Kids' Meals: What’s the Problem?

Growing bodies need healthy food to thrive. Busy parents with limited time to prepare food at home often rely on restaurant meals to feed their children. Restaurant food and drinks account for about 25 percent of children’s calorie intake,¹ often in the form of so-called “kids’ meals” which are combinations packaged and marketed by chains especially for 2-11 year olds. These meals should be packed with healthy options, but typically have been full of fat, sodium, and too many empty calories from sugary drinks. Over the past decade, advocates have been working with restaurant chains to revise their kids’ meal menus to include fruit, vegetables, and healthy beverages, to give growing children the real nutrition they need. Some progress has been made, but there’s still plenty of work to do to align kids’ meals with good nutrition standards.

Eating out can mean eating poorly. Children take in almost twice as many calories when they eat a meal at a restaurant as when they eat at home,² and kids’ meals can be particularly unhealthy. A 2013 study of the top 50 U.S. chain restaurants determined that 86 percent of kids’ meal combinations are too high in calories, 55 percent are too high in saturated fat, and 66 percent are too high in sodium.³ The food is not the only problem: kids’ meals have traditionally come with a soda, sugared fruit drink, or sweetened, flavored milk, all which are full of calories from sugar, and typically have little to no nutrition. A 2017 study of those top 50 chains showed that 38 of them had beverages on their kids’ meal menus, and 74 percent of those included sugary drinks.⁴ This is an improvement, compared to 2008 when sugary drinks were available on 93 percent of the kids’ menus.⁵ But it still means that too many sugary drinks are making their way into kids’ meals.

With national childhood obesity rates at an all-time high of 18.5 percent,⁶ these drinks are especially problematic because there is a substantial risk of weight gain and diabetes resulting from added sugars in beverages.⁷ The obesity rates for children in the target age range for kids’ meals is also alarming: 13.9% of 2-5 year olds and 18.4% of 6-11 year olds have obesity, as do more Black and Hispanic children than white children.⁸ Children with obesity are at an increased risk for type 2 diabetes, heart disease, stroke, certain cancers, asthma, low self-esteem, and depression.⁹ Studies have shown that reducing the intake of sugary drinks can lower the prevalence of obesity and obesity-related diseases.¹⁰

Over the last 10 years, some of the major fast food chains have pledged to do better by kids. They’ve promised to remove soda as the default beverage in kids’ meals and replace some of the fat and calories in the side dishes (e.g. fries) with healthier options (e.g. apple slices). Despite the commitments of eight major restaurant chains to implement some kind of improvement to their kids’ meals (see box¹¹), the percentage of those meals that meet evidence-based nutrition standards has barely budged—rising from 1% to just 3%.¹² Some progress is being made: In February, 2018, McDonald’s announced that by the summer its Happy Meals will contain 600 calories or fewer, with reduced sugar, saturated fat, and sodium. But otherwise, few changes have been made in the nutrient content of the main and side dishes, and the benefit of removing soda from kids’ meals is sometimes offset by offerings of sugary, flavored milks instead.¹² A 2017 study found that while the chains’ listed healthier options on their online menus, there was considerable inconsistency in what was actually offered at individual restaurants.¹³

Why is it so difficult for these chains to follow through on their pledges?

Chains Market Heavily to Kids

Major chain restaurants spend hundreds of millions of dollars per year to market fast food not only to parents, but also directly to young children, so clearly the kids’ meals are profitable for the chains. Preschool and elementary school-aged children see about three fast-food television ads per day, but are also exposed to ads on websites with “advergames” (branded games), and on mobile applications among others.¹⁴ As an added enticement, more than $300 million worth of toys per year are distributed as premiums with kids’ meals.¹⁵ They are often miniatures of beloved movie characters, making the meals, with toys, even more attractive to young children. Research conducted by the food industry confirms that this marketing generates purchases driven by children’s “pester power”—the ability of children to nag their parents enough that they influence them to purchase fast food for them.

Improving Kids Meals: What Can We Do?

Over the years advocates have endorsed a variety of policy approaches to improve the nutrition in kids’ meals. The original policy, enacted in Santa Clara County and San Francisco, CA in 2010, set nutritional standards for meals which came with a toy or prize. The restaurant could not include a toy if the meal didn’t conform to the standards. One chain’s response was to sell the toys separately, for a very low price.¹⁶ Subsequent advocacy focused on pushing industry to voluntarily pledge to make improvements, as noted above. And there have been legislative efforts to introduce default beverage ordinances in a few cities and counties in Maryland, California, and Colorado, and at the state level in Maryland and Vermont. These ordinances require restaurants to make the default beverage that comes with a kids’ meal a healthy one, rather than a soda. Since 2015, eight jurisdictions in California, one in Colorado, and one in Maryland have passed healthy beverage ordinances (see box). The new beverage defaults include milk, milk alternatives, water, and 100% juice in lieu of sodas and sugary juice drinks. While most ordinances do allow a customer to swap out the healthy default drink for a soda as part of the meal, the Santa Clara ordinance specifies that those who want to buy a sugary drink for the child will have to pay for it separately.

There is still room for improvement.¹⁷ Advocates can push the industry to further improve the nutrition in their kids’ meals by following the precedent set by cities and counties in Colorado and California in passing legislation to make healthy beverages the default in kids’ meals. They can encourage restaurants to make healthy choices the automatic default, rather than offering a choice of healthy and less-healthy options. At their local chain restaurants, advocates (including parents) can insist on adherence to the pledges made at the national level, and that chains can advertise to children only if all the offerings in kids’ meals are healthy. For more ideas, see the Rudd Center for Food Policy and Obesity’s report on advertising of kids’ meals in fast-food restaurants, and the Center for Science in the Public Interest’s report on soda in kids’ meals.

While additional scientific research studies are needed to describe the real-world impact of the kids’ meal default beverage policies, adoption of this policy is recommended by public health organizations such as the American Heart Association, the American Cancer Society, and the American Diabetes Association.¹⁸

Online resources

ENDNOTES

¹ Lin B, Morrison RM. “Food and Nutrient Intake Data: Taking a Look at the Nutritional Quality of Foods Eaten at Home and Away From Home.” Amber Waves 2012, vol 10(2), pp. 1-2. https://www.ers.usda.gov/amber-waves/2012/june/data-feature-food-and-nutrient-intake-data/. Accessed April 20, 2018.

² Powell LM, Nguyen BT. Fast-food and full service restaurant consumption among children and adolescents: Effect on energy, beverage, and nutrient intake. JAMA Pediatrics, 2013: 167(1), 14–20.

³ Batada A, Wootan MG. Kids’ Meals II: Obesity and poor nutrition on the menu. Center for Science in the Public Interest. https://cspinet.org/sites/default/files/attachment/cspi-kids-meals-2013.pdf. Published 2013. Accessed April 20, 2018.

⁴ Ribakove S, Almy J, Wootan M. Soda on the Menu. Improvements Seen but More Change Needed for Beverages on Restaurant Children’s Menus. Center for Science in the Public Interest. https://cspinet.org/sites/default/files/attachment/Soda%20on%20the%20Menu.pdf. Published July 2017. Accessed April 20, 2018.

⁵ Ibid.

⁶ Craig M, Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007-2008 to 2015-2016 [Published online March 23, 2018]. JAMA. doi: 10.1001/jama.2018.3060.

⁷ Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: A meta-analysis. Diabetes Care. 2010; 33(11): 2477–83.

⁸ Trust for America’s Health and the Robert Wood Johnson Foundation. The State of Obesity. Better Policies for a Healthier America. https://stateofobesity.org/childhood/. Published February 2018. Accessed April 20, 2018.

⁹ Office of the Surgeon General. The Surgeon General’s call to action to prevent and decrease overweight and obesity. Rockville, MD: U.S. Department of Health and Human Services. 2001; Food and Nutrition Board and Board on Health Promotion and Disease Prevention. Preventing childhood obesity: Health in the balance. Washington, DC: The National Academies Press; 2005: 67–69.

¹⁰ Hu FB. Resolved: There is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obesity Reviews 2013; 14(8): 606–19.

¹¹ Almy, Jessica. “Jack in the Box Removes Soda from its Kids’ Menus.” Statement of CSPI Senior Nutrition Policy Counsel Jessica Almy. https://cspinet.org/new/201602101.html. Published February 10, 2016. Accessed April 20, 2018.

¹² Harris J, Hyary M, Seymour N, Choi Y. Are Fast-Food Restaurants Keeping Their Promises to Offer Healthier Kids’ Meals? Rudd Report, University of Connecticut Rudd Center for Food Policy and Obesity. http://www.uconnruddcenter.org/files/Pdfs/272-9%20_%20Rudd_Healthier%20Kids%20Meals%20Report_Final%20Round_Web-150dpi_080117.pdf. Published August 2017. Accessed April 20, 2018.

¹³ Ibid.

¹⁴ Harris, JL, Schwartz, MB, Munsell, C et al. Fast food FACTS 2013: Measuring progress in nutrition and marketing to children and teens. Rudd Center for Food Policy and Obesity. http://www.fastfoodmarketing.org/media/fastfoodfacts_report.pdf. Published 2013. Accessed April 20, 2018.

¹⁵ Otten JJ. Food marketing: Using toys to market children’s meals. Minneapolis, MN: Healthy Eating Research. http://healthyeatingresearch.org/wp-content/uploads/2014/07/her_marketing_toys_AUGUST_14.pdf. Published August 2014. Accessed April 20, 2018.

¹⁶ Ibid.

¹⁷ Moran AJ, Block JP, Goshev SG, Bleich SN, Roberto CA. Trends in Nutrient Content of Children's Menu Items in U.S. Chain Restaurants. Am J Prev Med. 2017;52(3):284-291.

¹⁸ Center for Science in the Public Interest. Restaurant Chains Urged to Dump Soda from Kids’ Menus. https://cspinet.org/new/201401301.html. Published January 30, 2014. Accessed April 20, 2018.