Evaluation of Short-Term Changes in Fast-Food Restaurant Online Kids? Meal Beverage Offerings Following a State-Level Healthy Beverage Default Policy

Background: Consumption of food and beverages from restaurants is associated with poorer diet quality and a higher intake of sugar-sweetened beverages (SSBs) among children, and SSBs are commonly offered as part of kids' meals at restaurants. Thus, an increasing number of states and localities have mandated that only healthy beverages be provided by default with kids' meals. Objectives: We examined changes in default beverages offered with kids' meals 4 mo after an IL healthy beverage default (HBD) Act took effect. Methods: A pre-post intervention-comparison site study design was used, with WI as the comparison site. Data were collected on default beverages offered on restaurant website or application menus at 64 restaurants in IL and 57 restaurants in WI in November 2021, before the IL HBD Act took effect, and May 2022, 4 mo after the date on which the Act took effect. Difference-in-differences weighted logistic regression models with robust standard errors clustered on restaurants were computed to examine changes over time in beverage offerings in IL relative to those in WI. Results: There was no statistically significant increase in compliance with the IL HBD Act's criteria in restaurants in IL compared with those in WI (OR: 1.40; 95% CI: 0.45, 4.31). Although the compliance by fast-food restaurants increased from 15% to 38% in IL, there was a similar pattern in WI, with an increase from 20% to 39%. There were also no statistically significant changes in specific types of compliant beverages offered by default with kids' meals in IL compared with those in WI. Conclusions: These results highlight the need for communication and enforcement to ensure that restaurants make changes in response to HBD policies broadly, including on their online platforms, and without substantial lags. Future studies should continue to measure the effectiveness of HBD policies alongside implementation strategies to determine how these policies can best achieve improvements in the nutritional quality of kids' meals at restaurants.