Ongoing concerns about childhood obesity have prompted more state and local governments to adopt policies that make water and milk the default beverage option for kids’ meals in restaurants, rather than soda and other sugary drinks.

Researchers from the University of Delaware and the University of California evaluated the implementation of those policies in California and Wilmington, Del., and they found a startling difference in compliance rates.

In California, the proportion of restaurants with menus that showed the correct default beverage rules increased by 56 percent. But in Wilmington, there was no change in compliance before and after the policy was implemented.

In addition, restaurant employees in California and Wilmington rarely offered healthier drink options when kids’ meals were ordered, according to researchers, whose findings were recently published in an issue brief on HealthyEatingResearch, a program of the Robert Wood Johnson Foundation.

Policies like these are a needed step, but they are not enough to bring changes in restaurants – and, ultimately, in children and families, said Laura Lessard, assistant professor in the Department of Behavioral Health and Nutrition, who served as a co-principal investigator on the research project, along with Allison Karpyn, acting director of the Center for Research Education and Social Policy (CRESP). Additional training, support, and enforcement are needed for maximum impact.

“In order to make this policy, work efforts to promote understanding among restaurants and management are needed,” Karpyn added. “Managers told us that they would like to receive materials not just for their own staff but also so that parents will know that a healthy drink is the default.”

Healthy as the default

Reducing the consumption of sugar-sweetened beverages like soda has been shown to improve children’s health. On average, American children drink 143 calories a day from sugary drinks, and kids who consistently drink these beverages have higher chances of becoming overweight or obese. In both children and adults, obesity increases the risk for many chronic health conditions, including type 2 diabetes, heart disease, stroke, high blood pressure and more.

The state of California and the city of Wilmington, Del., instituted their own healthy beverage policies in 2019, requiring healthier beverage options in children’s meals, such as water, milk, and 100 percent juices without added sweeteners. Proponents said the goal was not to restrict options – consumers are free to purchase any drinks of their choosing – but to make healthier choices the default.

As part of their collaboration, researchers from the University of California Nutrition Policy Institute and UD’s CRESP collected data on kids’ meals served in California and Wilmington, including quick-service restaurants and sit-down establishments. They looked at beverages offered on the menus and in interactions with the cashier. Managers also were asked about what they knew about the policy, whether they supported it and if they had heard any customer complaints.

Researchers found that in California, the proportion of menus listing only healthy beverages increased 56 percentage points as a result of the policy change. In Wilmington, there was no change in the menu boards.

Only 29 percent of restaurant managers in California said they knew about the beverage policy, compared with none of the managers in Delaware. But when they learned more about it, 65 percent of managers in California and 100 percent in Wilmington said they supported the policy.

The findings suggest more education needs to take place for consumers and restaurant employees to help them understand and adhere to the new policies.

“There was significantly more publicity in California when their policy was being considered in the legislature and again when it passed,” Lessard said. “That resulted in much more awareness – as you saw in our data – compared to Wilmington, where the policy passed without much fanfare or media coverage.”

Considerations for the future

The researchers noted that their work took place before the COVID-19 pandemic earlier this year radically changed the way consumers purchase food and beverages. An increase in third-party ordering and delivery, as well as drive-through purchasing at this time, warrants further study at how these systems could also help to carry the policy change forward.

“Now that more ordering is happening online and through drive-thrus, there’s an opportunity to post information there as well,” Karpyn said.

In addition, best practices should be developed so cashiers and other employees can clearly define the beverages that meet the healthy criteria and also increase compliance in the healthy default policy.

In the future, researchers said, it will be important to understand if the policies result in other unintended effects, such as consumers deciding to purchase drinks separately to get around the healthy beverage.

Opportunities for students

At UD, participation spanned across campus, with students from several colleges involved in the data collection and writing, Lessard said. “It also provides important training to students on how cross-disciplinary teams are best suited to understanding complex problems.”

Junior Nicole Kennedy worked with the research team to create surveys, interview restaurant managers and analyze data for the project. Doing so helped her better understand the translational nature of the public policy arena.

“I saw that connecting policy and practice is much more layered and nuanced than what first meets the eye,” said Kennedy, who is majoring in public policy and Spanish studies and also in the Master of Public Administration 4+1 program. “This is something that we discuss in my public policy classes frequently and seeing it first-hand has changed how I will think through policy solutions in the future.”

Henry Wolgast said being part of the project sparked his interest in pursuing a master’s degree in urban affairs and public policy.

“I hope to utilize these skills and passion I developed in the course of this research to aid in the development and implementation of research-based environmental public policy with an emphasis on environmental justice,” he said.