Background

Over 1/3 of children eat fast food daily. We analyzed 3 children’s restaurant meal versions – default (as advertised), minimum (lower-calorie) and maximum (higher-calorie) – offered at US chain restaurants to understand how changes (e.g., additions, substitutions, portion size) impact nutrition quality and to assess price incentives to select maximum versions.

Methods

Default meals (n=92) were identified from 26 US restaurants’ online menus in 2017. We constructed minimum and maximum versions using realistic exchanges for existing menu items and obtained nutrition data from MenuStat and price data from online menus for a subset of default and maximum meals (n=34). Bootstrapped linear models assessed differences in nutrients between versions; the extent to which meal components (entrée, side dish, beverage) drove differences across versions; and difference in calories per dollar between default and maximum meals.

Results

Nutrient values differ significantly across versions for calories (default: 584kcals, minimum: 400kcals, maximum: 792kcals), saturated fat (8g, 6g, 11g), sodium (1046mg, 915mg, 1287mg), and sugar (35g, 14g, 51g). Beverages were the greatest driver of reductions in calories (default to minimum, -100kcals) and sugar (-20g) and increases in sugar (default to maximum, +16kcals). Side items were the greatest driver of reductions in saturated fat (-1g), and sodium (-69mg) and in increases in calories (+128kcals), saturated fat (+2g), and sodium (+202mg). Maximum meals had higher calories per dollar (177kcal/dollar) than default meals (128kcal/dollar) but the difference was not significant (p=0.053).

Conclusions

Realistic modifications to children’s combination meals using existing menu options can significantly alter nutrient composition. Calories per dollar suggest a financial incentive to “upsize” orders to less healthy meals. Promoting lower-calorie default items and parallel price incentives that nudge customers to lower-calorie options may promote healthier consumption.