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Open Access Research

Healthier side dishes at restaurants: an analysis of children’s perspectives, menu content, and energy impacts

Stephanie Anzman-Frasca12*, Franciel Dawes23, Sarah Sliwa2, Peter R Dolan1, Miriam E Nelson12, Kyle Washburn1 and Christina D Economos12

Author Affiliations

1 Child-Obesity-180, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA

2 Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA

3 Frances Stern Nutrition Center, Tufts Medical Center, 150 Harrison Avenue, Boston, MA 02111, USA

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International Journal of Behavioral Nutrition and Physical Activity 2014, 11:81  doi:10.1186/1479-5868-11-81

Published: 4 July 2014

Abstract

Background

Children consume restaurant-prepared foods at high rates, suggesting that interventions and policies targeting consumption of these foods have the potential to improve diet quality and attenuate excess energy intake. One approach to encouraging healthier dietary intake in restaurants is to offer fruits and vegetables (FV) as side dishes, as opposed to traditional, energy-dense accompaniments like French fries. The aims of the current study were to examine: children's views about healthier side dishes at restaurants; current side dish offerings on children's menus at leading restaurants; and potential energy reductions when substituting FV side dishes in place of French fries.

Methods

To investigate children’s attitudes, a survey was administered to a nationally representative sample of U.S. 8- to 18-year-olds (n = 1178). To examine current side dish offerings, children's menus from leading quick service (QSR; n = 10) and full service restaurant chains (FSR; n = 10) were analyzed. Energy reductions that could result from substituting commonly-offered FV side dishes for French fries were estimated using nutrition information corresponding to the children's menu items.

Results

Two-thirds of children reported that they would not feel negatively about receiving FV sides instead of French fries with kids' meals. Liking/taste was the most common reason that children gave to explain their attitudes about FV side dishes. Nearly all restaurants offered at least 1 FV side dish option, but at most restaurants (60% of QSR; 70% of FSR), FV sides were never served by default. Substituting FV side dishes for French fries yielded an average estimated energy reduction of at least 170 calories.

Conclusions

Results highlight some healthy trends in the restaurant context, including the majority of children reporting non-negative attitudes about FV side dishes and the consistent availability of FV side dish options at leading QSR and FSR. Yet the minority of restaurants offer these FV sides by default. Promoting creative, appealing FV side dishes can result in healthier, less energy-dense meals for children. Substituting or displacing energy-dense default side dishes with such FV dishes show promise as part of continued, comprehensive efforts to increase the healthfulness of meals consumed by children in restaurant settings.

Keywords:
Restaurants; Children; Food away from home; Fruit; Vegetables; Side dishes; Defaults; Healthy eating; Childhood obesity