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IntroductionIn 2011, San Francisco passed the first citywide ordinance to improve the nutritional standards of children\ue2\u20ac\u2122s meals sold at restaurants by preventing the giving away of free toys or other incentives with meals unless nutritional criteria were met. This study examined the impact of the Healthy Food Incentives Ordinance at ordinance-affected restaurants on restaurant response (eg, toy-distribution practices, change in children\ue2\u20ac\u2122s menus), and the energy and nutrient content of all orders and children\ue2\u20ac\u2122s-meal\ue2\u20ac\u201conly orders purchased for children aged 0 through 12 years.MethodsRestaurant responses were examined from January 2010 through March 2012. Parent\ue2\u20ac\u201ccaregiver/child dyads (n = 762) who were restaurant customers were surveyed at 2 points before and 1 seasonally matched point after ordinance enactment at Chain A and B restaurants (n = 30) in 2011 and 2012.ResultsBoth restaurant chains responded to the ordinance by selling toys separately from children\ue2\u20ac\u2122s meals, but neither changed their menus to meet ordinance-specified nutrition criteria. Among children for whom children\ue2\u20ac\u2122s meals were purchased, significant decreases in kilocalories, sodium, and fat per order were likely due to changes in children\ue2\u20ac\u2122s side dishes and beverages at Chain A.ConclusionAlthough the changes at Chain A did not appear to be directly in response to the ordinance, the transition to a more healthful beverage and default side dish was consistent with the intent of the ordinance. Study results underscore the importance of policy wording, support the concept that more healthful defaults may be a powerful approach for improving dietary intake, and suggest that public policies may contribute to positive restaurant changes