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"While reducing fast food is important to improve dietary quality, we [also] need to focus on the rest of the diet," said study researcher Jennifer Poti, a doctoral candidate in nutritional epidemiology at the University of North Carolina, Chapel Hill.
The children in the study who ate fast food were more likely to eat a typical unhealthy Western diet the rest of the day, Poti found.
Read: Fast food without the fat
The study, published in the American Journal of Clinical Nutrition, was supported by the Robert Wood Johnson Foundation and the US National Institutes of Health. No funding from the fast-food industry was involved.
The findings are a call for better overall nutrition education, said Connie Diekman, director of university nutrition at Washington University in St Louis. Diekman reviewed the findings but did not take part in the study.
Better nutrition education
"The fact that fast-food diners – especially adolescents – tend to choose nutrient-poor foods outside of the fast-food meal demonstrates the need for better nutrition education and a focus on the whole diet to meet health needs," Diekman said.
The researchers used 2007 to 2010 data from the US National Health and Nutrition Examination Survey. They studied nearly 4 500 US kids aged 2 to 18. The children or their parents completed two different 24-hour food-recall diaries, describing what they ate and drank.
Half of the children ate fast food, with nearly 40% of kids eating up to 30% of their total calories from fast food. About 10% of the children consumed more than 30% of their calories from fast food.
Read: Is fast food addictive?
Fast food not entirely off hook
The strongest link the researchers found was between the remainder of a kid's diet and weight issues – not the fast food alone. The connection between the remainder of the diet and overweight or obesity held even after they took kids' physical activity into account, Poti said.
Of course, fast food isn't entirely off the hook, she said.
"Fast food is still a very important factor and associated with poor diet quality and overweight and obesity," Poti said. "When we think about trying to improve our child's diet, we need to think about all the places our kids eat, and encourage better choices."
More prudent diet plan
Among the children who got more than 30% of their calories from fast food and ate a Western diet – which includes more soda and salty snacks and less milk and fruit – the remainder of the day, 40 percent were overweight or obese, Poti said.
Meanwhile, 28% of those who did not eat fast food and followed a more prudent diet plan – a lower intake of soda and chips and higher consumption of milk and fruit – had weight problems.
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