Limited implementation of California’s Healthy Default Beverage law for children’s meals sold online

Objective: To reduce children’s sugar-sweetened beverage intake, California’s Healthy-By-Default Beverage law (SB1192) mandates only unflavored dairy/non-dairy milk or water be the default drinks with restaurant children’s meals. The objective of this study is to examine consistency with this law for meals sold through online platforms from restaurants in low-income California neighborhoods. Design: This observational, cross-sectional study examines beverage availability, upcharges (additional cost), and presentation of beverage options consistent with SB1192 (using 4 increasingly restrictive criteria) within a random sample of quick service restaurants (QSRs) in SNAP-Ed eligible census tracts selling children’s meals online from November 2020-April 2021. Setting: Low-income California neighborhoods (n=226 census tracts). Participants: QSRs that sold children’s meals online via a restaurant-specific platform, DoorDash, GrubHub, and/or UberEats (n=631 observations from 254 QSRs). Results: Seventy percent of observations offered water; 63% offered unflavored milk. Among all beverages, water was most likely to have an upcharge; among observations offering water (n=445), 41% had an upcharge (average $0.51). Among observations offering unflavored milk (n=396), 11% had an upcharge (average $0.38). No observations upcharged for soda (regular or diet). Implementation consistency with SB1192 ranged from 40.5% (using the least restrictive criteria) to 5.6% (most restrictive) of observations. Conclusions: Based on observations from restaurant websites and three of the most popular online ordering platforms, most California QSRs located in low-income neighborhoods are not offering children’s meal beverages consistent with the state’s Healthy-By-Default Beverage law. As the popularity of online ordering increases, further work to ensure restaurants are offering healthy default beverages with children’s meals sold online is necessary.

Soft Drinks and Premiums with Children’s Meals Marketed on the Websites at the Top Restaurant Chains Worldwide

Objective: To assess the frequency with which soft drinks and premiums are available with children’s meals marketed on the top restaurant chains websites worldwide. Design: Cross-sectional structured observational assessment of secondary information about top international restaurant chain children’s meals. Setting: Websites of top restaurant chains for 193 countries and five regions of the United Nations (UN). Participants: Top restaurant chains (including McDonald’s, Subway, Burger King, and KFC) across 193 countries. Children’s meal images and descriptions were reviewed to determine if the meal was served with a soft drink as a beverage option and whether the meal offered a premium. Results: Children’s meals were marketed online on restaurant websites by at least one of the four chains in a total of 78 of the 193 countries (40.4%). Overall, 56.3% of countries with any online children’s meal marketing by the four chains included at least one chain that marketed soft drinks and 92.3% marketed premiums with the meal. Conclusions: Every region in the world includes marketing of children’s meals on the websites of the top restaurant chains. The high prevalence of premiums marketed online with children’s meals is of concern. Similarly, with over 50% of countries with online children’s meal marketing having at least one chain that offers soft drinks as part of the meals, additional regulation and education may be warranted.

Baseline Assessment of Children’s Meals and Healthy Beverage Options Prior to a State-Level Healthy Default Beverage (HDB) Law

In January 2020, Hawai‘i became the second state with a healthy default beverage (HDB) law, requiring restaurants to offer HDBs with their children’s meals. This observational study presents baseline characteristics of restaurants with a children’s menu and meal, and describes pre-law beverage options to inform future HDB policy language, implementation, and evaluation. Between November and December 2019, data were collected from a statewide sample of unique restaurants (n=383) with health inspection permits. Restaurants were assessed separately for a children’s menu and meal using website reviews, telephone calls, and in-person visits. Meals were evaluated in February 2020 for pre-law beverage type and compliance. Logistic regression was used to estimate the likelihood of having a children’s menu and meal. Most of the restaurants were full-service (70.2%) and non-chains (67.9%). While 49.3% of restaurants had a children’s menu, only 16.7% had a meal. Significant predictors of having a children’s menu were being full-service (OR=2.09; p=0.004), national/international (OR=5.32; p<0.001) or local chains (OR=1.99; p=0.03), neighbor island (non-Honolulu) locations (OR=2.49; p<0.001), and hotel locations (OR=3.77; p<0.001). Only being a national/international chain significantly predicted having a children’s meal (OR=7.57; p<0.001). Although 35.9% of children’s meals offered a non-sugar-sweetened beverage (SSB) option, only 3.1% offered law-compliant beverages. Inclusion of an SSB default option (60.9%) and not specifying the type of default beverage were the predominant factors for pre-law non-compliance. Results support the need for HDB regulations, especially for national/international chains, which were most likely to have children’s meals, and provide data to inform policies in other jurisdictions.

Evaluation of the organization of healthy free hot food for students in grades 1–4

The article presents the results of a survey of parents of junior high school students and parental control over the organization of meals. In the course of the sociological research the questions of satisfaction with the organization of hot breakfasts and lunches for pupils of classes 1–4 in connection with the transition to the 100 % coverage with healthy, hot free meals in general educational institutions were studied. Parents of children in grades 1–4 from 60 regions of the Russian Federation participated in the survey. Information was obtained and analyzed on the satisfaction of schoolchildren with organized meals according to the following criteria — satisfaction with the variety of meals, portion size, the number of meals offered, and their taste. The results of parental control are presented, which made it possible to identify the main directions of improving the organization of children’s meals — increasing the duration of breaks, monitoring children’s compliance with the rules of personal hygiene, organizing meals for children who require an individual approach to the organization of food for health reasons.

Reinventing health promotion for healthy default beverage laws in the face of COVID-19

Shortly after a healthy default beverage (HDB) law took effect in Hawai‘i, requiring restaurants that serve children’s meals to offer healthy beverages with the meals, the COVID-19 pandemic struck. Efforts to contain the virus resulted in changes to restaurants’ operations and disrupted HDB implementation efforts. Economic repercussions from containment efforts have exacerbated food insecurity, limited access to healthy foods, and created obstacles to chronic disease management. Promoting healthy default options is critical at a time when engaging in healthy behaviors is difficult, but important, to both prevent and manage chronic disease and decrease COVID-19 risk. This commentary discusses COVID-19’s impact on restaurant operations and healthy eating, and the resulting challenges and opportunities for this promising health promotion intervention.

Hubungan Perilaku Sosial dengan Kebiasaan Makan pada Anak Status Gizi Kurang

Social behavior is an activity in dealing with other people including friends, teachers, parents as well as other relations. Social behavior is an important aspect in forming eating habits. It is because the selection of children’s meals can be influenced by friends as well as parents. Meanwhile, eating habits is a consumption pattern obtained because it occurs repeatedly. This study aimed at investigating the correlation between social behaviors and eating habits of children with malnutrition status in working area of Negara II Public Health Centre in 2019. The research design used in this study was correlation analysis. The populations in this research were 56 children under age of 3-5 years old with malnutrition status in the working area of Negara II Public Health Centre, Jembrana Regency. From the total population, 52 children chosen by using probability sampling technique especially simple random sampling technique were used as the samples in this study. The statistic test used in this research was Spearman’s Rho. As the result of this study, it was found that most of the children’s social behaviors with good category were 27 (51%) and children eating habits with good category were 39 (75%). Based on the statistic test, it was found that p = 0.000 (p < 0.05), then Ho was rejected. It could be concluded that there was a correlation between social behaviors and eating habits of children with malnutrition status.

Nutrition composition of children’s meals in twenty-six large US chain restaurants

Objective:To compare the nutritional quality of children’s combination meals offered at large US chain restaurants characterised by three versions – default (advertised), minimum (lower-energy) and maximum (higher-energy).Design:We identified default children’s meals (n 92) from online restaurant menus, then constructed minimum and maximum versions using realistic additions, substitutions and/or portion size changes for existing menu items. Nutrition data were obtained from the MenuStat database. Bootstrapped linear models assessed nutrition differences between meal versions and the extent to which meal components (main dish, side dish, beverage) drove differences across versions. For each version, we examined the proportion of meals meeting the Guidelines for Responsible Food Marketing to Children.Setting:Twenty-six fast-food and fast-casual restaurants, in 2017.Participants:None.Results:Nutrient values differed significantly across meal versions for energy content (default 2443 kJ (584 kcal), minimum 1674 kJ (400 kcal), maximum 3314 kJ (792 kcal)), total fat (23, 17, 33 g), saturated fat (8, 6, 11 g), Na (1046, 915, 1287 mg) and sugar (35, 14, 51 g). The substitution of lower-energy beverages resulted in the greatest reduction in energy content (default to minimum, −418 kJ (−100 kcal)) and sugar (−20 g); choosing lower-energy side dishes resulted in the greatest reduction in total fat (default to minimum, −4 g), saturated fat (−1·1 g) and Na (−69 mg). Only 3 % of meals met guidelines for all nutrients.Conclusions:Realistic modifications to children’s combination meals using existing menu options can significantly alter a meal’s nutrient composition. Promoting lower-energy items as the default option, especially for beverages and side dishes, has a potential to reduce fat, saturated fat and/or sugar in children’s meals.

Meal deals, combos and bundling: the impact on the nutrition composition of children’s meals in restaurants

Increased consumption of food outside the home means that the nutritional content of meals served in restaurants now makes a significant contribution to overall diet. Children’s menus in restaurants, usually aimed at those aged 10 years and younger, are frequently high in energy, fat, salt, sugar and lack variety. The food and drink on children’s menus are often bundled together as a combo or meal deal that may be convenient to order and sometimes, but not always, cheaper. Bundling has the potential to add additional foods that may not have been selected individually thus increasing the amount ordered and consumed. Substituting some meal deal items for healthier options has the potential to make it easier to eat well when eating outside the home and improve dietary intakes. However, the impact of such measures on child health has yet to be fully explored.