Skip to main content
    • Aa
    • Aa

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.

Corresponding author
* Corresponding author: Email
Hide All
2. JM Poti & BM Popkin (2011) Trends in energy intake among US children by eating location and food source, 1977–2006. J Am Diet Assoc 111, 11561164.

3. LM Powell & BT Nguyen (2013) Fast-food and full-service restaurant consumption among children and adolescents: effect on energy, beverage, and nutrient intake. JAMA Pediatr 167, 1420.

5. CD Rehm & A Drewnowski (2014) A new method to monitor the contribution of fast food restaurants to the diets of US children. PLoS One 9, e103543.

7. JE Green , AG Brown & P Ohri-Vachaspati (2015) Sociodemographic disparities among fast-food restaurant customers who notice and use calorie menu labels. J Acad Nutr Diet 115, 10931101.

8. R Chen , M Smyser , N Chan 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. SJ Hardcastle & N Blake (2016) Influences underlying family food choices in mothers from an economically disadvantaged community. Eat Behav 20, 18.

10. MW Long , CW Leung , LW Cheung et al. (2014) Public support for policies to improve the nutritional impact of the Supplemental Nutrition Assistance Program (SNAP). Public Health Nutr 17, 219224.

12. SA Sliwa , S Sharma , WH Dietz 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.

15. S McGuire (2016) US Departments of Agriculture and US Department of Health and Human Services, Dietary Guidelines for Americans, 2015. Adv Nutr 7, 202204.

17. D Mallett (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.

19. B Elbel (2011) Consumer estimation of recommended and actual calories at fast food restaurants. Obesity (Silver Spring) 19, 19711978.

20. SN Bleich & KM Pollack (2010) The publics’ understanding of daily caloric recommendations and their perceptions of calorie posting in chain restaurants. BMC Public Health 10, 121.

22. C Gordon & R Hayes (2012) Counting calories: resident perspectives on calorie labeling in New York City. J Nutr Educ Behav 44, 454458.

23. I Brissette , A Lowenfels , C Noble 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.

25. MW Long , DK Tobias , AL Cradock et al. (2015) Systematic review and meta-analysis of the impact of restaurant menu calorie labeling. Am J Public Health 105, e11e24.

26. J Cantor , A Torres , C Abrams 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. HS Yin , M Johnson , AL Mendelsohn et al. (2009) The health literacy of parents in the United States: a nationally representative study. Pediatrics 124, Suppl. 3, S289S298.

28. DA Cohen , LI Lesser , C Wright et al. (2016) Kid’s menu portion sizes: how much should children be served? Nutr Today 51, 273280.

31. SN Bleich , BJ Herring , DD Flagg 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.

33. SN Bleich , JA Wolfson , MP Jarlenski 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. B Wansink & AS Hanks (2014) Calorie reductions and within-meal calorie compensation in children’s meal combos. Obesity (Silver Spring) 22, 630632.

35. S Anzman-Frasca , MP Mueller , S Sliwa 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. P Chandon & B Wansink (2012) Does food marketing need to make us fat? A review and solutions. Nutr Rev 70, 571593.

38. S Anzman-Frasca , MP Mueller , VM Lynskey 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. A McIntosh , KS Kubena , G Tolle 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.

41. PS Tandon , C Zhou , NL Chan et al. (2011) The impact of menu labeling on fast-food purchases for children and parents. Am J Prev Med 41, 434438.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 10
Total number of PDF views: 104 *
Loading metrics...

Abstract views

Total abstract views: 457 *
Loading metrics...

* Views captured on Cambridge Core between 28th April 2017 - 18th October 2017. This data will be updated every 24 hours.