Promoting healthier meal selection and intake among children in restaurants

ABSTRACT
US children’s diets are unhealthy, a critical issue to address in the context of the obesity epidemic. Restaurants
are one setting in which environmental shifts could promote healthier eating among children. One-third of
children eat food from quick-service (fast food) restaurants on a given day, and consumption of restaurant food
has been linked with increased energy intake and poorer diet quality. Taste is a key factor influencing food
choices for children in restaurants, so approaches that increase children’s liking of healthier options offer
promise to improve their eating behavior in these settings and more broadly. The goal of the proposed
research is to make healthier options more appealing and easier to choose via an in-restaurant intervention
that combines choice architecture and repeated exposure strategies. The choice architecture element will be a
placemat designed to make it easier to choose healthier kids’ meal items and omit dessert. The repeated
exposure element will be frequent diner cards, designed to increase exposure to and enjoyment of target
foods. Extensive basic research supports repeated exposure as a powerful strategy to improve children’s taste
preferences. Further, in a pilot study of 58 families in a quick-service restaurant, we showed the promise of our
planned intervention: Children provided with placemats promoting healthier kids’ meals ordered a greater
number of healthier foods than controls, and children who ordered promoted main dishes consumed less
saturated fat than those who did not. Our long-term goal is to establish the effectiveness of an in-restaurant
healthy eating intervention that can be implemented and disseminated across restaurants. The objective of this
grant is to expand on our preliminary research by rigorously testing effects of an intervention that combines
choice architecture and repeated exposure strategies on children’s food selection and intake in quick-service
restaurants and throughout the day. We will randomize restaurant locations to groups, and children who visit
restaurants regularly (n=930; 310 per cohort) will be exposed to placemats and frequent diner cards promoting
healthier meals or generic (control) versions of these materials. The frequent diner cards will incentivize
selection of a healthier featured meal over 6 occasions in the intervention group. The central hypothesis is that
after these exposures, intervention group children will be more likely to select a healthier meal. Children’s meal
selection and dietary intake in the restaurant and throughout the day will be assessed at initial and post-test
time points to test hypotheses that this intervention promotes healthier meal selection (Specific Aim 1) and
dietary intake (Specific Aim 2). Families’ behaviors at interim time points and potential impacts on restaurants
will also be monitored. Given how frequently children eat food from restaurants, the typical consumption
patterns while there, and the promise of repeated exposure to impact eating behaviors broadly, this
intervention has the potential for meaningful public health impact. The present approach is novel in its
application of behavioral strategies and offers the potential for lasting impacts on children’s diets and health.

Grant Number: 5R01HD096748-05
NIH Institute/Center: NIH
Principal Investigator: Stephanie Anzman-Frasca