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Low parental awareness about energy (calorie) recommendations for children’s restaurant meals: findings from a national survey in the USA

  • Vanessa M Lynskey (a1) (a2), Stephanie Anzman-Frasca (a3), Linda Harelick (a1) (a2), Ariella Korn (a2), Shanti Sharma (a1) (a2), Stephanie Simms (a2) and Christina D Economos (a1) (a2)...
Abstract Objective

To assess parental awareness of per-meal energy (calorie) recommendations for children’s restaurant meals and to explore whether calorie awareness was associated with parental sociodemographic characteristics and frequency of eating restaurant food.


Cross-sectional online survey administered in July 2014. Parents estimated calories (i.e. kilocalories; 1 kcal=4·184 kJ) recommended for a child’s lunch/dinner restaurant meal (range: 0–2000 kcal). Responses were categorized as ‘underestimate’ (<400 kcal), ‘accurate’ (400–600 kcal) and ‘overestimate’ (>600 kcal). Confidence in response was measured on a 4-point scale from ‘very unsure’ to ‘very sure’. Logistic regressions estimated the odds of an ‘accurate’ response and confident response (‘somewhat’ or ‘very sure’) by parental sociodemographic characteristics and frequency of eating from restaurants. Sampling weights based on demographics were incorporated in all analyses.




Parents (n 1207) of 5–12-year-old children.


On average, parents estimated 631 (se 19·4) kcal as the appropriate amount for a 5–12-year-old child’s meal. Thirty-five per cent answered in the accurate range, while 33·3 and 31·8 % underestimated and overestimated, respectively. Frequent dining at restaurants, lower income and urban geography were associated with lower odds of answering accurately. Parents’ confidence in their estimates was low across the sample (26·0 % confident) and only 10·1 % were both accurate and confident.


Parent education about calorie recommendations for children could improve understanding and use of menu labelling information in restaurants. Targeted strategies are recommended to ensure that such efforts address, rather than exacerbate, health disparities.

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1. Ogden C, Carroll M, Fryar C et al. (2015) Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief issue 219, 18.
2. Poti JM & Popkin BM (2011) Trends in energy intake among US children by eating location and food source, 1977–2006. J Am Diet Assoc 111, 11561164.
3. Powell LM & Nguyen BT (2013) Fast-food and full-service restaurant consumption among children and adolescents: effect on energy, beverage, and nutrient intake. JAMA Pediatr 167, 1420.
4. Powell LM, Nguyen BT & Han E (2012) Energy intake from restaurants: demographics and socioeconomics, 2003–2008. Am J Prev Med 43, 498504.
5. Rehm CD & Drewnowski A (2014) A new method to monitor the contribution of fast food restaurants to the diets of US children. PLoS One 9, e103543.
6. VanEpps EM, Roberto CA, Park S et al. (2016) Restaurant menu labeling policy: review of evidence and controversies. Curr Obes Rep 5, 7280.
7. Green JE, Brown AG & Ohri-Vachaspati P (2015) Sociodemographic disparities among fast-food restaurant customers who notice and use calorie menu labels. J Acad Nutr Diet 115, 10931101.
8. Chen R, Smyser M, Chan N et al. (2015) Changes in awareness and use of calorie information after mandatory menu labeling in restaurants in King County, Washington. Am J Public Health 105, 546553.
9. Hardcastle SJ & Blake N (2016) Influences underlying family food choices in mothers from an economically disadvantaged community. Eat Behav 20, 18.
10. Long MW, Leung CW, Cheung LW et al. (2014) Public support for policies to improve the nutritional impact of the Supplemental Nutrition Assistance Program (SNAP). Public Health Nutr 17, 219224.
11. Economos CD, Bakun PJ, Herzog JB et al. (2014) Children’s perceptions of weight, obesity, nutrition, physical activity and related health and socio-behavioural factors. Public Health Nutr 17, 170178.
12. Sliwa SA, Sharma S, Dietz WH et al. (2014) Healthy kids out of school: using mixed methods to develop principles for promoting healthy eating and physical activity in out-of-school settings in the United States. Prev Chronic Dis 11, E227.
13. Anzman-Frasca S, Dawes F, Sliwa S et al. (2014) Healthier side dishes at restaurants: an analysis of children’s perspectives, menu content, and energy impacts. Int J Behav Nutr Phys Act 11, 81.
14. US Department of Agriculture, Food and Nutrition Service (2016) Child Nutrition Programs: Income Eligibility Guidelines. Fed Reg 81, 1550115504.
15. McGuire S (2016) US Departments of Agriculture and US Department of Health and Human Services, Dietary Guidelines for Americans, 2015. Adv Nutr 7, 202204.
16. Troiano RP, Berrigan D, Dodd KW et al. (2008) Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 40, 181188.
17. Mallett D (2006) Sampling and weighting. In The Handbook of Marketing Research: Uses, Misuses, and Future Advances, pp. 159177 [R Grover and M Vriens, editors]. Thousand Oaks, CA: SAGE Publications, Inc.
18. Piron J, Smith LV, Simon P et al. (2010) Knowledge, attitudes and potential response to menu labelling in an urban public health clinic population. Public Health Nutr 13, 550555.
19. Elbel B (2011) Consumer estimation of recommended and actual calories at fast food restaurants. Obesity (Silver Spring) 19, 19711978.
20. Bleich SN & Pollack KM (2010) The publics’ understanding of daily caloric recommendations and their perceptions of calorie posting in chain restaurants. BMC Public Health 10, 121.
21. Krukowski RA, Harvey-Berino J, Kolodinsky J et al. (2006) Consumers may not use or understand calorie labeling in restaurants. J Am Diet Assoc 106, 917920.
22. Gordon C & Hayes R (2012) Counting calories: resident perspectives on calorie labeling in New York City. J Nutr Educ Behav 44, 454458.
23. Brissette I, Lowenfels A, Noble C et al. (2013) Predictors of total calories purchased at fast-food restaurants: restaurant characteristics, calorie awareness, and use of calorie information. J Nutr Educ Behav 45, 404411.
24. Sinclair SE, Cooper M & Mansfield ED (2014) The influence of menu labeling on calories selected or consumed: a systematic review and meta-analysis. J Acad Nutr Diet 114, 1375–1388.e15.
25. Long MW, Tobias DK, Cradock AL et al. (2015) Systematic review and meta-analysis of the impact of restaurant menu calorie labeling. Am J Public Health 105, e11e24.
26. Cantor J, Torres A, Abrams C et al. (2015) Five years later: awareness of New York City’s calorie labels declined, with no changes in calories purchased. Health Aff (Millwood) 34, 18931900.
27. Yin HS, Johnson M, Mendelsohn AL et al. (2009) The health literacy of parents in the United States: a nationally representative study. Pediatrics 124, Suppl. 3, S289S298.
28. Cohen DA, Lesser LI, Wright C et al. (2016) Kid’s menu portion sizes: how much should children be served? Nutr Today 51, 273280.
29. Cohen D, Bhatia R, Story MT et al. (2013) Performance Standards for Restaurants: A New Approach to Addressing the Obesity Epidemic. Santa Monica, CA: Rand Corporation.
30. Reger B, Wootan MG, Booth-Butterfield S et al. (1998) 1% or less: a community-based nutrition campaign. Public Health Rep 113, 410419.
31. Bleich SN, Herring BJ, Flagg DD et al. (2012) Reduction in purchases of sugar-sweetened beverages among low-income black adolescents after exposure to caloric information. Am J Public Health 102, 329335.
32. Ellison B, Lusk JL & Davis D (2013) Looking at the label and beyond: the effects of calorie labels, health consciousness, and demographics on caloric intake in restaurants. Int J Behav Nutr Phys Act 10, 21.
33. Bleich SN, Wolfson JA, Jarlenski MP et al. (2015) Restaurants with calories displayed on menus had lower calorie counts compared to restaurants without such labels. Health Aff (Millwood) 34, 18771884.
34. Wansink B & Hanks AS (2014) Calorie reductions and within-meal calorie compensation in children’s meal combos. Obesity (Silver Spring) 22, 630632.
35. Anzman-Frasca S, Mueller MP, Sliwa S et al. (2015) Changes in children’s meal orders following healthy menu modifications at a regional US restaurant chain. Obesity (Silver Spring) 23, 10551062.
36. Chandon P & Wansink B (2012) Does food marketing need to make us fat? A review and solutions. Nutr Rev 70, 571593.
37. List JA & Samek AS (2015) The behavioralist as nutritionist: leveraging behavioral economics to improve child food choice and consumption. J Health Econ 39, 135146.
38. Anzman-Frasca S, Mueller MP, Lynskey VM et al. (2015) Orders of healthier children’s items remain high more than two years after menu changes at a regional restaurant chain. Health Aff (Millwood) 34, 18851892.
39. McIntosh A, Kubena KS, Tolle G et al. (2011) Determinants of children’s use of and time spent in fast-food and full-service restaurants. J Nutr Educ Behav 43, 142149.
40. Domoff SE, Kiefner-Burmeister A, Hoffmann DA et al. (2015) Maternal feeding goals and restaurant menu choices for young children. Child Obes 11, 484488.
41. Tandon PS, Zhou C, Chan NL et al. (2011) The impact of menu labeling on fast-food purchases for children and parents. Am J Prev Med 41, 434438.
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Public Health Nutrition
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