The Happy Meal® Effect: The Impact of Toy Premiums on Healthy Eating Among Children in Ontario, Canada

“Toy premiums”, offered with McDonald’s Happy Meals ® , are a prominent form of food marketing directed at children. Two California jurisdictions recently implemented policies that only permit offering fast-food toy premiums with meals that meet certain nutritional criteria. The primary objective of the current study was to examine elements of this policy in a Canadian context and determine if children select healthier food products if toy premiums are only offered with healthier food options. The study also examined if the impact of restricting toy premiums to healthier foods varied by gender and age.

Methods

A between-groups experimental study was conducted with 337 children aged 6–12 years attending day camps in Ontario, Canada. Children were offered one of four McDonald’s Happy Meals ® as part of the camp lunch program: two “healthier” meals that met the nutritional criteria and two meals that did not. In the control condition, all four meals were offered with a toy premium. In the intervention condition, the toy was only offered with the two “healthier” meals.

Results

Children were significantly more likely to select the healthier meals when toys were only offered with meals that met nutritional criteria (OR=3.19, 95% CI: 1.89-5.40). The effect of pairing toys with healthier meals had a stronger effect on boys than girls (OR=1.90, 95% CI: 1.14-3.17).

Conclusion

Policies that restrict toy premiums to food that meet nutritional criteria may promote healthier eating at fast-food restaurants.

Key words: Obesity, nutrition policy, fast foods

Résumé

Objectifs

Les jouets offerts en prime avec les repas Joyeux Festin ® de McDonald sont une forme évidente de marketing alimentaire destiné directement aux enfants. Deux municipalités californiennes ont appliqué récemment des politiques qui interdisent d’offrir des jouets en prime, en restauration rapide, sauf avec des repas respectant certains critères nutritionnels. L’objectif principal de notre étude était d’examiner les éléments d’une telle politique dans le contexte canadien et de déterminer si les enfants choisissent des produits alimentaires plus sains si les jouets ne sont offerts qu’avec des options alimentaires plus saines. Nous avons aussi cherché à déterminer si les effets de la restriction des primes aux aliments plus sains variaient selon le sexe et l’âge des enfants.

Méthode

Une étude expérimentale intergroupe a été menée auprès de 337 enfants de 6 à 12 ans fréquentant des camps de jour en Ontario, au Canada. On leur a proposé l’un de quatre repas Joyeux Festin ® de McDonald dans le cadre du programme de déjeuner du camp: deux repas «plus sains» respectant les critères nutritionnels et deux repas ne respectant pas ces critères. Dans le groupe témoin, on a proposé les quatre repas avec un jouet en prime. Dans le groupe expérimental, le jouet n’a été proposé qu’avec les deux repas «plus sains».

Résultats

Les enfants ont eu significativement plus tendance à sélectionner les repas plus sains lorsque l’on n’offrait des jouets qu’avec les repas respectant les critères nutritionnels (RC=3,19, IC de 95 %: 1,89-5,40). L’association des jouets avec des repas plus sains exerçait un effet plus prononcé sur les garçons que sur les filles (RC=1,90, IC de 95 %: 1,14-3,17).

Conclusion

Les politiques qui restreignent l’offre de jouets en prime aux aliments qui respectent des critères nutritionnels peuvent favoriser une alimentation plus saine dans les restaurants rapides.

Mots clés: obésité, politique nutritionnelle, aliments de restauration rapide

Footnotes

Acknowledgements of Sources of Support: We would like to thank the Chaplin Family YMCA of Cambridge for their support of this study. This research was supported by a grant from the Propel Centre for Population Health Impact at the University of Waterloo, a Post-doctoral Fellowship Award funded by the Heart and Stroke Foundation of Canada and the CIHR/Training Grant in Population Intervention for Chronic Disease Prevention: A Pan-Canadian Program (Hobin, Grant #: 53893), a Canadian Institutes of Health Research New Investigator Award (Hammond), and a Canadian Cancer Society Research Institute Junior Investigator Research Award (Hammond).

Conflict of Interest: None to declare.

“McDonald’s” and “Happy Meal” are registered trademarks of the McDonald’s Corporation. “Coke” is a registered trademark of The Coca-Cola Company.

References

1. Tremblay M, Shields M, Laviolette M, Craig C, Janssen I, Gorber S. Fitness of Canadian children and youth: Results from the 2007–2009 Canadian Health Measures Survey. Health Rep. 2010; 21 (1):1–15. [PubMed] [Google Scholar]

2. Ball G, McCargar L. Childhood obesity in Canada: A review of prevalence estimates and risk factors for cardiovascular diseases and type 2 diabetes. Can J Appl Physiol. 2003; 28 :117–40. doi: 10.1139/h03-010. [PubMed] [CrossRef] [Google Scholar]

3. Franks P, Hanson R, Knowler W, Sievers M, Bennett P, Looker H. Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med. 2010; 462 (6):485–93. doi: 10.1056/NEJMoa0904130. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

4. Bowman S, Gortmaker S, Ebbeling C, Pereira M, Ludwig D. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics. 2004; 113 :112–18. doi: 10.1542/peds.113.1.112. [PubMed] [CrossRef] [Google Scholar]

5. Kant A, Graubard B. Eating out in America, 1987-2000: Trends and nutritional correlates. Prev Med. 2004; 38 (2):243–49. doi: 10.1016/j.ypmed.2003.10.004. [PubMed] [CrossRef] [Google Scholar]

6. French S, Story M, Jeffery R. Environmental influences on eating and physical activity. Annu Rev Public Health. 2001; 22 :309–35. doi: 10.1146/annurev.publhealth.22.1.309. [PubMed] [CrossRef] [Google Scholar]

7. Satia J, Galanko J, Siega-Riz A. Eating at fast-food restaurants is associated with dietary intake, demographic, psychosocial and behavioral factors among African Americans in North Carolina. Public Health Nutr. 2004; 7 :1089–96. doi: 10.1079/PHN2004662. [PubMed] [CrossRef] [Google Scholar]

8. Schmidt M, Affenito S, Striegel-Moore R, Khoury P, Barton B, Crawford P, et al. Fast-food intake and diet quality in black and white girls: The National Heart, Lung, and Blood Institute Growth and Health Study. Arch Pediatr Adolesc Med. 2005; 159 (7):626–31. doi: 10.1001/archpedi.159.7.626. [PubMed] [CrossRef] [Google Scholar]

9. O’Donnell S, Hoerr S, Mendoza J, Goh E. Nutrient quality of fast-food kids meals. Am J Clin Nutr. 2008; 88 :1388–95. [PubMed] [Google Scholar]

10. Kraak V, Pelletier D. The influence of commercialism on the food purchasing behaviour of children and teenage youth. Fam Economics Nutr Rev. 1998; 11 :31–41. [Google Scholar]

11. Brownell K, Horgen K. Food Fight: The Inside Story of the Food Industry, America’s Obesity Crisis, and What We Can Do About It. Chicago, IL: Contemporary Books; 2004. [Google Scholar]

12. Scholsser E. Fast Food Nation: The Dark Side of the All American Meal. New York, NY: HarperCollins; 2001. [Google Scholar]

13. Federal . Trade Commission. Marketing food to children and adolescents: A review of industry expenditures, activities and self-regulation, 2008. 2011. [Google Scholar]

14. Dietitians of Canada. Advertising of food and beverages to children: Position of Dietitians of Canada, December 2010. 2011. [Google Scholar]

15. Santa Clara County Board of Supervisors. An ordinance of the board of supervisors of the county of Santa Clara adding chapter XXII of division A18 to the County of Santa Clara ordinance code relating to toys and other incentives with restaurant food. 2011. [Google Scholar]

16. San Francisco Committee/Board of Supervisors. Ordinance amending Article 8 of the San Francisco Health Code by adding Sections 471.1 through 471.8, to set nutritional standards for restaurant food sold accompanied by toys or other youth focused incentive items. 2011. [Google Scholar]

17. Bernstein S. Fast-food industry is quietly defeating Happy Meal bans. 2011. [Google Scholar]

18. Elliott C. Assessing “fun foods”: Nutritional content and analysis of supermarket foods targeted at children. Obes Rev. 2008; 9 (4):368–77. doi: 10.1111/j.1467-789X.2007.00418.x. [PubMed] [CrossRef] [Google Scholar]

19. Harris J, Pomeranz J, Lobstein T, Brownell K. A crisis in the marketplace: How food marketing contributes to childhood obesity and what can be done. Annu Rev Public Health. 2009; 30 :211–25. doi: 10.1146/annurev.publhealth.031308.100304. [PubMed] [CrossRef] [Google Scholar]

20. Harris J, Schwartz M, Brownell K. Marketing foods to children and adolescents: Licensed characters and other promotions on packaged foods in the supermarket. Public Health Nutr. 2009; 13 (3):409–17. doi: 10.1017/S1368980009991339. [PubMed] [CrossRef] [Google Scholar]

21. Kovacic W, Harbour J, Leibowitz J, Rosch J. Marketing Food to Children and Adolescents: A Review of Industry Expenditures, Activities, and Self-Regulation. Washington, DC: FTC; 2008. [Google Scholar]

22. Institute of Medicine. Food Marketing to Children and Youth: Threat or Opportunity? Washington, DC: The National Academies Press; 2006. [Google Scholar]

23. McAlister A, Cornwell T. J Public Policy Marketing. 2011. Collectible toys as marketing tools: Understanding preschool children’s responses to foods. [Google Scholar]

24. Plain hamburger bun McDonald’s. Available at: https://doi.org/www.livestrong.com/thedailyplate/nutrition-calories/food/mcdonalds/plain-hamburger-bun/ (Accessed November 4, 2011).

25. 100% Wonder Whole Wheat Wraps. Available at: https://doi.org/www.livestrong.com/thedailyplate/nutrition-calories/food/wonder-bread/10025-whole-wheat-wraps/ (Accessed November 4, 2011).

26. Golley R, Hendrie G, McNaughton S. Scores on the dietary guidelines index for children and adolescents are associated with nutrient intake and socio-economic position. J Nutr. 2011; 141 :1340–47. doi: 10.3945/jn.110.136879. [PubMed] [CrossRef] [Google Scholar]

27. Int J Behav Nutr Phys Act. 2006.

28. Public Health Agency of Canada. Curbing childhood obesity: Federal, Provincial and Territorial framework for action to promote healthy weights. 2011. [Google Scholar]

29. CTV News. McDonald’s Happy Meals changing in US, Canada. 2011. [Google Scholar]

Articles from Canadian Journal of Public Health = Revue Canadienne de Sant e ́ Publique are provided here courtesy of Springer