Balancing Children's Menus

By Kimberly J. Decker, Contributing Editor

We should all take heart from a budding trend that points to more healthful fare on kids menus, both at schools and in commercial foodservice. Reinforcing good eating habits is a shared responsibility among parents, schools and the public, says Laura Marshall, director of marketing, Knouse Foods, Peach Glen, PA. With all those constituenciesnot to mention the kidswatching, the pressures on to deliver.

This means we need to offer healthier, more balanced, good-tasting menu choices, says Lorraine Niba, Ph.D., regional marketing manager, Americas, FrieslandCampina Domo, Paramus, NJ. Adding menu items with reduced levels of sugar and fat and increased levels of fiber, calcium, and other physiologically beneficial ingredients will greatly contribute to improving childrens health. Secondly, we need to communicate messages that encourage children to choose these healthier foods. Providing support to educate children, parents and educators on the benefits of healthier menus, and reducing caloric, sugar, and fat intakes, will enable these items to become more acceptable.

Room for improvement

Americans have never had better access to a wider array of foods than they enjoy now. Yet, says Ann Marie Krautheim, M.A., R.D., senior vice president, nutrition affairs, National Dairy Council, Rosemont, IL, that often doesnt equate to getting nutritional value from our calories.

According to National Health and Nutrition Examination Survey (NHANES) data from 1976 to 1980 and 2003 to 2006, the prevalence of obesity has increased for children aged 2 to 5 from 5.0% to 12.4%, and for those aged 6 to 11 from 6.5% to 17%; for those aged 12 to 19, prevalence increased from 5.0% to 17.6%. This puts kids at risk for health problems both now and later on, including cardiovascular disease, high blood pressure, high cholesterol, and type 2 diabetes.

Todays kids suffer from deficits, as well. While there are no glaringly obvious nutrient deficiencies, there are clearly nutrient imbalances among American kids today, says Niba. Fiber, high-quality protein, calcium, iron and folate can go lacking, even in our First World diets. According to USDA, only 2% of youth meet all the recommendations of the Food Guide Pyramid; 16% meet none.

A look at product offerings for children in schools and restaurants today shows that they are typically high in sugar, fat and calories, while falling short in healthful ingredients like fiber, proteins and minerals like calcium, Niba says. According to a 2008 study by Baylor University School of Medicine, Houston, only 3% of kids menus at restaurants meet the minimum standards set by the National School Lunch Program. Yet, even in schools, where standards hold sway, campus vending machines largely peddle fast foods and high-calorie snack items like carbonated sodas, candy and chips, Niba says, with far fewer options for healthier, whole foods.

Outsourcing mealtime

Todays kids face a vastly different lifestyle from kids a few decades ago, Niba says. They are surrounded by convenient, easy, fast foods that are high in calories and also come in larger serving sizes. No wonder USDAs Continuing Survey of Food Intake by Individuals shows that American kids obtain a substantial part of their energy from added sugar, primarily from soft drinks and desserts.

One-thirdand sometimes two-thirdsof a childs nutrition takes place at school; given busy schedules, the remainder often gets outsourced to the drive-thru or QSR. Chris Moore, senior vice president of strategic initiatives, Dairy Management Inc. (DMI), Rosemont, IL, notes that kids under the age of 18 are responsible for nearly one in four visits to quick-serve restaurants, and parties with kids comprise nearly 40% of QSR traffic. Children are a primary motivator for fast-food consumption, and most parents opt to eat fast food with their children when they visit a QSR, he says. Yet the majority of parents agree that fast food is not good for their children.

According to the May 2008 Nielsen report, Eating Out in America: A New War Wages, an average child eats an extra 350 calories per meal when dining out, prompting one who eats out at least three times per week to take in upward of 40% more calories daily than one who doesnt eat out. This excess owes not only to the high caloric density of the foods, but to portion creep, too: While experts recommend that serving sizes for kids aged 4 to 8 be about one-third an adults, our tendency to equate value with quantity often spurs us to put more on the plate.

Stealth health

The key is finding a palatable middle ground. I think its important to offer the favorites, such as mashed potatoes, but prepared in healthful ways that kids wont recognize, says Liz Ward, R.D., an ambassador to the egg industry. Its OK to offer something thats close to a favorite kid food, but healthier, like roasted sweet potatoes instead of french fries.

These tacticschristened stealth healthhave earned praise for their purported effectiveness. I cant speak for all children, but mine often look for something thats new and different and directed to kids: dishes that are not too obviously healthful with foods like plain, steamed broccoli, but with some interesting ingredients, like edamame, for example, says Ward.

In fact, formerly exotic foods like edamame are standard for todays young diners. I cant tell you how many people have said to me, My child tried sushi or curry or Thai food, says Wendy Bazilian, DrPH, R.D., a San Diego, CAbased author of The SuperFoodsRx Diet: Lose Weight with the Power of SuperNutrients and nutrition educator. We have much-broader palates, people are getting more adventuresome, and I just hope that it will translate into the school systemhealthfully. It could simply be a more healthfully made chicken or tuna salad made with lightand lessmayo and boosted with antioxidant-rich yellow curry, for example. If you take something thats healthful and spruce it upadd shapes and colors and textures that are interestingthe kids will like it. Engage kids in a way where you bring in attributes that appeal to them.

Engagement is the name of the game. Kids are often more open to trying new foods when they feel involved in the choices available to them, says Marshall. Schools can benefit from this by creating contests that engage kids and let them select the new foods added to the menu. Restaurants can benefit by having a variety of optionswhether as sides, snacks or entréesthat go beyond the basics and are flavorful and balanced. Parents gain confidence that their kids are making sound choices, and the kids themselves learn how to choose soundly and feel more like adults during the dining experience, she says. When designing a menu to appeal to children, remember that they aspire upward. They see themselves as grown-up enough to order adult food, even though their portion should be smaller.

Meeting in the middle

Understanding what kids want isnt divination. When kids go to a restaurant, they want fun, they want to be entertained, they want to interact with their food, says Chris Moore, senior vice president of strategic initiatives, Dairy Management Inc. (DMI), Rosemont, IL. They are adventure-seekers and they ultimately want food that tastes good. In other words, theyre a lot like us.

This makes it easier to build menus that please both their primary audience and their parents. Weve learned that there are two kinds of moms: indulgent moms and careful moms, says Dave Sheluga, director, consumer insight, ConAgra Mills, Omaha, NE. The former loosen the reins more when it comes to nutrition, while the latter specifically seek out healthful choices and actively assist in their childrens ordering. Both want their kids to be pleased with whats on the plate. Taste still rules over health, he says. The key implication for restaurateurs is that half of the moms theyre serving are health-oriented, and thats a pretty big audience.

Shelugas research indicates that careful moms look for more adult-leaning choices, with vegetable and whole-grain elements. Even though they still favor pizza, chicken nuggets, grilled-cheese sandwiches, hot dogs and hamburgers for the kids menu overall, he says, his advice for redesigning kids menus for health is to go all the way. Introducing just one or two nutritious entrées lets kids and parents opt out and choose something else, he cautions. If you include whole grains in all items and not allow an opt out, he says, you have your best chance for success. Operators should still soft-pedal the health message to parents, and make no mention of health or whole grains to the children themselves, he says. Ensure that there are no flavor, texture or appearance compromises with the healthier options.

Whole grains go undercover

Thats become easier recently thanks to the bumper crop of new white whole-wheat flours. Products like 100% whole-wheat flour with the lighter color, smoother texture and sweeter taste of refined, gives foods mainstream appeal that compares favorably with traditional white flour products, says Mike Veal, vice president, marketing, ConAgra Mills. This has been validated by numerous studies, he notes, which is why schools across the nation feature meal components from pizza and buns to pasta and chicken nuggets made with white whole-wheat flour. In tests conducted in 2005 with 350 first- through sixth-grade students in Hopkins, MN, kids ate pizzas and other foods made with white whole-wheat flour at the same rate as they did refined-flour products, notes Veal. Given that whole grains are importantand often underrepresentedsources of fiber, B vitamins, minerals and phytonutrients, the potential to work them seamlessly into menus is cause for cheer.

Weve seen excellent results with inclusion levels ranging from 30% to 100%, says Vealbut the flours light color and fine texture belie handling and performance thats pure whole wheat. When replacing refined flour with white whole wheat, mixing times and baking temperature requirements may need to change, and processors may need to add more moisture to their formulas, depending on the inclusion level, he says. They may also find that they need to add gluten or alter their dough conditioner profile to carry the additional fiber and maximize volume. He also advises against overmixing, which can damage the gluten structure.

Focus on the fruit

Interest in whole grains is part of a broader trend that celebrates the whole food over individual nutrients or overly processed, fortified products that resemble edible food-like substances, as some critics call them. When we look at the nutrient content of foods, we often forget to look at how the nutrients work together to enhance their individual qualities and how enhanced absorption of the nutrients can be accomplished when foods are eaten together, says Marcia D. Greenblum, M.S., R.D., senior director, nutrition education, Egg Nutrition Center, Park Ridge, IL. That whole package confers the greatest health, and makes the wisest addition to a childs diet.

Can we deliver whole-food nutrition to kids in menu-friendly, snackable forms? Fruit is one option. Its very practical to formulate fruits into menus at schools and in restaurants, says Marshall. Many quick-serve and fast-casual restaurants are substituting sliced apples and applesauce for fries and other sides to fit the healthy trend. She cites research finding apples in 43% of kids meals, right behind fries at 66%. The trick, she says, is to offer fruit in forms that are convenient and ready-to-use, reducing waste and labor and increasing profits.

Marshall points to traditional comforting snacks like applesauce packaged in single-serve cups as an example. Products can be sweetened with fruit juice, eschew high-fructose corn syrup, and come in kid-approved flavors like apple, strawberry and peach. More-exotic flavors, made with antioxidant-rich superfruit combinations like blueberry-pomegranate, key lime and cupuaçu, and raspberry-açaí using concentrates, are also available.

Dairys dividends

Getting as much play as fruit are dairy foods, which have long enjoyed a reputation for nourishment. And with sugary sodas, energy drinks and even juices in the hot seat, milk has never looked better. Moms are tired of sodas and water, suggests Moore. They want to see milk on kids menus more than other healthy beverages, even fortified orange juice. Fully 70% of parents want their kids to drink more milk at restaurants, he adds, and chocolate and white milk are the top two dairy items that both moms and kids look for. This makes milk an easy sales driver for restaurants to merchandise, he notes, and reinforces a healthful and wholesome image for restaurant chains.

Milk also provides nutrition that kids need. The 2005 Dietary Guidelines for Americans identified five nutrients of concern in childrens diets, three of whichcalcium, potassium and magnesiummilk supplies in spades. In addition to the individual nutrients within dairy foods, adds Krautheim, consumption of low-fat and fat-free milk and milk products improves the overall nutrient density of the diet and is a marker of a high-quality diet. Its often found that those who drink more milk also consume more of other nutrient-rich foods that we need, like whole grains, fruits and vegetables.

New research is uncovering more support for dairy. Emerging science shows that milk and several dairy fractions have physiological benefits in key areas related to childrens health, such as growth and development, insulin action, and immune support, Niba says. For example, though were still sussing out the exact mechanisms, substantial evidence indicates that whey proteins, whey peptides and amino acids rife in dairy, like leucine, exert metabolic effects that could help combat childhood obesity.

"Whey peptides, for instance, have been shown to have ACE-inhibitory activity, protecting against lipogenesis and the accumulation of fat stores, Niba says. The whey peptide glycomacropeptide (GMP) has been shown to contribute to satiety through its stimulation of cholecystokinin, a hormone that inhibits gastric secretions and gastric emptying. Dairy consumption has been shown to be inversely associated with insulin resistance in overweight individuals, too, and milk consumption modulates insulin action in overweight children.

The underlying message is simple: Menu more dairy. Products such as flavored milks, dairy beverages, yogurts and cheese are minimally processed and also very healthful, Niba says. Yogurts are already generally regarded as healthful foods and are a natural fit. Smoothies, which many children already love, can easily be added to childrens menus. For kids who resist dairy, she suggests high-tech stealth health. The addition of dairy proteins and calcium to fruit juices could also be a satisfactory means for children to meet their dairy intake requirements, she says. Even healthful snack-type products like granola-type bars and fruit snacks could be enhanced by adding dairy inclusions, making them even more wholesome with many essential nutrients like fiber and protein.

We can get too much of a good thing, though. Dairy foods, as part of an overall nutrient-rich diet, can be part of the solution to helping improve child health and wellness, says Krautheim. But attention should also be given to overall portion and calorie control.

Dairy can be quite rich, and when milks take on fun flavors and colors, they often take on extra calories, too. Knowing that many schools want to reduce sugar content in all their offerings, says Peggy Lee, M.B.A., S.N.S., director, dairy health & wellness, National Dairy Council, more than 90 industry-partner dairies across the United States have proactively reformulated flavored milk to be lower in both sugar and total calories, aiming for 150 calories and fewer than 25 grams of sugar. With pizza reportedly the most popular entrée in schools, she adds, the dairy industry is working with foodservice partners on formulating healthful, delicious varieties of school pizza. Initial work includes pizzas that offer whole-grain crusts, reduced-fat cheese and vegetables.

Healthy starts

What about breakfastwhich more schools are offering, and which more research is confirming as the most-important meal of the day?

"I know that many moms, like myself, sent their children off to school after eating eggs on important test days, hoping that the egg breakfast would help in some small way to increase their focus and get them better grades, says Greenblum. Now we have some scientific research to begin to corroborate what moms already knew to be true.

In a study conducted at the Pennington Biomedical Research Center, Baton Rouge, LA, overweight people who ate a breakfast that included eggs not only reported feeling more satisfied than after eating an isocaloric bagel breakfast, but ate fewer calories at lunch and for the next 36 hours. This can be extremely useful for kids who start school very early in the day and need to focus all their attention on schoolwork and shouldnt be distracted by feelings of hunger, which may come well before their set lunch period, says Greenblum. If theyre less hungry after an egg breakfast, she notes, theyre less likely to pick on empty-calorie snacks that fill them up and prevent them from eating more healthful foods at mealtimes.

How to add eggs to kids menus? Roll it in a tortilla with salsa and youve got a breakfast wrap to-go. Lately Ive been seeing recipes for poached eggs over spaghetti, which I wish I had thought of when my kids were little, says Greenblum.

Kimberly J. Decker, a California-based technical writer, has a B.S. in consumer food science with a minor in English from the University of California, Davis. She lives in the San Francisco Bay Area, where she enjoys eating and writing about food. You can reach her at [email protected].

Same Old, Same Old

Mintel Menu Insights, Chicago, analyzed kids menus from 2005 to 2009 and found the same items menued over and over: chicken fingers at 10%, trailed by grilled cheese, mac-and-cheese, burgers, hot dogs, pizza and corndogsdespite evidence that parents and kids are game for more nutritious and gastronomically ambitious foods. When asked, 77% of children claimed they were open to ordering dishes with vegetables, and 86% gave a similar thumbs-up to fruit. And while the studys authors lauded the grilled chicken strips with fresh garden salad from Bob Evans, Burger Kings apple fries and Elephant Bars tropical citrus salad with chicken as choices with the right stuff, they concluded that most kids menus dont rise to the level of todays kids palates.

Cleaning Up Kids Menus

Schools are busy teaching kids, notes Amy Klein, executive chef, Revolution Foods, Oakland, CA, so running the equivalent of a successful health-food eatery is a complication they dont need. So what were trying to doand what weve doneis open large commissaries around the country where we scratch-cook for them. That means soaking their own pinto beans to make burritos, for example, and finding the suppliers who can give them a clean tortilla with a little whole wheat thrown in, as well.

"We dont do a chicken nugget, but we do a grilled chicken tender, and we serve it with organic ketchup, says Klein. Our hot dog has five ingredients in it. Its stuff like that: watching sodium content, watching fat content and watching unnecessary preservatives, because we dont need this food to live forever. You want a taco? Its beef, beans, a clean tortilla, some fresh-roasted or steamed vegetables, and brown Spanish rice.

Company standards align pretty closely with Whole Foods, but without the high expense. In the schools where we work, we are cost competitive with those that arent necessarily doing the healthy option, Klein says. We started out truly to serve those with the least accessthe poorest schools where the rising rates of childhood obesity are just epidemic. We couldnt ignore that the National School Lunch Program was not necessarily supporting a turnaround in those statistics.

So, whats the reaction from students? When we started almost four years ago, I tried couscous and lentils, Klein says. In my Latino communities, the couscous and lentils werent working. So I pulled back on it. But with all my tacos, I serve brown Spanish rice, and at first there was a little pushback, but weve had kids eating that rice for four years now, and they get it. They like it.

They know how to meet the kids on common ground. We have what we call our Americana, kid-friendly favoritesthe hamburgers, the hot dogsbut in the middle there, weve got the tamales and jambalaya and turkey sausage with black-eyed peas, Klein says. Im working on a vegetarian red beans and rice formula right now. And yet, a hot dog once or twice a month does not a lousy diet make. Theres nothing wrong with having a hot dog as long as the ingredient integrity meets our standards and its not overly processed, she says. And we really started thinking what moderation means for us, and thats where weve come up with a pizza, but its a crust from a guy who bakes it for us down in L.A. And we use all-natural mozzarella cheese and a freshly made pizza sauce. And we put sausage on it, but an all-natural chicken sausage. Its very simple.

Some things arent so simple. Take that hot dog. Being nitrate-free, the color got a little grayish in spots after cooking, and it turned the kids off, says Klein. We started looking at more-processed hot dogs, but they had a lot of stuff in there to keep the color more consistent. So were working with our hot dog supplier to use some beet juice to keep the color the way it is. Its really changing our manufacturing principles, she says, from using a lot of the fake stuff to using natural colorings, using preservatives only where you need them, and not designing foods that have to have a three-year freezer life.

What Klein wants from her suppliers is food that looks like food: chicken that looks like chicken, beef that looks like beef, squash that looks like squashbut that might be peeled and precut because I dont want to have to do that myself, she says. The idea for me is that instead of recognizing brands on packages, kids start recognizing food.

Healthful Menus Matter

"There are many forces that will bring pressure to change, says Dave Sheluga, director, consumer insight, ConAgra Mills, Omaha, NE. Some of these influences include the current updating of the Child Nutrition Act, the 2010 updating of the Dietary Guidelines, Michelle Obamas focus on healthy kids, health-care reform, and more.

The Institutes of Medicine (IOM) sparked discussion in 2007 when it suggested limiting portion size and calorie, sodium, added sugar and fat contents in school a la carte, snack bar, and vending machine choices, while also asking schools to adopt common standards limiting on-campus food sales to fruits, vegetables, low-fat dairy and whole-grain snacks. The IOM recommended banning high-sugar sports drinks from elementary and middle schools, as well, while allowing those items, along with baked potato chips and pretzels, in high schools during limited, after-class hours.

In late 2009, the IOM weighed in again with recommendations for new nutrition standards to replace the current set, which hasnt been updated since 1995. No longer should the emphasis be on isolated nutrients, they say, but on whole foods and food groups chosen based on nutrient targets. The IOM advises schools to set a maximum calorie level, whereas current guidelines work from a minimum, and they advocate a sodium limit, which would also be new. Fruits and vegetables should no longer be interchangeable, and students should have to select either a fruit or a vegetable for their lunch to be reimbursed, whereas now they must take only three of the five items offeredusually milk, meat and starch. Schools would have to serve ½ cup per week of dark-green veggies, orange veggies and legumes, respectively, and half the grains served each week should be whole. Milk should only be low- or nonfat, and any packaged foods should be labeled as containing 0 grams of trans fats.

Some have taken up the cause already. I think we are doing well in some areas. The overarching goal has never changed, and that is to feed our kids well, says Wendy Bazilian, DrPH, R.D., a San Diego, CAbased nutrition educator and author of The SuperFoodsRx Diet: Lose Weight with the Power of SuperNutrients.

But Bazilian concedes theres room for improvement. Part of that has to do with our acquiescing to the idea that children have dull taste buds and dont want to eat nutritious food, she says. I think were selling our kids a little bit short here. Were creating a demand for less-healthful foods, and that somehow justifies making fewer healthful foods available to them. Yet todays kids are much more sophisticated than we give them credit for.

So, do menus feature chicken fingers and burgers because kids like them, or do kids like them because theyre whats on the menu? The answer is probably a bit of both. Liz Ward, R.D., an ambassador to the egg industry, says: Children have access to supermarkets with hundreds of thousands of different foods that they can sample. However, most eat the same foods over and over. By abetting this repetition, she says, we make it easier not to make the effort to offer other foods that may be healthier, yet just as appealing, to kids.

As a childs palate matures, so should menus. If we continue to offer the same foods over and over, Ward says, such as the overly sweet, salty or fatty fare that we are sure

theyll accept, then we will never know how their tastes have changed.