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updated 11/8/2010 4:46:10 PM ET 2010-11-08T21:46:10

Despite promises from fast-food chains to change the way they market their meals to children, kids now see more ads for fast food than ever, researchers say.

And once children are in a restaurant, unhealthy foods overshadow healthy ones on the menu. In most cases, unhealthy foods such as french fries automatically come as sides with a meal, rather than the more healthy options, such as apples, that are shown in commercials.

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The researchers would like to see healthy foods and beverages become the default options for kids' meals, and would like fast-food advertising aimed at children to be regulated in ways that make a real impact, said study researcher Marlene Schwartz, the deputy director of the Rudd Center for Food Policy & Obesity at Yale University.

Such attention to fast-food content and advertising is important considering that every day, about one-third of American children are eating a fast-food meal, she said.

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"It’s a huge source of meals for kids, and that’s why we feel they need to be really looked at more carefully."

Advertising to kids

In recent years, fast-food restaurants such as McDonald's have pledged to advertise more foods that are "better for you" to children under 12, abiding by their pledge to uphold Children's Food and Beverage Advertising Initiative launched in 2006 by the Council of Better Business Bureaus.

But the researchers found the volume of fast-food ads children are seeing is increasing. And often, children are exposed to ads during TV programs, such as "American Idol," not considered to be kids' shows. These ads are not subject to any special regulation.

In 2009, preschoolers saw 21 percent more ads for McDonald's and 9 percent more for Burger King than in 2007, the researchers said. Preschoolers now watch three fast-food ads per day on average, and children ages 6 to 11 see three-and-a-half on average, they said.

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Ads aimed at preschoolers focus on building brand loyalty rather than touting healthy foods, the researchers said. Websites such as McDonalds’ Ronald.com are specifically targeted to preschoolers. The researchers used data from The Nielsen Company, comScore, Inc. and Arbitron Inc. to measure children's exposure to fast-food ads and marketing.

This advertising is proving effective in getting kids into restaurants. Online surveys found 40 percent of kids ages 2 to 11 ask their parents to take them to McDonald’s at least once a week, and 84 percent of parents report giving in to this request at least once a week, the researchers said.

And while some argue parents should learn to refuse their children's desires for fast food, "As a society, do we think it’s a good idea for unhealthy products to be marketed directly to children, and constantly put parents in a position of having to say no?" Schwartz said.

"What parents really need is for restaurants to really support their efforts to have their kids eat healthy foods, not undermine them by going directly to the children," she told MyHealthNewsDaily.

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Inside the restaurant

The study also found that on fast-food menus, healthy options are relegated to the sidelines.

When researchers went into 250 fast-food restaurants across the country, they found that 86 percent of the time, french fires were served with kids' meals, and 55 percent of the time, soft drinks were served, rather than healthier options such as apple slices or milk.

They also examined the calories, sugar, fat and sodium content of thousands of kids' meal combinations in 12 of the largest fast-food chains in the U.S.

Out of the 3,039 possible combinations, only 12 met standards set by the Institute of Medicine for school lunches for preschoolers, and only 15 met the standards for older kids. Most meals also contained at least half of the maximum recommended daily amount of sodium.

The best meal combination, in terms of meeting nutrition criteria, was the Subway Veggie Delite sandwich with wheat bread and no cheese, a side of apple slices and apple juice as a drink, the researchers said. This meal has 285 calories, and 295 milligrams of sodium.

In contrast, the worst meal nutritionally was KFC's popcorn chicken with a biscuit as a side dish, soda as a beverage and string cheese as a snack. This meal contains 840 calories and 1,610 milligrams of sodium.

All of the 15 healthiest meal combinations came from either Subway or Burger King, the study said. The worst 21 combinations came from Taco Bell, Wendy's, McDonald's, Sonic, KFC, Burger King and Dairy Queen.

While meals at other, non-fast-food restaurants may frequently exceed calorie and sodium recommendations for children as well, these restaurants do not market to children as heavily as fast-food restaurants do, Schwartz said. And children more often eat at fast-food restaurants than traditional, sit-down restaurants, possibly because the latter are more expensive, she said.

The study will be presented today at the American Public Health Association’s annual meeting in Denver.

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