Recommendations Summary

PWM: Fast Food Meal Frequency in Children and Teens 2015

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

  • Recommendation(s)

    PWM: Fast Food Meal Frequency in Children and Teens

    If the overweight or obese child or teen consumes fast-food meals, the registered dietitian nutritionist (RDN) should encourage reduction in the frequency of fast-food intake to less than twice a week. Limited evidence in populations eight to 16 years of age at baseline, suggests that higher frequency of fast-food consumption, particularly more than twice a week is associated with increased adiposity; BMI Z-score; or risk of obesity during childhood, adolescence and during the transition from adolescence into adulthood.  

    Rating: Weak

    • Risks/Harms of Implementing This Recommendation

      There are no potential risks or harms associated with the application of the recommendations.

    • Conditions of Application

      • Evidence for this recommendation is based on children eight to 16 years of age and may not apply to children in other age groups
      • While the recommendation is based on evidence analysis of a specific meal consumption (fast food), modification of the frequency and portion size of fast-food meals should be considered when developing the nutrition prescription.

    • Potential Costs Associated with Application

      There are no obvious costs associated with the application of the recommendations.

    • Recommendation Narrative

      The following evidence to support the recommendations are excerpted from the Nutrition Evidence Library (Dietary Guidelines Advisory Committee 2015):

      What Is the Relationship Between Eating Out and Take-away Meals and Body Weight in Children and Adults? (DGAC 2015)
      Conclusion: Among children, limited evidence from prospective cohort studies in populations eight years to 16 years of age at baseline suggests that higher frequency of fast-food consumption is associated with increased adiposity;  BMI Z-score; or risk of obesity during childhood, adolescence and during the transition from adolescence into adulthood. Grade: Limited
      Key Findings

      A total of seven prospective cohort studies (Bisset et al, 2007; Fraser et al, 2012; Haines et al, 2007; Laska et al, 2012; MacFarlane et al, 2009; Taveras et al, 2005; Thompson et al, 2004) examined the relationship between frequency of fast-food meals, or consumption of other types of meals and anthropometric outcomes: 

      • Six studies examined fast-food meals: Three studies indicated increased fast-food intake, particularly more than twice per week, was associated with increased risk of obesity,  BMI/BMI Z-score or body fat (Bisset et al, 2007; Fraser et al, 2012; Thompson et al, 2004); two found no association (Laska et al, 2012; MacFarlane et al, 2009); and one found no association in boys and a negative association in girls (Haines et al, 2007)
      • Two studies looked at a variety of non-fast-food meals away from home, using varying definitions of food establishments and meal types and reported mixed findings for a relationship with weight-related outcomes (Taveras et al, 2005; Thompson et al, 2004)
      • In adolescents transitioning to adulthood, one study found high baseline frequency of fast-food intake was associated with increased BMI Z-scores at five-year follow-up
      • Risk of bias ratings ranged from four of 24 to seven of 24, consistent with low to moderate risk of bias 
      • This body of evidence is small and results are inconsistent; however, a majority of studies found an association between increased fast-food intake and weight outcomes.

    • Recommendation Strength Rationale

      • The Academy of Nutrition and Dietetics (AND) and the Pediatric Weight Management Expert Work Group concurs with the Nutrition Evidence Library Dietary Guidelines Advisory Committee conclusion statement and grade (2015 DGAC Grade for Children and fast-food consumption: Limited). 
      • Methodological limitations include:
        • Generalizability is relatively good for this body of evidence, although Hispanic/Latino participants are not well-represented and only one relatively small study included children under the age of nine years 
        • Three studies used self-reported and parent-reported height and weight to assess outcomes and only three reported BMI Z-scores.
        • Studies used different means of defining food locations; standardization is needed 
        • There were no data on the composition of meals consumed and studies did not control for overall energy intake.

    • Minority Opinions