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Diet, HealthyNCT04334525

Promoting Healthier Eating Among Children in Restaurants

A study testing Choice architecture + repeated exposure and Active comparator in people with Diet, Healthy, run by State University of New York at Buffalo at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Restaurants are normative eating contexts for many families. Restaurant meals tend to be higher in calories and lower in nutritional quality than those prepared at home. Targeting children's food selection in restaurants has the potential to improve diet quality, attenuate excess energy intake, and shape healthy… Read more about this study

Who is it for?
Ages 4 to 8 years
Conditions the study is for
Diet, Healthy
What is being tested?
Choice architecture + repeated exposure and Active comparator
Could I receive a placebo?
No, everyone receives an active treatment
How many people
554 participants
Where
1 siteUnited States
Study dates
13 Nov 2019to 24 Nov 2024
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 4 to 8 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Fluent in English (parent/guardian \& child)
  • 18 years or older (parent/ guardian)
  • Between the ages of 4-8 years (child)
  • Eats food from restaurants at least 2-3 times per month (child)
  • Does not have allergies that preclude safe participation in the study (child)
  • Eating a meal in the restaurant at the time of recruitment/baseline assessment
  • Did not participate in pilot phase of this study, which involved taste tests of possible healthier meal options at the same restaurant chain

Who cannot join

  • Is under 18 years of age (parent/ guardian)
  • Does not have a child in the range of 4-8 years
  • Does not speak English fluently (parent/guardian \& child)
  • Does not eat food from a restaurant at least 2-3 times per month (child)
  • Has food allergies that preclude safe participation in the study (child)
  • Not eating a meal in the restaurant at recruitment/baseline
  • Participated in pilot phase of this study, which involved taste tests of possible healthier meal options at the same restaurant chain

Trial locations and contacts

1 site in 1 country.

United States1 site
  • State University of New York at Buffalo

    Buffalo, New York, 14214

Other trials in United States

About this study

Restaurants are normative eating contexts for many families. Restaurant meals tend to be higher in calories and lower in nutritional quality than those prepared at home. Targeting children's food selection in restaurants has the potential to improve diet quality, attenuate excess energy intake, and shape healthy habits. The objective of this study is to make healthier kids' meal options more appealing and easier to choose via an in-restaurant intervention that combines repeated exposure and choice architecture strategies. Six locations of a quick-service restaurant will be paired based on income levels in the surrounding census tracts. A location from each pair will be randomized to each study group (intervention, control). Recruitment and data collection will be conducted across 3 cohorts, with recruitment conducted during a family's regular visit. Study participation will involve 7 more visits to the location where the family was recruited, 6 of which will be during an exposure period of about 2 months. Families in intervention restaurants will receive placemats promoting healthier featured kids' meals. Participating families will also receive a frequent diner card which, after purchasing one of the featured healthier kids' meals across 6 occasions, makes them eligible for a free kids' meal of their choice during a predetermined redemption period. In the control group, generic placemats will be provided, and participating families will be provided with frequent diner cards that can be used for any kids' meals. The aims of this study are: (1) to test effects of a healthier kids' meal intervention on children's meal orders, and (2) to test effects of a healthier kids' meal intervention on children's dietary intake. It is hypothesized that (1a) children in the intervention restaurants will be more likely than controls to select one of the promoted healthier kids' meals at post-test, (1b) children in the intervention group will order fewer calories and desserts and less saturated fat, sodium, and sugar at post-test versus controls, (1c) the promoted healthier meals will make up a greater percentage of kids' meals ordered in intervention restaurants versus controls, based on sales data across the study period, and (2) compared to controls, children in the intervention group will consume fewer calories and less saturated fat, sodium, and sugar in the restaurant at post-test.

Read the detailed description

Restaurants are normative eating contexts for many families. Restaurant meals tend to be higher in calories and lower in nutritional quality than those prepared at home. Targeting children's food selection in restaurants has the potential to improve diet quality, attenuate excess energy intake, and shape healthy habits. The objective of this study is to make healthier kids' meal options more appealing and easier to choose via an in-restaurant intervention that combines repeated exposure and choice architecture strategies.

Six locations of a quick-service restaurant will be paired based on income levels in the surrounding census tracts. A location from each pair will be randomized to each study group (intervention, control). Recruitment and data collection will be conducted across 3 cohorts. After recruitment, families will be asked to order and eat like they normally would. All participating families will then complete measures of children's orders, intake, and demographics. Then families will receive placemats and frequent diner cards. Families in intervention restaurants will receive placemats promoting healthier featured kids' meals. These families will also receive a frequent diner card, which after purchasing one of the featured healthier kids' meals across 6 occasions, makes them eligible for a free kids' meal of their choice during a predetermined redemption period. In the control group, generic placemats will be provided following baseline data collection, and families will also be provided with frequent diner cards that can be used for any kids' meals. During subsequent exposure periods, lasting about 2 months per cohort, families will return to the restaurant location where they were recruited on a weekly basis. Placemats will be available at the restaurant entrance, and corresponding signage will be displayed in the restaurant. In intervention restaurants, signs will advertise promoted meals and the option to select a toy in place of dessert. Participating children will be able to use their frequent diner card during this time to earn a free meal during the subsequent redemption period. Families will also be asked to complete a brief online survey once per week to monitor restaurant patronage. In each restaurant, study staff will conduct observations of a subsample of participating family and server interactions. Finally, post assessments will be completed during predetermined redemption periods, lasting about 3 months per cohort. Placemats and signage will still be available in restaurants during this time. Study staff will collect the frequent diner cards and ask families to order and eat like they normally would and to not throw out any food or leftovers. Families will be able to redeem any earned free kids' meals during this time. When the family is done eating, study staff will approach the table to administer study measures assessing orders, perspectives on the meal, and intake. Finally, families will also be prompted to complete an online dietary recall (ASA24) after their post assessment.

The specific aims of this study are: (1) to test effects of a healthier kids' meal intervention on children's meal orders, and (2) to test effects of a healthier kids' meal intervention on children's dietary intake. It is hypothesized that (1a) children in the intervention restaurants will be more likely than controls to select one of the promoted healthier kids' meals at post-test, (1b) children in the intervention group will order fewer calories and desserts and less saturated fat, sodium, and sugar at post-test versus controls, (1c) the promoted healthier meals will make up a greater percentage of kids' meals ordered in intervention restaurants versus controls, based on sales data across the study period, and (2) compared to controls, children in the intervention group will consume fewer calories and less saturated fat, sodium, and sugar in the restaurant at post-test.

Conditions
Diet, Healthy
Being tested
Choice architecture + repeated exposure, Active comparator
Keywords
child, restaurant, nudging, repeated exposure, diet, health

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Choice architecture + repeated exposureBehavioural

    Participants will receive placemats promoting healthier featured kids' meals and the opportunity to redeem their kids' meal token for a toy instead of dessert. Families will also receive a frequent diner card, which after purchasing one of the featured healthier kids' meals across 6 occasions, makes them eligible for a free kids' meal of their choice during a predetermined redemption period.

  • Active comparatorBehavioural

    Participants receive generic placemats and frequent diner cards that do not promote any specific kids' meal.

Study groups in NCT04334525
Study groupRoleWhat they receive
Generic placemats and frequent diner cardsActive comparatorParticipants will receive generic placemats listing all of the restaurant's kids' meals. Families will also receive a generic frequent diner card, which after purchasing (any) kids' meals across 6 occasions, makes them eligible for a free kids' meal of their choice during a predetermined redemption period. Corresponding signage will be displayed in the restaurant.
Receives: Behavioral: Active comparator
Placemats and frequent diner cards promoting healthier mealsExperimentalParticipants will receive placemats promoting healthier featured kids' meals and the opportunity to redeem their kids' meal token for a toy instead of dessert. Families will also receive a frequent diner card, which after purchasing one of the featured healthier kids' meals across 6 occasions, makes them eligible for a free kids' meal of their choice during a predetermined redemption period. Corresponding signage will be displayed in the restaurant.
Receives: Behavioral: Choice architecture + repeated exposure
Pilot phaseNo interventionPilot (taste testing) phase completed before the trial to finalize the healthier meals that would be promoted in the intervention.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Meal Type Ordered for Child in Restaurant

    Whether a healthier children's meal or other children's meal was ordered (bundled meal including promoted healthy main dish, healthy side, and healthy beverage). Counts reported indicate the number of children who ordered a healthy bundled meal.

    Measured: Post-test (about 4 months after recruitment)

  2. Change in Meal Type Ordered for Child in Restaurant

    Whether a healthier children's meal or other children's meal was ordered. Counts reflect the raw change in number of participants ordering the bundled healthy meal from baseline to post-test, by group.

    Measured: Baseline, midpoints 1-9 (weekly assessments about 2 months after recruitment), post-test (about 4 months after recruitment)

  3. Total Calories Ordered for Child in Restaurant

    Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total calories ordered

    Measured: Post-test (about 4 months after recruitment)

  4. Change in Total Calories Ordered for Child in Restaurant

    Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total calories ordered

    Measured: Baseline, midpoints 1-9 (weekly assessments about 2 months after recruitment), post-test (about 4 months after recruitment)

  5. Total Saturated Fat Ordered for Child in Restaurant

    Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total saturated fat ordered.

    Measured: Post-test (about 4 months after recruitment)

  6. Change in Total Saturated Fat Ordered for Child in Restaurant

    Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total saturated fat ordered.

    Measured: Baseline, midpoints 1-9 (weekly assessments about 2 months after recruitment), post-test (about 4 months after recruitment)

  7. Total Sugar Ordered for Child in Restaurant

    Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total sugar ordered.

    Measured: Post-test (about 4 months after recruitment)

  8. Change in Total Sugar Ordered for Child in Restaurant

    Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total sugar ordered.

    Measured: Baseline, midpoints 1-9 (weekly assessments about 2 months after recruitment), post-test (about 4 months after recruitment)

  9. Total Sodium Ordered for Child in Restaurant

    Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total sodium ordered.

    Measured: Post-test (about 4 months after recruitment)

  10. Change in Total Sodium Ordered for Child in Restaurant

    Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total sodium ordered.

    Measured: Baseline, midpoints 1-9 (weekly assessments about 2 months after recruitment), post-test (about 4 months after recruitment)

  11. Dessert Ordered for Child in Restaurant

    Whether or not a dessert was ordered. Counts below reflect the number of children ordering a dessert at post-test.

    Measured: Post-test (about 4 months after recruitment)

  12. Change in Dessert Ordered for Child in Restaurant

    Whether or not a dessert was ordered. Numbers below reflect change in likelihood of ordering dessert from baseline to post-test in the context of the generalized linear mixed model with all time points (baseline, midpoints 1-9, post-test).

    Measured: Baseline, midpoints 1-9 (weekly assessments about 2 months after recruitment), post-test (about 4 months after recruitment)

Secondary outcomes (8)
  1. Calories Consumed at Restaurant by Child in Restaurant

    Children's dietary intake will be measured using plate waste methodology. Grams consumed will be converted to percentages using total grams from pre-weights, and these percentages will be multiplied by the total calories in the full item to calculate calories consumed.

    Measured: Post-test (about 4 months after recruitment)

  2. Changes in Calories Consumed at Restaurant by Child in Restaurant

    Children's dietary intake will be measured using plate waste methodology. Grams consumed will be converted to percentages using total grams from pre-weights, and these percentages will be multiplied by the total calories in the full item to calculate calories consumed.

    Measured: Baseline, post-test (about 4 months after recruitment)

  3. Saturated Fat Consumed at Restaurant by Child in Restaurant

    Children's dietary intake will be measured using plate waste methodology. Grams consumed will be converted to percentages using total grams from pre-weights, and these percentages will be multiplied by the total saturated fat in the full item to calculate saturated fat consumed.

    Measured: Post-test (about 4 months after recruitment)

  4. Changes in Saturated Fat Consumed at Restaurant by Child in Restaurant

    Children's dietary intake will be measured using plate waste methodology. Grams consumed will be converted to percentages using total grams from pre-weights, and these percentages will be multiplied by the total saturated fat in the full item to calculate saturated fat consumed.

    Measured: Baseline, post-test (about 4 months after recruitment)

  5. Sugar Consumed at Restaurant by Child in Restaurant

    Children's dietary intake will be measured using plate waste methodology. Grams consumed will be converted to percentages using total grams from pre-weights, and these percentages will be multiplied by the total sugar in the full item to calculate sugar consumed.

    Measured: Post-test (about 4 months after recruitment)

  6. Changes in Sugar Consumed at Restaurant by Child in Restaurant

    Children's dietary intake will be measured using plate waste methodology. Grams consumed will be converted to percentages using total grams from pre-weights, and these percentages will be multiplied by the total sugar in the full item to calculate sugar consumed.

    Measured: Baseline, post-test (about 4 months after recruitment)

  7. Sodium Consumed at Restaurant by Child in Restaurant

    Children's dietary intake will be measured using plate waste methodology. Grams consumed will be converted to percentages using total grams from pre-weights, and these percentages will be multiplied by the total sodium in the full item to calculate sodium consumed.

    Measured: Post-test (about 4 months after recruitment)

  8. Changes in Sodium Consumed at Restaurant by Child in Restaurant

    Children's dietary intake will be measured using plate waste methodology. Grams consumed will be converted to percentages using total grams from pre-weights, and these percentages will be multiplied by the total sodium in the full item to calculate sodium consumed.

    Measured: Baseline, post-test (about 4 months after recruitment)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 Apr 2020
  2. Study start13 Nov 2019
  3. Primary completion22 Nov 2024
  4. Study completion24 Nov 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
A cluster-randomized design will be used. 6 locations of Anderson's, a regional quick-service restaurant in the Buffalo, New York, area will be paired based on income levels in the surrounding census tracts. A location from each pair will be randomized to each study group (intervention, control). Phased data collection will occur, with each pair of restaurants assigned to a cohort. There is also a pilot arm, consisting of separate children participating in taste tests prior to randomization to finalize the healthier meals to be promoted in the intervention.
Masking
None (open label)
Enrolment
554 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04334525
Sponsor's protocol ID
STUDY00003356
Other IDs
1R01HD096748-01A1
Status last verified
May 2026
First submitted
31 Mar 2020
Last updated
10 Jun 2026
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Anzman-Frasca S, Tauriello S, Epstein L, Ferrante MJ, Gampp A, Goldsmith J, Haines J, Leone LA, Paluch R. Promoting Healthier Meal Selection and Intake Among Children in Restaurants: Protocol for a Cluster-Randomized Trial. JMIR Res Protoc. 2025 Oct 10;14:e73618. doi: 10.2196/73618.

    PubMed 41072006

Questions about this trial

What is this clinical trial studying?

A study testing Choice architecture + repeated exposure and Active comparator in people with Diet, Healthy, run by State University of New York at Buffalo at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 10 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 10 Jun 2026). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Meal Type Ordered for Child in Restaurant (time frame: Post-test (about 4 months after recruitment)). The study lists 12 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04334525, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Jun 2026.

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