A study from Virginia Tech researchers finds children's menus at restaurants in the Dan River region of Virginia and North Carolina lack healthy food options, particularly in areas with high black populations.

Researchers reviewed menus at 137 restaurants using the Children's Menu Assessment (CMA) and found that urban areas had higher scores for healthy entrée options (for example, grilled chicken instead of breaded), whereas rural areas had higher scores for whole grain options. According to the study, the overall number of restaurants and the average CMA scores were significantly lower in predominantly black areas than in white and mixed race areas.

According to the report, one-third of the restaurants studied listed soda as a drink option on their children's menu, and even fewer offered 100 percent juice. Researchers note this as a concern given the association between sugar-sweetened beverage consumption and children's obesity risk, particularly for those children who consume more food away from home than at home.

On average, restaurants offered five entrees on the children's menu, with only 11 percent of the 137 restaurants studied including at least one healthy entrée. Only 9 percent offered a nonfried vegetable side item. While 39 percent offered fruit, only about 23 percent offered fruit without added sugar.

According to the study, 7 percent of restaurants included a dessert as part of the children's meal; however, none of the restaurants offered healthy dessert options, such as low-fat ice cream. Researchers also found that 29 percent of restaurants included a toy in the children's meal, and 8 percent used branded marketing to promote their children's meal.

The study also found that 29 percent of the restaurants specifically listed soda as the beverage option on the children's menu, and only 32 percent offered a healthier beverage substitution in place of a sugar-sweetened beverage. Although 50 percent of the restaurants offered milk, only 28 percent offered low-fat or skim milk as a beverage option for children. Additionally, 40 percent of restaurants offered juice drinks as a beverage option for children, but only 15 percent offered 100 percent juice as an option.

"The Dan River Region is a rural, health-disparate region with a high prevalence of obesity among both adults and children. The findings from this child-focused study support previous studies in the region that demonstrate an overall lack of healthy food options," researchers report. "Effective, comprehensive approaches to the individual and environmental factors contributing to obesity are urgently needed."