Growing bodies deserve healthy foods. Meals offered to children at restaurants should be packed with healthy options, not empty calories from extra sugar. So what can be done? Some advocates are working with restaurant chains to include healthy beverages with kids’ meals and to offer fruits and vegetables with those meals, to give growing children what they need to thrive.
Policies directed at kids’ meals aim to improve the nutritional content of restaurant meals marketed and served specifically to children. Several versions of these policies have been proposed or adopted, with at least four major variables:
- Meals with toys vs. all meals: The original policy approach—marked by the fast food toy ordinances enacted by Santa Clara County1 and San Francisco2 in 2010—entailed setting nutritional standards for meals accompanied by toys or other prizes.
- Voluntary vs. mandatory: A number of major restaurant chains have voluntarily committed to some kind of improvement—mostly by removing sugary drinks from children’s menus. Meanwhile, three jurisdictions have passed some version of a kids’ meal ordinance, and approximately a dozen more are pursuing legislation.
- Default beverage vs. whole meal: Most of the jurisdictions currently pursuing kids’ meal policies are aiming to regulate only the default beverage and not the entire meal. This is in line with the Davis, California ordinance,3 and the Stockton, California ordinance which is the most recent kids’ meal law to be enacted. Moreover, most of the voluntary commitments by major restaurant chains to improve their kids’ meals address only the default beverage.
- Source and strength of nutrition standards: With regard to policies that regulate default beverages, public health advocates are calling for the use of standards based on Recommendations for Healthier Beverages from Healthy Eating Research.
Kids’ meals and childhood obesity
In the period 2011-14, 17 percent of youth in the United States were obese.4 Obese children are at an increased risk for type 2 diabetes, heart disease, stroke, certain cancers, asthma, low self-esteem, and depression.5,6 Busy families with limited time to prepare food at home frequently rely on restaurant meals to nourish their children. In fact, Americans spend nearly half (48%) of all food dollars at restaurants,7 and children in the United States consume 19 percent of their daily calories at fast food and other restaurants.8
Eating out often means eating poorly: Children take in almost twice as many calories when they eat a meal at a restaurant as when they eat at home.9 Indeed, restaurant meals designed specifically for children are particularly unhealthy. A study of the top 50 U.S. chain restaurants determined that 86 percent of kids’ meal combinations are too high in calories, 55 percent are too high in saturated fat, and 66 percent are too high in sodium.10 Restaurant meals served with soda are especially problematic because there is a substantial risk of weight gain and diabetes resulting from added sugars in beverages.11 Reducing intake of sugary drinks has been shown to diminish the prevalence of obesity and obesity-related diseases.12
Kids’ meals are big business
Despite the commitments of six major restaurant chains to implement some kind of improvement to their kids’ meals, since 2008, the percentage of kids’ meals that meet evidence-based nutrition standards has barely budged—rising from 1% to just 3%.12 Meanwhile, major chain restaurants are spending hundreds of millions of dollars per year on ads, toys, and other marketing ploys to persuade children and their parents to purchase kids’ meals on a regular basis.13 This means that preschool and elementary school-aged children view approximately three fast-food television ads per day,14 and children receive more than $300 million worth of toys per year distributed as premiums with kids’ meals.15
Research conducted by the food industry confirms that marketing to children generates purchases driven by children’s “pester power.” In one sample year, fast food chains sold more than one billion kids’ meals with toys.15 One-third of children eat fast food on a given day,16 and on days they eat fast food, children consume 126 additional calories including extra sugar.16
There have been grassroots efforts to introduce default beverage ordinances in three Maryland jurisdictions (Baltimore, Montgomery and Prince George’s Counties); several California cities (Chula Vista, Compton, Hawthorne, Los Angeles, Long Beach, Paris, Riverside); and at the state level in Maryland and Vermont.
There have also been attempts in New York to restrict toys in kids meals that fail to meet nutritional standards.
A coalition of national advocacy organizations has been petitioning the major restaurant chains to remove sugary drinks from their kids’ menus, and thus far six have agreed: Applebee’s, Burger King, Dairy Queen, Jack in the Box, McDonald’s, and Wendy’s. (Subway, Panera, and a few others did not have soda on the kids’ menu to begin with.)
As of July, 2016 four jurisdictions—all in California—had enacted kids’ meals legislation. Santa Clara County and San Francisco adopted fast food toy ordinances in 2010,1,2 and Davis became the first in the nation to pass a default beverage ordinance in 2015. In June, 2016 the city of Stockton passed an ordinance requiring either water or milk to be served as the default beverage in children’s meals.
Key online advocacy resources
- Food Marketing Workgroup is a network of more than 225 organizations and academic experts who are concerned about the proliferation of marketing of unhealthful foods and beverages that targets children and adolescents.
- ChangeLab Solutions has a “healthy restaurants” resource page that includes a report on Creating Successful Healthy Restaurant Policies and Model Healthy Children’s Meals Ordinance
- Voices for Healthy Kids at the American Heart Association has a range of resources for advocates looking for ways to improve nutrition and access to good food for children.
1 Santa Clara, Cal. Code of Ordinances, Division A18, Chapter XXII, §§ A18-350-355.
2 San Francisco, Cal. Health Code §§ 471.1-471.9 (Ord. 290-10, File No. 101096).
3 Davis, Cal. Municipal Code, Article 17.02.
4 Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS data brief, no 219. Hyattsville, MD: National Center for Health Statistics; 2015.
5 Office of the Surgeon General. The Surgeon General’s call to action to prevent and decrease overweight and obesity. Rockville, MD: U.S. Department of Health and Human Services; 2001.
6 Food and Nutrition Board and Board on Health Promotion and Disease Prevention. Preventing childhood obesity: Health in the balance. Washington, DC: The National Academies Press; 2005: 67–69.
7 Lin B, Frazao E, Guthrie J. Away-from-home foods Increasingly important to quality of American diet. Agriculture Information Bulletin No. 749. Washington, DC: US Department of Agriculture, Economic Research Service; 1999.
8 Lin B, Morrison RM. Food and nutrient intake data: Taking a look at the nutritional quality of foods eaten at home and away from home. US Department of Agriculture, Economic Research Service; 2012.
9 Powell LM, Nguyen BT. Fast-food and full service restaurant consumption among children and adolescents: Effect on energy, beverage, and nutrient intake. JAMA Pediatrics, 2013: 167(1), 14–20.
10 Batada A, Wootan MG. Kids’ Meals II: Obesity and poor nutrition on the menu. Center for Science in the Public Interest; 2013.
11 Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: A meta-analysis. Diabetes Care. 2010; 33(11): 2477–83.
12 Hu FB. Resolved: There is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obesity Reviews 2013; 14(8): 606–19.
13 A review of food marketing to children and adolescents: Follow-up report. Washington, DC: Federal Trade Commission; 2010: ES–2.
14 Harris, JL, Schwartz, MB, Munsell, C et al. Fast food FACTS 2013: Measuring progress in nutrition and marketing to children and teens. Rudd Center for Food Policy and Obesity; 2013.
15 Otten JJ. Food marketing: Using toys to market children’s meals. Minneapolis, MN: Healthy Eating Research; 2014.
16 Jack in the Box removes soda from its kids' menus. Washington, DC: Center for Science in the Public Interest press release; February 10, 2016.