Chapter 7: Healthy Restaurant Eating with Kids and Teens with Diabetes

Children and teens growing up today will likely eat restaurant meals more frequently during their lives than any generation before, for many of the same reasons that we enjoy restaurant meals today. They are quick, convenient, and available 24/7 to fit our fast-paced lifestyles. With the digital age exploding and impacting restaurant eating as well as many other aspects of life, the easy access to and availability of restaurant foods will only become more prevalent in the coming years. So yes, today’s youth will need a set of skills and strategies for eating healthy restaurant meals even more than adults do now. This is particularly true for children and teens who have diabetes and/or are overweight or at risk of becoming overweight.

While not typically true for children with type 1 diabetes, too many kids and teens today are overweight or obese. Many of these children either have, or are at risk for developing, type 2 diabetes and other diseases related to being overweight. Prior to the last decade, prediabetes and type 2 diabetes were a rarity in children; so was excess weight. Today, about one in three American children and teens is overweight or obese. This is nearly triple the rate in 1963. Overweight and obesity for children and younger teens are defined, using the CDC growth charts from the year 2000, as age- and sex-specific BMIs between the 85th and 95th percentile, and at the 95th percentile or above, respectively.

Frequent restaurant meals have been shown through research to contribute to obesity-related health problems. Restaurant meals for kids and teens are often eaten in or taken out from fast-food chains, sandwich shops, or pizza joints. Ah, yes, pizza, the seemingly ubiquitous food for children and family events. Research shows that kids eat more calories, total fat, and saturated fat during restaurant meals than from home-cooked meals. And, as you might guess, they eat fewer servings of fruits, vegetables, and milk when they eat out.

Whether you are a parent, grandparent, or caregiver of a child or teen who has or is at risk for diabetes, take on the responsibility to train the younger generation in the ways of healthy restaurant eating. The reality is, food choices and eating habits become ingrained early in life. So it’s never too early to make healthy eating practices part of your normal family life. The sooner the better! Don’t single out the child with diabetes. Make healthy eating for diabetes management and beyond a family affair.

Those Darn Kids’ Meals and Menus

Yes, there are hurdles and high jumps in your way when it comes to teaching kids about healthy restaurant eating—kids’ meals, kids’ menus, and kids-eat-free special offers, to name a few.

Kids’ meals and menus are those listings of supposedly kid-friendly and kid-favorite foods posted in a special section of the menu board at fast-food restaurants or on a laminated card you’re often handed, whether you want it or not, at sit-down restaurants. These kid-friendly meals are most often a narrow list of foods that don’t score well when graded for healthfulness. When it comes to kids’ meals at American or family-fare restaurants, you can name the offerings on kids’ menus in your sleep: the sandwiches are hamburger, cheeseburger, hot dog, or grilled cheese, all served with french fries or chips. The entrées are macaroni and cheese, pizza, pasta and tomato sauce, and fried chicken fingers (or fried fish, in seafood spots). And all of these meals are most often served with sugar-sweetened beverages. One positive aspect of kids’ meals at fast-food restaurants is their smaller portions, which can be a benefit for adults who want to eat smaller fast-food portions. Fast-food restaurants won’t stop adults from ordering kids’ meals, but sit-down restaurants will. But, whether young or older, you’ll need to pick and choose to eat healthier fast-food meals.

Repeatedly feeding children these kid-favorite (but less-than-healthy) restaurant foods from a young age can result in several problems. The first is that children develop a taste for these high-fat foods rather than healthy ones. Another issue is that the scope of foods that children get exposed to narrows rather than widens. If kids are served the same short list of foods at home, at school, at family gatherings, and at restaurants, then those foods are all they’ll want and expect to eat. Let’s widen, not narrow, our kids’ palates. You’ll find plenty of ways in the pages ahead to expose children and teens to a wide range of restaurant cuisines, foods, and flavors.

Where are the vegetables, whole grains, fruits, and low-fat (or, better yet, fat-free) milk options? They’re still not plentiful on most kids’ menus, but due to the overweight and obesity epidemic in our younger generation, the pressure from many avenues is finally on large restaurant chains to take some responsibility and provide healthy offerings for kids. And they are beginning to make positive changes! Today, and this is expected to continue, fast-food burger-and-fries meals can be ordered with healthy kid-friendly sides—mini carrots, apple slices, applesauce, or fruit cup. Oh yes, there are still plenty of french fries, but the portion size is child appropriate, at least at some venues. To drink? Reduced-fat or fat-free white or chocolate milk and 100% orange or apple juice have become more readily available. Changes are also afoot in sit-down chains. Read about the National Restaurant Association’s Kids LiveWell program initiated in 2012. It’s catching on! This is all good news and can make parents’ efforts towards healthier eating just a bit easier to accomplish.

Kids LiveWell Program

In response to the pressure of childhood obesity advocates and in an attempt to do the right thing, the National Restaurant Association (NRA) has partnered with Healthy Dining Finder, an online resource to help find restaurants serving healthy options, to develop the Kids LiveWell program. It’s a voluntary program that restaurant chains of varying sizes can sign onto to endorse and put into practice in their restaurants. By early 2014, the program was being delivered by over 40,000 restaurants, many of which are part of restaurant chains.

The goal of the program is to help parents and children select healthier restaurant menu options. The program’s big push is to make it easier for kids to eat more fruit and vegetables, lean protein, whole grains, and low-fat dairy foods in restaurants. Another goal of the program is to limit unhealthy saturated fats, added sugars, and sodium in restaurant foods. Restaurant chains that participate can tout their involvement in the program and can promote the meals they serve that meet the specified nutrition guidelines. The nutrition guidelines and criteria for the program are in sync with the healthy eating guidelines in the Dietary Guidelines for Americans and with other leading health associations. These match well with the American Diabetes Association’s Nutrition Therapy Recommendations for the Management of Adults With Diabetes.

Kids LiveWell Nutrition Criteria

• Offer at least one full children’s meal (an entrée, side, and beverage) that is 600 calories or less; contains two or more servings of fruit, vegetables, whole grains, lean protein, and/or low-fat dairy; and limits sodium, fats, and sugar.

• Offer at least one other individual item that has 200 calories or less, with limits on fats, sugars, and sodium, and contains a serving of fruit, vegetables, whole grains, lean protein, or low-fat dairy.

Gather more details about the nutrition criteria at http://www.restaurant.org/Industry-Impact/Food-Healthy-Living/Kids-LiveWell/About. Learn more about Kids LiveWell at: http://www.restaurant.org/Industry-Impact/Food-Healthy-Living/Kids-LiveWell-Program. You can see what kind of healthy kids’ meals are available at each participating restaurant and find the exact nutrition information for these meals on the program’s website.

Tips and Tactics to Help Kids Eat Healthy

Here are a slew of general tips and tactics to help children and teens make healthy restaurant choices. Find cuisine-specific tips and tactics to help kids eat healthy in the chapters in Sections 2 and 3.

• Make healthy eating in restaurants a family affair. If you eat out frequently (a couple of times a week or more), it’s important to not think of or portray restaurant meals as special occasions. Rather, continue to practice the healthy eating habits you practice at home. Make this your modus operandi right off the bat. There’s no need to wait until kids are a certain age or have a health issue to make healthy eating a priority.

• Develop family guiding principles for restaurant eating. Then get buy-in from everyone. Say, for example, that everyone needs to try at least a few bites of each vegetable.

• Be a role model. As the saying goes, “Monkey see, monkey do.” Another expression that echoes the same sentiments is, “Actions speak louder than words.” If your children see you ordering healthy foods and not overeating, they are likely to follow suit without you even whispering a word. Be a constant and consistent role model. Over time, they will begin to practice healthy eating habits.

• Limit the use of kids’ menus unless they will help your children eat smaller portions or healthier foods and/or fit in some healthier fruits and vegetables.

• Take advantage of fast-food kids’ meals. They’re getting healthier, with the inclusion of fruit, juice, and/or low-fat or fat-free milk. Also the portions sizes (and thus calories and carbohydrate) are more appropriate for children. They could still use more vegetables, but we can hope this will come with time. In the meantime, include a side salad, if possible.

• Expose your children to a wide variety of cuisines, foods, and flavors. Widen the scope of foods they enjoy rather than narrowing their list to what adults believe are kids’ foods. Take them to ethnic restaurants—the common ones include Mexican, Chinese, and Italian; less common options are Thai, Middle Eastern, or Indian. Expose them to foods and people from around the globe. Beyond widening their palate, these ventures can help them increase their perspective of the vastness of the world and the myriad cultures.

• Order from the main menu and eat family style. Order fewer entrées than people at the table. Put the entrées in the middle of the table and request empty plates for everyone. Then split and share the entrées. Remember you are modeling healthier eating behaviors.

• Help your kids eat small portions by encouraging them to choose from the soups, salads, appetizers, and side dishes. Mix and match for a healthy and palate-pleasing meal that is kid sized. This may be easier in ethnic restaurants.

• Practice portion control when ordering in fast-food or sandwich shops. When dining on fast-food burgers and fries, split a larger order (medium or large size) of fries between several or all of the family members. Or order one sandwich and split it. Then split the sides as well. That’s often enough for you and one child.

• Fit in fruit as snacks if kids miss fruit at restaurant meals. Kids, as a group, are not eating enough fruit for good health.

• Divide up dessert. Kids love sweets, and teaching children with diabetes how to enjoy a small amount of sweets and control their glucose levels is an important lesson. A few sweet bites for each family member is enough, plus it teaches kids healthy behavior. Read more about managing sugary foods and sweets with diabetes in Chapter 5.

• Encourage the selection of healthier, nutrient-dense beverages or choose those with no calories. Lay low on sugar-sweetened beverages such as soda, fruit drinks, lemonade, and the like, unless they are sweetened with no-calorie sweeteners (or you are treating hypoglycemia). Most restaurants offer low-fat or fat-free milk. Make milk the number-one choice whether at home or eating out. Kids need their milk for calcium, vitamin D, and other essential nutrients—unless, of course, your child is lactose intolerant and needs to drink a lactose-free beverage. To keep calorie, carbohydrate, and sugar consumption low, water, sparkling water, club soda, and iced tea are good options depending on the child’s age. A splash of fruit juice may dress up these drinks. Fruit juice, as long as it is 100% fruit juice, is another option if your child has room for a fruit serving and the portion size is appropriate.

Find more Tips and Tactics to Help Kids Eat Healthy in the chapters in Sections 2 and 3. And thumb through Chapter 5 to get some assistance dealing with the diabetes-specific dilemmas of delayed meals and fitting in sugary foods and sweets. These tips may offer you guidance that extends beyond just restaurant meals.

As a parent or grandparent charged with fostering the healthy development of children (with or without diabetes), you have an opportunity to help them learn healthy restaurant eating habits from the start. Don’t give them a chance to learn unhealthy habits that they’ll need to unlearn. Unlearning bad habits is much tougher than learning good habits from the start. Help children and teens discover how to select healthier menu items in restaurants and put healthy eating skills and strategies into action. These habits will serve them well through their life. Though you may get screams, tugs, and pushback along the way, remember what’s best for the kids. Apply grit and determination. It may take a couple of decades, but they’ll thank you eventually.