Healthier Restaurant Environments as a Child Obesity Prevention Strategy

Abstract

Consumption of restaurant foods, including fast-foods and sugar-sweetened beverages (SSBs), has contributed to the rising global prevalence of obesity and related diseases among children and adolescents. The World Health Organization, U.N. International Children’s Emergency Fund, and Centers for Disease Control and Prevention have recommended reducing consumption of restaurant foods as a key child obesity prevention strategy, and many localities have considered policies to improve the nutritional quality of restaurant foods marketed towards youth. Although it is clear that the restaurant environment influences youth food and beverage choices, more research is needed to identify how the industry can improve, which aspects of the environment have the greatest influence on choice, and how those factors may contribute to socioeconomic health inequities. This dissertation used data from three sources to better understand how the restaurant food environment has changed over time, to describe the influence of this environment on youth perceptions and choices, and to identify possible levers for policy change. Chapter 1 described foods and beverages offered on kids’ menus of 45 leading U.S. chain restaurants over four years, and evaluated the influence of a restaurant industry self-regulatory initiative, called Kids LiveWell, which sought to improve nutrition in meals advertised to kids. Chapter 2 assessed adolescent estimates of sodium in fast-food meals, calculated actual sodium in meals purchased, and compared estimated to actual sodium. Chapter 3 used data from the U.S. Department of Agriculture National Household Food Acquisition and Purchase Survey -- a survey of foods and beverages acquired by a nationally representative sample of households -- to describe youth restaurant beverage purchases and differences by household socioeconomic status. Collectively, these data add to a growing body of evidence demonstrating a need for policies that improve the restaurant food environment by increasing the selection of healthful meals available to kids, increasing transparency about nutrition in restaurant foods, and reducing availability and promotions of SSBs, particularly those targeting youth in the lowest income households.