PEDS 1

Tandon, Pooja S., Jeffrey Wright, Chuan Zhou, Cara Beth Rogers, and Dimitri A. Christakis. "Nutrition
menu labeling may lead to lower-calorie restaurant meal choices for children." Pediatrics 125, no. 2
(2010): 244-248.

In todays society we can find a fast food joint, restaurant or convenient store just about on every
corner. Eating outside of the home has grown in popularity and become commonplace for a lot of people
across the United States. Parallel to this shift of eating out is our growing obesity epidemic which is now
affecting our younger generation. It has been said that people consume twice the number of calories
when dining out then if they were to eat at home. However, in todays world it can be difficult to find
nutrition information regarding a restaurants menu. Most of the time the nutrition facts about a food or
beverage are located online and inconvenient to access when deciding what to order at the local chain
restaurant. This study focused on whether nutrition labeling on a fast food chains menu would result in
lower-calorie meal choices by parents for their children.
This was a randomized controlled trial that took place in a Seattle, Washington primary care clinic
from October 2008 to January 2009. Parents of children between 3 to 6 years of age were asked to
participate and were only allowed to choose one child if more than one fell within the age range. Families
who were ineligible included those who never ate fast food, were non-English speaking, or who had a
child that was too sick to participate. Those who participated were given a McDonalds picture menu and
asked to specify what they would order for themselves and for their child if their next meal was at
McDonalds. The menus offered the majority of items sold at McDonalds including sandwiches,
hamburgers, fries, salads, drinks, Happy Meals, desserts and any sauces that they may request with their
meal. Between the control and intervention groups all menu information, pricing, etc. was the same
except for the nutrition labeling. All menu items presented to the intervention group had the nutrition
information listed beside the picture. All of the information was collected anonymously including self-
reported sociodemographics, heights and weights of parents and children, and the frequency and
reasoning for eating fast food.
Ninety-nine families participated in the survey; 77% were mothers, 75% were white, 88% had
more than a high school education and 62% reported eating fast food 1 to4 times in the past month. The
common reasons for eating fast food was the convenience, cheap cost, and that it was fun. There was
no significant difference in energy/calories ordered for the parent or the child between the group that
reported not eating fast food in the past month and the rest of the participants. The researchers also
found no correlation between frequency of fast food intake and energy/calories ordered in either group.
There was however, a positive relationship between energy/calories ordered for the parent and energy
ordered for the child (r=0.3, P= 0.2). Parents in the intervention group ordered an average of 102 calories
fewer for their children than did those in the control group (567.1 vs 671.5 cal; P=.04). The study found
that after all other variables were adjusted for using regression analysis, the nutrition-labeled menu on
average, reduced energy ordered by 20% (P=.004). There was no difference in the parents energy
between the 2 groups.
I chose this study because I myself notice that if there is nutrition information listed on the menu
(which is very rare), I tend to think a little harder about my meal choice. It is also interesting to see how
those around you at the table are affected by it as well. This study claims that it Is the first to suggest that
labeled menus may lead to significantly lower calorie content in restaurant meal purchased for children.
However, thinking about my experience with young children, it is often very difficult to select a meal for
them. Many within the 3-6 years age range already have an idea of what they want from McDonalds and
wont go for getting the apples instead of the fries. I feel as though it may be somewhat of a catch-22 for
some parents. They can see what is the healthier choice if the menu is labeled, but is their child going to
eat what they order? A limitation of this study was the fact that over half of the participants were
Caucasian mothers with more than a high school diploma. It would have been more beneficial to include
a variety of backgrounds and those with varying degrees of education. Also, it was quite a small sample
size which may affect the reliability.

RD Recommendations
If you know where you and your family will be dining/eating out on a given day, print out or
review the nutrition information prior to going in order to reduce the amount of saturated fat
and sodium that are hidden in most restaurant meals.

Help your child make more nutritious choices when eating away from home by substituting side
salads or apple slices for French fries. It may be beneficial for you to make similar choices as
your child so that they learn by example.

In order to prevent unwanted weight gain and poor meal choices, avoid eating out and cook
nutritious meals for your children at home! Prepare meals ahead of time so that prep time is
shortened!