Where are kids getting their empty calories? The role of stores, schools, and fast food restaurants

Little is known about the contribution of stores, schools, and fast food restaurants to excess empty calorie intake for US children. This analysis studied children aged 2–18 years (n=22,103) from 5 nationally representative surveys of dietary intake to identify the top sources of empty calories for each location and to compare trends from 1994–2010 by location for these key food groups. The percent of total intake from empty calories at stores (33%), schools (32%), and fast food restaurants (35%) was not significantly different in 2009–2010. Sugar sweetened beverages (SSBs), grain desserts, high fat milk, pizza, and sandwiches were top sources of empty calories at all three locations. From 1994–2010, improvements occurred as the % empty calories in milk, pizza, fries, and SSBs decreased at schools and stores. SSBs from schools were lower in % added sugar than fast food SSBs as schools replaced caloric colas with fruit juice drinks. However, large increases in the % added sugar in school‐bought milk resulted in higher % empty calories for school compared to store‐bought milk across time. Fries from schools were higher in % solid fat than store‐bought fries, and school pizza was no better than fast food pizza in % empty calories. In 2009–10, schools resembled fast food restaurants in their contributions to empty calories; nevertheless, stores remain the major source of empty calorie intake (436 ± 8.4 kcal/d) for US children. Grant Funding Source : Funding for this study comes from the Robert Wood Johnson Foundation (Grant 67506) and the National Institutes of Health (R01 HL104580 and CPC 5 R24 HD050924).