By Sofia Jouravel (Summary of MPH Culminating experience)
“Healthy kids’ meals” sounds more like an ironic statement than an attainable option these days. Ask someone what they associate with a kids’ meal and you will likely hear a combination of burger, fries, and a high fructose corn syrup-sweetened carbonated beverage. How many of Chicago’s chain restaurants actually offer healthy kids’ meals? That was the objective of graduating MPH student Sofia Jouravel’s Culminating Experience.
After compiling a database of every kids’ meal served in Chicago’s chain restaurants with publicly available nutrition information, meals were compared to the USDA’s National School Lunch Program and the National Restaurant Association’s’ Kids LiveWell program’s dietary guidelines. A statistical analysis was conducted to assess the health of the meals based on quantities of calories, fat, saturated fat, sodium, and sugar in meal components.
We have all heard the statistics on childhood obesity and overweight (43% of CPS students), but compounded with the frequency with which kids’ eat fast food (33%), the increased caloric intake when dining out (80% more than at home) and the amount of money fast food companies spend on marketing to kids ($583 million annually), we face a growing problem. The University of Connecticut’s Rudd Center for Food Policy & Obesity found that less than 1% of kids’ meals at national fast food restaurants met nutritional standards. The Chicago study found 11% of meals met USDA nutritional standards.
The reason for evaluating nutrition components such as calories, saturated fat, and sodium come from the Affordable Care Act’s Menu Labeling Final Rule, which as of May 5, 2017 will require disclosure of certain nutrition information for standard menu items at restaurants and similar retail food establishments if they are part of a chain of 20 or more locations nationwide and thus will allow parents to make informed decisions for their children’s’ (and their own) meals.
Out of the 71 restaurant chains identified in Chicago, 63 have already made their nutrition information available. Out of the 41 restaurant chains selling kids’ meals and publicizing nutritional information, only 1 offered kids’ meals meeting all nutrient density standards recommended by both sets of guidelines (USDA and Kids LiveWell). That restaurant was Subway. The majority of restaurants skew towards failing to meet nutrition guidelines. In fact, the second best restaurant, per USDA guidelines, is Roti with 60% of its combinations meeting guidelines. Only 5 restaurants offer kids’ meals where at least half of the combinations meet USDA standards (the same can only be said of Subway per Kids LiveWell criteria).
Comparing restaurants by individual components of nutrient density provides a different view into how restaurants meet guidelines and where improvements can be made. Looking at calorie limits, 7 (17%) restaurants offer kids’ meals that meet Kids LiveWell criteria and 12 (29%) meet USDA criteria. For sodium, the number of restaurants meeting Kids LiveWell criteria is 3 (7%) and 7 (17%) per USDA criteria. For percentage calories from fat, 2 (5%) restaurants meet both sets of criteria. For percentage calories from saturated fat, 3 (7%) restaurants meet both sets of criteria. Seven (17%) restaurants meet Kids LiveWell sugar criteria, which is not a criterion for the USDA guidelines.Examples of healthy meals include Roti’s chicken kabob pita sandwich with falafel, an apple, and water or Jason’s Deli’s Chicken Nuggetz (featuring antibiotic free chicken breast) with organic carrots and organic milk. On the other hand, a few of the unhealthiest meals include Olive Garden’s whole wheat linguini with 5 cheese marinara, steamed broccoli, and apple juice or Corner Bakery’s ham sandwich on harvest bread, with a cookie, and organic 1% chocolate milk.
What can be done? Participation in programs such as Kids LiveWell presents a beneficial tool for parents in selecting healthy meals for their children, but such efforts can be greatly enhanced with a majority, if not all, options falling within a healthy range, which as evidenced by Subway’s menu choices, is a possibility. With the support of evidence-based studies, health departments could work on voluntary recognition programs with restaurants focused on promoting health and decreasing chronic disease through consumer education, media, and incentives. Similar programs and policies nationwide have resulted in healthy menu modifications, with the hope that a continued trend towards healthful default menu items leads to behavior improvements when dining outside the home.