Don’t buy the kids’ menu hype

The Kids LiveWell program was started in 2011 by the National Restaurant Association to "provide... parents and children with a growing selection of healthful menu options when dining out." The 19 initially participating restaurant chains, which at its start included Denny's, Burger King, and Outback Steakhouse, agreed to offer a selection of children's items that meet the following criteria:

• Offer a children's meal (an entrée, side and beverage) with 600 calories or less; two servings of fruit, vegetables, whole grains, lean protein and/or low-fat dairy; with limits on sodium, fats and sugar;
• Offer at least one other individual item with 200 calories or less, with limits on fats, sugars and sodium, plus contain a serving of fruit, vegetables, whole grains, lean protein or low-fat dairy;
• Display or make available upon request the nutrition profile of the healthful menu options; and
• Promote/identify the healthful menu options.

The program started with about 15,000 participating locations and more than doubled in size to 42,000 locations in 2014, and the program includes a smartphone app to help parents find which restaurants are offering the healthier meals.

That's all very well to commit to offering one option, but they did say "a growing selection." During that same period, other restaurants have made commitments to improving their children's offerings, including changing the default sides from french fries to fruit (McDonald's) and removing soda as the default beverage (including Wendy's and Burger King). Have those restaurants participating in the LiveWell program improved their children's menu selections overall? And how does that compare with those restaurants who are not part of the program?

Fortunately, the New York City Department of Health and Mental Hygiene has created and maintains a website, www.MenuStat.org, that is a collection of nutrition data obtained from the websites of the United States' top-selling restaurant chains. A team of scientists from Harvard, Johns Hopkins, and the University of Pennsylvania used the data from the website to complete an analysis of over 4,000 children's menu items in 45 national restaurant chains (Am J Prev Med 2017;52(3):284-291).

For each year between 2012 and 2015 the authors computed an average amount of calories, sodium, and saturated fat for beverages, entrées, side dishes (including appetizers), and desserts, and compared those averages between those restaurants participating in the Kids LiveWell program and those restaurants who did not. They further looked at the amount of change between the years, comparing the averages for 2012 with the averages for 2013, then with the averages for 2014 and 2015.

What they found is not encouraging. In 2012, the average children's entrée among participating LiveWell restaurants had 373 calories, 796 milligrams of sodium, and just over 6 grams of saturated fat. The good news is that the participating restaurants cut calories and sodium in their entrée average by small amounts (about 5% and 3%, respectively) for the following 2 years, but in the third year (2015) there were only 12 fewer calories than in 2012. At the same time, however, they were increasing the number of calories in their side dishes and in their beverages in amounts that roughly equaled the amounts cut in the entrées.

Meanwhile, the restaurants not participating in LiveWell started out in 2012 with 349 calories, 788 milligrams of sodium, and 6 grams of saturated fat in their average entrée, and although those numbers remained about the same through 2015, the averages for their side dishes actually dropped as much as 19%!

The authors note, as well, that although the number of soda options available in all of the restaurants declined over the period they analyzed, at the same time the number of flavored milk options increased: just because it's milk does not mean it's not a sugar-sweetened beverage.

What this means for you

Don't let the presence of the Kids LiveWell logo on restaurant menus fool you into thinking that all of their children's menu items are healthy: look for the specific items that are approved, and check to make sure you follow any special ordering guidelines, such as requesting no added salt during cooking. Most importantly, check the restaurant's website ahead of time to look for the healthiest options regardless of whether the restaurant participates in the LiveWell program or not. It's always best to plan ahead to eat healthy, for you and your kids.

First posted: April 19, 2017