Low parental awareness about energy (calorie) recommendations for children's restaurant meals: Findings from a national survey in the USA

Objective To assess parental awareness of per-meal energy (calorie) recommendations for children's restaurant meals and to explore whether calorie awareness was associated with parental sociodemographic characteristics and frequency of eating restaurant food. Design Cross-sectional online survey administered in July 2014. Parents estimated calories (i.e. kilocalories; 1 kcal=4·184 kJ) recommended for a child's lunch/dinner restaurant meal (range: 0-2000 kcal). Responses were categorized as 'underestimate' (<400 kcal), 'accurate' (400-600 kcal) and 'overestimate' (>600 kcal). Confidence in response was measured on a 4-point scale from 'very unsure' to 'very sure'. Logistic regressions estimated the odds of an 'accurate' response and confident response ('somewhat' or 'very sure') by parental sociodemographic characteristics and frequency of eating from restaurants. Sampling weights based on demographics were incorporated in all analyses. Setting USA. Subjects Parents (n 1207) of 5-12-year-old children. Results On average, parents estimated 631 (se 19·4) kcal as the appropriate amount for a 5-12-year-old child's meal. Thirty-five per cent answered in the accurate range, while 33·3 and 31·8 % underestimated and overestimated, respectively. Frequent dining at restaurants, lower income and urban geography were associated with lower odds of answering accurately. Parents' confidence in their estimates was low across the sample (26·0 % confident) and only 10·1 % were both accurate and confident. Conclusions Parent education about calorie recommendations for children could improve understanding and use of menu labelling information in restaurants. Targeted strategies are recommended to ensure that such efforts address, rather than exacerbate, health disparities.