Kids’ Meals II: Obesity and Poor Nutrition on the Menu 
        
                            1                    2013 
                                           
                          Kids’ Meals II: Obesity and Poor Nutrition on the Menu 
         Report by Ameena Batada, Dr.P.H., with research assistance from Lauren Flewelling and 
        Alexandra Goode, at the University of North Carolina Asheville, and Margo G. Wootan, D.Sc., 
        Center for Science in the Public interest.  Thanks to Jordan Hall Preston and Kanydah Bellamy 
        for their assistance, and to Lisa Powell, Mary Story, and Jennifer Harris for their thoughtful 
                        review of the report. 
                          March 2013 
                              
                              
                              
                  For more information on this report, contact: 
                              
                       Ameena Batada, Dr.P.H. 
                     Department of Health and Wellness 
                    University of North Carolina at Asheville 
                        abatada@unca.edu  
                              
                              
                              
                 For more information on model policies, contact: 
                              
                       Margo G. Wootan, D.Sc. 
                  Center for Science in the Public Interest (CSPI) 
                        Phone: 202-777-8352 
                     Email: nutritionpolicy@cspinet.org 
                              
                              
                              
                              
                              
                              
                              
                              
                              
                              
                              
                              
                              
                              
                              
        Kids’ Meals II: Obesity and Poor Nutrition on the Menu is available online free of charge at 
                      
                              
                              
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                                                         Kids’ Meals II: Obesity and Poor Nutrition on the Menu 
               Executive Summary                                   More restaurants offer non-soft drink 
               Many restaurant chains offer menu items             beverage and fruit options, but soft drinks 
               especially for, and marketed to, children.          and fried potatoes are still more common 
               Given that children consume on average 25%          options on children's menus.   
               of their daily calories at fast-food and other       
               restaurants, the nutritional quality of those       To support parents’ efforts to feed their 
               meals is important.  This report investigates       children a healthy diet, restaurants should:  
               the types of children’s menu items and the          •   Participate in the National Restaurant 
               nutritional quality of children’s meals at the          Association's Kids LiveWell program and 
               largest restaurant chains in the United States.         reformulate meals so that all meet calorie, 
                                                                       sodium, fats, and other nutrition 
               Of the top 50 chains, 9 (18%) did not have              standards; 
               dedicated children’s menu items or meals.  Of       •   Offer more fruit and vegetable options 
               the 41 chains with children's items, 34 (83%)           and make those options the default side 
               offered children’s meal combinations and                dishes with every children’s meal; 
               provided adequate information for nutrition         •   Remove soft drinks and other sugary 
               analyses.  We assessed the nutritional quality          drinks from children's menus; 
               of all possible children’s meal combinations        •   Offer more whole grains as a part of 
               against a set of standards developed by a               children’s meals;  
               panel of nutrition and health experts, and          •   Provide calorie information for all menu 
               against the National Restaurant Association’s           items on menus or menu boards; 
               (NRA) Kids LiveWell standards.                      •   Market only healthy options to children 
                                                                       through all marketing approaches used by 
               Of the 3,494 meal combinations, 97% do not              the restaurant, including through mass 
               meet the expert nutrition standards for                 media, websites, in-store promotions and 
               children’s meals and 91% do not meet the                toy give-aways, school-related activities, 
               NRA's Kids LiveWell standards.  Nineteen of             and other venues;  
               the restaurant chains offering children’s               •  Only market the restaurant brand if the 
               meals (56%) do not have even one meal that                 majority (>50%) of that restaurant's 
               meets the expert nutrition standards and 9                 children’s options are healthy 
               chains (26%) do not have one meal that                     items/meals; otherwise healthier 
               meets the Kids LiveWell standards.                         meals should be prominently featured 
                                                                          in advertisements rather than 
               We also assessed how the nutritional quality               generically marketing the restaurant; 
               of children's meals has changed over time,                 and 
               comparing the nutritional quality of the meals          •  Join the Children’s Food and Beverage 
               now to the results of a similar study we                   Advertising Initiative (CFBAI).  
               conducted in 2008.  The overall percentage of        
               meals that met the nutrition standards               
               increased since 2008, from 1% to 3%.  The            
               percentages of meals meeting the calorie and 
               sodium limits increased and the percentage           
               meeting the saturated fats limit decreased.     3 
                
                                                                Kids’ Meals II: Obesity and Poor Nutrition on the Menu 
                 Introduction                                              information for nutritional analysis.  The 
                 Americans eat out much more today than 50                 chains that did not disclose nutrition 
                 years ago, with nearly half of food dollars               information were: Cracker Barrel Old Country 
                 (48%) now spent on restaurant foods                       Store and Restaurant, Hooters, Waffle House, 
                 (National Restaurant Association, 2012), up               the Cheesecake Factory, and Texas 
                 from 26% in 1970 (Lin et al., 1999). Many                 Roadhouse.  The Cheesecake Factory, did not 
                 restaurant chains offer menu items especially             list specific children’s items online but 
                 for, and marketed to, children.  Given that               indicated that customers should check with 
                 children consume on average 25% of their                  their server for children’s meals.  Pizza Hut 
                 daily calories at fast-food and other                     did not disclose nutrition information for 
                 restaurants (Lin and Morrison, 2012), and                 children’s items.  Baskin Robbins provided 
                 consumption of restaurant food is associated              nutrition information but did not offer meals. 
                 with increased energy intake and poorer diet               
                 quality (Powell and Nguyen, 2012), assessing              Nutrition information for each restaurant was 
                 the nutritional quality of children’s meals is of         obtained primarily in October-November 
                 importance.  Healthier children’s meals                   2012 from the restaurant’s website or from 
                 support families’ efforts to promote the                  corporate headquarters.  When nutrition 
                 healthy eating and weight of their children.              information for a particular item was not 
                 This report investigates types of children’s              available, we used information from the U.S. 
                 menu items and the nutritional quality of                 Department of Agriculture Nutrition Analysis 
                 children’s meals at the largest restaurant                Tool (NAT) 2.0 (USDA, 2012).  Fourteen 
                 chains in the United States.  It also                     restaurants did not make available 
                 summarizes the changes in nutritional quality             information about menu item weights and 
                 of children’s meals in the four years since we            eight restaurants did not make available 
                 conducted a similar assessment in 2008.                   information about certain individual 
                                                                           nutrients, such as trans and/or saturated fat 
                 Methods                                                   and sugars, and thus those nutrients for their 
                 We examined children’s menu items and                     foods could not be fully analyzed. 
                 meals (those found on children’s/kids’ menus               
                 or in children’s/kids’ sections of the menu) at           We analyzed the nutritional quality of all 
                 the 50 largest (by revenue in 2009) chain                 possible children’s meal combinations (each 
                 restaurants in the United States (Reed Elsevir            possible combination of an entree, side item, 
                 Inc., 2009).                                              and beverage from each restaurant’s 
                                                                           children’s menu, as described on the 
                 Of the top 50 restaurant chains, 9 (18%) did              restaurant website or on the in-restaurant 
                 not have dedicated children’s menu items or               menu).  For example, a hamburger, fries, and 
                 meals: Domino’s Pizza, Dunkin' Donuts, 7-                 soft drink were considered one possible 
                 Eleven, Papa John's, Golden Corral, Church’s              combination; a hamburger, fries, and low-fat 
                 Chicken, Little Caesars Pizza, HomeTown                   milk were considered another combination. 
                 Buffet/Old Country Buffet, and Starbucks. Of              Beverages of similar type were counted once 
                 the remaining 41 chains that did offer                    (for example, all soft drinks were treated as 
                 children’s menu items, 34 (83%) offered meal              one menu item, even when multiple flavors or 
                 combinations and provided adequate                        varieties, including diet versions, were 
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