March 25, 2011

Making Health the Default

Center for a Livable Future

Center for a Livable Future






A recent article featured in the Robert Wood Johnson Foundation News Digest on Childhood Obesity highlights a simple strategy that can be implemented in restaurants and other venues to improve the food environment.

The innovative new strategy is to change the offerings on children’s menus to highlight the healthier options. One way to do this is to set the default side options for children’s meals to healthier items. The default refers to the items that come with a combination meal if you do not explicitly ask for certain items. Traditionally, the default side options for combination meals have been soda and french fries. Healthier options are items that are advertised as alternatives to the defaults, such as apple slices, carrot sticks,100% fruit juices, low-fat milk, or water.

Shifting the restaurant food environment in this way-making lower-calorie beverage options and fresh fruits and vegetables the norm-may help to improve children’s nutrition when eating away from home. This is significant, as the number of meals children eat away from home has been increasing in recent years. Offering healthier items as the default also changes the decision-making environment by facilitating healthy choices rather than requiring people to alter their own behavior.

This type of strategy has been dubbed “libertarian paternalism” by University of Chicago professors Richard Thaler and Cass Sunstein in their recent book Nudge: Improving Decisions about Health, Wealth and Happiness. A “nudge” is designed to steer individuals towards a certain behavior without taking away their freedom of choice. In terms of this strategy, if the default or highlighted item is healthy, parents may be less likely to purchase high-fat, high-sugar side items as replacements because they will have to actively request those items. Furthermore, parents won’t have to argue with their children about which items to purchase. Check out the Nudge blog for other applications of libertarian paternalism.

This program could be easy for fast-food restaurants to adopt. Most of these restaurants already advertise and offer healthier items as part of their menus. The next step would be to redo menu boards to highlight the healthier items and retrain employees about how to present the choices available for children’s meals. Although McDonalds is doing pilot testing of a “Next-Generation” Happy Meal, which will come with an additional fruit or vegetable option, no large fast-food companies currently offer their healthy items as the default for children’s meals-or adult meals, for that matter.

Hats off to the Westside Café, who partnered with Healthy Kids Choice and Palomar Pomerado Health Community Action Council to adopt this type of program. A similar program has been in place at Walt Disney theme park restaurants since 2006 and adoption rates for the healthier options are reported at 66.5%. Fast-food restaurants around the country should follow in the footsteps of these pioneers and start making health the default on their menus.

To learn more, see a fact sheet and literature review on default options developed by the Center for Science in the Public Interest:


  1. Holly, you give very insightful recommendations becaue most parents face challenges where fries or high calorie foods are the only combinations available. I feel good when I read anything positive in regard to food and children-Thanks

  2. Posted by Holly

    Thanks Mary, I agree – I think it is fruitful as a researcher to develop ideas to improve the food environment, rather than harping on the ways in which it is negatively influencing us! I hope to blog again in the future about ways parents can get involved to advocate for change. Best, Holly

  3. Posted by pjnoir

    un-natural low fat foods are the kinds of foods to avoid. Dietary fat from animals will not nor have they ever made anyone fat- it is the incredible amopunts of grains and carbs that do it. A happy meal has about 3-4 oz of beef and not great beef either but thatr is another issue)- the soda and bun and all those french fries, fried in unhealthy veg oils are what the real problem is. Fear the bread not the butter. And watch out for those low fat yogurts that are just a sugar replacement for dessert- NOT HEALTHY at all – but we so badly want to believe they are.

  4. Thanks PJNoir – I agree that there are many reasons why Happy Meals can be considered unhealthy. The thing I am hoping to promote is adding low (or preferably no) calorie beverages to replace high-sugar sodas and also to provide fresh fruits or vegetables instead of fried potatoes. Thanks for the comments.

Leave a Comment

Your email address will not be published. Required fields are marked *