An assessment of the nutritional adequacy of children?s meal provision in restaurants

It is understood that the quality of the diet in childhood is important for short and long-term health. In the United Kingdom, reflecting trends internationally^1-4, there is a prevalence of obesity amongst the paediatric population^5-7. A number of governmental and non-governmental organisations are currently assessing the need to set a range of obesity specific policies, with the aim of highlighting the need for nutrients such as fat, saturated fat, sugar and sodium to be reduced in the diet^8-12.

Concerns about children?s health in this country make it important to examine all sources of children?s dietary intake. It has been shown that eating out in the United Kingdom is increasing^{13, 6}, and industry forecasts show this trend will continue¹⁴. The Parents Jury, part of the Food Commission, undertook a qualitative examination of children?s menus in the summer of July 2003¹⁵. It found that in general the meals are very disappointing in terms of choice, variety, the amount of processed food and the lack of healthier options. A nutritional analysis has never previously been undertaken to examine child specific menus in this country; this study was designed in order to make a nutritional assessment of meals provided specifically for children within the UK.

This study evaluated the nutritional quality of single meals, and the recommendations made by the Caroline Walker Trust were used for the purposes of comparison. The Caroline Walker Trust, a charitable public health organisation concerned with vulnerable groups in the population, established nutritional guidelines for school meals in 1992¹⁶. The guidelines were based on the Dietary Reference Values and Nutrients for the United Kingdom¹⁷, and provide figures for the recommended nutrient content of an average school meal for children over a one-week period. There has since been an addition to the guidelines for sodium, based on Scientific Advisory Committee on Nutrition guidelines, and zinc, which was in turn based on Dietary Reference Values¹⁸.

It was important to cover a wide range of eating occasions. However, it was decided that fast-food outlets would not be sampled. A classification was designed, with three establishments sampled under each; family establishments (Harvester, Garfunkel?s, Beefeater); places of interest (London Zoo, Science Museum, Natural History Museum); soft play (Whacky Wharehouse, Play Town, Adventure Kingdom); stores (Tesco, Ikea, John Lewis); and leisure (David Lloyd, Fairlop Waters, Redbridge Sports Club).

Menus were sampled from each establishment, and a member of staff was contacted by telephone and questioned regarding portion sizes, ingredients and cooking methods. In some cases exact weights were provided. From estimates of quantities, the Food Standards Agency Food Portion Sizes¹⁹ were used for the purposes of conversion to weight (g). In all cases cooking methods were recorded. For a number of restaurants the children?s meals came as a “meal package”, and were sold at a certain price, comprising a main meal, dessert and in some cases a drink. In these cases the total meal package was examined. A number of the children?s menus offered a choice of side orders, and in these instances meals were analysed using various combinations of the side orders. Meals were analysed for their nutrient composition and, in addition, their fatty acid composition using the McCance and Widowson?s 5^th Edition food tables²⁰. Meals were then compared to the Caroline Walker Trust guidelines for school meals.

None of the 141 meals analysed met all of the guidelines set by the Caroline Walker Trust, and in general meals breached a large number of them. Meals tended to be fat and energy dense, and fibre and micronutrient poor. In a number of cases every single meal provided by an establishment failed to meet the guidelines for a nutrient or, in some cases, a number of nutrients. In the case of energy, 57 and 37 per cent of meals exceeded the guideline for energy (kcal) for 5-6 and 7-10 year-olds respectively. In terms of macronutrients, 72 per cent of meals exceeded the guideline for total fat (g) for 5-6 year-olds and 57 per cent for 7-10 year-olds; 81 per cent of meals exceeded the guideline for fat as a percentage of total food energy.

As a consequence of the high fat content in many of the meals, 73 and 82 per cent respectively were low in carbohydrate (g) for 5-6 year-olds and 7-10 year-olds, and 87 per cent of meals failed to meet the guideline for carbohydrate as a percentage of total food energy. When meals were analysed with the addition of a drink and/or dessert, they were found to exceed the guideline for non-milk extrinsic (NME) sugars (g), and as a percentage of total food energy.

With regard to micronutrients, 60 and 82 per cent of meals did not meet the guideline for iron (mg) for 5-6 year-olds and 7-10 year-olds respectively; 70 per cent did not meet the guideline for calcium (mg) for 5-6 year-olds and the figure was 79 per cent for 7-10 year-olds. More than two-thirds (67 per cent) of meals did not meet the guideline for vitamin A (mg), while 37 and 66 per cent of meals did not meet the guideline for folate (mg) for 5-6 year-olds and 7-10 year-olds respectively.

Analysis showed that the extent to which some meals breached certain guidelines was of concern. For example, some meals provided more than twice the recommendation for energy, and four times the recommendation for fat and saturated fat. In some cases meals provided more than 65 per cent of total food energy from fat. A number of meals were entirely lacking in micronutrients such as vitamin C, vitamin A and folate. A good example of how considerably certain meals exceeded guidelines was the Rib Ticklers meal provided by the Harvester restaurant, which provided 1270 calories (more than twice the guideline, and for the younger age group almost a whole day?s requirement17), 80g of fat (four times the guideline), 24g of saturated fat (four times the guideline) and 2.3g of sodium (more than double the guideline for 5-6 year-olds).

Another concern with the menus was an almost complete lack of fruit and vegetables. Only two establishments (John Lewis and London Zoo) offered a selection of vegetables, and in a number of restaurants the only vegetable offered was peas. It has been identified that increasing fruit and vegetable intake in children and adolescents is important^21-23. Further, as identified by the Department of Health²⁴, using National Diet and Nutrition Survey for Young People²⁵ data, 1 in 5 children do not consume any fruit in a week.

Of course, it is understood that the frequency with which these meals may be consumed would not necessarily result in their having a significant impact on overall nutritional status. However, these findings have other important implications. Meals of this type are perpetuating the cultural norm for children?s food to be highly processed, nutritionally inadequate and devoid of fresh fruit and vegetables. In addition there are the issues of choice and accessibility. In a number of establishments (Tesco, Ikea, Fairlop Waters, and the Science Museum) a choice between only two or three meals was provided for children. In these establishments it was particularly difficult, and in the majority of cases impossible, to make a “healthy” selection. In terms of accessibility, although there is easy access for children to eat out, with meals competitively priced at between £2 and £5, there is rarely access to “healthy” alternatives.

With reference to current concerns about food promotion and advertising to children^8,10 one restaurant referred to a dish offered to children as a “healthy option” despite the fact that the meal did not meet the guidelines for energy (kcals), fat (g), fat as a percentage of total food energy, SFAs (g), SFAs as a percentage of total food energy, carbohydrate (g), carbohydrate as a percentage of total food energy, NSP (g), iron (mg), calcium (mg), vitamin A (mg) and C (mg), folate (mg) or sodium (g). Several outlets advertised and promoted meals and drinks that were nutritionally undesirable.

Given the current prevalence of obesity in the UK^25-29 it is essential that children have access to nutritionally desirable foods for all potential eating occasions. Eating out provides an important and valuable social occasion for families. However, if child specific menus are to be offered, measures need to be taken to provide food that offers healthy alternatives.

There has been a positive response from a number of the establishments examined in this study, and statements have been made by Harvester, Garfunkel?s and Whacky Wharehouse, indicating that they will continue to take steps to provide healthier children?s meals.

References

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29. World Health Organisation (1997). Highlights on Health in the United Kingdom.

The Caroline Walker Trust

This study was the research project component of Rachael Foulds? MSc. Rachael Foulds, having completed her MSc in Human Nutrition specialising in Public Health, is seeking employment in the field of nutrition and health.