Child Friendly Menu Labelling and Food Choices
Condition: Childhood Obesity
MeSH terms: Pediatric Obesity
Study type: Interventional

Summary: 
      Childhood obesity is a major problem in Canada. Children are eating larger portions and have
      easier access to high-fat, high-sugar foods and drinks. Menu labelling is a promising tool to
      teach families about healthier choices. The investigators will study the impact of combining
      child-friendly superhero food labels, fun food names, and a traffic light system on the food
      choices of children and their parents at SickKids. The investigators will use the hospital
      inpatient food ordering system (Meal Train) and look at food orders and eating patterns
      before and after introduction of the revised Meal Train menu. Only the design format of the
      menu was changed and all menu items remained unchanged. The investigators will also survey
      the families on their thoughts about the menu. This study will help doctors and dietitians
      develop strategies to deliver nutrition education to families.
    

Detailed description: 
      Childhood obesity is recognized as a major public health epidemic in Canada with over 31.5%
      of all 5- to 17-year-olds being overweight or obese. The etiology of this increase in
      childhood obesity can be attributed to trends in children's diets that include increasing
      access to foods high in fats, added sugars, and eating outside the home with routine exposure
      to large portions of energy-dense, nutrient-poor foods. Menu labelling and point-of-purchase
      nutrition information is a promising potential cost effective public health strategy and
      utilized in the adult population. In this study, the investigators plan to evaluate the
      impact of a combination of labelling techniques including attractive characters, descriptive
      food names and traffic light system on food choices made by children and their parents in an
      inpatient hospital setting at the Hospital for Sick Children. The investigators will assess
      patient ordering and consumption patterns before and after the introduction of a revised
      educational Meal Train menu. A crossover randomized control trial design will be employed to
      identify changes in fruit and vegetable intake, healthy ("green light") option intake, number
      of sweetened beverages and energy-dense nutrient-poor ("red light") foods chosen as well as
      the number of children that meet the Canadian Food Guide (CFG) daily serving recommendations.
      As a secondary analysis, the investigators will be collecting participant's age, sex and
      weight-for-age z-score (as defined by the World Health Organization guidelines) to
      investigate any potential relationships between these variables and food ordering patterns
      before and after introduction of the proposed educational menu. A questionnaire will also be
      distributed to assess parent and child perceptions of the revised Meal Train menu. The
      investigators hypothesize patient ordering and consumption patterns before and after the
      introduction of a revised educational Meal Train menu will promote healthier food selections.
      While this type of intervention has been studied in hypothetical restaurants and cafeteria
      setting, this will be the first study conducted in a hospital setting with pediatric
      inpatients and their parents.
    

Intervention name(s): Intervention MealTrain menu
Intervention type(s): Other
Intervention description(s): Nutrition education was incorporated using an interpretive traffic light system menu labeling. Dietitians categorized current menu items as green, yellow and red based on fiber, added sugar, saturated fats, and sodium content. A section entitled "Eat like a superhero" was created to prime children to consider what their potential role models choose, and incorporates descriptive names, suggest sample breakfast, lunch and dinner meals with photographs of portion sizes. Original cartoon female grapes and male broccoli superhero characters were created to employ promotional techniques specifically to promote fruits and vegetable selection for boys and girls.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Primary purpose: Prevention