Skip to main content Accessibility help

Obesity à la carte? Children’s meal options in German full-service restaurants

  • Sven Schneider (a1), Jennifer Hilger-Kolb (a1) and Lisa Rüsing (a2)



In light of the increasing prevalence of juvenile obesity seen around the world, obesogenic environments in general and the food environment in particular are receiving increasing attention in current public health research. Restaurants play a significant role in the food environment. The present study aimed to quantitatively describe and qualitatively evaluate the range of children’s meals available in full-service restaurants in Germany.


Five hundred restaurants were identified using a systematic quota sampling technique. The individual meals were evaluated using quality standards stipulated by the German Nutrition Society (DGE).


Nationwide sample of menus from full-service restaurants.


Meals (n 1877) from 500 menus were analysed.


Menus included 3·76 (sd 1·31) meals for children. About 70 % of the meals were limited to six typical dishes of low nutritional quality. In total, 54 % of meals included French fries or another form of fried potatoes. Of all meals, 23 % did not fulfil any of the eleven quality criteria set by the DGE and 38 % satisfied only one criterion. The majority of dishes on offer featured high energy density while simultaneously having low nutrient density. Healthy dishes were not highlighted visually in any menu.


The range of dishes on offer for children in German restaurants is severely lacking in variety and in need of improvement from a nutritional point of view. Considering the growing importance of restaurants as food environments, there is a need to improve the presentation of menus and the meals offered.


Corresponding author

*Corresponding author: Email


Hide All
1. Ng, M, Fleming, T, Robinson, M et al. (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384, 766781.
2. Schienkiewitz, A, Brettschneider, A, Damerow, S et al. (2018) Overweight and obesity among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends. J Health Monit 3, 1522.
3. Kurth, BM & Schaffrath Rosario, A (2007) The prevalence of overweight and obese children and adolescents living in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGs). Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 50, 736743.
4. Swinburn, B, Egger, G & Raza, F (1999) Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prev Med 29, 563570.
5. Kremers, SP, de Bruijn, GJ, Visscher, TL et al. (2006) Environmental influences on energy balance-related behaviors: a dual-process view. Int J Behav Nutr Phys Act 3, 9.
6. Glanz, K, Sallis, JF, Saelens, BE et al. (2005) Healthy nutrition environments: concepts and measures. Am J Health Promot 19, 330333.
7. Wilsher, SH, Harrison, F, Yamoah, F et al. (2016) The relationship between unhealthy food sales, socio-economic deprivation and childhood weight status: results of a cross-sectional study in England. Int J Behav Nutr Phys Act 13, 21.
8. Valdivia Espino, JN, Guerrero, N, Rhoads, N et al. (2015) Community-based restaurant interventions to promote healthy eating: a systematic review. Prev Chronic Dis 12, 140455.
9. Ayala, GX, Castro, IA, Pickrel, JL et al. (2016) A restaurant-based intervention to promote sales of healthy children’s menu items: the Kids’ Choice Restaurant Program cluster randomized trial. BMC Public Health 16, 250.
10. Statista (2013) Wie häufig gehen Sie in Restaurants bzw. Gaststätten essen? (nach Kindern im Haushalt) (How often do you eat at restaurants? (depending on number of children in household)). (accessed July 2018).
11. Statistisches Bundesamt (Federal Statistical Office) (2013) Wirtschaftsrechnungen – Einkommens- und Verbrauchsstichprobe. Aufwendungen privater Haushalte für Nahrungsmittel, Getränke und Tabakwaren (Economy Accounts – Income and Consumption Sample. Spendings of Private Households on Food, Beverages and Tobacco Products). Wiesbaden: Destatis.
12. Deutscher Hotel- und Gaststättenverband (German Hotel and Restaurant Association) (2015) Wirtschaftskraft und Jobmotor – Gastronomie und Hotellerie. Gesamtausgaben im Außen-Haus-Markt (Economic Force and Job Engine – Gastronomy and Hotel Business. Total Expenditure in the Out-of-House Market) . Berlin: Dehoga.
13. Batada, A, Bruening, M, Marchlewicz, EH et al. (2012) Poor nutrition on the menu: children’s meals at America’s top chain restaurants. Child Obes 8, 251254.
14. Uechi, K (2018) Nutritional quality of meals offered to children (kids’ meals) at chain restaurants in Japan. Public Health Nutr 21, 31013110.
15. Wellard, L, Glasson, C & Chapman, K (2012) Fries or a fruit bag? Investigating the nutritional composition of fast food children’s meals. Appetite 58, 105110.
16. Moran, AJ, Block, JP, Goshev, SG et al. (2017) Trends in nutrient content of children’s menu items in US chain restaurants. Am J Prev Med 52, 284291.
17. Saelens, BE, Glanz, K, Sallis, JF et al. (2007) Nutrition Environment Measures Study in Restaurants (NEMS-R): development and evaluation. Am J Prev Med 32, 273281.
18. Zoumas-Morse, C, Rock, CL, Sobo, EJ et al. (2001) Children’s patterns of macronutrient intake and associations with restaurant and home eating. J Acad Nutr Diet 101, 923925.
19. Cohen, DA & Bhatia, R (2012) Nutrition standards for away-from-home foods in the USA. Obes Rev 13, 618629.
20. Cornwell, B, Villamor, E, Mora-Plazas, M et al. (2018) Processed and ultra-processed foods are associated with lower-quality nutrient profiles in children from Colombia. Public Health Nutr 21, 142147.
21. International Markets Bureau (2011) Foodservice Profile Western Europe. Ottawa: Agriculture and Agri-Food Canada.
22. Bundesverband der Deutschen Ernährungsindustrie (Federal Association of the German Food Industry) (2017) BVE-Jahresbericht (BVE Annual Report). Berlin: BVE.
23. Statistisches Bundesamt (Federal Statistical Office) (2015) Umsatzsteuerstatistik – Fachserie 14 (Tax Statistics Series 14). Wiesbaden: Destatis.
24. McCrory, MA, Harbaugh, AG, Appeadu, S et al. (2019) Fast-food offerings in the United States in 1986, 1991, and 2016 show large increases in food variety, portion size, dietary energy, and selected micronutrients. J Acad Nutr Diet 119, 923933.
25. Krukowski, RA Eddings, K & Smith West, D (2011) The Children’s Menu Assessment: development, evaluation, and relevance of a tool for evaluating children’s menus. J Am Diet Assoc 111, 884888.
26. Deutsche Gesellschaft für Ernährung (German Nutrition Society) (2015) DGE-Qualitätsstandard für die Verpflegung in Tageseinrichtungen für Kinder (DGE Quality Standards for the Catering in Daycare Centers for Children). Bonn: DGE.
27. Deutsche Gesellschaft für Ernährung (German Nutrition Society) (2015) DGE-Qualitätsstandard für die Schulverpflegung (DGE Quality Standards for School Catering). Bonn: DGE.
28. Bundesinstitut für Bau-, Stadt- und Raumforschung im Bundesamt für Bauwesen und Raumordnung (Federal Institute for Building, Urban and Spatial Research in the Federal Office for Building and Regional Planning) (2017) Indikatoren und Karten zur Raum- und Stadtentwicklung (Indicators and Maps for Spatial and City Development). Bonn: BBR.
29. Gastro-check24 (2019) Convenience Produkt in der Gastronomie (Convenience product in the gastronomy). (accessed February 2019).
30. Monteiro, CA, Moubarac, JC, Cannon, G et al. (2013) Ultra-processed products are becoming dominant in the global food system. Obes Rev 14, 2128.
31. Louzada, M, Ricardo, CZ, Steele, EM et al. (2018) The share of ultra-processed foods determines the overall nutritional quality of diets in Brazil. Public Health Nutr 21, 94102.
32. Monteiro, CA, Cannon, G, Levy, RB et al. (2019) Ultra-processed foods: what they are and how to identify them. Public Health Nutr 22, 936941.
33. Fardet, A (2016) Minimally processed foods are more satiating and less hyperglycemic than ultra-processed foods: a preliminary study with 98 ready-to-eat foods. Food Funct 7, 23382346.
34. Vandevijvere, S, De Ridder, K, Fiolet, T et al. (2018) Consumption of ultra-processed food products and diet quality among children, adolescents and adults in Belgium. Eur J Nutr. Published online: 3 December 2018. doi: 10.1007/s00394-018-1870-3.
35. Louzada, ML, Baraldi, LG, Steele, EM et al. (2015) Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Prev Med 81, 915.
36. Nicklas, TA, Yang, SJ, Baranowski, T et al. (2003) Eating patterns and obesity in children. The Bogalusa Heart Study. Am J Prev Med 25, 916.
37. Diethelm, K, Gunther, AL, Schulze, MB et al. (2014) Prospective relevance of dietary patterns at the beginning and during the course of primary school to the development of body composition. Br J Nutr 111, 14881498.
38. Rauber, F, Campagnolo, PD, Hoffman, DJ et al. (2015) Consumption of ultra-processed food products and its effects on children’s lipid profiles: a longitudinal study. Nutr Metab Cardiovasc Dis 25, 116122.
39. Papies, EK & Veling, H (2013) Healthy dining. Subtle diet reminders at the point of purchase increase low-calorie food choices among both chronic and current dieters. Appetite 61, 17.
40. O’Donnell, SI, Hoerr, SL, Mendoza, JA et al. (2008) Nutrient quality of fast food kids meals. Am J Clin Nutr 88, 13881395.
41. Shonkoff, ET, Anzman-Frasca, S, Lynskey, VM et al. (2018) Child and parent perspectives on healthier side dishes and beverages in restaurant kids’ meals: results from a national survey in the United States. BMC Public Health 18, 56.


Obesity à la carte? Children’s meal options in German full-service restaurants

  • Sven Schneider (a1), Jennifer Hilger-Kolb (a1) and Lisa Rüsing (a2)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed