Fast Food For Children and Adolescents

28/7/2020 Fast food for children and adolescents - UpToDate
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Fast food for children and adolescents

Authors: Debby Demory-Luce, PhD, RD, LD, Kathleen J Motil, MD, PhD
Section Editors: Amy B Middleman, MD, MPH, MS Ed, Sanghamitra M Misra, MD
Deputy Editor: Alison G Hoppin, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jun 2020. | This topic last updated: Feb 19, 2020.
INTRODUCTION
Fast food restaurants or quick-service establishments are a common choice for purchasing food away from home
[1-3]. Socioeconomic trends, such as longer work hours, more women employed outside of the home, and a high
number of single-parent households have changed the way families obtain their meals [4-7]. As parents
experience busier lifestyles, they demand convenience for their family meals. The consumption of fast food is
fostered because of the quick service, convenience, good taste, and inexpensive prices relative to more
traditional home-style restaurants [8,9].
This topic review will discuss the epidemiology and nutritional consequences of fast food consumption in children
and adolescents, as well as influences that affect fast food intake and management strategies. Other dietary
habits among adolescents are discussed separately. (See "Adolescent eating habits".)
TERMINOLOGY
● Fast food – The term "fast food" is typically used to describe the type of food that was traditionally provided
at commercial, rapid-service restaurants such as McDonald's, Burger King, or Kentucky Fried Chicken. In
the past, most of the foods available at these restaurants were unhealthy, with excessive content of calories,
fat, and sodium (eg, burgers or fried foods, sugar-sweetened beverages, and sweet desserts). This is still
the case for many but not all items sold at this type of establishment. (See 'Concerns' below.)
● Healthy fast-casual food service – Fast-casual food service is sometimes used to describe fast-service
restaurants that typically market higher-quality, locally sourced and/or organic foods, with fewer highly
processed or frozen ingredients compared with traditional fast-food chain restaurants. Menus in these
restaurants often identify food selections that contain healthy fats and lower sodium content and provide
modest portion sizes; they often list nutritional information adjacent to selections.
● Junk food – "Junk food" is a colloquial term, typically used to describe food that is unhealthy because it is
high in calories from sugar or fat and low in components with nutritional value, such as dietary fiber, protein,
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vitamins, and minerals. The nutritional profile of these foods is sometimes described as "empty calories."
Junk food may include some high-protein foods, such as meat prepared with saturated fat. Most junk food is
highly processed.
These terms are used inconsistently, and there is substantial overlap between these categories. In particular,
many traditional fast food establishments have modified their menus by offering lower-fat items in addition to
traditional selections [10-12]. As a result, it is possible to order a healthier meal that provides a good supply of
nutrients that children and adolescents need for growth and development [13]. Conversely, some items available
at "healthy" fast-casual food service establishments are high in calories, fat, and sodium, similar to traditional
"fast food." Thus, it is important to educate children and their families to be alert to the nutritional content of
specific foods so that they can make healthier choices within any of the above categories. (See 'More nutritious
fast food choices' below.)
BACKGROUND
Epidemiology — The National Restaurant Association estimates that the average American eats out an average
of four times a week [14]. Approximately 33 percent of children and adolescents in the United States consume
fast food on a typical day, providing on average approximately 12 percent of daily calories, and intake increases
with age [15-17]. In the United States, more than 48 percent of today's food dollar is spent away from home, a
value that has almost doubled over the past 50 years [18-20]. In non-metropolitan areas, adolescents and
parents who live in towns with five or more fast food outlets were 30 percent more likely to eat fast food
compared with those in towns with no fast food outlets [21]. The influence of in-town fast food outlets on fast food
intake was strongest among families with low motor vehicle access. In contrast, fast food dining is less common
when families have closer proximity and easier access to supermarkets [22]. Consumption of fast food is
promoted by extensive advertising campaigns, including on social media, some of which target young children
[23-29].
Increases in fast food consumption have been reported in other countries [30-32]. Longitudinal studies conducted
among Chinese school-aged children show substantial increases in consumption of western-style fast food,
particularly among adolescents, based on data obtained from the 2004 and 2009 Chinese Health and Nutrition
Survey [33]. The increase in fast food consumption was observed among all age, gender, and family income
groups. Fast food consumption is high in childhood and increases in adolescence [34].
Adverse health consequences of frequent fast food consumption — Establishment of healthy eating
patterns in childhood is linked to a reduction in chronic diseases, such as obesity, coronary heart disease,
hypertension, type 2 diabetes, osteoporosis, and diet-related cancers later in life [35-41]. Conversely, frequent
consumption of fast food has adverse effects on nutrition because of excessive content of energy and fat and low
nutritional value [17,42-46]. Proximity to fast food restaurants is associated with higher rates of obesity in the
neighborhood [47]. Moreover, consumption of fast food is associated with other poor nutritional habits: Surveys
show that parents who reported purchasing fast food for family meals at least three times per week were
significantly more likely than parents who reported purchasing fewer than three fast food family meals to report
the availability of soft drinks and chips in the home [48]. Of note, the "empty calorie" content (low nutritional

value) of children's dietary intake from retail food stores and schools is similar to that of fast food restaurants. The
source of added sugar and fat from retail food stores and schools, including sugar-sweetened beverages, grain
desserts, pizza, and high-fat milk, was similar to that from fast food restaurants including high-fat milk beverages,
dairy desserts, french fries, and pizza [49]. More importantly, children from middle and low social class
backgrounds were more likely to report low intake of fruits and vegetables, given low exposure to supermarket
food sources and high exposure to fast food outlets [50].
Educational strategies — Fast foods are a way of life for many American families, and eliminating fast foods
may not be realistic. The challenge is to teach children and adolescents to make wise food choices when visiting
fast food establishments. This is an important issue since the establishment of healthy eating patterns in
childhood is linked to a reduction in chronic diseases, such as obesity, coronary heart disease, hypertension, type
2 diabetes, osteoporosis, and diet-related cancers later in life [35-41]. Healthful eating patterns for children over
the age of two can be achieved by consumption of a prudent diet that is moderate in total fat, saturated fatty
acids, and cholesterol and high in complex carbohydrates, fiber, calcium, and antioxidant nutrients such as
vitamins C and E and the carotenoids [51-53]. (See "Dietary recommendations for toddlers, preschool, and
school-age children" and "Dietary history and recommended dietary intake in children".)
To encourage children to learn healthy eating patterns, an important strategy is to limit children's exposure to fast
food marketing messages. Targeting schools in low-income, urban neighborhoods is particularly important
because of the increased availability of fast food restaurants in these areas [54]. Other strategies might include
avoiding television networks that air child-directed advertisements for children's fast food meals with the
collection of fast food meal toy premiums [55-57]. Active mediation of fast food marketing by parents can also
help to reduce fast food consumption [58]. Greater educational achievement by mothers is associated with
reduced fast food consumption in their children, suggesting that providing educational opportunities for women
may improve nutrition in their offspring [59]. One Australian study showed that children were more likely to
choose a healthier meal if the meal was advertised next to an appealing trailer for a movie [60].
NUTRITIONAL CONSIDERATIONS OF FAST FOODS
"Junk food" is a descriptive term commonly associated with fast food. Although "junk food" has negative
connotations, not all foods found in fast food restaurants contribute to adverse dietary lifestyles and eating habits.
One meta-analysis reported a mixed relationship between fast food restaurants and weight-related behaviors and
outcomes in children [61]. The extent to which fast foods influence the nutritional status of the child or adolescent
depends upon several factors [62]:
● The nutritive quality of the menu items

● The choice of menu items that comprise a meal
● The amounts consumed
● The frequency with which the meals are eaten
Concerns

Nutrient content — Many fast foods can be high in energy, total and saturated fat, added sugar, cholesterol,
and sodium and low in vitamins A and C, folic acid, fiber, and calcium [17,43,63-66]. This nutrient profile is
evident in traditional fast food meals such as a hamburger, french fries, fruit turnover, and soft drink; or fried
chicken, mashed potatoes with gravy, biscuit, and soft drink (table 1) [67]. Fat accounts for 45 to 55 percent of
calories in some fast foods (as compared with recommended fat content of 30 percent or less of total calories). In
a survey of fast food purchased at lunchtime from chain retailers in New York, only 1 in 36 meals purchased met
the US Food and Drug Administration's guidelines for "healthy" sodium levels (600 mg/meal) and one in five
meals exceeded the recommended daily limit for sodium (2300 mg) [68]. The average meal purchased contained
880 calories and 1750 mg sodium. In an analysis of 12 national fast food restaurants with over 5400 possible
"kids' meal" combinations, less than 1 percent met the Institute of Medicine recommended nutrition standards in
regard to fat, sugar, sodium, and whole grains for elementary school meals [69,70].
The findings from a national household survey among children highlight the nutritional effects of fast food
consumption [71]. Compared with children who did not eat fast food on a given day, children who did eat fast food
consumed:
● More total energy (2236 versus 2049 kcal/day)

● More total fat (84 versus 75 g/day)
● More total carbohydrates (303 versus 277 g/day)
● More added sugars (122 versus 94 g/day)
● More sugar-sweetened, carbonated beverages (471 versus 243 g/day)
● Less milk (236 versus 302 g/day)
● Less fiber (13.2 versus 14.3 g/day)
● Fewer fruits and non-starchy vegetables (103 versus 148 g/day)
Similar findings were noted in a longitudinal multicenter cohort study of female adolescents [63]. In this study,
increased frequency of fast food consumption was associated with increased intake of energy and sodium and
increased intake of total fat and saturated fat as a percentage of calories.
In a national study of adolescents, intake of milk, fruits, and vegetables were generally low and achievement of
recommended intake was less likely in youth who consumed fast food [42]. No relationships were seen between
fast food consumption and achievement of recommendations for grains, meats/beans, and oils. In this study, no
association was seen between adolescents' weight status and level of fast food intake.
Portion size — In response to health authorities' call to reduce portion sizes, fast food outlets have changed
the names for portion sizes for menu items and meals. For example, major fast food outlets have phased out
"super-sized," "biggie-sized," and "jumbo-sized" items; food items and meals are now available in "small,"
"medium," and "large." However, at point of ordering, customers are encouraged to upgrade smaller menu items
to larger sizes for a few cents more. Because of these marketing techniques, children and adolescents learn to
equate "volume" with "value." In addition, most fast food outlets have "specialty burgers" available with one to
four beef patties and additional bacon and cheese "extras." Energy, fat, and sodium consumption increases
substantially with the number of "extras." The choice of "large-size" or "specialty burgers" can significantly
increase the energy, fat, and sodium content of the meal. As an example, a large hamburger supplies 540 kcal
and 28 g of fat, compared with 250 kcal and 8 g of fat in a regular hamburger (table 1) [67]. Similarly, a large-size
order of french fries, large soft drink, and dessert can add up to an additional 1030 kcal. Such a meal can provide
1570 kcal and 62 g of fat, which is approximately 80 percent of total daily energy needs and 100 percent of daily
fat needs for a 13-year-old child [72,73]. Thus, the high energy density of a fast food meal tends to encourage
overconsumption [43,65]. Legislation to require labeling on menus describing calorie content at the point of
purchase is in place in several states, and national legislation is in progress [74]. As of May 2018, restaurant
chains with 20 or more locations in the United States were mandated to label their menus and menu boards with
calorie information [75].
Customers who purchase fast food exhibit somewhat more restraint when the energy content is revealed. In a
survey study of several fast food chains, customers purchased a mean of 827 calories per meal and 34 percent
purchased more than 1000 calories per meal [76]. When calorie information was posted at the point of purchase
at one fast food outlet, patrons who noticed the information purchased an average of 52 fewer calories than
those who did not notice the information. Similarly, in another study, 106 adolescents were asked to order dinner
from fast food menus and then order from fast food menus with calorie and fat information posted next to the
menu items. Although the majority (70 percent) of the adolescents did not modify their food-ordering behavior, 30
percent reduced calorie- and/or fat-ordering behavior [77]. Parents of young children also tend to respond to
nutritional information if it is provided on the menu. In a randomized trial, the energy content of the food ordered
by parents for their three- to six-year-old children was reduced by an average of 100 kcals when nutrition
information was provided on the menu [78]. A parent's selection of food for his or her child also correlates with
the parent's interest in and perceived empowerment about nutrition decisions [79].
The social context of most fast food meals also encourages overconsumption: Many fast food meals are
consumed while riding in the car or watching television. In this type of setting, children tend to overeat because
their attention is distracted and they are less aware of satiety signals [13].
Association with obesity — Fast food consumption may be particularly problematic for overweight
adolescents [80]. In one study of fast food consumption among lean (body mass index [BMI] ≤85th percentile for
age and sex) and overweight (BMI >85th percentile but <98th percentile) adolescents, both groups were
instructed to eat as much or as little as desired during a one-hour "extra-large" fast food meal [81]. In this setting,
both groups ingested a large amount of energy (mean energy intake 1652 kcal, or 62 percent of estimated daily
requirement). However, overweight adolescents consumed more energy (1860 versus 1458 kcal, or 66.5 versus
57 percent of estimated daily requirement). In addition, whereas lean adolescents had similar total energy intakes
on days during which they did and did not consume fast food (2575 versus 2622 kcal), overweight adolescents
had increased total energy intake on fast food days (2703 versus 2295). In another study, ready access to fast
food outlets was independently associated with an increased odds of diagnosed childhood obesity [82]. More
frequent fast food consumption was associated with higher BMI measures in children [34]. Another large study of
public school children in New York City found that living close (less than 0.25 mile or one-half block) to fast food
restaurants was associated with a higher risk of overweight or obesity compared with those living further away (3
percent difference) [83]. However, another study suggests that consumption of a Western diet is more strongly
associated with obesity and poor dietary outcomes than consumption of fast food itself [84]. Other studies have
suggested that the intake of fast food among children presenting for obesity treatment may not be associated
with the degree of obesity at baseline or the degree of weight loss during treatment [30,85].

MORE NUTRITIOUS FAST FOOD CHOICES
A steady diet of fast foods that is haphazard and that contains too much fat; too many calories; and too little fiber,
vitamins, and minerals can be unhealthy for children and adolescents [86]. However, an occasional fast food
meal can fit into an otherwise well-balanced diet. It is important to look at the overall diet quality rather than focus
on one food or one meal. Nutritional excesses or deficiencies should be compensated for at other meals [62].
General suggestions — Adolescents in focus groups report that the main barriers to making healthy nutritional
choices are taste preferences for less healthy foods and a lack of concern about personal health [87]. Although
eating out in fast food restaurants is a fact of life for many American families, clinicians and parents can be
powerful role models for their children and can teach them how to choose fast foods wisely [87-89]. The following
represent general recommendations:
● Fill in "nutrient gaps" from a typical fast food meal by healthy snacks at home. Offer fresh fruits, vegetables,
cheese and crackers, low-fat milk, calcium-fortified juices, and frozen yogurt as snacks. Making healthful
foods taste better, look better, and be more convenient is also important [87].
● Encourage portion control; educate adolescents that anything that equates with bigness such as "large,"
"extra," "double," or "triple" will be high in calories and fat. Recommend smaller portions, since a regular
serving is enough for most children, or sharing with a parent or sibling.
● Opt for whole-grain foods, fruits, vegetables, and calcium-rich foods.
● Enjoy eating out, be adventurous, and visit a variety of types of ethnic fast food restaurants. Try Mexican,
Asian, Italian, and seafood restaurants as well as those serving American fare. As with eating at home,
variety is the key to a well-balanced diet [67].
● When planning a fast food meal, try to choose an establishment that promotes healthier options at the point
of purchase. This practice encourages some restraint and may help children learn how to make healthier
purchases. (See 'Portion size' above.)
● Aim to remove the focus on individual foods as "good" or "bad." Instead, provide information on how to
evaluate the nutrient density of a food item. It is the total dietary intake that contributes to a healthy eating
plan [90,91].
Specific suggestions — By selecting foods that are naturally nutrient dense (lower in fat content and higher in
vitamins, minerals, and fiber) and a cooking method that does not add a large amount of fat, well-balanced meals
are available in an increasing number of fast food establishments (table 1) [13,92]. Because children and
adolescents tend to underestimate calorie content of their fast food choices, it may be helpful to choose fast food
establishments that post calorie information prominently at the point of purchase to encourage restraint and
informed purchasing by customers [76,93,94]. Unfortunately, although restaurant menu-labeling increased
parents’ nutrition information awareness, it did not decrease calories purchased by children or parents [95,96].
The following specific suggestions can be used to improve the nutritional quality of meals at fast food
establishments:

● Sandwiches
• Request single-patty hamburgers and grilled, charbroiled chicken (rather than breaded and deep-fried).
For deli sandwiches, select lean turkey or roast beef, which provide less than 30 percent of their energy
from fat. These meats are good sources of iron and zinc.
• Limit toppings such as cheese, bacon, and mayonnaise. Mayonnaise can add approximately 80 calories
(9 g of fat). Deli sandwiches made of lean turkey or roast beef (mustard only) provide less than 30
percent of their energy from fat. Low-fat extras such as lettuce, tomato, onions, mustard, and low-fat
salad dressings make healthy sandwich toppings.
• Select whole-wheat buns when possible to provide B vitamins and fiber.
● Alternative main dishes
• Try chili or soft tacos. Soft tacos have less fat than hard tacos because the tortilla has not been fried.
Chili is a good source of fiber, zinc, folic acid, and iron.
• Use salsa to add extra flavor; limit the use of high-fat sour cream and guacamole.
● Side dishes
• Choose a baked potato rather than french fries, but limit the use of butter, sour cream, bacon bits, and
shredded cheese. Baked potatoes provide vitamin C and fiber. Vegetables or chili are healthy choices
for toppings. If available, separate side dishes of steamed vegetables or fruit supply vitamins A and C
and fiber.
● Pizza
• Order thin-crust pizzas made with whole wheat, low-fat cheese, and vegetables or lower-fat meat, such
as ham or chicken. Higher-fat sausage or pepperoni should be avoided.
• Even with these adjustments, pizza is often a source of excessive calories. Check the calorie content of
the pizza and adjust intake accordingly.
● Salad
• Avoid large amounts of high-fat items, such as regular fat-containing dressing, bacon bits, and shredded
cheese.
• Assorted fresh fruits and vegetables or beans add extra fiber, vitamins, and minerals.
● Beverages
• Water (plain or sparkling) is a healthy option, particularly for adolescents who are overweight.
• Choose low-fat milk or yogurt shakes as substitutes for soft drinks. These dairy foods provide calcium
and vitamin D.

• Fruit juice provides folic acid and vitamin C, but intake should be limited (eg, one or fewer servings
daily) because it also has high sugar and energy content.
● Desserts – Select low-fat frozen yogurt cones or sundaes and fresh fruit [97]. Avoid fried pies, ice cream,
and cookies.
INFORMATION RESOURCES
It is possible to teach children and adolescents how to evaluate healthy food choices by allowing them to "order"
from the menus of their favorite fast food restaurants on the internet. It is important to compare the fast food
choices not only with other fast food options but also with dietary recommendations for children, especially for
energy intake (table 2A-B).
● The website ChooseMyPlate, from the United States Department of Agriculture, is an interactive tool that
presents guidelines for healthy eating, which are also summarized in a separate UpToDate topic review.
(See "Dietary history and recommended dietary intake in children", section on 'Terminology for dietary
standards'.)
● The website HealthyDiningFinder is a resource of healthier menu selections from 50,000 nationwide
restaurants. These selections emphasize lean protein, fruits, vegetables, and whole grains. Featured menu
items must meet specific nutrient criteria for calories, fat, and saturated fat. To be included, entrees must
have the following characteristics:
• Lean meats, fruits and/or vegetables, and 100 percent whole wheat.
• No more than 750 calories, 25 g fat, 8 g saturated fat. Side dishes, appetizers, and desserts must
contain no more than 250 calories, 8 g fat, and 3 g saturated fat. Foods lower in sodium and cholesterol
also are featured.
● The website Fast Food Facts provides a list of typical food selections from many of the common fast food
restaurants. Each food selection contains tables that show the relative amounts of dietary energy and fat, the
proportion of calories from fat in the particular item selected, or a comparison of several food items. In
addition, many fast food restaurants provide nutrition information pamphlets upon request. In this way, fast
foods are not necessarily seen as forbidden foods but, rather, some of the menu items are better choices to
make.
SOCIETY GUIDELINE LINKS
Links to society and government-sponsored guidelines from selected countries and regions around the world are
provided separately. (See "Society guideline links: Healthy diet in children".)
SUMMARY

● Frequent consumption of fast food has adverse effects on nutrition because of excessive content of energy
and fat and low nutritional value (table 1). Moreover, consumption of fast food is associated with other poor
nutritional habits. (See 'Introduction' above.)
● Because fast food is widespread in the United States and many other countries, eliminating fast food
consumption entirely is not a realistic goal for many families. Instead, the clinician should focus on reduction
in fast food intake by providing nutritional education and suggesting healthier alternatives to the individual
patient (table 1). (See 'Introduction' above and 'More nutritious fast food choices' above.)
● Common nutritional hazards of many fast foods are that they provide excessive energy (calories), total and
saturated fat, cholesterol, and sodium and are low in vitamins A and C, folic acid, fiber, and calcium. In
addition, portion sizes for many fast foods are in excess of typical caloric needs for most individuals, and
marketing techniques further promote excessive consumption by equating "volume" with "value." (See
'Nutrient content' above and 'Portion size' above.)
● Many fast food establishments now offer some items with improved nutritional value, in addition to traditional
selections. By selecting foods that are lower in fat content and higher in vitamins, minerals, and fiber, well-
balanced meals are available in an increasing number of fast food establishments. (See 'Specific
suggestions' above.)
● The clinician should provide general guidance to help their patients reduce the frequency and improve the
nutritional value of their fast food consumption. In addition, detailed nutritional information about fast food is
available through the internet, and the clinician can use these sites to review and discuss the patient's usual
fast food choices. It is important to compare the fast food choices not only with other fast food options but
also with dietary recommendations for children, especially for energy intake (table 2A-B). (See 'Information
resources' above.)
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97. Wardlaw GM. Contemporary Nutrition: Issues and Insights, 3rd ed, Brown & Benchmark Publishers, Dubuq
ue 1997.
Topic 5352 Version 21.0

GRAPHICS
Energy (calories) and fat content of fast food meals, comparing typical with healthier choices
Typical choices Healthier choices
Percent Percent
of of
Energy Fat Energy Fat
Menu item (serving size) energy Menu item (serving size) energy
(kcal) (g) (kcal) (g)
from from
fat fat
Pizza Hut [1]
Small cheese express hand- 510 18 31 Veggie Lover's small Thin 'N 200 6 25
tossed pizza (2 slices) Crispy pizza (2 slices)
Hershey's triple-chocolate 380 16 37 Cinnamon sticks (2 pieces) 160 4.5 25

brownie (1/6 th square)
Pepsi (20 fl oz) 250 0 0 Diet Pepsi (20 fl oz) 0 0 0
TOTAL 1140 34 30 TOTAL 360 10.5 30

[2]
McDonald's
Big Mac hamburger 540 30 50 Hamburger 250 8 28
French fries (large) 490 23 42 Side salad with low-fat balsamic 50 2 36

vinaigrette dressing
Baked apple pie 240 11 41 Apple slices (1 pack) 15 0 0
Coca-Cola (large) 290 0 0 Dasani water bottle 0 0 0
TOTAL 1560 64 41 TOTAL 315 10 32

[3]
Burger King
Double Whopper hamburger 980 65 59 Garden grilled chicken salad 320 14 38

with cheese
French fries (large) 430 19 40 Avocado ranch dressing 170 17 88
Hershey's ice cream sundae pie 300 18 53 Applesauce 50 0 0
Sprite (20 fl oz) 190 0 0 Unsweetened tea (20 fl oz) 0 0 0
TOTAL 1900 102 54 TOTAL 540 31 57

[4]
Kentucky Fried Chicken
Extra crispy chicken drumstick 500 35 63 Grilled chicken thigh 150 9 54

and thigh
Mashed potatoes with gravy 130 4.5 31 House side salad with light 30 0.5 15
Italian dressing
Chocolate chip cake (1 slice) 300 15 45 Chocolate chip cookie 120 6 45
Mountain Dew (20 fl oz) 270 0 0 No-calorie peach iced green tea 5 0 0
(20 fl oz)
TOTAL 1200 54.5 45 TOTAL 305 15.5 51
Data from:
1. Pizza Hut Interactive Nutrition Menu. Available at: https://m.nutritionix.com/pizza-hut/menu/premium/ (Accessed on April 9, 2020).
2. McDonald's Nutrition Calculator. Available at: https://www.mcdonalds.com/us/en-us/about-our-food/nutrition-calculator.html
(Accessed on April 9, 2020).
3. Burger King USA Nutritionals (October 2017). Available at: https://fastfoodnutrition.org/burger-king (Accessed on April 9, 2020).
4. Kentucky Fried Chicken Nutrition Calculator. Available at: https://www.kfc.com/nutrition (Accessed on April 9, 2020).
Graphic 116600 Version 3.0

Estimated caloric needs per day by age, gender, and physical activity level
Activity level
Age (y) Males Females
Sedentary* Moderately active ¶ Sedentary* Moderately active ¶
2 1000 1000 1000 1000
3 1000 1400 Δ 1000 1200 Δ
4 1200 1400 Δ 1200 1400 Δ
5 1200 1400 Δ 1200 1400 Δ
6 1400 1600 1200 1400
7 1400 1600 1200 1600
8 1400 1600 1400 1600
9 1600 1800 1400 1600
10 1600 1800 1400 1800
11 1800 2000 1600 1800
12 1800 2200 1600 2000
13 2000 2200 1600 2000
14 2000 2400 1800 2000
15 2200 2600 1800 2000
16 2400 2800 1800 2000
17 2400 2800 1800 2000
18 2400 2800 1800 2000
19 to 20 2600 2800 2000 2200
These estimates are based on Estimated Energy Requirements (EER) equations, using reference heights (average) and reference
weights (healthy) for each age-gender group. [1] For children and adolescents, reference height and weight vary. The estimates are
rounded to the nearest 200 calories. An individual's energy needs may be higher or lower than these average estimates.
* Sedentary means a lifestyle that includes only the light physical activity associated with typical day-to-day life.
¶ Moderately active means a lifestyle that includes physical activity equivalent to walking about 1.5 to 3 miles per day at 3 to 4 miles per
hour, in addition to the light physical activity associated with typical day-to-day life.
Δ Data published in 2014 suggests that estimates for energy requirements of active preschool-aged children are too high. This is because
new data suggests that physical activity levels for this age group are narrower than previously thought. [2]
References:
1. Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino
Acids. Washington (DC): The National Academies Press; 2002.
2. Butte NF, et al. Revision of dietary reference intakes for energy in preschool-aged children. Am J Clin Nutr 2014; 100:161.
Table data from: U.S. Department of Health and Human Services and U.S. Department of Agriculture.2015 – 2020 Dietary Guidelines for
Americans. 8th Edition. December 2015, appendix 2. Available at: http://health.gov/dietaryguidelines/2015/guidelines/

Recommended daily amount from each food group, by calorie level
Calorie level
Food group
1200 1400 1600 1800 2000 2200 3000
Grains* 4 ounces 5 ounces 5 ounces 6 ounces 6 ounces 7 ounces 10 ounces
Vegetables ¶ 1.5 cups 1.5 cups 2 cups 2.5 cups 2.5 cups 3 cups 4 cups
Fruits Δ 1 cup 1.5 cups 1.5 cups 1.5 cups 2 cups 2 cups 2.5 cups
Dairy ◊ 2.5 cups 2.5 cups 3 cups 3 cups 3 cups 3 cups 3 cups
Protein foods 3 ounces 4 ounces 5 ounces 5 ounces 5.5 ounces 6 ounces 7 ounces
* In general, 1 slice of bread, 1 cup of ready-to-eat cereal, or 0.5 cup of cooked rice, cooked pasta, or cooked cereal can be considered as 1
ounce equivalent from the grains group. At least one-half of these servings should be whole grains.
¶ 1 cup vegetables is approximately equal to 12 baby carrots or 1 large tomato. Because of high water content, a serving of lettuce must be
twice as large (1 cup of lettuce = 0.5 cup of other vegetables).
Δ 1 cup of fruit is approximately equal to 1 apple or banana, 2 plums, one-eighth melon, or 8 strawberries.
◊ Milk should be fat-free or low-fat after 2 years of age.
Data from: the United States Department of Agriculture "ChooseMyPlate" website, available at: www.choosemyplate.gov.

Contributor Disclosures
Debby Demory-Luce, PhD, RD, LD Nothing to disclose Kathleen J Motil, MD, PhD Nothing to disclose Amy B
Middleman, MD, MPH, MS Ed Grant/Research/Clinical Trial Support: Pfizer [Meningococcal serogroup B
vaccine]. Sanghamitra M Misra, MD Nothing to disclose Alison G Hoppin, MD Nothing to disclose
Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by
vetting through a multi-level review process, and through requirements for references to be provided to support the content.
Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence.
Conflict of interest policy

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NUTRITIONAL CONSIDERATIONS OF FAST FOODS

● The nutritive quality of the menu items

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● More total energy (2236 versus 2049 kcal/day)

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MORE NUTRITIOUS FAST FOOD CHOICES

● Opt for whole-grain foods, fruits, vegetables, and calcium-rich foods.

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• Select whole-wheat buns when possible to provide B vitamins and fiber.

● Alternative main dishes

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SOCIETY GUIDELINE LINKS

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14. National Restaurant Association. Rapid response. Available at: www.restaurant.org/pressroom/rapid_respo

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Topic 5352 Version 21.0

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Typical choices Healthier choices

Pizza Hut [1]

Hershey's triple-chocolate 380 16 37 Cinnamon sticks (2 pieces) 160 4.5 25

Pepsi (20 fl oz) 250 0 0 Diet Pepsi (20 fl oz) 0 0 0

TOTAL 1140 34 30 TOTAL 360 10.5 30

Big Mac hamburger 540 30 50 Hamburger 250 8 28

French fries (large) 490 23 42 Side salad with low-fat balsamic 50 2 36

Baked apple pie 240 11 41 Apple slices (1 pack) 15 0 0

Coca-Cola (large) 290 0 0 Dasani water bottle 0 0 0

TOTAL 1560 64 41 TOTAL 315 10 32

Double Whopper hamburger 980 65 59 Garden grilled chicken salad 320 14 38

French fries (large) 430 19 40 Avocado ranch dressing 170 17 88

Hershey's ice cream sundae pie 300 18 53 Applesauce 50 0 0

Sprite (20 fl oz) 190 0 0 Unsweetened tea (20 fl oz) 0 0 0

TOTAL 1900 102 54 TOTAL 540 31 57

Extra crispy chicken drumstick 500 35 63 Grilled chicken thigh 150 9 54

Chocolate chip cake (1 slice) 300 15 45 Chocolate chip cookie 120 6 45

TOTAL 1200 54.5 45 TOTAL 305 15.5 51

Graphic 116600 Version 3.0

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Sedentary* Moderately active ¶ Sedentary* Moderately active ¶

2 1000 1000 1000 1000

3 1000 1400 Δ 1000 1200 Δ

4 1200 1400 Δ 1200 1400 Δ

5 1200 1400 Δ 1200 1400 Δ

6 1400 1600 1200 1400

7 1400 1600 1200 1600

8 1400 1600 1400 1600

9 1600 1800 1400 1600

10 1600 1800 1400 1800

11 1800 2000 1600 1800

12 1800 2200 1600 2000

13 2000 2200 1600 2000

14 2000 2400 1800 2000