Preventing Chronic Disease | Improving Children’s Menus in Community Restaurants: Best Food for Families, Infants, and Toddlers (Best Food FITS) Intervention, South Central Texas, 2010–2014 - CDC
Improving Children’s Menus in Community Restaurants: Best Food for Families, Infants, and Toddlers (Best Food FITS) Intervention, South Central Texas, 2010–2014
Sylvia Hurd Crixell, PhD, RD; BJ Friedman, PhD, RD; Deborah Torrey Fisher, BS; Lesli Biediger-Friedman, PhD, RD, MPH
Suggested citation for this article: Crixell SH, Friedman B, Fisher DT, Biediger-Friedman L. Improving Children’s Menus in Community Restaurants: Best Food for Families, Infants, and Toddlers (Best Food FITS) Intervention, South Central Texas, 2010–2014. Prev Chronic Dis 2014;11:140361. DOI: http://dx.doi.org/10.5888/pcd11.140361
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Abstract
Background
Approximately 32% of US children are overweight or obese. Restaurant and fast food meals contribute 18% of daily calories for children and adolescents aged 2 to 18 years. Changing children’s menus may improve their diets. This case study describes Best Food for Families, Infants, and Toddlers (Best Food FITS), a community-based intervention designed to address childhood obesity. The objective of this study was to improve San Marcos children’s access to healthy diets through partnerships with local restaurants, removing sugar-sweetened beverages, decreasing the number of energy-dense entrées, and increasing fruit and vegetable offerings on restaurant menus.
Approximately 32% of US children are overweight or obese. Restaurant and fast food meals contribute 18% of daily calories for children and adolescents aged 2 to 18 years. Changing children’s menus may improve their diets. This case study describes Best Food for Families, Infants, and Toddlers (Best Food FITS), a community-based intervention designed to address childhood obesity. The objective of this study was to improve San Marcos children’s access to healthy diets through partnerships with local restaurants, removing sugar-sweetened beverages, decreasing the number of energy-dense entrées, and increasing fruit and vegetable offerings on restaurant menus.
Community Context
San Marcos, Texas, the fastest growing US city, has more restaurants and fewer grocery stores than other Texas cities. San Marcos’s population is diverse; 37.8% of residents and 70.3% of children are Hispanic. Overweight and obesity rates among school children exceed 50%; 40.3% of children live below the poverty level.
San Marcos, Texas, the fastest growing US city, has more restaurants and fewer grocery stores than other Texas cities. San Marcos’s population is diverse; 37.8% of residents and 70.3% of children are Hispanic. Overweight and obesity rates among school children exceed 50%; 40.3% of children live below the poverty level.
Methods
This project received funding from the Texas Department of State Health Services Nutrition, Physical Activity, and Obesity Prevention Program to develop Best Food FITS. The case study consisted of developing a brand, engaging community stakeholders, reviewing existing children’s menus in local restaurants, administering owner–manager surveys, collaborating with restaurants to improve menus, and assessing the process and outcomes of the intervention.
This project received funding from the Texas Department of State Health Services Nutrition, Physical Activity, and Obesity Prevention Program to develop Best Food FITS. The case study consisted of developing a brand, engaging community stakeholders, reviewing existing children’s menus in local restaurants, administering owner–manager surveys, collaborating with restaurants to improve menus, and assessing the process and outcomes of the intervention.
Outcome
Best Food FITS regularly participated in citywide health events and funded the construction of a teaching kitchen in a new community building where regular nutrition classes are held. Sixteen independent restaurants and 1 chain restaurant implemented new menus.
Best Food FITS regularly participated in citywide health events and funded the construction of a teaching kitchen in a new community building where regular nutrition classes are held. Sixteen independent restaurants and 1 chain restaurant implemented new menus.
Interpretation
Improving menus in restaurants can be a simple step toward changing children’s food habits. The approach taken in this case study can be adapted to other communities. Minimal funding would be needed to facilitate development of promotional items to support brand recognition.
Improving menus in restaurants can be a simple step toward changing children’s food habits. The approach taken in this case study can be adapted to other communities. Minimal funding would be needed to facilitate development of promotional items to support brand recognition.
Background
Although the increase in incidence rates of overweight and obesity in children has been leveling, approximately 32% of US children and adolescents aged 2 to 19 are overweight or obese (1). Dietary intake is a modifiable determinant of body weight. Ecological models depict potential influences on diet that range from personal factors (eg, biological, lifestyle) to broader realms of influence (eg, social, environmental, public policy) (2). Of the broader influences, food consumed away from home, which falls in the environmental realm, has become prominent. Children and adolescents aged 2 to 18 obtain 34% of daily calories from food consumed outside the home, 18% of which comes from fast food and full-service restaurants (3). Compared with home-cooked meals, foods consumed away from home are higher in calories, fat, sodium, and sugar and contain fewer essential nutrients (4). Meals away from home often include sugar-sweetened beverages and lack fruits and vegetables (4). Improving offerings on children’s menus in restaurants may improve dietary intake and thereby combat obesity (5).
Some community interventions have attempted to improve the nutrition profile of restaurant menus. For example, Shape Up Somerville worked with local restaurants to reduce portion sizes, add fruits and vegetables, and offer reduced-fat dairy products (6). Steps to a Healthier Salinas targeted taquerias to encourage the development and promotion of healthier foods (7). In San Antonio, Texas, iexclPor Vida! involved registered dietitians working with local restaurants to identify menu items that met Dietary Guidelines for Americans (8,9).
The objective of this study was to improve San Marcos children’s access to healthy foods by working with local restaurants to help them improve their menus by removing sugar-sweetened beverages, decreasing the number of energy-dense entrées, and increasing fruit and vegetable offerings. This article describes Best Food FITS, a community program dedicated to combatting obesity by engaging restaurants to improve children’s menus in a community with high rates of childhood obesity.
Figure 1. Sample Preintervention and Best Food for Families, Infants, and Toddlers (Best Food FITS) Menu from a Mexican Food Restaurant in San Marcos, Texas. The Best Food FITS menu includes the a) Best Food FITS logo, b) the popular Broccolicious character, and c) other characters. All graphics were created by the marketing department at Texas State University. [A text description of this figure is also available.]
Acknowledgments
This community intervention was funded by a $150,000 grant from the Texas Department of State Health Services Nutrition, Physical Activity, and Obesity Prevention Program. We thank the Best Food FITS coalition members and the many restaurant owners and managers in San Marcos, Texas, who kindly collaborated to improve children’s menus in this community. In particular, we thank Paul Suphton, owner of Grins Restaurant, for offering the first Best Food FITS menu. This work would not have been possible without the enthusiastic assistance of undergraduate and graduate students enrolled in the Texas State University Nutrition and Foods program.
Author Information
Corresponding Author: Sylvia Hurd Crixell, PhD, RD, Professor, School of Family and Consumer Sciences, Nutrition and Foods, Texas State University, 601 University Drive, San Marcos, Texas 78666. Telephone: 512-789-6695. Email: scrixell@txstate.edu.
Author Affiliations: BJ Friedman, Deborah Torrey Fisher, Lesli Biediger-Friedman, School of Family and Consumer Sciences, Texas State University, San Marcos, Texas.
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