Healthy Menu Orders for Children Sustained Over The Long Haul

Healthy kids' meal with strawberries

Healthy Menu Orders for Children Sustained Over The Long Haul

November 02, 2015

Health Affairs highlights new findings following up on first-of-its-kind research examining ordering patterns after a healthier children’s menu was introduced

(November 2, 2015) BOSTON –To parents of picky eaters across the country, the idea that simply changing kids’ menu options can encourage healthier choices in restaurants might seem like a pipe dream. But according to new research published today in the November issue of Health Affairs, customers at one restaurant chain that began offering healthier kids’ meals in April 2012 have continued to choose the healthier options more than two years later.

In a previous study published in the journal Obesity, researchers from ChildObesity180 at Tufts University Friedman School observed healthier ordering patterns shortly after the Silver Diner family restaurant chain made healthy changes to its children’s menu. The team then followed up to measure outcomes more than one and two years later. The new research shows that the healthy changes in orders of children’s items were sustained, and in some cases continued to improve, over the following two years:

  Before menu changes Shortly after menu changes (POST) Follow-up 1 (one year after POST) Follow-up (two years after post)
Healthy children’s entrées ordered 3.1% 45.7% 44.6% 43.0%
Healthy children’s side dishes ordered 38.4% 74.1% 76.1% 74.8%
French fries ordered 57.0% 22.0% 20.2% 21.4%
Soda ordered 34.7% 29.7% 25.3% 24.1%

“This research supports the view that sustained behavior change is possible when healthier choices are more prevalent and prominent, and made the default option,” said Christina Economos, Ph.D., director of ChildObesity180, associate professor at Tufts University Friedman School and the study’s senior author. “The findings hold a much bigger lesson about encouraging healthy choices in every environment kids move through during the day, not just restaurants.”

Moreover, including more healthy options on the menu has not hurt overall restaurant revenue and may have even supported continued growth. Total annual revenue across all of the restaurant chain’s locations grew by 5.3 percent from 2013 to 2014, exceeding the average revenue growth in leading family dining chains.

“If businesses help make the healthy choice easier for families and children, they will make it, which is good news,” said David Krol, MD, MPH, senior program officer at the Robert Wood Johnson Foundation, which provided funding for the study. “The fact that the chain has seen its revenue grow also shows that there is a solid business case for making the shift to healthier options.”

The new children’s menu, which is still in place, features more meals meeting the nutrition standards of the National Restaurant Association’s Kids LiveWell program, compared to the children’s menu prior to the April 2012 changes. In addition, all meals automatically include a healthy fruit or vegetable side, and French fries and soda have been removed from the menu. In the new study, aggregate data from 335,209 children’s meals orders were analyzed one year (September 2013-March 2014) and two years (September 2014-March 2015) after the initial evaluation.

“We commend ChildObesity180 and the Silver Diner for this important research which will greatly inform the field,” said Barbara Picower, president and chair of The JPB Foundation, which provided funding for this study. “We know forming and supporting children to practice healthy food choices will develop lifelong habits.”

To learn more about our work related to healthy restaurant meals for kids, visit

No financial support was received from the Silver Diner.

About ChildObesity180:  Aiming for a “180” on Childhood Obesity
Based at Tufts University Friedman School of Nutrition Science and Policy, our premise is unique:  Top national leaders from the private, public, nonprofit, and academic sectors committed to developing, measuring, and implementing evidence-based solutions to reverse the alarming epidemic of childhood obesity in America. For more information, visit