Fast food for children and adolescents
- Debby Demory-Luce, PhD, RD, LD
Debby Demory-Luce, PhD, RD, LD
- Adjunct Professor
- North Harris College
- Kathleen J Motil, MD, PhD
Kathleen J Motil, MD, PhD
- Section Editor — Pediatric Nutrition
- Professor of Pediatric Nutrition
- Baylor College of Medicine
- Section Editors
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Amy B Middleman, MD, MPH, MS Ed
Amy B Middleman, MD, MPH, MS Ed
- Section Editor — Adolescent Medicine
- Professor of Pediatrics, Chief of Adolescent Medicine
- University of Oklahoma Health Sciences Center
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, providing on average about 12 percent of daily calories, and intake increases with age [11,12]. 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 [14-16]. 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 [17,18]. The marketing of these items contributes to the fast food consumption of children in the United States [18-21]. 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 [26-30]. 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 [34-39]. 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 [40-42].
- Briefel RR, Johnson CL. Secular trends in dietary intake in the United States. Annu Rev Nutr 2004; 24:401.
- Fitzgerald CM, Kannan S, Sheldon S, Eagle KA. Effect of a promotional campaign on heart-healthy menu choices in community restaurants. J Am Diet Assoc 2004; 104:429.
- Dumanovsky T, Nonas CA, Huang CY, et al. What people buy from fast-food restaurants: caloric content and menu item selection, New York City 2007. Obesity (Silver Spring) 2009; 17:1369.
- Guthrie JF, Lin BH, Frazao E. Role of food prepared away from home in the American diet, 1977-78 versus 1994-96: changes and consequences. J Nutr Educ Behav 2002; 34:140.
- Bowers, DE. Cooking trends echo changing roles of women. Food Rev 2000; 23:23.
- St-Onge MP, Keller KL, Heymsfield SB. Changes in childhood food consumption patterns: a cause for concern in light of increasing body weights. Am J Clin Nutr 2003; 78:1068.
- Jabs J, Devine CM. Time scarcity and food choices: an overview. Appetite 2006; 47:196.
- Story M, Neumark-Sztainer D, French S. Individual and environmental influences on adolescent eating behaviors. J Am Diet Assoc 2002; 102:S40.
- Rydell SA, Harnack LJ, Oakes JM, et al. Why eat at fast-food restaurants: reported reasons among frequent consumers. J Am Diet Assoc 2008; 108:2066.
- National Restaurant Association. Rapid response. Available at: www.restaurant.org/pressroom/rapid_response.cfm?ID=607 (Accessed on February 3, 3008).
- Powell LM, Nguyen BT, Han E. Energy intake from restaurants: demographics and socioeconomics, 2003-2008. Am J Prev Med 2012; 43:498.
- Vikraman S, Fryar CD, Ogden CL. Caloric Intake From Fast Food Among Children and Adolescents in the United States, 2011-2012. NCHS Data Brief 2015; :1.
- Longacre MR, Drake KM, MacKenzie TA, et al. Fast-food environments and family fast-food intake in nonmetropolitan areas. Am J Prev Med 2012; 42:579.
- National Restaurant Association. Restaurant industry to continue to be major driver in nation's economy through sales employment growth in 2008. Available at: www.restaurant.org/pressroom/pressrelease.cfm?ID=1535 (Accessed on February 3, 2008).
- National Restaurant Association. Restaurant industry forecast 2011. www.restaurant.org (Accessed on May 22, 2011).
- National Restaurant Association. Restaurant industry fact book 2014. Available at: https://www.restaurant.org/Downloads/PDFs/News-Research/research/Factbook2014_LetterSize.pdf (Accessed on February 08, 2014).
- Andreyeva T, Kelly IR, Harris JL. Exposure to food advertising on television: associations with children's fast food and soft drink consumption and obesity. Econ Hum Biol 2011; 9:221.
- Yale University Rudd Center for Food Policy and Obesity. Fast Food FACTS 2013. Available at: http://www.fastfoodmarketing.org/media/FastFoodFACTS_Report.pdf (Accessed on February 08, 2014).
- Harrison K, Marske AL. Nutritional content of foods advertised during the television programs children watch most. Am J Public Health 2005; 95:1568.
- Powell LM, Szczypka G, Chaloupka FJ. Adolescent exposure to food advertising on television. Am J Prev Med 2007; 33:S251.
- Thompson DA, Flores G, Ebel BE, Christakis DA. Comida en venta: after-school advertising on Spanish-language television in the United States. J Pediatr 2008; 152:576.
- Yale University Rudd Center for Food Policy and Obesity. Fast food facts. http://www.fastfoodmarketing.org/fast_food_facts_in_brief.aspx (Accessed on May 23, 2011).
- Fleming-Milici F, Harris JL, Sarda V, Schwartz MB. Amount of Hispanic youth exposure to food and beverage advertising on Spanish- and English-language television. JAMA Pediatr 2013; 167:723.
- Powell LM, Szczypka G, Chaloupka FJ, Braunschweig CL. Nutritional content of television food advertisements seen by children and adolescents in the United States. Pediatrics 2007; 120:576.
- Hall, S. Marketing to children: Growing the customers of tomorrow. Restaurants USA 1999; 19:22.
- Sebastian RS, Wilkinson Enns C, Goldman JD. US adolescents and MyPyramid: associations between fast-food consumption and lower likelihood of meeting recommendations. J Am Diet Assoc 2009; 109:226.
- O'Donnell SI, Hoerr SL, Mendoza JA, Tsuei Goh E. Nutrient quality of fast food kids meals. Am J Clin Nutr 2008; 88:1388.
- Powell LM, Nguyen BT. Fast-food and full-service restaurant consumption among children and adolescents: effect on energy, beverage, and nutrient intake. JAMA Pediatr 2013; 167:14.
- Marcino TJ, Guthrie J, Lin BH. How food away from home affects children's diet quality. No. ERR-104, Economic Research Service; US Department of Agriculture, Washington, DC 2010.
- Kirkpatrick SI, Reedy J, Kahle LL, et al. Fast-food menu offerings vary in dietary quality, but are consistently poor. Public Health Nutr 2014; 17:924.
- Boutelle KN, Fulkerson JA, Neumark-Sztainer D, et al. Fast food for family meals: relationships with parent and adolescent food intake, home food availability and weight status. Public Health Nutr 2007; 10:16.
- Poti JM, Slining MM, Popkin BM. Where are kids getting their empty calories? Stores, schools, and fast-food restaurants each played an important role in empty calorie intake among US children during 2009-2010. J Acad Nutr Diet 2014; 114:908.
- Svastisalee CM, Holstein BE, Due P. Fruit and vegetable intake in adolescents: association with socioeconomic status and exposure to supermarkets and fast food outlets. J Nutr Metab 2012; 2012:185484.
- Department of Health and Human Services. Healthy people 2010: National health promotion and disease prevention objectives. Washington, DC: U.S. Government Printing Office, 2000.
- Thompson DR, Obarzanek E, Franko DL, et al. Childhood overweight and cardiovascular disease risk factors: the National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr 2007; 150:18.
- Whincup PH, Gilg JA, Donald AE, et al. Arterial distensibility in adolescents: the influence of adiposity, the metabolic syndrome, and classic risk factors. Circulation 2005; 112:1789.
- Greer FR, Krebs NF, American Academy of Pediatrics Committee on Nutrition. Optimizing bone health and calcium intakes of infants, children, and adolescents. Pediatrics 2006; 117:578.
- Van Horn L, McCoin M, Kris-Etherton PM, et al. The evidence for dietary prevention and treatment of cardiovascular disease. J Am Diet Assoc 2008; 108:287.
- Holt EM, Steffen LM, Moran A, et al. Fruit and vegetable consumption and its relation to markers of inflammation and oxidative stress in adolescents. J Am Diet Assoc 2009; 109:414.
- Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr 2006; 136:2588.
- Uauy R, Solomons N. Diet, nutrition, and the life-course approach to cancer prevention. J Nutr 2005; 135:2934S.
- Nicklas T, Johnson R, American Dietetic Association. Position of the American Dietetic Association: Dietary guidance for healthy children ages 2 to 11 years. J Am Diet Assoc 2004; 104:660.
- Robinson TN, Borzekowski DL, Matheson DM, Kraemer HC. Effects of fast food branding on young children's taste preferences. Arch Pediatr Adolesc Med 2007; 161:792.
- Cottone E, Byrd-Bredbenner C. Knowledge and psychosocial effects of the film super size me on young adults. J Am Diet Assoc 2007; 107:1197.
- Nielsen SJ, Siega-Riz AM, Popkin BM. Trends in food locations and sources among adolescents and young adults. Prev Med 2002; 35:107.
- American Academy of Pediatrics. Fast foods, organic foods, fad diets, and herbs, herbals and botanicals. In: Pediatric Nutrition, 7th ed, Kleinman RE, Greer FR. (Eds), American Academy of Pediatrics, Elk Grove Village 2011. p.299.
- Schmidt M, Affenito SG, Striegel-Moore R, et al. Fast-food intake and diet quality in black and white girls: the National Heart, Lung, and Blood Institute Growth and Health Study. Arch Pediatr Adolesc Med 2005; 159:626.
- Colapinto CK, Fitzgerald A, Taper LJ, Veugelers PJ. Children's preference for large portions: prevalence, determinants, and consequences. J Am Diet Assoc 2007; 107:1183.
- Krebs NF, Himes JH, Jacobson D, et al. Assessment of child and adolescent overweight and obesity. Pediatrics 2007; 120 Suppl 4:S193.
- Ebbeling CB, Garcia-Lago E, Leidig MM, et al. Altering portion sizes and eating rate to attenuate gorging during a fast food meal: effects on energy intake. Pediatrics 2007; 119:869.
- Duyff, RL. The American Dietetic Association Complete Food and Nutrition Guide. Chonimed Publishing, Minneapolis 1996.
- Johnson CM, Angell SY, Lederer A, et al. Sodium content of lunchtime fast food purchases at major US chains. Arch Intern Med 2010; 170:732.
- National Research Council. School meals: Building blocks for healthy children, The National Academies Press, Washington, DC 2010.
- Food and Nutrition Board, National Academy of Science-National Research Council. Recommended dietary allowances, 10th ed, National Academy Press, Washington, DC 1989.
- American Academy of Pediatrics Committee on Nutrition: Statement on cholesterol. Pediatrics 1992; 90:469.
- United States Food and Drug Administration, Questions and answers on the new menu and vending machines nutrition labeling requirements. Available at: http://www.fda.gov/Food/LabelingNutrition/ucm248731.htm#5 (Accessed on June 06, 2011).
- Bassett MT, Dumanovsky T, Huang C, et al. Purchasing behavior and calorie information at fast-food chains in New York City, 2007. Am J Public Health 2008; 98:1457.
- Yamamoto JA, Yamamoto JB, Yamamoto BE, Yamamoto LG. Adolescent fast food and restaurant ordering behavior with and without calorie and fat content menu information. J Adolesc Health 2005; 37:397.
- Tandon PS, Wright J, Zhou C, et al. Nutrition menu labeling may lead to lower-calorie restaurant meal choices for children. Pediatrics 2010; 125:244.
- Tamborlane, WV (Ed). The Yale Guide to Children's Nutrition. Yale University Press, New Haven 1997.
- Bowman SA, Gortmaker SL, Ebbeling CB, et al. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics 2004; 113:112.
- Yamamoto JA, Yamamoto JB, Yamamoto BE, Yamamoto LG. Adolescent calorie/fat menu ordering at fast food restaurants compared to other restaurants. Hawaii Med J 2006; 65:231.
- Ebbeling CB, Sinclair KB, Pereira MA, et al. Compensation for energy intake from fast food among overweight and lean adolescents. JAMA 2004; 291:2828.
- Poti JM, Duffey KJ, Popkin BM. The association of fast food consumption with poor dietary outcomes and obesity among children: is it the fast food or the remainder of the diet? Am J Clin Nutr 2014; 99:162.
- National Restaurant Association. Industry forecast predicts trends in healthier options and "greener" restaurants in 2009. Available at: www.restaurant.org/pressroom/pressrelease.cfm?ID=1726 (Accessed on April 7th, 2009).
- Creel JS, Sharkey JR, McIntosh A, et al. Availability of healthier options in traditional and nontraditional rural fast-food outlets. BMC Public Health 2008; 8:395.
- National Restaurant Association. Healthy kids meals, local produce, mini desserts among hottest menu trends for 2009, according to National Restaurant Association Research. Available at: www.restaurant.org/pressroom/pressrelease.cfm?ID=1708 (Accessed on April 7th, 2009).
- Elbel B, Gyamfi J, Kersh R. Child and adolescent fast-food choice and the influence of calorie labeling: a natural experiment. Int J Obes (Lond) 2011; 35:493.
- Block JP, Condon SK, Kleinman K, et al. Consumers' estimation of calorie content at fast food restaurants: cross sectional observational study. BMJ 2013; 346:f2907.
- Tandon PS, Zhou C, Chan NL, et al. The impact of menu labeling on fast-food purchases for children and parents. Am J Prev Med 2011; 41:434.
- Illinois Nutrition Education and Training Program. Navigating in a Fast Food World. Available at: www.kidseatwell.org/parents/newsletter/NAVIGATINGINAFASTFOODWORLD.html (Accessed on February 3, 2008).
- Neumark-Sztainer D, Story M, Perry C, Casey MA. Factors influencing food choices of adolescents: findings from focus-group discussions with adolescents. J Am Diet Assoc 1999; 99:929.
- McBean LD, Miller GD. Enhancing the nutrition of America's youth. J Am Coll Nutr 1999; 18:563.
- Sutherland LA, Beavers DP, Kupper LL, et al. Like parent, like child: child food and beverage choices during role playing. Arch Pediatr Adolesc Med 2008; 162:1063.
- O'Dea JA. Children and adolescents identify food concerns, forbidden foods, and food-related beliefs. J Am Diet Assoc 1999; 99:970.
- Freeland-Graves J, Nitzke S. Position of the American Dietetic Association: total diet approach to communicating food and nutrition information. J Am Diet Assoc 2002; 102:100.
- Wardlow, GM. Contemporary Nutrition: Issues and Insights, 3rd ed, Brown & Benchmark Publishers, Dubuque 1997.