Apple slices or french fries? The nutritional quality of food and beverage products promoted in fast food marketing to young people

Introduction: Exposure to fast food marketing is associated with higher BMI and poor diet quality among young people. In response to public health concerns, several large restaurant chains have introduced healthier menu options, including new items for children's meals. This presentation examines the impact of these changes, including the nutrition profile of products marked directly to young people, the techniques used to promote these healthy options in the restaurants, and the nutrition quality of items youth actually consume. Methods: We collected nutrition information for all menu items in the largest chains and conducted an audit of in-store marketing practices and pricing at 1,100 fast food restaurants. We engaged in mystery shopping to identify the default offerings for children's meals. Further, we obtained syndicated data to measure fast food products purchased by Caucasian, African American and Hispanic youth. The nutrition quality of products marketed and purchased were assessed using standardized systems, including the Healthy Eating Index and the Nutrient Profiling Model developed for the U.K. Food Standards Agency. Results: This analysis provides a comprehensive picture of the largest fast food marketers' relative efforts to promote energy-dense nutrient-poor foods versus healthier options to young people. It also documents the ultimate relationship between those efforts and the diet of young consumers. Discussion: Introducing healthier menu options is only the first step to improving the nutrition quality of fast food consumed by young people. Restaurants must also promote the healthy options at the point of purchase, offer them as the default item, and price them competitively.