title: Healthier side dishes at restaurants: an analysis of children's perspectives, menu content, and energy impacts.
abstract: BACKGROUND
  Children consume restaurant-prepared foods at high rates, suggesting that interventions and policies targeting consumption of these foods have the potential to improve diet quality and attenuate excess energy intake. One approach to encouraging healthier dietary intake in restaurants is to offer fruits and vegetables (FV) as side dishes, as opposed to traditional, energy-dense accompaniments like French fries. The aims of the current study were to examine: children's views about healthier side dishes at restaurants; current side dish offerings on children's menus at leading restaurants; and potential energy reductions when substituting FV side dishes in place of French fries.
  
  
  METHODS
  To investigate children's attitudes, a survey was administered to a nationally representative sample of U.S. 8- to 18-year-olds (n = 1178). To examine current side dish offerings, children's menus from leading quick service (QSR; n = 10) and full service restaurant chains (FSR; n = 10) were analyzed. Energy reductions that could result from substituting commonly-offered FV side dishes for French fries were estimated using nutrition information corresponding to the children's menu items.
  
  
  RESULTS
  Two-thirds of children reported that they would not feel negatively about receiving FV sides instead of French fries with kids' meals. Liking/taste was the most common reason that children gave to explain their attitudes about FV side dishes. Nearly all restaurants offered at least 1 FV side dish option, but at most restaurants (60% of QSR; 70% of FSR), FV sides were never served by default. Substituting FV side dishes for French fries yielded an average estimated energy reduction of at least 170 calories.
  
  
  CONCLUSIONS
  Results highlight some healthy trends in the restaurant context, including the majority of children reporting non-negative attitudes about FV side dishes and the consistent availability of FV side dish options at leading QSR and FSR. Yet the minority of restaurants offer these FV sides by default. Promoting creative, appealing FV side dishes can result in healthier, less energy-dense meals for children. Substituting or displacing energy-dense default side dishes with such FV dishes show promise as part of continued, comprehensive efforts to increase the healthfulness of meals consumed by children in restaurant settings.
authors.affiliation: Child-Obesity-180, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA. stephanie.anzman_frasca@tufts.edu.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Anzman-Frasca
authors.forename: Franciel
authors.initials: F
authors.lastname: Dawes
authors.forename: Sarah
authors.initials: S
authors.lastname: Sliwa
authors.forename: Peter R
authors.initials: PR
authors.lastname: Dolan
authors.forename: Miriam E
authors.initials: ME
authors.lastname: Nelson
authors.forename: Kyle
authors.initials: K
authors.lastname: Washburn
authors.forename: Christina D
authors.initials: CD
authors.lastname: Economos
mesh_terms: D000293:Adolescent; D002648:Child; D004032:Diet; D002149:Energy Intake; D005006:Ethnicity; D005247:Feeding Behavior; D005260:Female; D058870:Food, Organic; D005638:Fruit; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D062407:Meals; D012147:Restaurants; D014481:United States; D014675:Vegetables