Encouraging Healthier Choices for Children in Restaurants: A Review of Interventions and Health Promotion Strategies

Restaurants are normative eating contexts for many families and thus are prime targets for health promotion efforts as restaurant meals are typically high in calories, saturated fat, and sodium. Recently, health promotion efforts have focused on children's menus in an effort to improve the food intake of children in these settings. The goal of the present narrative review is to summarize the current, peer-reviewed literature describing interventions and other health promotion efforts to improve the healthfulness of children's meal selection and/or intake in restaurants. Efforts to accomplish this goal were organized into implicit (subtle and typically involving environmental changes) and explicit (direct and typically information-based) strategies and described using a narrative method. Significant changes in children's ordering of restaurant food were consistently demonstrated in studies using optimal defaults (an implicit strategy) to increase the healthfulness of children's meals. Future research and policy efforts in this area could further examine this strategy alongside other strategies such as personalized prompts or pricing promotions, evaluating impacts across a wider range of sociodemographic groups. Future studies should also include randomized controlled trials with objective assessments of children's intake to build upon existing knowledge and improve the healthfulness of the restaurant environment for children.