Fast food restaurants or quick-service establishments are often the overall choice for food away from home [1-3]. Socioeconomic trends, such as longer work hours, more women employed outside the home, and a high number of single-parent households have changed the way families obtain their meals [4-7]. As parents experience busier lifestyles, they demand convenience for their family meals. The consumption of fast food is fostered because of the quick service, convenience, good taste, and inexpensive prices relative to more traditional home-style restaurants [8,9].
The National Restaurant Association estimates that the average American eats out an average of four times a week . About 33 percent of children and adolescents in the United States consume fast food on a typical day, and intake increases with age [11-13]. It is estimated that adolescents visit fast food restaurants approximately twice a week . In non-metropolitan areas, adolescents and parents who live in towns with five or more fast food outlets were 30 percent more likely to eat fast food compared with those in towns with no fast food outlets. The influence of in-town fast food outlets on fast food intake was strongest among families with low motor vehicle access . (See "Adolescent eating habits".)
In the United States, more than 47 percent of today's food dollar is spent away from home, a value that has almost doubled over the past 50 years [16-18]. Driven by consumers' growing need for convenience, sales at quick-service restaurants were expected to generate $168 billion in 2011; a 3 percent gain over 2010 . Snack, convenience, fast foods, and sweets continue to dominate food advertisements viewed by children [19,20]. The marketing of these items contributes to the fast food consumption of children in the United States [20-23]. On a typical day, preschool-aged children (2 to 5 years) view three television fast food advertisements, elementary-school children (6 to 11 years) view four television fast food advertisements, and adolescents (12 to 18 years) view five fast food television advertisements . Hispanic preschoolers, children, and adolescents viewed, on average, 11.6 to 12.4 television food ads per day, an observation of particular concern given the higher rates of obesity among Hispanic youth . One study indicates that 98 percent of television food-product advertisements viewed by adolescents promote foods that are high in fat, sugar, or sodium . In the United States, $8 billion is spent on food and beverages by children between the ages of 4 and 12 years, and these children also exert a strong influence on their parents' choices of quick-service establishments .
Frequent consumption of fast food has adverse effects on nutrition because of excessive content of energy and fat and low nutritional value [27-31]. Moreover, consumption of fast food is associated with other poor nutritional habits: surveys show that parents who reported purchasing fast food for family meals at least three times per week were significantly more likely than parents who reported purchasing fewer than three fast food family meals to report the availability of soft drinks and chips in the home . Of note, the “empty calorie” content (low nutritional value) of children’s dietary intake from retail food stores and schools is similar to that of fast food restaurants. The source of added sugar and fat from retail food stores and schools, including sugar-sweetened beverages, grain desserts, pizza, and high-fat milk was similar to that from fast food restaurants including high-fat milk beverages, dairy desserts, french fries, and pizza . More importantly, children from middle and low social class backgrounds were more likely to report infrequent fruit and vegetable intake, given low exposure to supermarket food sources and high exposure to fast food outlets .
Fast foods are a way of life for many American families, and eliminating fast foods may not be realistic. The challenge is to teach children and adolescents to make wise food choices when visiting fast food establishments. This is an important issue since the establishment of healthy eating patterns in childhood is linked to a reduction in chronic diseases, such as obesity, coronary heart disease, hypertension, type 2 diabetes, osteoporosis, and diet-related cancers later in life [35-40]. Healthful eating patterns for children over the age of two can be achieved by consumption of a prudent diet that is moderate in total fat, saturated fatty acids, and cholesterol, and high in complex carbohydrates, fiber, calcium, and antioxidant nutrients such as vitamins C and E and the carotenoids [41-43].