RTI uses cookies to offer you the best experience online. By clicking “accept” on this website, you opt in and you agree to the use of cookies. If you would like to know more about how RTI uses cookies and how to manage them please view our Privacy Policy here. You can “opt out” or change your mind by visiting: http://optout.aboutads.info/. Click “accept” to agree.
A natural experiment to evaluate changes in kids' meal beverages in fast-food restaurants following a healthy default policy, 2019-2022
Cradock, A. L., Barrett, J. L., Block, J. P., Bolton, A. A., Bresnahan, C., Harnack, L., McCulloch, S., Roberto, C. A., Wiant, K., & Moran, A. (2025). A natural experiment to evaluate changes in kids' meal beverages in fast-food restaurants following a healthy default policy, 2019-2022. Journal of the Academy of Nutrition and Dietetics. Advance online publication. https://doi.org/10.1016/j.jand.2025.03.010
BACKGROUND: Jurisdictions have implemented "healthy beverage policies" requiring restaurants to make lower-sugar beverages the default option listed on kids' menus to improve the nutrition of restaurant offerings for children.
OBJECTIVE: To compare changes in beverage offerings in kids' meals written on menu boards within chain restaurants before and after policy implementation in intervention and comparison communities.
DESIGN: Quasi-experimental study with comparison using photo and audit observations at restaurants October 2019-June 2022.
PARTICIPANTS/SETTING: Forty-three restaurants in 3 fast-food chains serving kids' meals with a beverage that did not make lower-sugar beverages the default option at baseline in two intervention communities (New York, NY, Philadelphia, PA) and one comparison community, (Newark, NJ).
INTERVENTION: Policies that require only healthier beverages as default options are written on kids' meal menus.
PRIMARY OUTCOME: Beverage options listed in the kids' meal on the menu board were allowable under healthy beverage policies.
ANALYSIS: Descriptive and repeated measures analysis for difference in primary outcome from baseline to follow-up overall and by policy status.
RESULTS: At follow-up, 39 (91%) locations, including 8 (89%) locations in the comparison area with no healthy default policy, listed only beverages allowable as defaults under healthy beverage policies (p<0.001 vs. baseline, all locations). From baseline to follow-up, two chains changed the beverages listed with the kids' meal to align with the healthy default policies in all but one location, whereas one chain made no menu changes(p<0.001). No statistically significant differences in menu changes were observed between intervention and comparison areas.
CONCLUSIONS: After healthy beverage policies were enacted in two of three communities, most locations in two restaurant chains listed only allowable beverages regardless of location outside of cities where the policies were in place. Regional implementation in response to new local healthy default policies may result in broader accessibility of healthier children's beverage options.
RTI shares its evidence-based research - through peer-reviewed publications and media - to ensure that it is accessible for others to build on, in line with our mission and scientific standards.