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Food quality, policy, and advertisingIn the late 1970s, children in the USA ate 17% of their meals away from home, and fast foods accounted for 2% of total energy intake. By the mid-1990s to late-1990s, the proportion of meals eaten away from home nearly doubled to 30%, and fast food consumption increased five-fold, to 10% of total energy intake.151 From 1965 to 1996, per capita daily soft drink consumption among 11–18-year old children rose from 179 g to 520 g for boys and from 148 g to 337 g for girls.88 There are 170 000 fast food restaurants in the USA alone. These trends have been driven, in part, by enormous advertising and marketing expenditures by the food industry, including an estimated US$12·7 billion directed at children and their parents.152 Marketing campaigns specifically target children, linking brand names with toys, games, movies, clothing, collectibles, educational tools, and even baby bottles.152 By contrast, the advertising budget for the US National Cancer Institute’s “5-A-Day” programme to promote consumption of fruits and vegetables was $1·1 million in 1999.153 Large meals, often containing a child’s total daily energy requirements, can be purchased for little additional cost over smaller portions, whereas fresh fruits and vegetables tend to be less readily available and comparatively more expensive.154,155 Furthermore, fast-food and soft-drink vending machines pervade schools.152 That US children overconsume added sugar and saturated fat, and underconsume fruits, non-starchy vegetables, fibre, and some micronutrients, is therefore not surprising.88
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