A bill to improve the nutritional value of fast food restaurant meals marketed to children—like McDonald's Happy Meals—could have a wide enough impact to reduce calories, fat, and sodium, according to a new study led by researchers at NYU Langone Medical Center.

The study, which will publish in the American Journal of Preventive Medicine online on August 31, includes collaboration from NYU College of Global Public Health, NYU Wagner Graduate School of Public Service, and NYU Steinhardt School of Culture, Education, and Human Development.

The "Healthy Happy Meals" Bill, proposed by New York City Council member Benjamin J. Kallos, who represents the Upper East Side of Manhattan and Roosevelt Island, would require that fast food meals marketed to kids using toys or other promotional items include a serving of fruit, vegetables or whole grain. They must also be limited to 500 calories or less, with fewer than 35 percent of calories coming from fat, fewer than 10 percent coming from saturated fat, fewer than 10 percent from added sugars, and fewer than 600 milligrams of sodium. The bill is currently being considered by the City Council, and is similar to legislation recently enacted in California

To identify whether the bill might make a public health impact on nutrition improvement and number of children reached, the researchers analyzed receipts collected in 2013 and 2014 from 358 adults, which included purchases for 422 children at multiple New York City and New Jersey locations of Burger King, McDonald's, and Wendy's, three fast food chains that market kids' meals.

Adults purchased on average 600 calories for each child, with 36 percent of those calories coming from fat, according to the findings. Over one-third of children ordered kids' meals, and 98 percent of kids' meals did not meet the nutritional criteria outlined in the proposed legislation.

If kids' meals meet the bill's criteria and children's orders do not shift, there would be a 9 percent drop in calories—representing 54 fewer calories—a 10 percent drop in sodium, and a 10 percent drop in percentage of calories from fat.

"While 54 calories at a given meal is a small reduction, small changes that affect a wide number of people can make a large impact," said Brian Elbel, PhD, lead author and associate professor in the Departments of Population Health at NYU Langone and at NYU Wagner. "Passing the bill could be a step in the right direction, though no single policy can singlehandedly eliminate childhood obesity."

"The policy's effectiveness will depend on whether the food industry attempts to neutralize it through marketing or other strategies," said Marie Bragg, PhD, co-author and assistant professor in the Department of Population Health at NYU Langone and at the NYU College of Global Public Health. "For example, the industry could remove children's meals altogether, forcing children to order the larger portions from the adult menu."

Dr. Bragg offered another approach: "Policymakers could consider broader restrictions on marketing, similar to legislation in Chile that banned any use of toy premiums in children's meals in 2012," she said.

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