Advertising promotional food and beverage items on the outside windows and walls of restaurants is not an uncommon practice. Research indicates that this practice is more commonly utilized in low- income neighborhoods and that food products promoted are of low nutritional quality. Both groups had similar representations for breakfast foods, burgers, desserts and shakes, sides and snacks. When compared to high-income neighborhoods, low-income neighborhoods had a significantly higher representation for beverages and sugar-sweetened beverages. High-income neighborhoods had almost twice the amount of meals geared towards children (17.1%) compared to lowincome neighborhoods (9.3%). The findings of this study suggest the need to assess the level of exposure to (and subsequent purchases related to) external promotions of foods and beverages with low nutritional quality in low-income neighborhoods. Such findings can help inform future health promotion interventions and policy development, particularly in lower-income communities where nutrition-related chronic diseases are prevalent.

•    Fast food
•    Promotions
•    Low-income
•    Nutritional content

Basch C, Ethan D, Samuel L, Zagnit EA (2014) Nutritional Content of Meal Items and Beverages Promoted at a Popular Fast Food Chain in New York City. Ann Public Health Res 1(1): 1003.

NYC: New York City; SSBs: Sugar-Sweetened Beverages; mg: Milligrams; g: Grams; FDA: U.S. Food and Drug Administration; GRAS: Generally Regarded as Safe

It is not uncommon for fast food restaurants to display food and beverage promotional advertisements in the windows and on the outside walls of their stores. A frequently-used marketing strategy, outdoor signage that promotes food and beverages can boost product sales and influence a consumer’s decision prior to entering the restaurant. Accessibility to fast food restaurants, as well as the number of promotional advertisements, have been found to be high in low-income neighborhoods [1]. These neighborhoods have also been shown to have more fast food restaurants and fewer healthful food vendors than higher-income neighborhoods [2,3]. The number of fast food restaurants that are geographically situated within predominantly low-income areas have been identified as a contributor to the obesity epidemic in these communities [3,4].

The number of promotional advertisements found on the outside of fast food restaurants may contribute to higher rates of fast food consumption. Before entering these establishments, customers are encouraged to purchase greater quantities of processed food and beverages at a lower price (“two for one” or a large-sized drink for the price of a small). Individuals living in low-income neighborhoods may be more susceptible to manipulation by fast food restaurants than those in highincome areas where these restaurants are less prevalent and nutritious food options are more abundant. Evidence from past research suggests that the nutrition information displayed in the promotional advertisements found on the outside of fast food restaurants must be examined more closely. The present study therefore sought to analyze the nutritional content of foods and beverages promoted on the outside walls and windows of popular fast food chain store sites in New York City (NYC).

This study is ancillary to a larger study conducted in 2013 to determine the number of promotional products, pricing, and location of nutrition information in a popular fast food restaurant chain in New York City [5]. This study focused on the 2 highest-income boroughs (Staten Island and Manhattan) and 2 lowest-income boroughs (Brooklyn and Bronx) [6]. In total, 35 high and 35 low income stores were visited. At each store site, all promotions located on exterior windows and walls were recorded and nutritional information was garnered and analyzed from the company web site. Analysis involved the comparison of the nutritional content of the food being promoted (calories, percent of sugar-derived calories, total fat, saturated fat, trans fat and sodium contents). In addition, the nutrition content of meal items and beverages across the identified promotions from qualifying fast food restaurants across NYC was compared. We excluded all restaurants that had no promotions listed. In addition, all promotions for which nutritional information was not available were excluded. It should be noted that when promotions included multiple food items on an advertisement, all food items were included in this analysis. Therefore, this study contains fewer restaurants and significantly more promoted items than the original study [5].

Of the 70 stores visited, 10 were excluded for having no promotions or for having only promotions listed for which nutrition information was not available. Table 1 summarizes the proportion of different meal and beverage options promoted in low- and high-income neighborhoods. Both groups had similar representations for breakfast foods, burgers, desserts and shakes, sides and snacks, X2 (3) = 0.413, p >0.05. When compared to high-income neighborhoods, low-income neighborhoods had a significantly higher representation for beverages and sugarsweetened beverages, X2 (1) = 0.012, p <0.02. As compared to low-income neighborhoods (9.3%), high-income neighborhoods had almost twice the amount of meals geared towards children (17.1%) (p<0.02).

The nutritional information of the foods and beverages (computed per serving) are summarized in Table 2. Though slightly higher in the low-income neighborhoods, an independent t-test indicated no significant difference between the two neighborhood groups in terms of calories, sodium, fat, saturated fat and cholesterol contents of beverages promoted (p>0.05). For all other food options as well, no significant differences were observed between the two groups (p>0.05).

Fast food consumption is prevalent among Americans with adults consuming an average of 11.3% of their total daily calories from fast food during 2007-2010 [7]. Although most Americans believe that eating fast food is unhealthy, almost half report eating it weekly [8]. In both adults and children alike, fast food consumption increases with weight status [7,9]. Also, fast food consumption has been shown to be higher in younger populations and among non-hispanic blacks [7,10]. Although a recent analysis of fast food consumption among high- and low-income groups showed similar rates [7], the effects of fast food could further compound health conditions such as diabetes which are shown to be more prevalent in low-income groups [11]. Given fast food’s generally high levels of sodium, fat, sugar, and high-calorie content, frequent consumption can have deleterious effects on health and has been cited as a contributor to obesity [1,12,13]. Several of the promotional food and beverage products analyzed for this study were found to be high in these components.

Although no significant difference was found between the neighborhood groups for sodium and fats, it is nonetheless important to note their high amounts found across several of the food categories. The 2010 Dietary Guidelines for Americans recommends sodium intake for adult Americans not exceed 2300 mg/serving [14,15]. Except for the beverages and desserts and shakes groups, all other food categories were high in sodium. The average sodium level of individual products in these food categories was at least 43% of the 2300 mg/serving limit. The average sodium content in meals marketed to children was over 668 mg/serving representing over 44% and 35% of the maximum sodium intake recommended by the Institute of Medicine for children aged 1-3 years and 4-8 years, respectively [16].

Increased consumption of trans fat has been implicated as a leading risk factor coronary heart disease [17]. Within the study sample, the highest amounts of trans fats were found in burgers (1.4 -1.5 g/serving) and desserts and shakes (0.9 g/ serving). These values are higher than the FDA’s recommended threshold of 0.5 g/serving to declare a food as free of transfat [18]. Per a preliminary determination by the FDA in 2013, partially hydrogenated vegetable oils, a significant source of trans fats in processed foods would no longer be given a GRAS status (“Generally Regarded as Safe”) [17]. Such a ruling could effectively reduce the presence of trans fats in processed foods and prevent an estimated 7,000 deaths related to heart disease and 20,000 heart attacks each year [17].

Meals for children were promoted in both groups. More meals for children were promoted in the high-income group, but the same nutritional composition of meals for children was found in both income brackets. These foods provided almost half and more than a third of the recommended calorie intake for children aged 2-3 years (1000 kilocalories/day) and 4-8 years respectively (1200 kilocalories/day) [19]. In addition, it is recommended that saturated fat be limited to less than 10% of calorie intake [20]. Based on the recommended 1000 kilocalories for children aged 2- 3 years and 1200 kilocalories for those aged 4-8 years [19], our findings show that meals geared towards children exceeded these recommendations. In addition, these meals were found to be high in sodium, contributing 35-45% of the recommended sodium intake for children less than 8 years. This is of concern since researchers have found that children and adolescents who consume fast food tend to have diets of lower nutritional quality and also consume more total energy [21]. Advertising has been shown to play a role in their consumption of these foods: greater exposure to fast food advertisements (and lower prices) has been linked with increased fast food consumption by both children and adolescents [22-24].

A significant difference was found between groups in the proportion of beverages as well as the beverages that were sugar-sweetened (p <0.02) where a greater representation of both was found on the outside advertisements identified in the low-income group. Consumption of sugar-sweetened beverages (SSBs) has been linked with chronic diseases including obesity, type 2 diabetes, and coronary heart disease [25-28]. Further, research indicates that higher SSB consumption is correlated with lower socioeconomic status among both adults and children [21,29]. Although there are no recommended limits for sugar intake, foods that have more than 25% of their calories derived from sugar are considered nutritionally inferior [30]. The leading source of added sugar in the American diet, [31] SSBs in our study were promoted more heavily in communities with higher rates of chronic disease than their wealthier counterparts.

Limitations of the study include the limited time frame in which the data were collected, and it may be possible that the products promoted were seasonal in nature. In addition, not all products had nutrition information available. This study nonetheless offers insight into the nutritional composition of fast food products commonly promoted on the exterior walls and windows of a popular fast food chain within the study’s time frame. A growing body of research suggests that in low-income communities, consumption of and access to fast food restaurants may impact weight status and poor dietary practices, both of which can contribute to chronic disease [1,32]. Purposeful placement of outdoor fast food promotions can be viewed as a means of priming the target audience to purchase these products [33]. Our findings indicate that this practice occurred more among store sites in the low-income communities. Similar findings from a recent national study also found a higher prevalence of exterior fast food advertising in these communities versus more affluent ones [22].

Table 1: Proportion of meal and beverage options promoted low- and high-income neighborhood franchises of a fast food restaurant.

Table 2: Nutritional information (average per serving) of meal and beverage options promoted in low- and high-income NYC neighborhood franchises of a popular fast food restaurant.

In low-income communities, the “target audience” of fast food establishments is a population with high rates of nutrition-related chronic diseases. Exterior marketing of foods and beverages that are of low nutritional value may influence purchasing habits and increase consumption of these products. Of note in our findings, the window and wall promotions assessed did not provide nutrition information such as sodium and sugar content for advertised products. This suggests that customers who purchase these foods based on their advertised appeal may not be fully informed of nutritional content. For instance, customers may be positively influenced by a drink promotion but are unaware of added sugars and high-calorie nature of the drink. There is a need to assess the level of exposure to exterior promotions for products with low nutritional quality -- and related effects on purchasing habits -- in low-income neighborhoods. Such findings can help inform future health promotion interventions and policy development that support health literacy and informed purchasing, particularly in low-income communities where nutrition-related chronic diseases are prevalent.

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