The New Orleans Healthy Default Beverage Policy and Beverage Ordering Among Children.

Importance: Sugar-sweetened beverages (SSBs) are the leading source of added sugar in US children's diets and are linked to increased obesity risk, and restaurants are critical settings for interventions to reduce SSB consumption. Local menu ordinances requiring default healthier beverages (HDB) are gaining in popularity, but to date, there has been no rigorous evaluation of their effectiveness. Objective: To evaluate the outcomes of an HDB ordinance on beverage ordering for children in restaurants. Design, Setting, and Participants: Difference-in-differences study using caregiver-reported survey data before and after policy implementation (September 2022 and 2024, respectively) in 2 urban parishes in Louisiana: New Orleans (intervention city) and Baton Rouge (comparison city). Parents and caregivers (≥18 years) of children aged 2 to 12 years who had ordered or eaten at a restaurant with their child in the past 30 days were surveyed. Exposure: Implementation of the New Orleans Healthy Kids' Meal Beverage Ordinance, which mandates that only water, unflavored or low-fat milk, or 100% juice be offered as default beverages with children's meals. Main Outcomes and Measures: The primary outcome was ordering of a healthy default beverage with the most recent children's restaurant meal. Secondary outcomes included beverage volume, sugar and calorie intake, and selection of beverage types. Models were weighted and adjusted for demographics, dining mode, and caregiver attitudes. Results: A total of 1006 caregivers completed the baseline survey (736 [73.2%] female; 506 in New Orleans, 500 in Baton Rouge), and 1131 completed the postpolicy survey (548 [48.5%] female; 556 in New Orleans, 575 in Baton Rouge). Healthy beverage ordering decreased in both cities, but comparison of before-and-after differences between the 2 cities indicates the ordinance was associated with higher odds of ordering a healthy beverage (adjusted odds ratio [aOR], 2.10; 95% CI, 1.16 to 3.83; P = .02), attenuating the ordering decline in New Orleans. Sugar intake decreased by 5.6 g (95% CI, -9.6 to -1.5 g; P = .007), and calorie intake declined by 34.0 kcal (95% CI, -59.1 to -8.9 kcal; P = .008). The odds of ordering water increased (aOR, 2.08; 95% CI, 1.12 to 3.85), while the odds of ordering 100% juice decreased (aOR, 0.59; 95% CI, 0.36 to 0.96). No significant changes were observed for SSBs or beverage volume. Conclusions and Relevance: In this survey study, the New Orleans HDB ordinance was associated with modest but meaningful improvements in children's beverage ordering, supporting default-based policies as a tool for promoting healthier dietary behaviors.