Table 4:

Key themes and quotes extracted from focus groups and shop-along interviews with caretakers of 6–12-year-olds about their use of calorie labels and menu label messaging when ordering for their children

Theme	Representative Quote
Parent’s use of calorie labels
Although calorie labeling is not relevant for their children, it can be helpful for some.	“Well, the hard thing is, he’s slim. So I’m not really watching his calories.” “I think that I would say I don’t use the calories for my children, mainly because usually people who are counting calories are on diets…Children usually don’t have that issue of trying to lose weight. They have a high metabolism because they run around a lot.” “…My little brother, he overweight. So if I take him to eat somewhere, I can’t let him go all out. For my son, I can be more lenient because he’s more active and he run around.” “I think it’s good…it’s considerate. Some children are the size they’re supposed to be…But then some of these kids are like—they’re kind of big…So I think it’s good to just have the calories because it’s being considerate.”
Eating out is a special treat.	“Yeah, it don’t matter—calories. I let them enjoy. They’re kids.” “When you’re out, I don’t tend to put a barrier on what my kids eat at a restaurant like that… Just let go. It’s not every day. […] So that’s how I typically treat them when we go out. So the kids’ calories and all that stuff, I don’t really pay attention to that.”
Caregivers have inaccurate knowledge about calories and are skeptical about the accuracy of labels.	“Well, they’ll give you a calorie count, which is impossible, because, number one, you do a calorie count of what’s in there, the calories change the way you heat it up, how long it’s been stored. It changes the calorie. So none of that’s right. And I know that firsthand.” “…Because we’re sitting here and we are ignorant as hell towards calories. We don’t know nothing. I’m like whatever…If you don’t know, you’re going to remain ignorant or you’re going to figure it out. Change got to start somewhere.” “I look at it. Sometimes I’m not sure, like well, I donť even know how many calories the child’s supposed to have. So I’m confused with that part of it.”
Multiple factors influence food choices.	“All the healthiness [of the food] is gone. So once you go into most fast food restaurants, even the parfaits, the fruit comes packaged already. So they got preservatives. Even though they’re putting it together as a healthy snack, it’s really not. It’s processed.” “And then your water. They’re putting all that in the water. In your tap water…And then people say plastic bottle, it’s plastic, you don’t know how long it’s been sitting in the bottle.” “100 percent fruit juices because I believe they’re equivalently healthy to milk and water, and more, I guess, variety.” “How to feed your kids properly. So you want to—you sit up at night talking to your significant other and you’ll be like, damn, I should have gave them an apple instead of giving them that cup of ice cream or something like that. So you’ve got to find a balance. And it’s kind of hard sometimes.”
Messaging about portion size and moderation was preferred over calorie information for some parents.	“You know what? It’s really fun to order the perfect proportions of food and that’s what’s on your plate and then you finish it…” “Educating the parent on how portions supposed to be served for their self and for their children. Because the parents needs to be educated on portion control. And the child need- portion control and calories.”
Differences across restaurant settings	“Yeah. Well, my daughter eats nuggets and fries from McDonalds. Same thing every time.” “If I’m here, I’m not worried about healthy. If I’m coming to McDonalds, I’m eating everything I want because health went out the window when I walked in.” “But if iťs like a restaurant like [a full-service chain restaurant], I would probably get something with greens or healthy and stuff like that. Yeah, I think healthy first. Yeah.” “For me, if I run to a [full-service] chain restaurant, I plan on spending some time there. So I wouldnť get nothing I could eat real quick anyway. […] But fast food, I would just grab something quick.”
Non-judgmental information	“I already said it. Don’t judge me.” “It just frustrates—like, who are you to tell me what to do? I mean, I know what’s best for my child, and if I choose—it’s my choice.”
Financial value and enjoyment of food	“…and the other reason why it’s good ordering off the kids’ menu because the kids’ menu they get a meal, they get a drink and they get a side, and all for $3.50.” “…And it’s like they put all the flavor in our food and leave the kids’ food bland, like the kids don’t want to taste nothing. Like they don’t have no taste buds or something.” “Yes. I would get the salmon, but I’m not gonna lie…when I look at meals I’m thinking no more than $10.”
Message preferences	“I like the fact that it says—it suggests to change the soda with milk or water.it gives information how to make a small change.” “I like the small changes…I just think it’s attainable. I think if you tell people—even in terms of every meal, just change one little thing every meal, you’ll be in a better place. And then you get a taste for it after a while, because your body gets used to it.” “You mainly want to relate to whoever you’re talking to. So I’m guessing he looked like a kid you will find in like a public school in Philadelphia and everything drinking the milk. He’s smiling.” “Iťs like you see yourself, like a mirror of what you could be like that. Oh, I could do that.”