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Out of 3,039 possible kids' meal combinations, only 12 meet the researchers' nutrition criteria for preschoolers. Only 15 meet nutrition criteria for older children.

Teens ages 13-17 purchase 800-1,100 calories in an average fast food meal, roughly half of their recommended total daily calories.

At least 30% of the calories in menu items purchased by children and teens are from sugar and saturated fat.

At most fast food restaurants, a single meal contains at least half of young people's daily recommended sodium.

Most fast food restaurants have at least one healthy side dish and beverage option for a kids' meal, but the healthy options are rarely offered as the default.

Even though McDonald's and Burger King show only healthy sides and beverages in child-targeted advertising, the restaurants automatically serve french fries with kids' meals at least 86% of the time, and soft drinks at least 55% of the time.

Companies facing increasing pressure about portion sizes are renaming, rather than eliminating, their biggest sides and drinks.

At Burger King, a 42-ounce "King" drink is now "large"; a 32-ounce "large" is now a "medium"; a 21-ounce "medium" is now a "small"; and a 16-ounce "small" is now "value."

Forty percent of children ages 2-11 ask their parents to go to McDonald's at least once a week, and 15% of preschoolers ask to go every day. 84% of parents report taking their child ages 2-11 to a fast food restaurant at least once in the past week.

The average preschooler sees almost three ads per day for fast food; children ages 6-11 see three-and-a-half ads; and teens ages 12-17 see almost five ads per day.

Children's food choices are affected by secondhand exposure to ads for foods and beverages targeted to adults.

More than 60% of fast food ads viewed by children were for foods other than kids' meals.

Older children (ages 6-11) are more likely to order an item from the dollar menu or a combo meal (27%) than to order a kids' meal (21%).

Compared with 2007, in 2009 preschoolers saw 21% more ads for McDonald's, 9% more for Burger King, and 56% more for Subway. Children (ages 6-11) saw 26% more ads for McDonald's, 10% more for Burger King, and 59% more for Subway.

Fast food advertising targeting preschoolers focuses on building brand loyalty rather than promoting specific food items.

McDonalds' 13 websites get 365,000 unique child visitors ages 2-11 and 294,000 unique teen visitors ages 12-17 each month. Targeted marketing for fast food starts as young as age 2 through websites such as McDonalds' Ronald.com.

Hispanic preschoolers see 290 Spanish-language fast food TV ads each year. McDonald's is responsible for one-quarter of young people's exposure to Spanish-language fast food advertising.

African American children and teens see at least 50% more fast food ads than their white peers. McDonald's and KFC, in particular, specifically target African American youth with TV advertising, targeted websites, and banner ads.

African American children see nearly twice as many calories as white children see in fast food TV ads every day.

Frequently Asked Questions

What is this research about?
This is a comprehensive study of the nutrition and marketing of fast food to children. This report presents the nutrient quality of fast food, evaluates the products marketed to children as compared to those marketed to adults, quantifies young people's exposure to fast food marketing, and describes the various marketing practices used to reach children and their parents. The data collected for this report was from all of 2009 and the first six months of 2010.

Why are you only concerned with food marketing to children?
Due to their earlier state in cognitive development, children are more vulnerable to the influence of marketing. Children have a more difficult time than adults distinguishing between entertainment and marketing content on television. In addition, lifelong taste preferences and brand loyalties are being established in childhood. Hence, foods marketed to children should be held to a higher standard.

Why fast food?
Fast food plays a large role in the diets of young people. Fast food is the most unhealthy food product marketed to children, other than sugar-sweetened beverages, and is relentlessly and aggressively targeted toward them. Few fast food items meet healthy nutrition standards and there is concern about the impact of fast food consumption on young people's overall nutrition and health. Fast food companies spent more than $300 million promoting fast food to young people in 2006, which was more than any other food category (excluding carbonated beverages). The restaurants market their products to children extensively using the internet, social media, television, and in-store promotions.

How did you objectively determine what makes a healthy fast food item?
Central to this research is the evaluation of the nutrient content of more than 3,000 menu items offered by 12 fast food restaurants in the United States. We reviewed the scientific literature on how to score foods for their nutrition and believe that the most scientifically-validated system is the nutrient profiling system used in the United Kingdom. This nutrition profiling system was developed by Rayner and colleagues at Oxford University and is used by government in the United Kingdom to determine which foods can be marketed to children on television.

How did you choose the 12 fast food restaurants included in the analysis?
We included the ten restaurants with the highest sales in 2008 and 2009, as well as Domino's and Dairy Queen due to the large number of television advertisements seen by children for these restaurants. Sales for the 12 restaurants in our full analysis totaled $98 billion, representing 71% of sales for the top 50 restaurants. The restaurants in our analysis represent several segments of the fast food market including burgers, sandwiches, snacks, Mexican food, pizza, and chicken. The number of U.S. locations of these 12 restaurants totaled almost 100,000. These 12 restaurants comprised 41% of locations for the top 50 restaurants.

How did you assess all the ways that companies market to children?
We analyzed youth exposure and conducted content analyses of television advertisements, restaurant websites, fast food advertisements on other websites, social and viral media, radio advertising, and mobile marketing applications. We also commissioned an audit of marketing practices inside fast food restaurants across the United States, which documented the content of signage, pricing, and sales practices.

Young people's exposure to advertising for individual restaurants and products was documented using licensed syndicated media research data, including television ratings data from the Nielsen Company, data from comScore Media Metrix and Ad Metrix to document website and internet advertising exposure, and data from Arbitron to garner radio exposure.

How did you assess marketing outcomes (i.e. what children actually order and consume)? We conducted a survey of parents about what type of fast food purchases they made for their children. We also evaluated syndicated data from The NPD Group, a market research company, documenting menu item purchases. We combined the menu item purchases data with the nutrition data for restaurant menus to evaluate the nutritional quality of fast food purchases.

Does this study assess fast food restaurants based on nutrition or marketing?
Both. This research assesses the nutritional quality of fast food restaurant menus and documents the exposure and content of fast food advertising to children.

Which fast food restaurants have the healthiest kids' meal options?
Subway and Burger King have the greatest number of kids' meal combinations that meet all three nutrition criteria for young children. See our list of Best and Worst Kids' Meals.

How did you determine calories and sodium limits for each age group?
We based our nutrition criteria on the limits established by the Institute of Medicine for the National School Lunch Program. Averages across ages within each group were calculated to set reasonable limits for preschool, elementary, and older children.

Age group	Maximum calories per meal	Maximum sodium per meal (mg)
Preschool	410	544
Elementary	650	636
Older Children	700	720

For more information about these calculations, see the Fast Food FACTS report.

Isn't it obvious that food companies market to children? Why is this news?
For the first time, data from numerous sources, including exposure data from syndicated media research companies, content analyses, validated nutrition profiles, observed in-restaurant marketing practices, and data on menu item purchases have been brought together into a usable format for parents, researchers, and advocates. These are the same data sources used by the fast food industry and advertising agencies in their own research on marketing. The Fast Food FACTS report allows the public to see all of the ways fast food restaurants are marketing to children and learn more about specific restaurants.

What about food company pledges to be more responsible in how they market to children?
Through the Children's Food and Beverage Advertising Initiative (CFBAI) sponsored by the Council of Better Business Bureaus, many food marketers have pledged to reduce the marketing of the least healthy products to children. In the fast food sector, only McDonald's and Burger King are members of the CFBAI. Despite being members of the pledge, we found that McDonald's and Burger King advertise directly to children more than any other fast food restaurants. The average child in the U.S. views one McDonald's ad on television every day and one Burger King ad every two days. Since 2007, McDonald's and Burger King increased their television advertising to children by 26% and 11% respectively. These two restaurants also maintain the most frequently visited fast food advergaming sites on the internet.

What about restaurant efforts to make foods healthier?
Fast food restaurants have added some healthy options to their menus. For example, customers can order a chicken salad or grilled chicken sandwich with 600 calories or less and healthy NPI scores at most restaurants. Also, many restaurants promote healthy menus and offer fruit/vegetable sides and healthy beverages with kids' meals. Despite this, of the 3,000 menu items of the 12 restaurants in our analysis, just 17% were of good overall nutritional quality (i.e., would qualify as healthy according to NPI score) and did not exceed recommended calories and sodium for the average moderately active teen.

How was this study funded?
Support for this project was provided by grants from the Robert Wood Johnson Foundation and the Rudd Foundation.