While many children look forward to eating out at a restaurant or grabbing some fast food, those meals are also sources of excess calories, fat, sodium, and sugar.  

Now that a third of American children are either overweight or obese, those are all things many American children need less of in their diets.

In the face of an epidemic, there’s been consumer pressure for restaurants to offer more nutritionally sound options for kids.

Over the years improvements have been made. However, finding healthy food on kids’ menus can still be difficult.

A recent assessment published in the Journal of Nutrition Education and Behavior by researchers at Tufts University found that few sit-down or fast food restaurants offered meals that met the nutritional requirements to be considered healthy.

Sarah Sliwa, Ph.D., an instructor at Tufts University Friedman School of Nutrition Science and Policy and the study’s lead author, wrote that the consistently low availability of meals meeting four nutrition criteria — low in calories, fat, saturated fat, and sodium — suggests healthier children’s meals aren’t the norm.

“Improving the availability of healthier kids' meals is a critical step toward increasing children's exposure to healthier foods, but that alone is not enough,” Sliwa said in a press release.

Read More: How Much Fast Food Do Children Eat? »

Minor Gains on Kids Menus

In 2013, the Center for Science in the Public Interest assessed the nutritional value of 3,494 combinations available from the top 41 restaurant chains that offered kids’ menus.

The researchers found that more than 90 percent of those meals didn’t meet certain degrees of nutritional standards, including the National Restaurant Association’s (NRA) own Kids LiveWell standards.

Soft drinks and fried potatoes were the most common options on children’s menus. The most common meal combinations included fried chicken fingers, French fries, and soda.

More than half of the restaurant chains didn’t even have one meal that met expert standards. All of Subway’s options, however, met nutritional standards.

From 2008 to 2013, many restaurants made improvements in terms of calories and sodium, but even more failed to meet guidelines on saturated fat.

Read More: Nutritious Food out of Reach for 20 Percent of U.S. Homes with Children »

‘Feasible’ Improvements Since 2013

The latest assessment from Tufts examined the top 10 full-service restaurants and 10 fast food restaurants, also known as quick-service restaurants, that offered a kids menu and made their nutrition information publicly available.

Nearly three-fourths of fast food restaurants and nearly two-thirds of full-service restaurants met the recommendation that meals contain fewer than 600 calories. However, one quarter to less than one third met the recommendations for fat, saturated fat, and sodium content.

Their study did not address sugar content in the meals. That ingredient may also contribute to obesity, diabetes, and other adverse health conditions.

Overall, researchers say improvements are “feasible,” but they expect this to improve when calorie counts on menus are published nationwide in December.

“Given the ongoing obesity epidemic and evidence linking a greater supply of healthy children’s meal options with healthier orders, continued efforts to monitor and influence both supply and demand for healthier children’s meal options in restaurants are warranted,” the researchers concluded in their study.

Read More: Picky Eating May Be a Sign of Anxiety, Depression »

Dieticians Weigh in on Kids Meals

The new research didn’t surprise Rene Ficek, a registered dietitian and lead nutrition expert at Seattle Sutton’s Healthy Eating.

She said that’s because healthy dining outside the home “will always be an oxymoron” as fats and salts are what humans find truly satisfying.

 “This is true with even kids’ meals. Restaurants aim to please and satisfy, thus they resort to adding fat and sodium to make them more palatable,” Ficek told Healthline. “When restaurants were encouraged to provide meals to a limited calorie count, they simply reduced portions to fit specifications. This is essentially why the analyzed meals currently meet calorie recommendations but fail to meet fat and sodium recommendations.”

Franceen Friefeld, RD., LD., P.H.Ec., a registered dietician and author of the Healthy Meals for Your Busy Life Cookbook, said there’s clear potential for healthier options.

“When it comes to healthy eating, and particularly as it applies to industry programs, taking baby steps is prudent” she told Healthline. “But in time, the Kids LiveWell restaurants should consider an increase in the number of meals that are required to meet program standards in order to qualify. Currently the requirement is for just one meal.”

While Friefeld says the Tufts study has its limitations, such as not using sales and plate waste data, there are other ways to increase the incidence of healthy options on kids’ menus.

These include removing sugar-sweetened beverages, changing the way less healthy foods are prepared, pairing healthier sides and drinks with entrees by default, and offering more balanced meal combinations.

“By letting the children chose their own components within a defined set of balanced food groups, they become a part of the process, which will drive sales and satisfaction,” Friefeld said.