Abstract
INTRODUCTION: The food environment is an important determinant of children's eating behavior. Improving the environment to encourage healthier choices is crucial to prevent obesity, especially in restaurants where the majority of kids' menus are unhealthy. This study explored the perceptions, attitudes, motivations, influencing factors, and opportunities of restaurant owners, managers, and chefs for implementing healthier kids' menus in Dutch restaurants. METHOD: We used a mixed methods design in two consecutive study parts. Part I consisted of an online unstandardized questionnaire that was completed by 44 restaurant owners, 26 chefs, 18 managers, and 6 other restaurant employees (n = 94). This was followed by semi-structured interviews with 3 restaurant owners, 2 chefs, and 1 manager, to gather exploratory information in Part II (n = 6). The quantitative data were categorized into three groups: restaurants without kids' menus (n = 18), restaurants with unhealthy kids' menus (n = 24), and restaurants with (partially) healthy kids' menus (n = 52). Group differences were assessed using the Kruskal-Wallis test. We used thematic analysis for the interviews. RESULTS: Parts I and II showed that the restaurant sector is aware of the need, and willing and motivated to offer healthier kids' menus. Nevertheless, the concerns about food waste, the unhealthy demand from children and parents, and seeing eating out as a free pass to consume unhealthy meals by children and parents were important factors limiting the implementation of healthier kids' menus. DISCUSSION: We discussed potential solutions to enhance demand and acceptance of healthier kids' menus, such as attractive names, storytelling, offering children's portions based on adult menus, and using participatory approaches in which parents, children, and chefs co-create meal composition.