In recent years, the frequency with which individuals dine outside their homes, particularly in restaurants, has increased [1,2,3]. A possible negative impact of this behaviour on nutritional habits has been described [4]. Eating in restaurants is associated with unhealthy food choices [5], weight gain [6] and obesity [7, 8]. In addition, compared with eating at home, dining out is considered a cause of the increased consumption of sweets and bakery products, soft drinks and other non-alcoholic beverages [2]. Thus, eating outside the home distances diners from the Mediterranean diet, which is considered beneficial and protective because of its high contents of fruits and vegetables, cereals, nuts and olive oil, which reduce the risk of cardiovascular disease and obesity [9].
The literature describes tools that restaurants can use to clarify menu labels to facilitate healthy eating (for example, by offering low-fat entrees and providing nutritional information) and increase the number of options for healthy eating (for example, by increasing the number of healthy or low-fat entrees as well as fruit and vegetable servings) [10]. In the U.S., a tool proposed by the Nutrition Environment Measures Survey in restaurants (NEMS-R) has the following aims: a) increase the number of healthy food choices (i.e., the accessibility of healthy options), b) expand the availability of specific foods (i.e., fruit, non-fried vegetables, and whole-grain bread) and beverages (diet soda and 100% fruit juice), and c) provide nutrition information to identify healthy food choices [11].
This tool proposes criteria similar to those of the Spanish Mediterranean Diet (AMED) certification for increasing the number of healthy food choices on restaurant menus to encourage healthier eating habits outside the home [12]. Thus, restaurant involvement in the creation of a healthy environment would involve offering dishes as an enjoyable way to improve customers’ health and fight obesity, cardiovascular diseases, and associated problems.
Recently, 6 restaurant-based strategies were proposed to improve the nutritional information provided to customers on menus to promote healthy choices [5]. In addition, based on a review of 27 restaurant interventions, national and international policy changes, such as obligatory nutritional menu-labelling in restaurants, were suggested [5].
However, the confirmation of the effects of these 6 restaurant-based strategies, such as the introduction of healthy choices and labels on restaurant menus [5], has been limited. To help restaurants promote healthy choices in an enjoyable family environment, robust evidence is required.
Additionally, the prevalence of food allergies has increased to 10.8% of adults [13] and 6–8% of children, affecting families around the world [14]. Food intolerance is common in the modern world, affecting 15–20% of adults [15]. The most common types of food intolerance worldwide involve certain cereal products (gluten), dairy products (lactose), certain vegetables, drinks (coffee) and miscellaneous items (hot spices) [15]. Consequently, avoiding restaurant dishes that could aggravate food intolerance is a challenge. Furthermore, in December 2014, the Spanish government approved the 1169/2011 menu-labelling regulation, which stipulates that restaurants must provide customers with information regarding the contents of 14 ingredients associated with allergies/intolerance, including gluten, crustaceans, eggs, fish, peanuts, soy, milk, nuts, celery, mustard, sesame, sulphites, lupin and shellfish, in all offered dishes [16]. These 14 foods are associated with food allergies and intolerance, which induce different responses in humans: allergies involve the immune system, while intolerance is a condition in which a food cannot be digested [15, 17]. Customers and their families need information on allergy- and intolerance-associated food to facilitate their choice of dishes. However, restaurant interventions that specify the process of implementing changes to respond to this demand are not available, leading to a challenge for restaurants.
Consequently, the Cambrils Park Resort and Camping Sangulí, two family-oriented holiday resorts with various types of food establishments, such as restaurants, takeaways and snack bars, are determined to encourage offering healthy foods and allergen-free dishes that are free of ingredients associated with sensitivity and allergies/intolerance (gluten and lactose). Thus, the principal aims of this study were a) to promote healthy diets by increasing healthy food offerings and b) to increase the number of foods offered specifically as gluten-free and lactose-free and to inform patrons by including nutritional and allergen information that complies with Regulation 1169/2011 regarding the food served in restaurants, takeaways and snack bars. A secondary aim was to improve customer food satisfaction.