Children who order a combination meal at fast-food restaurants are more likely to get a sugary drink that ups the meal's total calories, according to a new study.
Researchers found those beverages such as soft drinks, sweet tea and flavored milk add about 179 more calories to meals.
"Sugar-sweetened beverages are increasingly linked to health problems such as diabetes," said senior study author Dr Brian Elbel of the New York University School of Medicine.
"Any information we can find about why this high-risk group of kids is purchasing these drinks is important," he said. "We haven't had a great sense of who these kids are, especially at fast food restaurants."
The research team analyzed nearly 500 receipts and surveys collected in fast-food restaurants in New York City and in nearby Newark and Jersey City, New Jersy during 2013 and 2014. They found that 60 percent of the drinks bought for children were sugar-sweetened, and combination meals were more likely to include a sugary drink.
"It's always tough to get data on kids that represents the real world, and this was based on what kids are actually purchasing, not some experimental setting," Dr Elbel told Reuters Health. "We were surprised by the broad variety of purchase predictors we saw."
Male children and those above age 12 were more likely to get a sugar-sweetened beverage
In addition to ordering a combination meal, male children and those above age 12 were more likely to get a sugar-sweetened beverage and consume a higher number of calories and grams of sugar. Caregivers and parents who had a high school degree or less, bought the meal during dinner hours, and ate at the restaurant were also more likely to purchase sugary drinks for their kids.
"We know that families frequent fast-food restaurants often, and these places have highly caloric meals," Dr. Elbel said. "A preponderance of healthy food is not being purchased."
About 17 percent of children under age 19 in the U.S. are classified as obese by the Centers for Disease Control and Prevention. A major contributor to the recent growth in obesity has been increased calories, the study authors write September 15 in the American Journal of Public Health. The Dietary Guidelines for Americans recommend that children limit sugar intake to 10 percent of total calories, or about 120-180 calories.
"We're no longer fighting about whether children need to drink fewer sugary drinks. That's accepted," said Dr. Marlene Schwartz, director of the Rudd Center for Food Policy and Obesity at the University of Connecticut in Hartford, who was not involved with the study.
"The question now is finding the best way to do that," she told Reuters Health. "Based on this study, if parents substitute milk or water for the sugary drink, that eliminates almost 200 calories right there."