Best and Worst Fast Food Kids' Meals

A new report suggests fast food is still unhealthy, adding to concerns about childhood obesity.

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A Happy Meal at McDonald's

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Even if you don't want fries with that kids' meal, chances are your fast food restaurant wants to give you some. Chains like McDonald's, Taco Bell, and Burger King offer unhealthy sides and drinks 84 percent of the time, in lieu of their more nutritious offerings like apple slices, yogurt, and juice. That's among the findings of a new analysis released Monday by researchers at Yale University's Rudd Center for Food Policy and Obesity, which examined fast food marketing and nutrition trends. The fast food industry has stepped up its efforts to reach children and teens, the researchers say: Last year, preschoolers saw 56 percent more ads for Subway, 21 percent more ads for McDonald's, and 9 percent more ads for Burger King than they did in 2007. And often, they're bombarded with images of snacks and desserts—children see more than two advertisements each day promoting unhealthy menu items.

The report adds weight to concerns about the childhood obesity epidemic. As fast food marketing campaigns become more aggressive, children are more likely to chow down on greasy fries and burgers, Rudd Center researchers say, which could take a toll on their waistlines. And childhood obesity isn't just a short-term problem: Obese teens are 16 times more likely than their peers to become severely obese by age 30, according to a study published today in the Journal of the American Medical Association. (Severe obesity was defined as a body mass index of 40 or greater; obesity was defined as a BMI of more than 25.) Severe obesity can lead to diabetes, hypertension, asthma, arthritis, and a shorter life, says senior author Penny Gordon-Larsen, a nutrition researcher at the University of North Carolina-Chapel Hill.

"It's very easy to eat a high-calorie, high-fat diet," she says. "We have so much food around—high-fat, high-sugar, tasty food that we need to be very careful of. Those foods are marketed well to people, and making healthier choices takes a lot more work."

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That's why California is taking steps to blunt the influence fast-food marketing can have by banning toys that come with kids' meals loaded with calories, fat, and sugar. Last week, San Francisco's Board of Supervisors approved an ordinance that would prevent fast food chains from offering toys with kids' meals, unless they contain less than 600 calories—no more than 35 percent from fat— and 640 milligrams of sodium. All meals would also be required to include fruits and vegetables. The legislation could become law in December.

Industry officials cite some chains' increasing emphasis on healthy options: "There can be no dispute that the restaurant industry has been committed to providing a growing array of nutritious offerings for children," Joy Dubost, director of nutrition and healthy living at the National Restaurant Association, said in a statement to reporters. "Numerous surveys show the increasing number of healthful options in kids' meals. And nutritious offerings in childrens' meals is the number one food trend in [fast food] restaurants."

The Rudd Center researchers analyzed the calories, fat, sugar, and sodium in more than 3,000 possible combinations that chains market as kids' meals. The meals were then ranked as "best" and "worst" based on guidelines set in 2009 by the Institute of Medicine, an independent advisory panel to the U.S. government. Preschool children should consume no more than 410 calories and 544 milligrams of sodium per meal, according to the IOM, compared to 650 calories and 636 milligrams of sodium for elementary school children, and 700 calories and 720 milligrams of sodium for older children. Only 12 kids' meal combos met the IOM's nutrition criteria for preschoolers, while 15 met the criteria for elementary kids. Another 20 combos met kids' calorie goals, but were too high in at least one area, like sodium, the Rudd researchers found. Just 36—or approximately 1 percent—of the kids' meal combos they examined qualified as "best," which the researchers ranked.