10 of the restaurants offered free refills only for soft drinks (Hurley and Liebman, 2004).

Children and youth aged 11 to 18 years visit fast food outlets an average of twice per week (Paeratakul et al., 2003), and this frequency is associated with increased intake of soft drinks, pizza, french fries, total fat, and total calories, as well as with reduced intake of vegetables, fruit, and milk (French et al., 2001b). In a study of 6,212 children and adolescents between the ages of 4 and 19 years of age participating in the CSFII, those who ate fast food consumed more total energy, more energy per gram of food (greater energy density), more total fat and carbohydrates, more added sugars, more sweetened beverages, less milk, and fewer fruits and non-starchy vegetables than those who did not consume fast food (Bowman et al., 2004). Adolescents aged 13 to 17 years were found to consume more fast food regardless of whether they were lean or obese. Moreover, obese adolescents were less likely to compensate for the extra energy consumed by adjusting their energy throughout the day than were their lean counterparts (Ebbeling et al., 2004).

Expanding Healthier Meals and Food Choices

Given these trends and data, full-service and fast food restaurants should continue to expand their healthier meal options and food choices—particularly for children and youth—through the inclusion of fruits, vegetables, low-fat milk, and calorie-free beverages among their offerings. It is also important for restaurants to expand options for healthier children’s meals, encourage parents to help their children make smarter eating choices, and remind parents of their rights as customers to substitute side dishes and customize meals to their satisfaction. Research is needed to monitor consumers’ and children’s responses to these expanded options.

Restaurants should also initiate a voluntary, point-of-sale, nutrition-information campaign for consumers. Meanwhile, in accordance with the recommendations of the Food and Drug Administration (FDA) Obesity Working Group’s recommendations (FDA, 2004), consumers at restaurants should be encouraged to request information about the nutritional content of complete meals, foods, and beverages offered and consequently be provided with accurate, standardized, and understandable details at the point of sale. This nutritional information should include total calories, fat, cholesterol, and fiber, together with instruction on meaningfully interpreting these values within the context of typical consumers’ total energy and dietary needs.

Nutrition labeling of restaurant meals and individual foods should take varying sizes or options into account and should be located near the price of the selections; this will ensure that the consumer is made aware of the

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