Orders of healthier children's items remain high more than two years after menu changes at a regional restaurant chain

In a previous study we showed that customers ordered healthier food following the April 2012 implementation of a healthier children's menu at Silver Diner, a regional restaurant chain. In this study we used newly available data to assess orders of children's menu items both one and two years after our last assessment. Previous assessments took place in September 2011-March 2012 and in September 2012- March 2013, before and after implementation of the new menu, respectively. Orders were abstracted from the restaurant's central database. We found that the overarching changes from the previous study were sustained during the two follow-up periods, with some small fluctuations (for example, the prevalence of healthy side dish orders changed from 38 percent of children's meals ordered to 74 percent, then 76 percent, and then 75 percent in the successive study periods). Ordering patterns at follow-up remained healthier than before the menu change and in some cases continued to improve. Similar interventions have the potential to promote sustainable healthier ordering patterns and inform policy.