Implementation

Implementing the HDKM Policy Once Passed

Prior to passing a HDKM ordinance a substantial amount of ground work must take place. However, a concerted effort to ensure the ordinance is successfully implemented in the community is also of utmost importance. To be successful, the following are integral: engaging with the municipality to ensure that messaging and information are in place for restaurant inspectors (as well as city attorneys), working with restaurants to train staff and update menus, communicating to the public via press releases, continuing educational outreach, and, if possible, collecting data and reflecting on successes and challenges one year out.

Preparing for Ordinance Passage

Coordinate with Municipality

Every effort should be made to ensure that city staff are aware of ordinance parameters, available training, and written materials.

  • Share flowchart for LPHA/Municipality roles
  • Ensure that the City Attorney and code enforcement are aware of the ordinance parameters
  • Introduce City Attorney to a City Attorney from a municipality that has already passed a similar ordinance if possible
  • Plan for frequency of communicating with restaurants not in compliance

City staff should be given resources to reduce their workload in supporting restaurants to transition kids’ meals default healthy beverages. These documents include:

  • Letters of violation/fine (in conjunction with City)
  • Rules in Public Health Consumer Protection packages for new restaurant
  • Scripts to be used when speaking to restaurant managers regarding the ordinance:

What is this new ordinance?

The (city name) City Council adopted an ordinance on (date) to support healthy beverage choices for children and their families. Ordinance XX requires (town) restaurants to promote healthy drinks without added sugar on children’s menus and by having the wait staff only verbally offer unsweetened drinks. The ordinance does not prevent the sale of sugary beverages to children, nor does it prohibit customers from purchasing them.

Why does the ordinance target sugary drinks?

Sugary beverages are the greatest source of added sugar and excess calories in children’s diets. Children who consume one or more drinks a day have an increased risk of health issues including type 2 diabetes, heart disease, cavities, and liver disease. Most notably, 1 in 3 children born in the year 2000 or later will develop type 2 diabetes. For children of color, research indicates this number is even higher stating that 1 in 2 children will develop type 2 diabetes. This ordinance will help make strides towards prioritizing and improving the health of children within (city).

How can I receive help in transitioning my kids menu?

(city) Public Health will provide training and technical assistance to assist your restaurant in establishing compliance with the ordinance

How will the ordinance be enforced?

Compliance will be reviewed as part of the regular Food Safety inspection process.

What’s the benefit for my restaurant?

This is low effort and sends the positive message that your restaurant supports youth health. Many chains have already done this including McDonald’s, Wendy’s, Dairy Queen, Burger King, IHOP/Applebee’s, Jack in the Box, so it helps your restaurant to be seen as a leader.

Will this cost my restaurant money?

Healthy drinks on children’s menus are cost neutral to consumers and food services alike, since your children’s meal already includes a drink in the one price. If concerned about re-printing menus we might have grant funds to help.

Is this really a trend in the industry?

Healthful Kids’ Meals is listed at the #6 trend in the National Restaurant Association’s What’s Hot 2018 Culinary Forecast. And as of spring 2018, ten other cities in the U.S. have passed ordinances supporting restaurants to only list healthy drinks on children’s menus. This is happening in California, Baltimore, and even in Lafayette CO!

What do customers think?

This supports parents by giving them easy access to healthy options. People stick to default healthy drinks 66% of the time. Any drink can still be ordered.

Are sugary drinks really that bad?

Children who drink at least 1 sugary drink a day are at increased risk of tooth decay/cavities, type 2 diabetes, heart disease, asthma, and depression.

We also know that a preschooler’s drink of choice remains their same one in adulthood. So if they start off usually having a healthy drink they will keep up the good health habit.

Letter to restaurants from the city to affected restaurant introducing the policy:

Dear Restaurant Owner,

On (date), the (town) City Council adopted an ordinance to support healthy beverage choices for children and their families. Ordinance XX requires (town) restaurants to promote healthy drinks without added sugar on children’s menus. The ordinance does not prevent the sale of sugary beverages to children, nor does it prohibit customers from purchasing them. The ordinance is only applicable to businesses within the City of XX.

This policy was brought forward by the (coalition name) to protect and promote the health of children by making it easier for parents to make the healthiest choices at restaurants for their children. Sugary beverages are the largest source of added sugar and excess calories in children’s diets.

Children who drink at least one sugary drink per day are at a 33% increased risk for heart disease and a 25% increased risk for type II diabetes. Most notably, 1 in 3 children born in the year 2000 or later will develop type 2 diabetes. For children of color, research indicates this number is even higher stating that 1 in 2 children will develop type 2 diabetes. This ordinance will help make strides towards prioritizing and improving the health of children within (town).

You are receiving this letter as your establishment may be impacted by the ordinance. Issued with this letter is a copy of the policy, an overview of enforcement, a fact sheet to share with your staff, and contact information to support your establishment through this change. If your establishment has a children’s menu that includes a beverage then modifications to the menu and communication with staff should be addressed.

(town) Public Health will provide training and technical assistance to assist your restaurant in establishing compliance with the ordinance Subsequently, compliance will be reviewed as part of the regular Food Safety inspection process.

Sincerely,

City of (town)

A jar with coins and a plant in it.

Securing Funding

Agency or municipality funding is helpful to support impacted restaurants; funds can be used to offset the costs of reprinting children’s menus and to support staff in providing technical assistance and training for restaurants. In particular, Smaller, non-chain restaurants may need financial support to reprint menus. Funding can be found through grants, partnering with cities, through local chambers, or through sugary drink taxes.

Seeking Intern Support

Utilizing an intern or an Master of Public Health or capstone student can be mutually beneficial. Roles may include:

  • Contacting restaurants to see if they have questions
  • Disseminating training information
  • Distributing a survey to customers (see below under "Data Collection")

Intern Job Description: 

  • Time Commitment: 5-10 hours a week.
  • Hourly Rate: $X/hour
  • Major Objective:
    o The goal of this internship opportunity is to support (LPHA) in implementing the Healthy Drinks in Kids’ Meals Ordinance. This includes working with local restaurants to transition menus and train staff, collecting restaurant data, and continuing to educate the community in sugary drink reduction.
  • Duties and Responsibilities:
    o Support restaurants in reprinting menus, and offer technical assistance and funding
    o Train restaurant staff to offer unsweetened beverages to kids
    o Do community outreach on social media and at local events to educate residents about why reducing sugary beverage consumption is important
    o Collect data from restaurants
    o Other duties as assigned
  • Knowledge, Skills, and Abilities:
    o Thorough and skilled researcher
    o Attention to detail
    o Self-motivated
    o Thrives in autonomous environments
    o Experience preparing communications and presentations
    o Open and clear communicator

Immediately Following The Passing Of The Ordinance

Press
Have a press release prepared to be distributed the day after the ordinance passes to help control the narrative and to stay ahead of negative press.

  • Sample Press Release

FOR IMMEDIATE RELEASE

CONTACT: (name, email, phone number)

Ordinance makes the healthy choice the easy choice

(town) County, (State) – On (date), the (town) City Council voted to approve (ordinance name), a city ordinance aimed at promoting children’s health by requiring that healthy beverages such as water, milk, and milk alternatives be offered on restaurant kids’ menus. The ordinance was spearheaded by the (coalition name).

Sugary drinks are the number one source of added sugars in the American diet. Children who drink at least one sugary beverage a day are 55% more likely to be overweight or obese.

Having healthy default drinks on children’s menus is a top restaurant trend that is supported by the National Restaurant Association and the American Beverage Association, and it has already been implemented in California, Hawaii, Delaware, Cleveland, Baltimore, and Lafayette, Colorado.  Further, several chains, such as McDonald’s, Disney Theme Parks, Wendy’s, Burger King, Dairy Queen, IHOP and Applebee’s have successfully committed to healthy beverage defaults on kid’s menus.

It’s a simple change that places beverage choice in the hands of parents. And it works: a study of Disney’s default healthy beverage policy found that people stick with the healthy choice 66 percent of the time. Further, McDonalds customers ordering milk, water, or juice instead of soda increased from 37 percent in 2013 to 52 percent in 2018.

The impact of sugary drink consumption on health is also an issue of equity;  Latino children are disproportionately impacted. A significant reason for this disparity is the targeted marketing beverage companies use to market to kids, particularly children of color.

[Add quotations from coalition members, local elected officials, the head of your LPHA]

Click here
  • Have an op-ed ready for local media in other local municipalities in which you’d like the ordinance to pass (this sample op-ed courtesy of Andy Krauss and the Prince George’s County Ordinance campaign):

It’s Time to Make Healthy Options Easier Choices for Anne Arundel County Children and Their Families

On Monday, our neighbors in Prince George’s County did something to improve the health for everyone who lives, works, plays and eats in the jurisdiction.

The county put into effect a law will that makes it easier for families and their children to choose healthier food and drink options, when ordering kids’ meals at county restaurants. It is the first law of its kind in the country to include healthier comprehensive options for both food and drinks. It makes water, milk and 100% fruit or vegetable juice default beverage options for all kids’ meals served at Prince George’s County restaurants. It also ensures that food options in kids’ meals limit calories, sugar, salt and fat. Families will be able to order other beverage items upon request. The bill will improve health for county children by making the healthy option the easy choice.

Prince George’s County follows in the footsteps of Baltimore City, which put into effect a similar law in 2018. 

While I am happy to see these jurisdictions make commitments to health, I can’t help to think how we could benefit from doing the same right here in Anne Arundel County.

As a 30-year veteran as a health professional for the state of Maryland, I know how powerful these statements are for Prince George’s County and Baltimore City. I know how this will not only improve the health and quality of life of our children, but also the families that raise them. Developing healthy eating habits as kids leads to maintaining healthy eating habits as an adult. It will help everyone stay away from chronic diseases such as type 2 diabetes, heart disease and tooth decay, which in turn protects the population from epidemics such as COVID-19.

Studies have shown that greater fast food intake over a one-year period was associated with increasing weight status during that time in this preschool‐age cohort More than one-third of Maryland children age 10-17 are not at a healthy weight. In short, young children with unhealthy weights become older children with unhealthy weights. That leads to chronic disease for adults.

Busy parents with limited options are often faced with the need to eat out on a regular basis with their families. The default options for kids’ meals in restaurants are almost always sugary drinks. These meals also include more calories, fat and sugar than meals served at home. Our lives are busy, and more and more, we’re grabbing a meal on the run or eating out. That’s why it’s so important that restaurants offer healthy food and beverage options— especially for children.

As President of the NAACP’s Anne Arundel County branch and health chair of Maryland State Conference, I also know that the sugary drink industry spends millions on relentless marketing, specifically to children. Celebrities who appeal to young people, particularly youth of color, are paid to promote unhealthy drinks. Half of the highly advertised sugary drink brands targeted Black consumers. Recently, Big Soda companies have been profiting from the Black Lives Matter movement by appealing to the Black community during a time of great vulnerability.

The NAACP health committee has the mission of focusing on optimal health outcomes. We are committed to eliminating racial and ethnic inequities that exist. Those inequities tend to undermine communities of color and life opportunities and their ability to contribute fully to the common good.

Our kids need better opportunities to put them on the path to living long, healthy and productive lives. Passing a healthy kids’ meal bill in Anne Arundel County would go a long way towards doing exactly that. It would make healthy options easier choices for our children and their families, while going a long way towards improving our overall health.

Jacqueline Allsup

President, Anne Arundel County Branch of the NAACP

Click here
A salad in a bowl with fork and napkin.
A healthy kids council flyer with a picture of a child drinking milk.

Celebration

Take time to gather your coalition and members of the community who aided in passing the ordinance to celebrate and to acknowledge everyone’s hard work. If possible, use the group’s forward momentum and harness collective efforts to brainstorm other ways to improve children’s health and/or reduce sugary beverages in your community.
If funds allow, consider placing an ad in the local newspaper thanking council members and supporters.

A little girl drinking milk from a glass.

Implementation

Data Collection
Data collected from restaurant inspectors prior to or during ordinance passage can be used to discern which restaurants to reach out to for technical assistance and to support enforcement. Additionally, the survey can be repeated one year from implementation to gauge the ordinance's effectiveness in enacting change.

The City of (city name) passed an ordinance that requires local restaurants and city venues with a kid’s menu to include water or unflavored milk as the default beverage for the meal. This ordinance does not prohibit a restaurant’s ability to sell, or a customer’s ability to purchase, a sugary beverage, if requested by the purchaser of the childrens meal.

[Provide local data and impact of targeted marketing on health outcomes]

We are asking you, as a resident of the (city), to complete this survey to help provide feedback. Thank you in advance for your time!

Do you reside in (town)?
On average, how many times per week do you visit fast food establishments/ local restaurants?
On average, how many times per week do you purchase a kids' meal at a local restaurant or fast food establishment?
What type of drink do you typically order with your kids' meal?
How do you choose your kids' meal beverages?
Do you usually accept the first drink option that is offered to you with the kid's meal? (e.g.,"Would you like a juice or milk with your order?")
This field is for validation purposes and should be left unchanged.

Restaurant Outreach

Outreach is critically important in successfully implementing HDKM ordinances. Research indicates that restaurants benefit from post-ordinance education and staff training. 91 percent of restaurant managers indicate that staff training and information would help to implement healthy drinks in kids’ meal policies. Little is accomplished if children’s menus offer only unsweetened drinks but servers continue to offer sugary beverages to kids when taking orders. Restaurants benefit from initial training (in-person or virtual) that outlines ordinance requirements and the provision of signage reminding servers and cashiers to only offer healthy drinks listed on the children’s menu to kids.

• Documents:

  • Signage for restaurant kitchens to remind staff not to offer sugary drinks to kids:
A poster with an image of a drink and the words " remember ! only offer unsweetened drinks to kids ".
A flyer with a glass of water and orange.

Healthy Default Beverage Ordinance
Promoting Healthy Drinks for Children

The Healthy (city) ordinance makes it easier for (city) residents and visitors to make healthy beverage choices for their children. The policy shifts the choices currently offered on children’s menus from beverages that contain added sugar to water, sparkling water, milk, and non-dairy milk alternatives. The policy is aligned with national trends that support making children’s meals healthier.

Requirements

Offer Only Select Beverage Options If your facility offers any type of “Children’s Meal” or “Kid’s Menu” that includes a beverage, the default beverage must be one of the following:

  • Water, sparkling water, or flavored water (with no added natural or artificial sweeteners)
  • Unflavored milk
  • A non-dairy milk alternative

When a children’s meal is ordered, the beverage offered must be one of the options listed above, unless otherwise requested by the customer.

Use Images of Healthy Beverages
The beverage listed or displayed on the children’s menu must be one of the beverages listed above.

Accommodate Customer Requests
If a customer requests it, restaurants may serve any beverage as a substitute for a kid’s meal default beverage

A picture of two milk packages with the same image on them.
Unflavored Milk
A group of glasses with water in them
Type of Water, Sparkling Water, or Flavored Water no added natural or artificial sweetener
A green cutting board with different food items on it.
A picture of the drink label for milk, water, and sparkling water.

Support

Enacting a recognition program for restaurants helps promote the change and provides visual support. To recognize restaurants in the community that have taken the step to offer healthy drinks with their kids' meals, window clings can be distributed in English and in Spanish. This also serves to promote unsweetened beverages to customers. A press release regarding the clings can be submitted to local news sources to highlight the movement towards healthier drinks.

A sticker of two people with glasses on their heads.

FOR IMMEDIATE RELEASE

CONTACT: (name, email, phone number)

(county) County Public Health recognizes restaurants that prioritize children’s health

Window clings will highlight restaurants that offer healthy drinks for kids

(Town) County, (State) – (City) families will soon have an easy way of knowing whether a restaurant offers healthy drinks with their kids’ meals. (County) County Public Health is distributing “Super Kids – Healthy Kids’ Drinks Served Here” window clings to restaurants that offer water, milk, or non-dairy milk alternative or water to children to advertise their commitment to the health of (city’s) kids. The window clings are available in Spanish and English.

Restaurants that serve healthy drinks to kids are taking an important step in protecting and promoting children’s health! Sugary drinks are a major contributor to chronic disease for children and adults alike. They are the number one source of added sugars in the American diet. Children who drink at least one sugary drink per day are at a 33% increased risk for heart disease and a 25% increased risk for type II diabetes.

What restaurants serve to children is increasingly important. Americans eat meals outside of their home more often than ever. In fact, close to half of food expenditures are now spent at restaurants and the average family eats out four or more times per week. A child who eats out four times per week and who has a sugary beverage each time can gain eight pounds of additional weight annually.

Restaurants that offer healthy drinks to kids are responding to a growing demand for healthier options for children. Even kids are on board. A recent national study found that over 80 percent of children surveyed would be happy to receive a restaurant meal served with milk, water, or flavored water instead of soda.

If you own a restaurant that offers healthy drinks with kids’ meals and haven’t received a window cling, please contact (name) at (email address or phone).

City Council Outreach

Gratitude for the time City Council has spent discussing the ordinance should be expressed in a thank you note. It is also worthwhile to take time to ask council members what type of evaluation metrics would be most useful to them for assessing the effectiveness and impact of the ordinance.

Community Outreach

While most community education should have been done prior to the ordinance passing, continued outreach may be useful. Following are resources and verbiage for engaging the community in healthy drinks education:

Online Resources

  • Hidden Sugar

    How much sugar is actually in your child’s sugary beverage and how does it affect their health? Hidden Sugar covers this and offers ideas about encouraging healthy drinks.

  • Open Truth Now

    Open Truth explores how the soda industry targets young people, communities of color, and parents to increase profits and brand loyalty.

  • Cut Sugary Drinks

    Diabetes, cavities, and heart disease are some of the outcomes of consuming sugary beverages. Cut Sugary Drinks explores the connections between soda and poor health in children.

  • Sugary Drink Facts

    Despite promising to take action to reduce the amount of calories from soda that people consume, the sugary beverage industry spent 1 billion in advertising in 2018. Learn more about how our most vulnerable communities are targeted.

  • Sugar Science

    Sugar Science is a source for evidence-based, scientific information about sugar and its impact on health.

  • Potter the Otter

    Potter the Otter teaches kids why water is the best beverage for growing bodies in a fun and engaging way.

A pitcher and two glasses of milk on a table.
A woman drinking water from a blue bottle.

Sugary Beverage Alternatives

  • Ways to encourage healthy drinking habits: 
  • Add flavor by brewing a pitcher of infused water. Steep water with fruit (lemon, strawberries, grapefruit, kiwi, limes), veggies (cucumber, ginger, celery), or herbs (cinnamon sticks, basil, mint). Create your own combinations! The longer you let it brew the more flavorful it will be.
  • Another way to make water flavorful is to add a teabag. Herbal teas are caffeine-free and kid-friendly. Brew a cozy mug of peppermint tea on chilly days. When it’s hot, try making refrigerator iced tea: let four teabags steep in a pitcher of water overnight.
  • If bubbles are what make soda appealing to you, try a water carbonator and make fizzy water at home. Or choose from a wide variety of commercial sparkling waters.
  • Let kids pick out their own water bottles at the store.
  • Keep water bottles filled up around the house and in your car and your bags. When you’re out and about and become thirsty, you won’t be tempted to buy a soda on the run.

Why Healthy Drinks in Kids’ Meal Ordinances?

  • Kids consume a lot of sugar!
  • Sugary drinks are the largest source of added sugar in American diets.
  • American kids drink a bathtub full—30 gallons!—of sugary drinks each year.
  • One serving of soda has about ten teaspoons of sugar, which is equal to:
  • Nine chocolate chip cookies
  • Three glazed donuts
  • A bag of M&Ms
  • Too much sugar leads to health issues
  • Just one sugary beverage a day increases the risk of dietary-related chronic diseases, such as heart disease, type 2 diabetes, liver disease and cavities.
  • If a child has one serving of soda a day they are:
  • 33 percent more likely to develop heart disease
  • 25 percent more likely to develop type 2 diabetes
  • 31 percent more likely to develop cavities
  • For kids born after 2000, one in three is expected to develop type 2 diabetes. For children of color it jumps to one in two.
  • The average family with kids eats out four to five times a week. If a child has a child-sized soda four times a week, that leads to an 8.5 pound weight increase per year.
  • The average soda that comes with a kid’s meal contains more sugar than a child is recommended to consume in one day.
  • Having healthy default beverages on children’s menus leads to families choosing non-sweetened beverages approximately 66% of the time.
  • Sugary drinks are disproportionately marketed to kids. $866 million dollars a year is spent on marketing sugary and energy drinks.
  • African-American teens see twice as many sugary beverage ads as Caucasian kids.
  • In 2010, Hispanic preschoolers aged two to five saw 79% more Coca Cola ads and 54% more ads for Powerade than white preschoolers.
  • Ensuring that kids have access to healthy drinks without added sugars, like water and milk goes a long way in protecting their health. Just one sugary beverage a day increases the risk of dietary-related chronic diseases, like heart disease, type 2 diabetes, liver disease and cavities, the top cause of missed school days for kids.
  • The current generation of children is the first in American history to have a lower life expectancy than their parents. For kids born after 2000, one in three are expected to develop diabetes, and for children of color the risk jumps to one in two. In fact, sugary drinks are the largest source of added sugar in our diets and kids are drinking a bathtub full—or 30 gallons—of sugary drinks each year.
  • There are ways we can make our environment healthier by making healthy choices the easy choices for parents and kids. Families eat out four to five times a week and most children’s meals come with sugary drinks. If restaurants offer healthy drinks it has a big impact on the health of kids in our community. Customers are free to order any beverage they choose as his is NOT a ban or tax, but only non-sweetened drinks like water, milk, or tea are printed on children’s menus that include bundled kids’ meals.
  • Having healthy default drinks on children’s menus is a top restaurant trend that is supported by the National Restaurant Association and the American Beverage Association, and it has already been implemented in California, Hawaii, Delaware, Cleveland, Baltimore, and Lafayette, Golden, and Longmont, Colorado. Further, several chains, such as McDonald’s, Disney Theme Parks, Wendy’s, Burger King, Dairy Queen, IHOP and Applebee’s have successfully committed to healthy beverage defaults on kids menus.
  • It’s a simple change that places beverage choice in the hands of parents. And it works: a study of Disney’s default healthy beverage policy found that people stick with the healthy choice 66 percent of the time. Further, McDonalds customers ordering milk, water, or juice instead of soda increased from 37 percent in 2013 to 52 percent in 2018.
  • Guidelines developed by the AAP, AND, AHA, and AAPD recommend children five years old and younger should only be drinking water and unflavored milk.
A bottle of water sitting on top of a wooden table.
A news article about milk and water.
A group of children laying in the middle of a circle.

Social Media Outreach

  • Establish a social media presence in the community for your coalition to extend their presence. Having a social media strategy for your ordinance serves to not only benefit the coalition’s current endeavors surrounding the healthy drink defaults, but also serves as a platform for future campaigns.
  • Post at least 1-2 times per week to stay relevant, increase followers/engagement
  • Research shows that people rarely read long social media posts. Some evidence suggests that posts with 30 words or less are the most read/viewed posts.
  • Coalition members and their peers are encouraged to post pictures/content supporting healthy beverage defaults/healthy beverages in general
  • Content Ideas:
  • Educate the community about the risks associated with sugary drinks, particularly for children
  • Raise awareness about unfair marketing to youth
  • Promote peers drinking healthy drinks in their daily lives, and at community events; use tags to extend beyond Facebook
  • Raise awareness about food chains making the switch to healthy beverage defaults
  • Focus on how healthy defaults are restaurants supporting parents by making the healthy choice, the easy choice. Parents want to provide healthier options to their kids; healthy defaults reduce the ‘pester power’ to drink sugary drinks.

Reflection

One-year post-implementation, report back to city council and/or your coalition to demonstrate change and the impact of the ordinance.

  • PowerPoints can include:
  • Overview of policy 
  • Restaurants that previously served sugary drinks compared to now
  • Survey results taken at time of ordinance passing compared to one-year post-implementation
  • How many kids impacted, assuming 4-5 meals out a week
  • Positive feedback from restaurants and parents
A group of people sitting at a table with food.