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Analyzing default beverage options for kids’ meals

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Introduction Heading link

Recent estimates show nearly one in five (19.7%) United States (U.S.) children and adolescents have obesity. Childhood obesity is associated with increased risk of having obesity and other adverse health conditions in adulthood, including coronary heart disease and diabetes. As a result, reducing childhood obesity

is a leading health indicator for Healthy People 2030. Sugar- sweetened beverages (SSBs) are the largest source of added sugars intake for children and adolescents, with almost two- thirds consuming an SSB on a given day, and SSB consumption is associated with increased risk of childhood obesity. This suggests policies that discourage SSB consumption could play a role in addressing childhood obesity.

In 2015-2018, 36.3% of children and adolescents consumed fast food on a given day. Consumption of fast food is associated with poorer diet quality for these age groups, including greater consumption of SSBs. Indeed, studies have consistently shown fast-food kids’ meal offerings to be of poor nutritional quality. One study found some improvements in the availability of healthier options on kids’ menus between 2004 and 2015, although it noted that these were generally not default options. Another study examining 2012-2015 fast-food and full-service restaurant kids’ menus found little nutritional progress. Default beverage options have been shown to contribute to higher calorie and sugar content in fast-food restaurant kids’ meals.9Additionally, SSBs have been shown to consistently represent four-fifths of kids’ meal beverage offerings in a study that included both fast-food and full-service restaurants.

A study of upcharges (i.e., charges added to the meal price when specific items are selected) associated with fast-food kids’ meal beverage offerings found soda was never upcharged and only 3% of other sweetened beverage selections resulted in an upcharge, while 41% of water, 28% of 100% fruit juice, and 5-20% of diluted fruit juice and milk selections led to an upcharge. Consumers may be dissuaded from ordering healthier beverages if those selections come with an additional charge, even if they are included among the default offerings.

Both voluntary standards such as the National Restaurant Association’s Kids LiveWell initiative and legally mandated requirements such as California’s healthier default beverage law (SB1192) have been implemented to improve the nutritional quality of kids’ meal beverages. Evidence on the impact of these measures is mixed, with varied results both across studies and within studies across different outcome measures (e.g., cashier verbal offerings versus menu postings).

On August 20, 2021, Illinois passed a healthy beverage default (HBD) act, effective January 1, 2022, requiring beverages offered by default (i.e., automatically included, absent consumer request for an alternative beverage) with children’s meals meet specific criteria. Specifically, the following beverages are the only allowable defaults under the Act: (1) water with no added natural or artificial sweeteners, which may be sparkling or flavored; (2) 100% juice, which may be diluted with plain or carbonated water, in a serving size of ≤8 ounces; (3) non-fat or 1% dairy milk with ≤130 calories per serving; and (4) non-dairy milk with ≤130 calories per serving, which must further contain no added natural or artificial sweeteners and meet the standards for the National School Lunch Program. Using data collected as part of a larger evaluation, this brief examines differences across platforms (i.e., both physical locations and online menu listings) in default beverage offerings with kids’ meals and associated upcharges in Illinois and Wisconsin fast-food restaurants prior to the Illinois HBD Act taking effect.

Key findings Heading link

  • Prior to implementation of an Illinois act to improve the healthfulness of kids’ meal beverage defaults, this study of fast-food restaurants in Illinois and neighboring Wisconsin found less than a third of verbal cashier offerings and restaurant website or mobile application menu listings satisfied those criteria.
  • Two-thirds of cashier offerings (67%) and more than half of restaurant website or mobile application menu listings (54%) included soda as a default kids’ meal beverage offering.
  • Just under half of interior menu boards (45%) met the healthy beverage default criteria.
  • Among third-party ordering platforms, including Grubhub, Uber Eats, and DoorDash, 55-69% met the healthy beverage default criteria.
  • Beverage upcharges were uncommon (≤11%) for compliant milk and juice, except for compliant milk offerings on interior menu boards (28% subject
    to upcharge). Bottled water incurred upcharges more frequently (33-39%). Soda was never subject to an upcharge.

About the authors Heading link

  • Julien Leider is a senior research specialist with SPH’s Institute for Health Research and Policy.
  • Andrea Pipito is a research specialist with SPH’s Institute for Health Research and Policy.
  • Lisa Powell, PhD, is a distinguished professor of health policy and administration at the UIC School of Public Health.

Read the full research brief

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