Childhood obesity levels continue to rise in the United States, and obesity is accompanied by serious health consequences. According to ChildObesity180, a Tufts University initiative, to find solutions to the childhood obesity epidemic, children with obesity are more likely to develop chronic illnesses, and their life expectancy may be shorter than that of their parents. While obesity in children appears to be leveling off after rapid increases since 1980, rates of obesity continue to be high. The solution, like the cause, is multifactorial. One key strategy is to improve the diets of children by encouraging them to eat more fruits and vegetables at home, in school and especially at restaurants.

A Mixed Report Card

The National Fruit and Vegetable Alliance (NFVA), a partnership of health organizations and trade associations established to increase demand for fruits and vegetables, issued a report card in 2015 on its National Action Plan to Promote Health through Increased Fruit and Vegetable Consumption. Sadly, few children meet the recommended targets for fruits and vegetables. Fruit and vegetable consumption dropped over all, with kids and adults eating items such as lettuce, corn and green beans less often and consuming fewer side dish salads. One bit of good news — teens increased their intake by 34 percent for fruit and 3 percent for vegetables between 2009 and 2014.

Restaurants Take Action

Several years ago, the National Restaurant Association, Washington, D.C., launched its Kids LiveWell program in collaboration with Healthy Dining Finder, a California-based company that provides nutrition information and guidance for restaurant menus. The goal of Kids LiveWell — now run exclusively by the National Restaurant Association — was to help parents and children select healthful menu options when dining out. The program is voluntary for restaurants. Establishments that participate receive nutrition information on chosen dishes, along with promotional materials to share with customers. More than 40,000 restaurant locations have taken part in the program, including nationwide chains such as Au Bon Pain, Bonefish Grill, Burger King, Burgerville, Carrabba’s Italian Grill, Chevys Fresh Mex, Chili’s Grill & Bar, Corner Bakery Cafe, Cracker Barrel, Denny’s, El Pollo Loco, Friendly’s, IHOP, Joe’s Crab Shack, Outback Steakhouse, Silver Diner, Sizzler, T-Bones Great American Eatery and Zpizza.

Criteria were established for restaurant meals and side dishes qualifying for Kids LiveWell approval. Restaurant menus have to include at least one children’s meal (entrée, side and beverage) with no more than 600 calories, and two or more servings of fruit, vegetables, whole grains, lean protein and/or low-fat dairy, with limits on sodium, fats and sugar, and at least one other individual item with 200 calories or less and at least one serving of fruit, vegetables and other healthy food categories. Fruit and vegetable options have to measure at least 1/2 cup.

“Restaurants often offer a wide variety of produce on their regular menu, and many of these choices can carry over to the kid’s menu,” says Erica Bohm, vice president and director of strategic partnerships, Healthy Dining Finder, San Diego. “Both kids and their parents have ever-more sophisticated tastes, and restaurants can tap into this trend by expanding their produce options across the menu.”

Guidance for restaurants on ways to increase produce consumption among children can be gleaned from academic studies on childhood behavior. Professor David R. Just, Ph.D., co-director, Cornell Center for Behavioral Economics in Child Nutrition Programs, Ithaca, NY, and his colleagues have conducted multiple experiments identifying environmental factors that could lead children to make healthier food choices. Among the suggestions based on their findings:

• Offer at least two types of fruits or vegetables

• Serve fruit sliced or cut

• Vary vegetables — serve some hot and some cold

• Pair cut vegetables with hummus, salsa or other dips

• Incorporate vegetables into an entrée

• Offer an herb and seasoning station for vegetable dishes

• Feature a fruit or vegetable of the day

Just highlights two key takeaways — convenience and branding. He points out the success of baby carrots (no peeling or cutting necessary) and pre-cut fruit. Missing teeth and braces make biting into fruit difficult, so he points out the importance of taking an extra step for the child. Just advocates for taking advantage of branding opportunities with cartoon characters. “Talking about vitamins and living longer when you eat fruits and vegetables is not very exciting to kids. So restaurants have to create excitement with kid-friendly characters.”

Strong Partnerships

Healthy Dining Finder and Kids LiveWell flourished by the strength of their relationships up and down the supply chain, and particularly with the involvement of growers and distributors. Boehm says “restaurants and their guests depend upon growers to provide flavorful, quality choices for a fair price. In turn, growers can invite restaurant chefs and staff into the fields for a fun, educational and first-hand experience with produce. This relationship also helps restaurants seeking kid-oriented options or something new to add interest to their menu. Foodservice distributors can help restaurants by offering a variety of produce options that are easy to turn around and serve, and highlighting interesting, new or particularly flavorful or cost-effective items.”

“We work with numerous partners, including R&D departments and buyers, at our restaurant clients,” says Nancy Johnston, senior manager, produce sales for Sysco, Houston. “If we have a new produce item we think restaurants might like to serve to kids, we put it in front of a chain’s buyers. We help bring together our customers with suppliers to discuss ways to promote fruits and vegetables in a positive way.”

Johnston says Sysco also actively partners with the Produce Marketing Association (PMA). At PMA’s Fresh Summit, held in October 2016, a sensory “contest” was held where children from a local Big Brothers Big Sisters program tasted and rated recipes from 15 different suppliers. Top-rated dishes included Broccoli Rabe and Black Bean Quesadillas with Broccoli Rabe Guacamole (supplied by D’Arrigo Bros. of California —Andy Boy), Better for You Brownies (Avocados From Mexico), Smoky Chipolte Potato Lettuce Cups (Black Gold Farms) and Tilapia Tacos with BBQ Beet Carrot Slaw (Love Beets USA). The children received a food-filled backpack as a gift.

Mike Turner, vice president, culinary and supply chain, Walk-On’s, Baton Rouge, LA, is guiding efforts to develop a menu for tweens who have outgrown the children’s menu. Walk-On’s maintains a strong relationship with its local distributor, Ventura Foods, Brea, CA, to work together to “come up with cool and funky ideas for different menu categories.” Turner also works with the Louisiana State University School of Nutrition to use nutrition information to help guide the addition of new menu items.

Can’t Beat ‘Em? Join ‘Em

“If you force a child to choose between carrots and fries, the fries will win,” says Cornell’s Just. “But if you have two side dishes in a meal, you can offer fries plus fruits or vegetables. A few years ago, apples were the default in the kid’s meal, and chains were forcing kids to give up fries for fruit. That was tough. Today, kids can get a small amount of fries and a small amount of fruit in their meal.”

It may take consistent and persistent efforts to change a child’s palate. “We still have a big challenge because children are used to the taste of processed foods, fattening foods and fries,” says Johnston.

Your Kid Customers

Kids have particular preferences, and Sysco’s Johnston notes restaurants are getting more creative with kid favorites. Some restaurants have experimented with such items as cauliflower mac and cheese. But basics like apple slices and Clementines are highly popular.

“Kids tend not to like cooked fruits and veggies, but they will eat them raw,” says Sodexo’s Feldman. “Serve carrots, broccoli, cucumber, celery along with kid-friendly dips. Try serving less common vegetables such as jicama. Make vegetables look good and smell good. Entice kids with limited time offers that are around for just a short period of time. Make kids happy and their parents will be happy, too.”

Chef Lisa Feldman, director of culinary for Sodexo USA, Gaithersburg, MD, cautions to avoid over-simplifying the kid’s menu. “Pay attention to what kids are eating at home. It is not the same as what restaurants put on the kids meal. Restaurant owners and chefs should look at what they serve their own kids in their own home and then transfer that to the restaurant.”

Amy Myrdal Miller, MS, RDN, founder and president of Farmer’s Daughter Consulting, Sacramento, CA, has a similar observation. “We tend to dumb down kids foods,” she says. She also notes children mature at a younger age and they want to eat what their parents and older siblings eat. “Make their dishes bold, awesome and delicious!”

Restaurants should think beyond the menu when marketing fruits and vegetables to children. Wendy’s, for example, offers few vegetables on its Kids Meal menu, but features an innovative line-up of salads, including a Strawberry Mango Salad and a Power Mediterranean Salad. The regular menu at Cheesecake Factory is filled with creative, potentially kid-friendly dishes featuring fruits and vegetables.

“Tweens present a unique challenge because they are transitioning out of the kids menu, but not yet fully into the adult menu,” says Walk-On’s Turner. “We gather them in a focus group and ask them what they want to eat. Some of the items we are considering for our tweens menu include local watermelon and tomato salad, kale and quinoa salad with chicken, variations of street tacos, lettuce wraps and center-of-plate proteins over grain with vegetables and a lemon sauce. We also plan to offer tweens interactive fun on a smartphone app.”

Tell The Story

Myrdal Miller advises restaurants to tell stories on and about the menu. “Kids read and they want to be more grown-up, so weave the story about the origin of a dish into the menu description. For example, Korean tacos inspired by food trucks in Los Angeles.”

“We find consumption goes way up when we talk about local farms, farmers, and where food comes from,” says Sodexo’s Feldman. “If you have a relationship with local farmers and tell a nice story, kids are more inclined to try a dish because they want to support local.”

“This generation of kids expects to know where food comes from, how it is grown and how it gets to the table,” says Wendy Reinhardt Kapsak, president and chief executive for Produce for Better Health Foundation. “Restaurants have a great opportunity to think not only about providing a great experience, but also about educating. Share the story.”

Social Media’s Power

As children get older, they become more likely to be influenced by social media. Chef Feldman suggests that less common dishes such as Vietnamese báhn mi sandwiches and wraps with vegetables would not have become as popular without social media. Instagram is particularly well-suited to food photos.

Evolve and Innovate

The McDonald’s Happy Meal offers a case study in changing eating habits by changing the menu. In 2011, McDonald’s announced its “Commitments to Offer Improved Nutrition Choices” plan aimed to help customers — especially families and children — make nutrition-minded choices when visiting McDonald’s or eating elsewhere.

By including fruit in every Happy Meal, McDonald’s hoped to address a challenge children face in meeting the recommended daily consumption of produce. In partnership with the Alliance for a Healthier Generation, McDonald’s made several commitments in 2013 to increase customers’ access to fruit and vegetables, and help families make informed choices. McDonald’s has added new side options to its Happy Meal menu in various markets, including cherry tomatoes, grapes, melons and Clementines. By 2015, 83 percent of U.S. McDonald’s outlets offered a side salad, fruit or vegetable instead of fries as part of value meal bundles. The company sold 380 million bags of apple slices in 2014 and has served 78 million Cuties Clementines since the program launch.

“We’ve added new tastes, ingredients and innovations that have changed the industry,” says Cindy Goody, PhD, MBA, RDN, senior director, nutrition, McDonald’s USA. “We’re continuing to evolve what goes into our menu. We’re having conversations with our suppliers, customers and restaurant teams, and we are making changes based on what we’re hearing to ensure high quality for our customers. Our produce evolution of the past two decades started with the addition of apple slices to the menu in 2000 as a Happy Meal option. We’ve offered blueberries for a limited time in a yogurt parfait. We’ve introduced different types of produce — last year at this time we updated our salad blend to include a variety of lettuces, baby spinach and kale, and that all comes from our customers’ evolving palates. Six days a week, strawberries for McDonald’s restaurants are picked by hand and only the freshest are chosen to make the McCafe Smoothie base and Fruit ‘N Yogurt Parfaits.”

Farmer’s Daughter’s Myrdal Miller shares suggestions from a recent panel discussion, among them reorganizing distributor databases to reflect solutions rather than individual items, and developing more value-added items for kids.

Follow What Works

ChildObesity180 embarked on a series of research projects aimed at improving the nutritional quality of children’s menu options and demonstrating that healthy menu changes can be good for children and good for business. In one study, the immediate and longer-term effect of making the kids’ menu healthier at the Silver Diner restaurant chain was studied. Silver Diner reconfigured its menu by pairing healthy side dishes — strawberries, mixed vegetables or side salads — with all kids’ meals by default. The new menu, introduced in 2012, made healthier items more prevalent, prominent and automatic.

The results were positive. After the menu changes, three-quarters of kids’ meal orders included healthy sides. Strawberries were the most popular healthy side dish, accounting for nearly two-thirds of orders. Menu changes led to healthier ordering patterns without limiting choice or reducing revenue. “Our follow-up study found that ordering patterns remained healthier two years after the new menu was introduced — and in some cases, continued to improve,” says Heather Angstrom, senior project manager, communications, ChildObesity180 at Tufts University. “The majority of children accepted the new healthier menu, and they were neutral-to-positive about receiving fruit and vegetable sides instead of French fries.”

Add A Pinch Of Fun

Wellness in the Schools aims to make healthy eating fun for children. “We give cooking lessons,” says Wolfson. “We do medleys of tastings, making them cute and fun. We teach interactively. We give kids a vegetable passport that gets stamped when they eat fruits and vegetables. Then we survey the kids to learn what they enjoyed and why, and how much they ate.”

Boehm, of Healthy Dining Finder, notes some of the most successful produce options put the emphasis on fun and flavor. “Whether it is making fruits and vegetables dippable or bite-sized, giving them fun names or turning them into kid-friendly works of art, these choices make dining out and eating fruits and veggies an experience that is appealing to kids. Dining out becomes a more nutritious “treat” for everyone in the family.”

Lessons From School

The school meals program brings years of experience serving fruits and vegetables to children that can serve as lessons for restaurants. Chef Lisa Feldman, director of culinary, Sodexo USA, Gaithersburg, MD, develops recipes and menus for schools and other Sodexo clients. She is particularly fond of incorporating global flavors from Asia, Latin America and Africa into meals for kids, which she encourages kids to taste first. “We do a lot of sampling of our globally seasoned dishes,” says Feldman. “Kids have no idea what they are, but they learn by trying that the dishes taste good.”

The ambitious New York City-based Wellness in the Schools (WINS) initiative was founded by Chef Bill Telepan and encourages partnerships with restaurant chefs in metro New York. “We do a lot of tastings to introduce school kids to foods they may not know,” says Marjorie Wolfson, managing director. “We also develop materials and lessons to explain to children what is in fruits and vegetables, why they are healthier and why we prepare them the way we do. Whether in newsletters, cooking lessons or tastings, we take advantage of opportunities to educate children about the foods they eat.”

Tastings often follow themes. On strawberry tasting day, children enjoyed strawberry smoothies and salads with strawberries. On another occasion, one of the WINS restaurant partners brought in mashed sweet potatoes. Another chef prepared and served different soups. Wolfson stresses the importance of helping children make connections with what is being served in the cafeteria through teaching, learning and experiencing.

Cathy Powers, MS, RDN, chairs the Culinary Institute of America Healthy Kids Collaborative, an initiative that brings together school nutrition professionals, chefs, suppliers and other school nutrition stakeholders. Her experience in the program suggests variety is key. “Offer more than one vegetable because some kids may like broccoli but not carrots. Research from Cornell University’s SmarterLunchroom.org supports this — the most successful school programs serve at least four vegetables per meal.”

Partner With Parents

Parents typically are the gatekeepers for children’s meals. When asked why their kids don’t eat more fruits and vegetables, moms who participated in a survey by the Produce for Better Health Foundation, Hockessin, DE, named food preferences — that is, what kids like to eat — and cost as the top barriers. So it’s important for restaurants to tap into the “mom network.” Restaurants can reach moms through the internet, named as the top source for information on getting kids to eat more produce, as well as through advice and success stories from other moms.

Putting fruits and vegetables on menus can motivate moms to order them. The National Fruit and Vegetable Alliance 2015 Report Card noted increased availability of fruits and vegetables on menus resulted in more moms saying that getting family members to eat fruit at restaurants and fast food establishments improved over time.

The Datassential 2016 MenuTrends keynote report on kid’s menus asked parents about the importance of certain factors on the menus. Fruits and veggies was the Number One response, followed by healthy options for kids. When asked what would make parents choose a particular restaurant for family dining, healthier sides were the second-most common response. The survey found that green beans, broccoli, salad greens and sweet potatoes are top vegetables for kids, joined by melons, blueberries, raspberries, blackberries and mangos as top fruits.

Parents typically are the gatekeepers for children’s meals. When asked why their kids don’t eat more fruits and vegetables, moms who participated in a survey by the Produce for Better Health Foundation, Hockessin, DE, named food preferences — that is, what kids like to eat — and cost as the top barriers. So it’s important for restaurants to tap into the “mom network.” Restaurants can reach moms through the internet, named as the top source for information on getting kids to eat more produce, as well as through advice and success stories from other moms.

Putting fruits and vegetables on menus can motivate moms to order them. The National Fruit and Vegetable Alliance 2015 Report Card noted increased availability of fruits and vegetables on menus resulted in more moms saying that getting family members to eat fruit at restaurants and fast food establishments improved over time.

The Datassential 2016 MenuTrends keynote report on kid’s menus asked parents about the importance of certain factors on the menus. Fruits and veggies was the Number One response, followed by healthy options for kids. When asked what would make parents choose a particular restaurant for family dining, healthier sides were the second-most common response. The survey found that green beans, broccoli, salad greens and sweet potatoes are top vegetables for kids, joined by melons, blueberries, raspberries, blackberries and mangos as top fruits.

One missed opportunity for restaurants is the time between sitting down and receiving food that was ordered. “Full-service restaurants can take advantage of the wait time as a prime opportunity to serve fruits and vegetables,” says Professor David R. Just, Ph.D., co-director, Cornell Center for Behavioral Economics in Child Nutrition Programs, Ithaca, NY. “Kids are hungry and bored, and in need of something to keep busy. Because they haven’t yet filled up on less healthy foods, they are more likely to eat fruits and vegetables.”

One missed opportunity for restaurants is the time between sitting down and receiving food that was ordered. “Full-service restaurants can take advantage of the wait time as a prime opportunity to serve fruits and vegetables,” says Professor David R. Just, Ph.D., co-director, Cornell Center for Behavioral Economics in Child Nutrition Programs, Ithaca, NY. “Kids are hungry and bored, and in need of something to keep busy. Because they haven’t yet filled up on less healthy foods, they are more likely to eat fruits and vegetables.”

For more on marketing produce to kids, check out “The Lucrative Kids Market” in the September 2015 issue of PRODUCE BUSINESS or “Encouraging Kids to Snack on Fresh Produce.”