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Short communication
Changes in chain restaurant kids’ meal beverage offerings on online
ordering platforms after a healthy beverage default policy in New
Orleans, Louisiana
Samantha Marinello
a,*
, Julien Leider
b
, Melissa Fuster
c
, Megan Knapp
d
, Lisa M. Powell
a
a
Health Policy and Administration (MC 923), School of Public Health, University of Illinois Chicago, 1603 W Taylor St, Chicago, IL 60612, USA
b
Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, 1747 W Roosevelt Rd, Chicago, IL 60608, USA
c
Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70112, USA
d
Department of Public Health Sciences, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA
ARTICLE INFO
Keywords:
Kids’ meals
Healthy beverage default
Online ordering platforms
Restaurant policy
Nutrition policy
ABSTRACT
Objective: Consumption of restaurant food is associated with poorer diet quality and greater consumption of
sugar-sweetened beverages among children; and online restaurant purchases have increased substantially. New
Orleans, Louisiana, enacted a healthy beverage default (HBD) ordinance effective January 1st, 2023, that
restricted beverages automatically included with kids’ meals, but that did not apply to online ordering platforms.
This study evaluated whether this ordinance impacted online offerings.
Methods: Data on online kids’ meal beverage offerings one month before and 8–11 months after the ordinance
effective date were collected for chain restaurants in New Orleans and Baton Rouge, Louisiana. Online ordering
platforms included restaurant websites/applications and three third-party platforms (Grubhub, Uber Eats, and
DoorDash). Difference-in-differences (DID) weighted logistic regression models with robust standard errors
clustered on restaurant were used to estimate relative changes in (1) compliance with HBD ordinance re-
quirements, (2) default offerings of only water, milk, and 100 % juice, and (3) any default offerings of soda.
Results: The DID results revealed no statistically signicant changes in compliance or beverage offerings in
restaurants in New Orleans compared to Baton Rouge following the HBD ordinance; further, nearly all estimated
odds ratios were close to 1, indicating no meaningful differences in changes in outcomes across sites.
Conclusions: This study found no evidence that the New Orleans HBD ordinance led to changes in kids’ meal
default beverage offerings on online ordering platforms. The results underscore the need for HBD policies that
specically apply to online ordering platforms, and for enforcement and monitoring of these platforms.
1. Introduction
In 2022, nearly 40 % of U.S. household food expenditures were spent
at fast-food and full-service restaurants (U.S. Department of Agriculture,
2024). Industry data show that restaurant purchases through online
ordering platforms have increased substantially (McKinsey and Com-
pany, 2021). These ndings are consistent with a large international
study, which found increases in purchases from online food delivery
services between 2018 and 2021 (Gupta et al., 2024). Children may be
more affected by the increasing popularity of online ordering platforms,
as adults living with children are more likely to use these services
(Keeble et al., 2020). Because restaurant food is a signicant contributor
to children’s dietary intake (Fryar et al., 2020), policies that aim to
improve the healthfulness of kids’ meals, which are generally of low
nutritional quality (Dunn et al., 2020), have the potential to improve
diet and reduce chronic diseases. Consumption of restaurant food among
children is associated with higher intake of total energy and sugar, as
well as greater consumption of sugar-sweetened beverages (SSBs)
(Powell and Nguyen, 2013)—the largest contributor of added sugars in
children’s diets (Bowman et al., 2019). Fast food and SSBs have also
been identied as primary dietary risk factors for overweight and
obesity among children (Jakobsen et al., 2023).
In an effort to encourage healthier beverage choices and improve
dietary intake among children in restaurant settings, a number of U.S.
jurisdictions have enacted laws that restrict default beverage offerings
that are automatically included in kids’ meals (Perez et al., 2022).
* Corresponding author.
E-mail address: smarin23@uic.edu (S. Marinello).
Contents lists available at ScienceDirect
Preventive Medicine Reports
journal homepage: www.elsevier.com/locate/pmedr
https://doi.org/10.1016/j.pmedr.2025.103067
Received 13 December 2024; Received in revised form 4 April 2025; Accepted 6 April 2025
Preventive Medicine Reports 53 (2025) 103067
Available online 9 April 2025
2211-3355/© 2025 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-
nc-nd/4.0/ ).
Nearly all limit default beverages to water, milk, and 100 % juice
meeting certain criteria (Perez et al., 2022). While default interventions
vary substantially in their ability to inuence choices, in some contexts
they are highly effective; for example, default opt-ins have been shown
to dramatically increase organ donation signup and enrollment in
retirement savings plans (Jachimowicz et al., 2019). They are also found
to improve nutrition-related choices, including, for example, default
offerings as part of school lunches (Vecchio and Cavallo, 2019).
Before healthy beverage default (HBD) policies can improve kids’
beverage purchases, they must rst impact kids’ meal beverage offerings
at restaurants; this includes physical restaurant locations as well as
online ordering platforms. To date, a limited number of pre-post eval-
uations of restaurant compliance with enacted HBD laws have been
conducted in California, Wilmington, Delaware, Columbus, Ohio, and
Illinois (Pipito et al., 2022; Powell et al., 2023; Powell et al., 2024;
Ritchie et al., 2022). With the exception of California restaurant interior
and drive-thru menu boards, these studies found no statistically signif-
icant changes in default offerings on either menu boards or online
ordering platforms (Pipito et al., 2022; Powell et al., 2023; Powell et al.,
2024; Ritchie et al., 2022). The purpose of this study was to assess the
impact of the New Orleans, Louisiana, HBD ordinance (City of New
Orleans, 2022; New Orleans Health Department, 2022) on default bev-
erages included with kids’ meals on restaurant online ordering plat-
forms. This policy went into effect January 1st, 2023, and applied to
physical restaurant locations. To our knowledge, this is the rst evalu-
ation of the New Orleans HBD ordinance.
2. Methods
This study used a pre-post intervention-comparison site research
design to examine changes in kids’ meal beverage offerings following
the effective date of the New Orleans HBD ordinance. Data were
collected from online ordering platforms in New Orleans, the interven-
tion site, and Baton Rouge, Louisiana, a nearby comparison-site city, one
month before the policy effective date (in December 2022) and 8–11
months after (in September–December 2023). This study did not require
institutional review board approval because data were collected from
online ordering systems and no human subjects were involved.
2.1. Measures and outcomes
Data on kids’ meal beverage offerings from online menus were
collected and coded using the Food Policy Program Fast-Food Restau-
rant Kids’ Meal audit tool, which has been shown to have high interrater
reliability (Powell et al., 2022). Beverage characteristics included
beverage type (e.g., regular soda, water); milk avor, fat percentage,
and calories; and juice size and 100 % juice status. Based on our audit
tool, a beverage or set of beverages were classied as defaults if they
were shown immediately after a kids’ meal was selected through the
online ordering platform. If the platform allowed customers to take
additional action to select other beverages, those beverages were not
considered defaults. This study denition is consistent with the ordi-
nance, which denes a default beverage as a “beverage automatically
included as part of a children’s meal, absent a specic request by the
purchaser of the children’s meal for an alternative beverage” (City of
New Orleans, 2022).
The three outcomes assessed in this study were (1) restaurant
compliance with the requirements of the New Orleans HBD ordinance,
(2) default offerings limited to any type of water, milk, or 100 % juice,
and (3) any default offerings of soda (regular or diet).
Compliance was assessed based on the provisions of the New Orleans
HBD ordinance. For a restaurant to be compliant, kids’ meal default
beverages must be restricted to the following beverage types: water
(unavored, unsweetened, uncarbonated); non-fat or 1 % unsweetened
milk or non-dairy milk alternatives containing ≤130 cal per serving; and
100 % juice with no added sweeteners and ≤6.75 oz (City of New
Orleans, 2022; New Orleans Health Department, 2022).
2.2. Study sample
For a larger study of kids’ meal beverage offerings (Leider et al.,
2023), lists of all licensed restaurants in New Orleans and Baton Rouge
were used to identify 343 potentially eligible restaurants that had kids’
meals. To be eligible for this study, restaurants had to offer a kids’ meal
that included a beverage on at least one of four online ordering plat-
forms: the restaurant website or application and three third-party plat-
forms (Grubhub, Uber Eats, and DoorDash). For each restaurant, data
were collected from each platform that offered a kids’ meal that
included a beverage. Prior to data collection, these restaurants were pre-
screened by research staff to determine study eligibility and remove
duplicates (i.e., the same exact restaurant location repeated more than
once) and a total of 144 restaurants were excluded (129 no kids’ meal or
no beverage with kids’ meal online; 11 did not use online ordering
platforms under consideration; one duplicate; three used for eld testing
or location undetermined). After data were collected and coded, an
additional 61 restaurants were excluded (30 did not use any of the
platforms under consideration; 13 no kids’ meal; 17 no beverage with
kids’ meal; one duplicate). Further, for each outcome and platform type,
restaurants were only included in the analytic sample if they had data
both pre-post policy and they were a chain present in both New Orleans
and Baton Rouge.
The nal sample for analyses of the restaurant website/application
included 67 restaurants to assess changes in compliance, 67 restaurants
to assess changes in default offerings of only water, milk, and 100 %
juice, and 71 restaurants to assess changes in default offerings of soda.
The nal sample for analyses of third-party platforms included 107
menus (from 41 restaurants) to assess changes in compliance, 148
menus (from 54 restaurants) to assess changes in default offerings of
only water, milk, and 100 % juice, and 153 menus (from 55 restaurants)
to assess changes in default offerings of soda. Across analytic samples,
79–87 % were fast-food restaurants and the remaining 13–21 % were
full-service restaurants.
2.3. Statistical analysis
Summary statistics were computed on default beverage offerings in
New Orleans and Baton Rouge before and after the effective date of the
New Orleans HBD ordinance. To estimate changes in offerings in New
Orleans relative to Baton Rouge, difference-in-differences (DID) logistic
regression models with robust standard errors clustered on restaurants
were employed. Both summary statistics and regression models were
weighted for each outcome so that each restaurant chain would receive
the same total weight in each site and time period. Statistical analyses
were conducted in Stata/SE 18.0 (StataCorp LLC, College Station, TX)
and results were considered statistically signicant at p <.05.
3. Results
Table 1 provides summary statistics for default beverage offering
outcomes in New Orleans and Baton Rouge before and after the effective
date of the New Orleans HBD ordinance. Prior to the ordinance going
into effect, 64 % and 39 % of restaurant websites/applications and third-
party ordering platforms in New Orleans were compliant, respectively.
Changes in compliance were similar across New Orleans and Baton
Rouge, which did not have an HBD ordinance at either time point:
increasing on restaurant websites/applications (from 64 % to 73 % in
New Orleans and from 55 % to 64 % in Baton Rouge) and decreasing on
third-party ordering platforms (from 39 % to 31 % in both New Orleans
and Baton Rouge). New Orleans and Baton Rouge also had similar
changes in default soda offerings on both restaurant websites/applica-
tions and third-party ordering platforms and in offering only water,
milk, or 100 % juice as default beverages on third-party ordering
S. Marinello et al.
Preventive Medicine Reports 53 (2025) 103067
2
platforms. On restaurant websites/applications, there was a small in-
crease in offering only water, milk, or 100 % juice in New Orleans (64 %
to 73 %) while there was no change in Baton Rouge (64 % before and
after the effective date).
The DID regression results are shown in Table 2 and revealed no
statistically signicant changes in compliance, default offerings of only
water, milk, or 100 % juice, or default soda offerings on the restaurant
website/application nor on the third-party platforms in New Orleans
relative to Baton Rouge 8–11 months after the New Orleans HBD ordi-
nance went into effect. Further, nearly all estimated odds ratios were
close to 1, indicating no meaningful differences in changes in outcomes
across sites.
4. Discussion
This study found no evidence of changes in chain restaurant kids’
meal default beverage offerings on online ordering platforms 8–11
months after the New Orleans HBD policy went into effect. Online
restaurant menus in New Orleans and Baton Rouge had similar pre-post
changes in compliance with the requirements of the New Orleans policy,
default offerings of only water, milk, and 100 % juice, and default of-
ferings of soda.
These ndings suggest that any potential changes in beverage of-
ferings made at physical restaurant locations did not spill over to
restaurant menus on online ordering platforms and are generally
consistent with other pre-post evaluations of HBD policies (Pipito et al.,
2022; Powell et al., 2023; Powell et al., 2024; Ritchie et al., 2022).
Studies that assessed online ordering platforms found no statistically
signicant changes in compliance in Illinois fast-food restaurants, rela-
tive to matched comparison restaurants in Wisconsin, four months and
12 months after the policy went into effect, nor in Columbus fast-food
restaurants relative to matched comparison restaurants in other Ohio
localities four months after that policy went into effect (Pipito et al.,
2022; Powell et al., 2023; Powell et al., 2024). Assessments of physical
restaurant locations have yielded mixed results but show adherence to
HBD policies has been far from complete. The 12-month Illinois evalu-
ation found no changes in compliance relative to Wisconsin on interior
and drive-thru menu boards (Powell et al., 2024). The evaluation of
California and Wilmington HBD policies found compliance on interior
and drive-thru menu boards increased in fast-food restaurants in Cali-
fornia (10 %–66 %) and remained the same in restaurants in Wilmington
(31 % before and after the effective date) 7–12 months after these pol-
icies went into effect (Ritchie et al., 2022). A limitation of this latter
evaluation, though, is that it did not use a comparison site to control for
other potential changes in beverage offerings that were unrelated to the
policy. Indeed, in studies that used a comparison site, some have found
increases in compliance for some platforms in both treatment and
comparison sites (Pipito et al., 2022; Powell et al., 2023; Powell et al.,
2024).
This study is subject to limitations. First, our sample only included
chain restaurants and may not be generalizable to independent restau-
rants. Second, because our sample size was limited, we could not assess
differences in outcomes between fast-food and full-service restaurants.
Third, particularly given the geographic proximity of New Orleans and
Baton Rouge, chain restaurants in both cities may have changed their
beverage offerings in response to the New Orleans HBD policy. Fourth,
because we only had data for one pre-policy time point, we were not able
to provide evidence on the plausibility of the parallel trends assumption
required by our DID models. Fifth, this study did not assess compliance
of menus at physical restaurant locations. Strengths of this study include
using the same chain restaurants from a comparison site and the use of a
reliable tool to assess kids’ meal beverage offerings.
5. Conclusions
This study found no changes in kids’ meal default beverage offerings
on online platforms 8–11 months after the New Orleans HBD policy
went into effect. Because online purchases from restaurants are
becoming increasingly popular, the results underscore the importance of
including online ordering platforms in HBD policies. Regulating these
platforms can increase their reach and therefore their potential impacts
on the healthfulness of children’s meals. Future studies are needed to
assess the effect of the New Orleans HBD policy on beverage offerings at
physical restaurant locations.
Disclosure of Funding and Conicts of Interest: This work was supported
by a grant (2020-85774) from Bloomberg Philanthropies’ Food Policy
Program (www.bloomberg.org). Access to the REDCap data system was
provided by the University of Illinois Chicago Center for Clinical and
Translational Science (grant #UL1TR002003). The authors report no
Table 1
Default beverage offerings in chain restaurants in New Orleans, Louisiana, and
Baton Rouge, Louisiana, one month before (December 2022) and 8–11 months
after (September–December 2023) the effective date of a New Orleans healthy
beverage default (HBD) ordinance.
New Orleans Baton Rouge
Before After Before After
n% % n% %
Default beverage offerings compliant with New Orleans HBD ordinance
Restaurant website or
application
31 64 73 36 55 64
Third-party ordering platforms 51 39 31 56 39 31
Default beverage offerings limited to water, milk, or 100 % juice
Restaurant website or
application
32 64 73 35 64 64
Third-party ordering platforms 75 60 45 73 64 46
Soda offered as a default beverage
Restaurant website or
application
33 33 25 38 42 33
Third-party ordering platforms 77 35 44 76 36 44
Statistics for each outcome were weighted so that each restaurant chain would
receive the same total weight in each site and time period. Sample sizes for the
computation of percentages, in terms of unweighted numbers of restaurant
menus by site, shown in the n columns.
HBD, healthy beverage default.
Table 2
Changes from December 2022 to September–December 2023 in default beverage
offerings in chain restaurants in New Orleans, Louisiana, relative to Baton
Rouge, Louisiana, following the effective date of a New Orleans healthy
beverage default (HBD) ordinance.
nDifference-in-differences
OR 95 % CI
Default beverage offerings compliant with New Orleans HBD ordinance
Restaurant website or application 134 1.04 0.41, 2.66
Third-party ordering platforms 214 0.99 0.57, 1.72
Default beverage offerings limited to water, milk, or 100 % juice
Restaurant website or application 134 1.52 0.70, 3.33
Third-party ordering platforms 296 1.11 0.36, 3.39
Soda offered as a default beverage
Restaurant website or application 142 0.95 0.39, 2.34
Third-party ordering platforms 306 1.07 0.35, 3.30
Difference-in-differences results are shown from logistic regression models with
robust standard errors clustered on restaurant that were weighted for each
outcome so that each restaurant chain would receive the same total weight in
each site and time period. Sample sizes in terms of the total number of restaurant
menu-level observations across both sites and time periods shown in the n col-
umn.
HBD, healthy beverage default; OR, odds ratio.
S. Marinello et al.
Preventive Medicine Reports 53 (2025) 103067
3
conicts of interest.
CRediT authorship contribution statement
Samantha Marinello: Writing – original draft, Methodology,
Formal analysis. Julien Leider: Writing – review & editing, Methodol-
ogy, Data curation. Melissa Fuster: Writing – review & editing, Data
curation. Megan Knapp: Writing – review & editing, Data curation. Lisa
M. Powell: Writing – review & editing, Supervision, Methodology,
Funding acquisition, Conceptualization.
Declaration of competing interest
The authors declare the following nancial interests/personal re-
lationships which may be considered as potential competing interests:
Lisa M Powell reports nancial support was provided by Bloomberg
Philanthropies. If there are other authors, they declare that they have no
known competing nancial interests or personal relationships that could
have appeared to inuence the work reported in this paper.
Data availability
Data will be made available on request.
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