The prevalence of obesity among US youth is 17%.¹ Fast food intake is associated with obesity and the prevalence of fast food consumption is high among US youth. Data from the National Health and Nutrition Examination Survey (NHANES) in 2007–2008 showed that 33% of children aged 2–11 years and 41% of adolescents aged 12–19 years consumed fast food on a given day.² Among those who consumed fast food, the average daily energy intake from fast food was 576 kcal (31% of total energy intake) among children and 988 kcal (42% of total energy intake) among adolescents.² Furthermore, consuming meals at fast food or full-service chain restaurants is associated with poorer diet quality among youth because of the higher intake of calories, solid fat, sodium, added sugars, and sugar-sweetened beverages (SSBs).^3–5

The portion sizes of kids’ meals, which are specifically targeted to children, are generally smaller than restaurant meals targeted to adults. According to a report by the Center for Science in the Public Interest, 56% of the 50 chain restaurants that offer kids’ meal did not have even one meal that met the expert nutrition standards in 2012.⁶ In the more recent years, restaurant chains have been improving the quality of kids’ meals, such as providing healthier sides as the default option.⁷ For example, McDonald’s™ switched to apples in place of French fries, which increased the percent of children who received fruit with their kids’ meals from 28% in 2010 to 85% in 2013.⁸ Also, sales of soda among children decreased at McDonald’s™ once sodas were removed as the default drink from kids’ meals; soda sales were 56% of drink orders in July 2013–May 2014 and were reduced to 48% in July 2014–May 2015.⁹ In addition, all of the kids’ meals at Subway® restaurants include apple slices and apple juice or low-fat milk as default option, meeting the expert and industry nutrition standards.⁶

Most chain restaurants offer kids’ meal options and kids’ meals are heavily marketed to children.^7,10 Despite the availability and popularity of kids’ meals, no studies have looked at the prevalence of kids’ meal purchases and factors associated with kids’ meal purchases at the national level. Furthermore, there is no information on potential reasons for why parents purchase kids’ meals for their children, nor whether parents would be willing to purchase kids’ meals if the meal options were healthier. This information could be used to better understand current kids’ meal purchase patterns and to identify needs for intervention strategies to improve the quality of the kids’ meal. Therefore, the objectives of this cross-sectional study were to examine 1) the sociodemographic and behavioral characteristics associated with parents’ purchases of kids’ meals, 2) parents’ reasons for purchasing kids’ meals, and 3) parents’ willingness to purchase kids’ meals if more healthy options were available at fast food and chain restaurants.

Among the 1,147 parents included in the analytic sample, 51% of all parents (Table 1) reported purchasing kids’ meals during the past month. Kids’ meal purchases differed significantly by parental age and parental SSB intake (χ² tests, p<0.05). Specifically, the proportion of parents who purchased kids’ meals during the past month was highest among parents aged 18–34 years and those who consumed SSBs daily (Table 1).

The adjusted odds of purchasing kids’ meals were significantly higher among younger parents (OR=3.4 for parents aged 18–34 years and OR=1.63 for those aged 35–49 years vs. ≥50 y) and daily sugar-sweetened beverage consumers (OR=2.7 vs. none). Kids’ meal purchase was not associated with parents’ sex, race/ethnicity, education, income, marital status, region, weight status, physical activity, or smoking.

Among parents who purchased kids’ meals (n=463), the top three reasons for purchasing them were 1) my child asked for kids’ meals (48%), 2) I usually purchase kids’ meals for my child (42%), and 3) they had healthier sides like fruits or fruit cups (25%) (Figure 1). The two least commonly reported reasons for purchasing kids’ meals were 1) I saw in-store advertisements (e.g., posters) that highlighted kids’ meals, and 2) I saw out-of-store advertisements (e.g., commercials, billboards).

Among parents who did not purchase kids’ meals (n=677), 37% responded that they were willing to purchase kids’ meals if more healthy options were available in restaurants (Figure 2). Parents’ willingness to purchase kids’ meals if more healthy options were available in the restaurants differed significantly by parental age (χ² tests, p<0.05), but not by sex or race/ethnicity. The proportion of parents who were willing to purchase kids’ meals if more healthy options were available was highest (47%) among younger parents (18–34 years) (Figure 2).

In our sample, over half of US parents living with children 17 and under reported purchasing kids’ meals during the past month and those who were younger and consume SSB daily were more likely to purchase kids’ meals after adjusting for sociodemographic and behavioral characteristics. We found no differences by other characteristics often found to differ in nutrition behaviors including income, education, or race/ethnicity. To our knowledge, there is no information on the prevalence of kids’ meal purchases prior to our study, a previous study reported that 1 in 3 children aged 2–11 years and 2 in 5 adolescents aged 12–19 years consumed fast food on a given day.² We found that parents aged 18–34 years were 3.44 times more likely to purchase kids’ meal compared to those aged ≥50 years. It is possible that younger parents are more likely to have younger children who may be more attracted to kids’ meals than older children. It is possible that younger parents are more likely to have younger children who may be more attracted to kids’ meals than older children. Older parents may be more likely to have older children (e.g., preteens and teens) who buy their own food whereas younger parents are more likely to buy for their younger children. Further, the portion sizes of kids’ meal may be perceived to be too small for preteens and teens; thus, older parents may not purchase them. For example, NPD market research found that kids’ meals are the most common meals purchased by or for children age under 13 in fast food restaurants.¹⁰ Researchers found that age is correlated with SSB intake, with younger adults being higher consumers than older adults¹⁷ which may partially explain our findings.

In our study, parents reported purchasing kids’ meals because their child requested it or because they habitually purchased kids’ meals. Even though our study found that advertisements did not influence parents to purchase kids’ meals, body of evidence have shown that advertisements are often targeted towards children, which might encourage children to ask their parents for food items.^7,10,24–26 Experts have recommended that all foods and beverages marketed to children and adolescents aged 2–17 should support a diet that accords with the Dietary Guidelines for Americans in order to prevent obesity and risk factors associated with chronic diseases ²⁷ Yet, in 2008, 99% of 1,662 kids’ meal combinations¹⁸ and in 2012, 97% of 3,494 of kids’ meal did not meet the nutrition standards⁶ when compared to the Dietary Guidelines for Americans.¹⁹ Given that parents generally do not know how many calories are recommended for their child per meal²⁰ and people tend to underestimate calorie content of meals from fast food or chain restaurants²¹, improving dietary quality of kids’ meal combinations to meet the nutrition standards can benefit parents looking for healthier options for their children when eating out. In attempts to provide healthier options in restaurants, the National Restaurant Association (NRA) launched Kids LiveWell in 2011, a voluntary industry program committed to providing healthful children’s menu choices that meet qualifying nutrition criteria (e.g., 600 calories or less for full kids’ meals; ≤770 mg of sodium).²² Kids LiveWell aims to improve the dietary quality of kids’ meals by increasing nutrient-dense foods such as fruits and vegetables while reducing calories. At a single regional full-service chain restaurant, it was documented that the Kids LiveWell improved the dietary quality of kids’ meals without decreasing revenue by reducing the total calories children ordered by 63 kcals per meal (684 kcals vs 621 kcals), and increasing the frequency that healthy options were selected.²³ In our study, the offering of healthier sides such as fruits or fruit cups was third most common reason to purchase kids’ meals, which demonstrates how industry can meet consumer demands in a healthier way.

Among parents who did not purchase kids’ meals, the youngest parent group (18–34 years) was most willing to purchase kids’ meals if more healthful options were available. Young parents, often described as the “Millennials,” have been reported to be more focused on what their kids eat and demand healthy kids’ food when eating out.²⁸ It is possible that young parents purchase kids’ meals when they perceive them as a healthier choice when eating out. This rationale is partly supported by our finding that one of the top three reasons to purchase kids’ meal included ‘offerings of healthier sides such as fruits or fruit cups.’

To our knowledge, this is the first study to examine the prevalence of purchasing of kids’ meals among parents, parental characteristics associated with purchase of kids’ meals, reasons for the purchase, and desire for healthier meal options. However, this study has several limitations. First, our findings may not be generalizable to all US parents because a convenience sample of adults from an online consumer panel survey was used. However, data were weighted to match the U.S. Current Population Survey proportions for sex, age, household income, race/ethnicity, household size, education level, census region, metro status, and whether or not a respondent had internet access prior to joining the panel. Second, the SummerStyles data include self-reported information, which could be subject to recall and reporting biases. Third, no reliability or validity data is available on the instruments that were used to measure kids’ meals purchase. Fourth, our study measured recall of kids’ meals purchased by parents and not actual consumption of kids’ meals by their children. Lastly, our study only focused on lack of healthier options as the reason for not purchasing kids’ meals because of the potential public health benefit that consuming healthier kids’ meals would have. It is possible that there are other important reasons why parents do not purchase kids’ meals, such as: limited options that don’t appeal to their children, portion sizes that are too small for older children, pricing factors (e.g., cheaper to split an adult meal), or lack of ethnic food options in kids’ meal offerings. Future research exploring reasons for not purchasing kids’ meals can help understand parent’s desires in terms of kids’ meals and inform industry to make changes.

In conclusion, kids’ meal purchases were somewhat common; about 1 in 2 US parents living with children aged 17 y and under reported purchasing kids’ meals in the past month. Younger parents and parents who consumed SSB at least once a day were more likely to purchase kids’ meals in fast food and chain restaurants. Nearly half of parents who purchased the meals, purchased them as a result of their children’s request and more than one third of parents who did not purchase the meals were willing to purchase kids’ meals if more healthy options were available. Our findings suggest that intervention efforts to improve quality of kids’ meals may benefit both children’s health and industry profits because of the high prevalence of kids’ meal purchases and because a substantial proportion of parents were willing to purchase kids’ meals if more healthy options were available.