Contrary to popular belief, more healthy kids' meals were ordered after a regional restaurant chain added more healthy options to its kids' menu and removed soda and fries, researchers from ChildObesity180 at Tufts University Friedman School reported today in the journal Obesity. Including more healthy options on the menu didn't hurt overall restaurant revenue, and may have even supported growth.

Researchers examined outcomes before and after the Silver Diner, a full-service family restaurant chain, made changes to its children's menu in order to make healthier items easier to choose. This study is the first of its kind to look at both ordering patterns of children's food plus a restaurant's sales data after making menu changes. Aggregate data from more than 350,000 children's meals ordered were analyzed, along with a random subsample of individual checks (18,712) from both before (September 2011-March 2012) and after (September 2012-March 2013) the menu changes went into effect.

After the menu changes, instituted in April 2012, nearly half of the children's entrées ordered were from the healthier kids' meal options (46%, compared to 3% before the changes). The proportion of kids' meal orders that included at least one healthy side also increased dramatically--from 26% before the changes to 70% after the changes were made. Notably, overall chain revenue continued to grow after the menu changes, exceeding that of leading family dining chains during the same time period.

"Our study showed that healthier children's menu options were ordered a lot more often when those options were more prevalent and prominent on kids' menus, highlighting the promise of efforts to shift the status quo and make healthier options the new norm," said Stephanie Anzman-Frasca, Ph.D., research associate at ChildObesity180 and lead author of the new paper. "Given how frequently kids go to restaurants, and evidence that this can be linked with consuming excess calories, offering and promoting healthier menu options could play a role in reversing the childhood obesity epidemic."

The restaurant chain made three main changes to the children's menu:

1. Offered more healthy kids' meals: More kids' meals met nutrition standards set by the National Restaurant Association's Kids LiveWell program (59%, compared to 22% before the changes).

2. Automatically included healthy sides: Healthy side dishes--strawberries, mixed vegetables, or side salads--were automatically included with all kids' meals by default.

3. Took less healthy options off the kids' menu: Fries and sugary fountain drinks including soda and lemonade were removed from the menu. They were still available as substitutions at no extra charge but had to be requested.