Restaurant Response to the San Francisco Toy Ordinance: Changes in Toy Marketing and Children's Menu Options

Background: On December 1, 2011, San Francisco, CA became the first US city to pass the Healthy Food Incentives Ordinance, which prohibits fast food restaurants from giving away free toys or other incentives in combination with the purchase of a children's meal unless it meets minimal nutrition criteria. Restaurants were given a year to comply with this ordinance and could respond by improving the healthfulness of it's children's menu items or by changing it's toy marketing or distribution practices.;Purpose: Compare changes in children's menu items, food environments and toy/marketing practices at ordinance-affected restaurants in San Francisco before and after ordinance enactment.;Methods: All possible children's menu combinations at 30 ordinance-affected fast food restaurants (representing 8 national/global chains) were evaluated at 4 time points: 3 pre-ordinance enactment and 1 post-ordinance enactment using corporate nutrition information. The restaurants' food environment and toy marketing practices were assessed using the Children's Menu Assessment (CMA) tool.;Results: While many restaurants added healthier sides or beverages to their children's meals during the study period, nutrition analysis showed that no combinations of children's meals met the ordinance's nutritional criteria at any time point. Eleven of thirty restaurants did not comply with the ordinance. The remaining 19 restaurants complied by offering the toy for ten cents (n=7), eliminating the children's meal (n=6), or eliminating toy giveaways (n=6). Overall, CMA scores improved an average of 0.89 points from time point 1 to time point 4 due to a mix of both improvements and declines in score by chain. Improvements were seen in the areas of nutritional guidance, toy/marketing practices, presence of unhealthy desserts and side dish score while a decline was seen in beverage scores. Percentage of healthy meals, healthy desserts and healthy grains did not change.;Conclusions: The ordinance was not effective in inducing restaurants to meet ordinance nutrition criteria. The greatest barrier to compliance with the ordinance's nutrition criteria appeared to be the addition of 0.75 cups of vegetables to children's meals. Additionally, the wording of the ordinance, specifically the inclusion of the word "free," allowed restaurants to comply by charging ten cents for their toys or eliminating children's meals from their menu. Time and care should be spent on the wording of future ordinances to ensure the words chosen will produce the desired outcomes. However, within the year the ordinance was enacted, many national and global fast food chains made healthful changes to their children's menu or toy/marketing practices. While we cannot say these changes were a direct response to the toy ordinance, it is evident fast food restaurants are capable and willing to make healthful changes.