As debate heats up about whether a McDonald's Happy Meal should include a toy or not comes shocking findings from a new study out of Yale's Rudd Center for Food Policy & Obesity about kids and fast food.

The new evaluation, the most comprehensive study of fast food nutrition and marketing ever conducted, shows fast food marketers target children across a variety of media and in restaurants.

And they're not marketing the healthy foods on the menu.

In addition, the study finds that restaurants provide largely unhealthy defaults for the side dishes and drinks that come with kids' meals.

The report's authors studied marketing efforts of 12 of the nation's largest fast food chains, and examined the calories, fat, sugar and sodium in more than 3,000 kids' meal combinations and 2,781 menu items.

Their evaluation of marketing practices revealed that the fast food industry spent more than $4.2 billion on marketing and advertising in 2009, focusing extensively on television, the Internet, social media sites and mobile applications.

Broken promises

"Despite pledges to improve their marketing practices, fast food companies seem to be stepping up their efforts to target kids," said lead researcher Jennifer L. Harris, Ph.D., M.B.A., director of marketing initiatives at the Rudd Center.

"Today, preschoolers see 21% more fast food ads on TV than they saw in 2003, and somewhat older children see 34% more,” said Harris.

According to the study, 40% of kids ages 2-11 ask their parents to go to McDonald's at least once a week. 15% of preschoolers ask to go every day.

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.

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.

This incessant advertising is working. 84% of parents with kids ages 2-11 reported taking their young child to a fast food restaurant at least once in the last week.

While fast food restaurant commercials may hawk healthy sides like apple slices and low-fat milk, the study found restaurants like McDonald's and Burger King serve french fries with kids' meals at least 86% of the time, and soft drinks at least 55% of the time.

Must be dipped

The healthy sides are rarely served as a default; they have to be requested.

Plus, it seems healthy foods never have a chance to be seen as tasty on their own. At McDonald's, where apple slices can be switched out for fries in a Happy Meal, they're routinely seen with a side of caramel sauce for "dipping." The idea the apples should be dipped in something is so strong, the slices are called "Apple Dippers."

The study finds unhealthy foods and beverages still dominate restaurant menus.

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

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

If that "large" cup is holding Coke, that's just over 509 calories for the drink alone.

Minorities targeted

Perhaps most troubling, the study found these companies target African American and Hispanic youth:

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.

Along with TV, the Internet is quickly becoming a way for fast food restaurants to market to children.

Targeted marketing for fast food starts as young as two years old through websites such as McDonalds'

McDonalds' 13 websites get 365,000 unique child visitors ages 2-11 and 294,000 unique teen visitors ages 12-17 each month.

Brand loyalty

The study found fast food advertising aimed at very young children, as young as two, tries to build brand loyalty rather than promoting specific food items in the hopes of hooking them young.

"Our results show that the fast food industry's promises to market less unhealthy food to young people are not enough," added study co-author Kelly Brownell, Ph.D., director and co-founder of the Rudd Center.  "If they truly wish to be considered partners in public health, fast food restaurants need to drastically reduce the total amount of marketing that children and teens see for fast food and the iconic brands that sell it."

For the study, researchers measured youth exposure to marketing and advertising messages from all restaurants by using syndicated data from The Nielsen Company, comScore, Inc., and Arbitron Inc. When this information was unavailable, independent studies were implemented, along with content analyses and audits inside the restaurants.

The report was supported by grants from the Robert Wood Johnson Foundation and the Rudd Foundation.

The detailed findings of this study will be presented in Denver today during the American Public Health Association's annual meeting.