Changing the Environment by Offering Healthy Restaurant Choices: A Public Health and Business Perspective

Introduction: Research has shown that fast-food restaurants contribute to increasing obesity rates; that marketing impacts meal choices and consumption levels; and that disparities in access to healthy foods exist across communities. Evidence is also mounting that menu labeling can positively impact consumer choices.

Purpose: The Colorado Physical Activity and Nutrition Program developed a unique restaurant intervention, the Smart Meal and the Smart Meal for Kids program, to address the issues surrounding high-fat foods and lack of healthy-eating choices. Customer demand for, and awareness of healthy meal options in restaurants is varied. The Smart Meal program makes healthier choices easier for adults and children. It not only impacts individuals, but also creates a healthier food environment.

Methods: The process of this intervention uses the social ecological theory as the guiding framework, supporting the model that social environments impact individual behavior. The nutrition requirements of Smart Meals include: two servings or more of beans, whole grains, fruits or vegetables and limits calories, fat and sodium for adults and children. Decals are used for store identification. Menus are analyzed and logos, along with nutrition requirements, are placed on the menus alongside qualifying items.

Results: The Smart Meal program is the only nationally recognized program to be supported by CDC and approved as a practice-based intervention program by Center TRT. A 129-week interrupted time series evaluation of Smart Meal sales in 110 Denver restaurant locations in 2006-2008 showed that sales of high calorie side orders decreased while Smart Meal sales increased. In 2009-10, a new branding campaign and launch of the Smart Meal website www.smartmealcolorado.com will provide data on an exponential scale. It is being replicated in Sonoma County, California, and two other states are being trained. Discussion: The data from a popular fast food hamburger chain's pilot intervention will provide evidence of menu labeling impact that has not been accomplished in any other restaurant intervention.