Ordering patterns following the implementation of a healthier children's restaurant menu: A latent class analysis

Objective: Identify ordering patterns following implementation of a healthier children's menu. Methods: A healthier children's menu was introduced in 2012 at a regional restaurant chain, featuring more meals meeting Kids LiveWell (KLW) nutrition standards, KLW side dishes bundled with meals, and the removal of French fries and soda. Latent class analysis was conducted on child meal orders placed after menu implementation (n = 8,611). The average calorie content and proportion of orders meeting calorie recommendations (≤600 kcal) in each class were evaluated. Results: The best-fitting model contained six latent classes representing different ordering patterns: “healthy meals” (27.0%), “healthy meals, add-ons” (9.6%), “unhealthy sides” (9.2%), “healthy substitutions” (30.9%), “healthy substitutions, add-ons” (1.0%), and “unhealthy substitutions” (22.4%). Classes denoted as “healthy” were likely to contain meals with KLW items. Orders in the healthy meals class contained fewer calories than orders in all other classes (P < 0.0001). The majority of orders meeting calorie recommendations were in the healthy meals (59.4%) and healthy substitutions (27.1%) classes. Conclusions: Ordering patterns consistent with the healthier menu were common and more likely to meet calorie recommendations. Ordering patterns inconsistent with menu changes also emerged and can inform intervention efforts to reach patrons who may reject or compensate for healthier items.