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.

To develop a worked example of product reformulation of a very popular ‘junk food’ to meet nutritional guidelines for public health in a ready meal.

Indicative survey of popular Margherita pizzas, followed by product reformulation, applying dietary guidelines to generate a single-item pizza meal containing 30 % daily amounts of energy and all nutrients. An iterative process was used; first to optimize nutrient balance by adjusting the proportions of bread base, tomato-based sauce and mozzarella topping, then adding ingredients to provide specific nutrients and consumer tasting.

Urban areas of contrasting socio-economic status.

Untrained unselected adults (n 49) and children (n 63), assessing pizza at tasting stations.

Most commercial pizzas provide insufficient information to assess all nutrients and traditional Margherita pizza ingredients provide insufficient Fe, Zn, iodine, and vitamins C and B12. Energy content of the portions currently sold as standard range from 837 to 2351 kJ (200 to 562 kcal), and most exceed 30 % Guideline Daily Amounts for saturated fat and Na when a 2510 kJ (600 kcal) notional meal is considered. The ‘nutritionally balanced pizza’ provides the required energy for a single-item meal (2510 kJ/600 kcal), with all nutrients within recommended ranges: Na (473 mg, ∼45 % below recommended level), saturated fat (<11 % energy) and dietary fibre (13·7 g). Most adults (77 %) and children (81 %) rated it ‘as good as’ or ‘better than’ their usual choice.

Nutritional guidelines to reduce chronic diseases can be applied to reformulate ‘junk food’ ready meals, to improve public health through a health-by-stealth approach without requiring change in eating habits.