MINNEAPOLIS -- Fast-food restaurants have added carrots, yogurt and other nutritious options to their menus in the past few years. But when your family pulls into Burger King, is your child more likely to want a double cheeseburger, fries and a Dr Pepper -- or macaroni and cheese, apples (hold the caramel dip) and milk?
The answer, according to a report on fast-food marketing released Monday, is not just influenced by taste, but by a blitz of television and online marketing aimed at children and by fast-food restaurants that push unhealthy options first at their counters and drive-through windows.
The Yale Rudd Center for Food Policy & Obesity found preschool children are exposed to 21 percent more fast-food ads than they were in 2003, and older children now see 34 percent more.
"Children really are exposed to a massive amount of marketing for lots of unhealthy foods," said Kelly Brownell, director of the Yale food policy center. "We believe that children deserve protection from that -- that government has been too lax with this, and that the companies have shown themselves to be untrustworthy when they make pledges to protect children from this."
Noting that the link between soft drinks, fast food and the nation's rising rate of child obesity is profound, Brownell said he hopes the report will cause a chain of events, from public outrage to legislative proposals that will compel the industry to improve its marketing on its own.
In a response, the National Restaurant Association said it has already taken steps, such as endorsing legislation to list calorie and nutrition information on restaurant menus.
"Healthful options in kids' meals and nutritious offerings in children's meals (are) the No. 1 food trend in quick-service restaurants," said Joy Dubost, the association's director of nutrition and healthy living.
Even so, the researchers found that of 3,039 possible kids' meal combinations studied by the team, only 36 met healthy criteria -- including calories and sodium -- for school-age children. Only 15 met healthy criteria for preschoolers. And the healthy meals were mostly variations of Subway's veggie sub (no cheese) or Burger King's macaroni and cheese.
Kids meals at the bottom of the health scale included a cheeseburger, fries, Mountain Dew and Dilly Bar at Dairy Queen and popcorn chicken, a biscuit, Mountain Dew and string cheese at KFC.
The authors found that ads directed at children don't feature healthy or unhealthy foods all that much, because their goal is to build brand loyalty through cartoon characters and toy promotions.
But most of the ads that children actually see are directed at adults and aired during televised sports or entertainment shows such as "Glee." Those ads do promote unhealthy options and large portions, the study found.
Even when ads promote healthy options, the study found that most restaurants still offer unhealthy ones -- fries instead of yogurt, for instance -- at their counters. The researchers tested this by sending families into restaurants to see what sides and drinks were offered first.
"In most cases, you have to work very hard to get a healthy side and drink in a kids' fast-food meal," said Marlene Schwartz, a lead author of the report. "You have to know it exists and know to ask for it."
Only Subway restaurants regularly made healthier sides and drinks the first options for kids' meals, Schwartz said.
Letrice Cephus of Minneapolis doesn't bother pushing healthy sides when she takes her 15- and 10-year-old boys out for fast food on weekends. But then, she and her husband don't allow fast food during the week, even when the boys whine "I'm bored of chicken" or they hear about video game giveaways by one of the chains.
"They probably would be better off (with healthy sides), but it's like a cheat day," she said. "It's my cheat, too."
The Yale group billed Monday's findings as the most comprehensive to date on the effect of marketing to children by 12 of the nation's fast-food chains.
It also studied the use of Internet banners, social media campaigns and interactive websites.
Mary Story, co-director of the University of Minnesota's Obesity Prevention Center, said direct marketing to preschoolers, even when the Ronald website says "Hey Kids. This is advertising!" in the corner, should be considered unethical.
"Preschoolers? That's starting really young," she said. "And they're the ones who are pestering their parents to take them to the fast-food places."
The Yale study found that 40 percent of children asked to go to McDonald's weekly, and 15 percent of preschoolers asked to go every day.
Story wasn't part of the Yale study, but she served on a panel at the American Public Health Association's annual meeting in Denver that introduced the findings.
Fast-food chains could really help parents, she said, by offering healthy sides as a default for kids' meals and making people ask for fries instead. "The parents that are bringing their kids now to fast-food restaurants were the first generation to really be targeted aggressively with fast-food marketing," she said.
Kelly Haynes' 4-year-old son loves Happy Meal toys, and rips them from the box on the drive home from the McDonald's drive-through in St. Michael. His mom has bigger concerns. The only meat her son eats is McDonald's chicken nuggets, or identical store-bought nuggets. At least he loves fruit and eats McDonald's apples -- as long as Haynes remembers to ask for them.
"(I ask) every time," she said, "or they will give me fries."
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