo. She looks to continue her work with similar studies in Western New York.
Q. You say the kids' menu hasn’t changed much during the last half-century but the eating habits of American kids have.
This doesn’t apply to every restaurant but the things you find on kids' menus typically seem to be pretty consistent when you look across restaurants. There are a narrow set of foods when you think about what children will accept and will like; things like chicken nuggets and pizza and grilled cheese, and french fries and sweetened beverages. In prior contexts, we could think about individuals and families eating out more as special occasions, so you could argue it’s not much of a problem to have these palatable, less-nutritious foods characterizing kids' menus. But today, we know about one-third of children eat just fast food on any given day, and there’s more and more evidence that a regular part of a family’s eating experiences is fast food. If you think about that – and you couple that with the fact that we now have an obesity epidemic – it suggests that we want foods at restaurants to be more representative of the foods we’d want in other settings; school meals for example.
I see restaurants as an opportunity to make a change in the foods kids come into contact with in those settings. The evidence suggests that it’s a really promising time for these efforts. Within the restaurant industry, they do surveys capturing the top trends and for the past six years healthier children's meals have been highlighted as a top trend. More broadly, there’s been a lot in the news lately about how people are broadening tastes and how people are looking for healthier foods, more natural foods. There’s also going to be calorie labeling, where restaurants with more than 20 locations are required to list the calories in all of their offerings on the menu. That’s set to role out in December 2016.
Q. Can you talk about how this study was undertaken, and describe the Silver Diner chain?
The Silver Diner chain is a regional chain. Almost all of their locations are in the Baltimore/Washington, D.C. area, with one exception, Cherry Hill, N.J. At the time the study was undertaken, they had 13 standard locations. They serve over 4 million customers per year and it’s more of a traditional sit-down diner. The Silver Diner on its own decided to implement this new children’s menu back in April of 2012. My colleagues at Tufts and I were able to collaborate with them to evaluate what happened when this healthier menu was introduced.
Q. How did the chain's menu change?
Changes took place in three different categories. There was a greater percentage of healthier children’s menu items overall. The way that was defined was those that met criteria from the National Restaurant Association’s Kids Live Well program. This program puts forth standards, such as a children’s meal can’t exceed 600 calories, and they also have particular rules on the percentage of calories that can come from saturated fat and sugar and certain food groups. Before the menu changes, less than a quarter of the items on the kids' menu met the criteria. After the changes, about 60 percent met the criteria. They also changed the structure of the menu so that every meal was bundled with a healthier side dish by default, either salad, mixed vegetables or strawberries. The third thing they did was remove french fries and fountain drinks completely from the kid’s menu. Even though those items were no longer on the menu, perhaps decreasing the temptation, consumers who wanted them could still request them and substitute them at no charge.
Q. How did things play out in your research?
Our first paper on this, which was published in the journal Obesity last spring, looked at children’s meal orders before and shortly after these menu changes. We saw pretty substantial increases in the ordering of the healthier items and substantial decreases in the ordering of the less-healthy items. Before the healthy menu changes, about 3 percent of orders came from those healthier kids' meals. After the new menus, those went up to about 46 percent of entrees. In terms of sides, before the menu changes, we saw that 29 percent of orders had strawberries bundled as a side and after the menu changes, 63 percent did. With french fries, we saw a decrease from 57 percent of bundled sides down to 22 percent.
We wanted to do this new study that just came out in Health Affairs on Nov. 2 because we wanted to see what happened one year after the change and two years after. We did see the healthier changes were substantially sustained. In a few areas, the increases in healthier orders continued to increase. We saw continued increases in orders of healthier beverages and continued decreases in orders of soda.
Q. For parents, what's the take-home message?
This restaurant chain changed its menus to try to make it easier for families and kids to to make healthier selections, but they also left a little ability to make some substitutions to still have some choice. I would encourage parents to look for restaurants that take this approach. It’s becoming more common for restaurants to do things like removing sweetened beverages from their children’s menu. These efforts will continue with increased demand. If parents look for restaurants where it’s easy to make the healthy choice, that will say to restaurants that there’s continued demand for these sorts of healthy changes. It should also make things easier on parents. With the Silver Diner, the french fries and the soft drinks weren’t even on the menu, so you can assume that would decrease the likelihood of a food fight where the parent is trying to encourage the child to eat something healthier than when a child sees a picture of french fries on the menu.
Q. You also looked at the Silver Diner’s revenue growth during the two study periods. What happened?
We saw that revenue continued to increase throughout these periods. We can’t say that the healthy children’s menu directly increased the revenue growth but we can say that their revenue was not harmed during the periods these healthy changes were put into place.
Q. Will you conduct follow-up research while at UB?
My immediate next steps are to do some laboratory based research. We don’t know which aspects of the menu changes in this study were having the biggest effect. I want to isolate that in a controlled lab study where we can bring kids in and see different menus and ask them some questions. After that, I’m hoping we can have a menu intervention packaged up and ready to go, something that we feel confident about. I would definitely be looking for partners in the Buffalo area. I’m at the beginning phases to make those connections. We’ll be looking to work with restaurants and other community partners. (Those interested can email firstname.lastname@example.org.)