The development and validation of a menu healthiness assessment tool (Menu-Health) for small-to-medium sized businesses in the UK out-of-home food sector

Out-of-home eating makes a significant contribution to dietary intake. Food consumed out-of-home is often higher in energy and less nutritious than food consumed at home. Evaluating the healthiness of catering practices in the out-of-home food sector (OHFS) is challenging for small-to-medium sized businesses, and validated assessment tools are limited. The objective of the present research was to develop and validate a menu healthiness assessment tool for small-to-medium sized UK OHFS businesses. We devised and validated a menu healthiness assessment tool, Menu-Health, based on UK nutritional guidance and recommendations. Content validity was assessed by six independent experts. Inter-rater reliability and predictive validity were assessed by applying the tool to 66 OHFS businesses in the Northwest of England. We sampled 33 businesses with an accredited tiered local authority healthier catering award. These businesses were paired with similar non-award holder businesses, matched by business type, cuisine type and Indices of Multiple Deprivation (IMD) decile. Inter-rater agreement for overall menu healthiness assessment score was 92%. The tool also had strong inter-rater agreement and excellent inter-rater reliability. Only 18% of assessed OHFS businesses had a ‘good’ overall healthiness score (≥71%). Regression analyses examined if award status or award level, business type and IMD decile predicted healthiness scores. As expected, takeaways and dessert outlets had lower healthiness scores than cafés, restaurants and pubs, as did outlets located in more deprived areas (IMD 1–2 vs. 3–10). Award holder status was not significantly associated with healthiness scores. However, higher award tier level was associated with higher menu healthiness scores. Menu-Health provides a comprehensive, validated and reliable method of assessing and comparing the food, drink and catering practices of small-to-medium sized UK OHFS businesses. It is potentially a useful tool for researchers, public health teams and local authorities to evaluate the healthiness of local OHFS environments.