A new analysis from the Yale Rudd Center for Food Policy & Obesity found that fewer than 1 percent of all kids meals at 18 fast food restaurants -- 33 out of 5,427 -- met the recommended nutrition standards set by the Institute of Medicine. Even worse, only 3 percent met the standards set by the food industry itself.
The number of possible kids meal combinations increased 54% since the Center first examined the issue in 2010, but there was no change in the number of combinations that qualified as healthy meals for elementary school-age children. Just some creative reshuffling, apparently.
However, the nutritional quality of specific items offered in some kids meals has improved. Most fast-food chains now offer at least one healthy side dish in their kids' meals (apple slices, carrots, string cheese). And three-quarters have increased healthy beverage options such as unsweetened tea, water and milk.
"To be honest, it was pretty disappointing," Jennifer Harris, director of marketing initiatives at the Center, who presented the new analysis, "Fast Food FACTS 2013," on Tuesday at the American Public Health Assn. meeting in Boston, told the Boston Globe. "Most of the main dishes in kids meals still have a lot of fat and sodium, so they're not healthy choices at all."
On the plus side, two-thirds of kids ordering McDonald's Happy Meals now get apple slices and a half-size serving of fries instead of a full serving of fries, since McDonald's made this the default option in 2011. (Hey kids, pssst ... you can request a full serving of fries instead of those dried-out apple slices and mini-fries.)
"People are creatures of habit, and they'll just continue ordering what they always have unless someone gives it to them automatically," Harris said. (And then when someone gives it to them automatically, they begin sobbing in the back seat.)
Walt Disney World theme parks also changed their default side dishes for kids' meals a few years ago, automatically providing carrots and milk and only replacing them with a soda and fries upon request from a parent (which about 40 percent of parents do).
Likewise, Subway offers yogurt and apple slices instead of chips or cookies as the default choices with their kids' sandwiches.
At the same time, most fast food restaurants stepped up advertising to children since 2010, and they aren't advertising their carrot sticks. In 2012, preschoolers saw 1,023 fast food ads -- 2.8 per day, according to the Yale report. Three-fifths of fast food restaurants also increased TV advertising to older children. McDonald's display ads for Happy Meals increased 63%, to 31 million ads monthly. Three-quarters appeared on kids websites, such as Nick.com, Roblox.com and CartoonNetwork.com. Fast food marketing via social media and mobile devices -- media that are popular with teens -- grew exponentially.
"Most advertising promotes unhealthy regular menu items and often takes unfair advantage of young people's vulnerability to marketing," Harris said.
The Center helpfully provides a list on its website of the 49 "best" fast-food options for kids at each fast-food chain, including McDonald's, Wendy's, Burger King, Subway, Arby's, Panera Bread, Jack N the Box, Chick-fil-A, KFC and Sonic. But even the "best" meals are highly processed and contain little fiber and nutrients. Only the top 26 selections "meet all nutrition criteria for elementary school-age children"; the rest merely "meet maximum calories for elementary school-age children."
The No. 1 best kids meal combination is Arby's offering of Kraft Macaroni and Cheese with apple slices and bottled water. (In fact, Kraft Mac & Cheese holds six out of the 10 top spots, which ought to tell you something.) Burger King's best meal is chicken nuggets with sweet and sour sauce. Also in the top 10 is Subway's Veggie Delite sandwich with no cheese on wheat bread (No. 7).
The Center qualifies its choices by saying, "Inclusion on the best list does not necessarily indicate that the meal is healthy, only that it is a relatively better choice from that restaurant." Faint praise indeed.
Then it ranks the worst kids meal combinations. The worst of the worst, coming in at No. 1, is McDonald's McDouble with fries and a Hi-C Orange Lavaburst. The meal weighs in at 880 calories (including 294 from saturated fat) and 1,085 milligrams of sodium. No. 2 is Sonic's Junior Deluxe Cheeseburger with tots and a Powerade Mountain Blast slush. Chicken nuggets from various fast-food chains hold four spots in the Top 10 Worst.
"Each of these combinations exceed multiple nutrition recommendations for children and are never a healthful choice," the researchers say.
Among the researchers recommendations are: limit advertising on children's TV networks and third-party kids websites; stop unfair marketing targeted to children, including ads that focus on promotions, not food; ensure that preschoolers are not exposed to fast food advertising; establish age limits on fast food marketing to youth via social media and mobile devices.
The report concludes: "There were some improvements, but they have been small, and the pace too slow," according to Marlene Schwartz, Rudd Center director. "Without more significant changes, we are unlikely to see meaningful reductions in unhealthy fast food consumption by young people."
Especially if they don't want to.
Want more Squid Ink? Follow us on Twitter or like us on Facebook, and follow Samantha Bonar at @samanthabonar.