toddler boy with beverage in front of him

Children are particularly vulnerable to the negative health effects of sugary drinks, yet prior to a recent law aimed at improving healthy options for Hawaiʻi’s keiki, it was rare to find healthy beverages as a “default” option with kids’ meals in Hawaiʻi restaurants.

mcgurk headshot
Meghan McGurk

University of Hawaiʻi at Mānoa public health researchers found that among a random sample of 64 restaurants across the state that offered kids’ meals, just two restaurants listed only healthy drinks such as water, low-fat milk or 100% juice as a default beverage option with the meal. The researchers conducted their study prior to the enactment of a law requiring restaurants to offer a healthy drink as the default choice.

“The hope is that Hawaiʻi‘s new law will nudge customers into healthier choices by making the healthy choice the easy choice,” said Meghan McGurk, who led the study and works as a researcher with the Office of Public Health Studies in the Thompson School of Social Work and Public Health. The paper is published in the Journal of Healthy Eating and Active Living (JHEAL).

Pandemic challenges

McGurk and her co-authors focused on restaurants that offered children’s meals in which the food is bundled together with a drink. Since January 1, 2020, Hawaiʻi restaurants offering such meals have been subject to the new law. The researchers conducted their study during November and December 2019 because they wanted to know how many restaurants were complying with the law before they were required to do so.

“Shockingly, sugar-sweetened beverages were offered as a default option for keiki by more than 60% of restaurants in the sample,” McGurk said. “This makes the success of this law more important.” Unfortunately, however, the pandemic has created challenges for the new law’s implementation. McGurk and her co-authors discussed the impacts of COVID-19 on the new law, and other health promotion efforts, in a separate paper also published recently in Global Health Promotion.

“There are many reasons it’s become more difficult during the pandemic for restaurants to offer healthy drink options,” McGurk said. “In order to even remain open, restaurants have had to spread out their tables and change employee procedures. They may be reluctant to change children’s items because kids’ meals do not generate much revenue and many restaurants are currently struggling due to the pandemic.”

In addition, many restaurants have turned to third-party delivery services to maintain their business, which adds fees that cut into restaurant profits. It is also unclear whether the menus posted on third-party sites fall under the scope of healthy beverage law.

Positive effects of pandemic

“However, the pandemic may also have positive effects on health promotion efforts,” McGurk said. Self-service beverage stations, which allow customers to refill cups with sugary drinks many times, are being discouraged to prevent viral spread. Also, new technology being used to social distance, such as tableside ordering apps, could help ensure healthy options are consistently offered as the default beverage for keiki.

“The COVID-19 pandemic has highlighted the importance of policies that improve access to healthy foods to prevent and manage chronic disease,” McGurk said. “We now have a great opportunity to improve restaurant and menu design and promote healthy food environments.”

McGurkʻs co-authors on the JHEAL paper include: Stephanie L. Cacal, Uyen Vu, Tetine Sentell and Catherine M. Pirkle of the Office of Public Health Studies, and Toby Beckelman, Jessica Lee and Alyssa Yang of the Hawaiʻi State Department of Health (DOH). Her co-authors on the commentary include Pirkle, Beckelman, Lee, Yang, Sentell and Katherine Inoue and Heidi Hansen-Smith of DOH.

This research is an example of UH Mānoa’s goal of Excellence in Research: Advancing the Research and Creative Work Enterprise (PDF), one of four goals identified in the 2015–25 Strategic Plan (PDF), updated in December 2020.