To reduce children’s sugar-sweetened beverage intake, California’s Healthy-By-Default Beverage law (SB1192) mandates only unflavoured dairy/non-dairy milk or water be the default drinks with restaurant children’s meals. The objective of this study is to examine consistency with this law for meals sold through online platforms from restaurants in low-income California neighbourhoods.

This observational, cross-sectional study examines beverage availability, upcharges (additional cost) and presentation of beverage options consistent with SB1192 (using four increasingly restrictive criteria) within a random sample of quick-service restaurants (QSR) in Supplemental Nutrition Assistance Program Education eligible census tracts selling children’s meals online from November 2020 to April 2021.

Low-income California neighbourhoods (n 226 census tracts).

QSR that sold children’s meals online via a restaurant-specific platform, DoorDash, GrubHub and/or UberEats (n 631 observations from 254 QSR).

Seventy percent of observations offered water; 63 % offered unflavoured milk. Among all beverages, water was most likely to have an upcharge; among observations offering water (n 445), 41 % had an upcharge (average $0·51). Among observations offering unflavoured milk (n 396), 11 % had an upcharge (average $0·38). No observations upcharged for soda (regular or diet). Implementation consistency with SB1192 ranged from 40·5 % (using the least restrictive criteria) to 5·6 % (most restrictive) of observations.

Based on observations from restaurant websites and three of the most popular online ordering platforms, most California QSR located in low-income neighbourhoods are not offering children’s meal beverages consistent with the state’s Healthy-By-Default Beverage law. As the popularity of online ordering increases, further work to ensure restaurants offering healthy default beverages with children’s meals sold online is necessary.

To compare the nutritional quality of children’s combination meals offered at large US chain restaurants characterised by three versions – default (advertised), minimum (lower-energy) and maximum (higher-energy).

We identified default children’s meals (n 92) from online restaurant menus, then constructed minimum and maximum versions using realistic additions, substitutions and/or portion size changes for existing menu items. Nutrition data were obtained from the MenuStat database. Bootstrapped linear models assessed nutrition differences between meal versions and the extent to which meal components (main dish, side dish, beverage) drove differences across versions. For each version, we examined the proportion of meals meeting the Guidelines for Responsible Food Marketing to Children.

Twenty-six fast-food and fast-casual restaurants, in 2017.

None.

Nutrient values differed significantly across meal versions for energy content (default 2443 kJ (584 kcal), minimum 1674 kJ (400 kcal), maximum 3314 kJ (792 kcal)), total fat (23, 17, 33 g), saturated fat (8, 6, 11 g), Na (1046, 915, 1287 mg) and sugar (35, 14, 51 g). The substitution of lower-energy beverages resulted in the greatest reduction in energy content (default to minimum, −418 kJ (−100 kcal)) and sugar (−20 g); choosing lower-energy side dishes resulted in the greatest reduction in total fat (default to minimum, −4 g), saturated fat (−1·1 g) and Na (−69 mg). Only 3 % of meals met guidelines for all nutrients.

Realistic modifications to children’s combination meals using existing menu options can significantly alter a meal’s nutrient composition. Promoting lower-energy items as the default option, especially for beverages and side dishes, has a potential to reduce fat, saturated fat and/or sugar in children’s meals.

Whole-grain intake among children is well below recommendations. The purpose of the present study was to test the acceptability and liking of pizza made with whole-grain crust compared with refined-grain crust among children in restaurant and school settings.

Plate waste data were collected via observation from child restaurant patrons consuming pizza made with either whole-grain or refined-grain crust. Waste was estimated by trained observers over eight months (August 2012–March 2013). Percentage waste was calculated and compared by crust type. A taste test was conducted with school children who tasted pizza made with whole-grain crust alongside pizza made with refined-grain crust and rated their liking of each product. Liking ratings were compared by crust type.

Five Green Mill restaurant (a Midwest US chain) locations and one elementary school in the Minneapolis/St. Paul metropolitan area, Minnesota, USA.

Child restaurant patrons (n 394) and school children (n 120, grades 3–5).

Children consumed as much of the pizza made with whole-grain crust (42·1 %) as the pizza made with refined-grain crust (44·6 %; P=0·55), based on an average serving size of 350–400 g. Liking ratings for both types of pizza were high (>4·5 of 5) and did not differ by crust type (P=0·47).

These positive consumption and liking outcomes indicate that whole-grain pizza crust is well accepted among children in a restaurant setting. The impact on whole-grain intake could be substantial if large, national restaurant chains served pizza made with whole-grain crust.