Background/Objectives: Sugar-sweetened beverage (SSB) consumption is associated with child obesity, an understudied issue in the southern United States, where obesity rates are the highest in the country. We examined the factors associated with high SSB intakes among children aged 2–12 years in two major cities in Louisiana, New Orleans and Baton Rouge. Methods: We conducted a cross-sectional study using an online survey. The sample consisted of caregivers of children aged 2–12 years who eat restaurant meals (either dine-in, delivery, or take-out) at least once a month and reside in or near New Orleans or Baton Rouge, LA. Multivariable logistic regression was used to examine factors associated with high child SSB intake frequency (≥4 times/week), including restaurant use, caregiver attitudes towards SSB, and their demographics (n = 1006). Results: Most caregivers reported weekly child SSB consumption (74.6% ≥ 1×/week; 38.1% ≥ 4+/week) and restaurant use (58.8% ≥ 1×/week). High SSB frequency (≥4+/week) was associated with a higher frequency of restaurant use, lower caregiver education, agreement with the statement that SSBs are an important part of family meals, and disagreement with the statement that restaurants should not offer SSBs with children’s meals (p < 0.05). Conclusions: Our results revealed a high frequency of SSB consumption among children who dine at restaurants monthly, with significant associations observed between SSB intake, restaurant meals, and pro-SSB attitudes. These findings may support the need for regulations, such as healthy default beverage policies for children’s menus, to potentially reduce SSB intake and shift social norms, particularly in regions with high childhood obesity rates like Louisiana and the southern USA.

Childhood obesity and related health consequences are associated with sugar-sweetened beverage consumption and present significant health challenges in the U.S., particularly among minoritized and low-income populations. Louisiana, with some of the highest obesity and cardiometabolic disease rates in the U.S., exemplifies these concerns. Dining out increases sugar-sweetened beverage intake and underscores the need for interventions. This observational study examines the proportion of restaurants offering beverages with children’s meals on printed and QR code menus, the types of beverages they offer, and correlates of offering these beverages across 287 restaurants in New Orleans, Louisiana, before its healthy default beverage policy was implemented and in Baton Rouge, Louisiana, which does not have a healthy default beverage policy. On-site environmental assessments were conducted in restaurants offering children’s menus. Only 14.6% of restaurants with children’s meals offered only healthy default beverage options, 39.4% offered sugar-sweetened beverages, and 46% did not specify children’s beverages on their menus. Logistic regression analysis indicated that restaurants categorized as fast food, affiliated with a chain, or offering children's meals with age restrictions were significantly more likely to include beverages in their children's meals. Furthermore, chain and fast-food restaurants were more likely than fast-casual restaurants to include only healthy default beverages on the children’s menus. Ultimately, this research contributes to the broader discourse on improving nutritional environments in restaurant settings and underscores the need for evidence-based interventions to mitigate the impact of sugar-sweetened beverage consumption on childhood obesity and health outcomes. The findings provide a foundation for future studies evaluating the effectiveness of healthy default beverage policies.

Healthy Default Beverage (HDB) ordinances have been implemented across the United States to reduce sugar sweetened beverage (SSB) intake by making healthier options the default for children's meals. This study explored restaurant staff knowledge and perceptions of the HDB ordinance and its potential impact one year after its implementation in New Orleans, Louisiana, United States. We conducted 21 in-person interviews with restaurant staff across 20 restaurants from March to May 2024, including independent, national chain, and local chain establishments. The interviews focused on the popularity of children's meals, beverages offered, restaurant staff knowledge and perceptions of the ordinance, and potential policy-related health benefits. The majority of restaurant staff supported the policy but expressed concerns about its implementation. Restaurant staff estimated that most children's meals were still ordered with SSBs. Staff felt the policy alone may not change behavior. They highlighted the need for broader public education on the health risks of SSBs. This study identified key factors that may impact the effectiveness of the HDB ordinance, including the need for clearer guidelines, stronger enforcement mechanisms, and better support from public health authorities. Findings suggest that both restaurant staff and parents require further education to ensure the policy's success, especially in marginalized communities. Future research should focus on societal, cultural, and enforcement factors to optimize the impact of HDB policies in improving children's health outcomes.

This study examined the nutritional environments of restaurants offering children’s menus and their association with neighborhood-level factors in a southern United States city with disproportionately high childhood obesity rates. On-site assessments were conducted to generate nutrition environment scores for restaurants offering children’s menus in New Orleans, Louisiana ( n = 191). Restaurants were geocoded and linked to neighborhood characteristics, including racial/ethnic composition and socioeconomic opportunity measured by the Social and Economic Child Opportunity Index (COI-SE). Multivariate linear regressions assessed associations between nutrition environment scores and neighborhood characteristics, adjusting for restaurant-specific attributes. Restaurants located in neighborhoods with COI-SEs above the median had significantly higher nutrition environment scores (+ 2.41 points; 95% CI 0.47, 4.35; p = 0.015). This relationship appears to be driven by the associations with the healthy options and facilitators to healthy eating sub-scores. Neighborhood racial/ethnic composition was not associated with nutrition environment scores. Restaurant characteristics were associated with nutrition environment quality: sit-down restaurants had lower scores than fast-food restaurants (− 2.35 points; 95% CI −4.45, −0.24; p = 0.029), while chain restaurants scored higher than independent establishments (+ 2.13 points; 95% CI 0.44, 3.82; p = 0.014). These findings suggest that neighborhood socioeconomic opportunity and restaurant characteristics shape children’s exposure to healthier restaurant food environments. Health strategies that prioritize place-based policies and support healthier children’s menu offerings, particularly in lower-opportunity neighborhoods, may help address inequities in food environments and reduce disparities in child health.