Parents Wildly Underestimate Children’s Calorie Intake

As a weight loss surgeon, I see more and more patients come to my office who are adolescents that are morbidly obese. There is a common denominator among them: they don’t eat at home, and they don’t cook.  They come in with their parents, and their parents have no idea what their kids are eating, and if they do- the have no idea how many calories are in the meals they are consuming.  So when a study presented last week at the annual meeting of The Obesity Society confirmed that parents tend to underestimate the calorie content in their kids’ fast food meals, I wasn’t shocked. This is similar to studies that have shown that adults underestimate calories in their own meals at  restaurants. But this is the first study to show how well parents estimate the calorie content of their kids’ fast food meals.

The new study involved 330 children (ages 3-15) and their parents. Of the group, 57 percent of the children were overweight or obese. The children were ethnically diverse – 33 percent black, 30 percent Hispanic, 19 percent white, 3 percent Asian, and 15 percent other or multiracial. The researchers visited 10 restaurants in each of four New England cities: three McDonald’s, three Burger King, two Subway, one KFC, and one Wendy’s. Each restaurant was visited six times at dinnertime.

The researchers found that many of the parents purchased “large” meals for their children; the average meal contained 733 calories, that is way more than they should be having for dinner. The parents thought the meals contained about 562 calories, still too many calories. Seventy two percent  if the parents underestimated the calorie content of their children’s meals, with 24 percent underestimating by more than 500 calories.

“There was an association between larger meals and larger underestimations, which may hold some promise for menu labeling”, said lead researcher, Jason Block, MD, of Harvard Medical School. Still, even with calorie labeling, a larger problem is when kids go to eat without parental supervision. The largest underestimation was at Burger King, followed by Subway, Wendy’s, and McDonald’s.

Many of the calories consumed at fast food restaurants are via sugar-sweetened beverages, in addition to fat laden fries. Kids age 2 – 19 consume about 7.2 trillion calories in sugar sweetened beverages per year. Other new research presented at the Annual Meeting showed that overweight kids who replaced their usual sugary beverages with water or other calorie-free drinks gained less weight than their peers who continued drinking sweetened beverages. In our previous post we show how that schools that have strict regulations about the food they sell children have less obesity and morbid obesity (click here).

While some estimate the cost of childhood obesity at about 3 billion per year, according to William Dietz, MD, PhD who is the Former Director of the Division of Nutrition, Physical Activity, and Obesity at the Centers of Disease Control and Prevention (CDC). Studies such as these highlight the importance of parent education in addressing and reversing this expensive and complex health threat. As a parent, this study is a wake-up call to all of us- we need to get kids out of the restaurants, and get them home where they can learn to cook, and learn an appreciation for food.

The idea that providing the nutritional content for food would help is a partial answer- a bigger answer, getting the kids to take charge, having them cook at home, learn about great food, local food, and getting the families out of the restaurants and into their own kitchens.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit

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Latest Comments

  1. Cathy in Ohio says:

    I agree with part of this. I’m not so sure it’s the eating out as much as just parents not monitoring what their kids eat, regardless of doing the eating, in or out. What I see every where I look is that families now consider things like snacks, (chips, cookies, candy) and soda pop, as being staples and they are in the home constantly. I started paying attention to this when I realized there were so many overweight kids and yet I was seeing many meals prepared that were not much different than when I was a kid or when I was raising my own kids, and yet I (and my siblings and my own children) were all of normal weight. But, we did not get snacks and certainly no soda pop except for very special occasions. I say that in all seriousness. I am 60 yo now and when we were kids I can still remember when “The Wizard of Oz” would be televised one night a year. It was a big production in our home as not only would we get to watch the movie but it would be one of those special events where we would get snacks (popcorn and potato chips) and also pop. It didn’t matter that the pop was one 12oz glass bottle split 3 ways. My mother was a great cook and she made home cooked meals everyday but they certainly were not low cal. We grew up on fried chicken, mashed potatoes, meatloaf, etc…..If families would just eliminate snacks and pop except for rare and special occasions it would certainly help obesity….We were allowed one candy bar a month and sometimes not even then. Exceptions were holidays when mom was a baking fool..

  2. Lynn says:

    I see lots of morbidly obese children and some of them should probably be placed in foster care for their own benefit. I guess that parents today are afraid to say “no” to excess snacks, second helpings, mindless eating, or setting limits on where kids go with their money to buy junk food. If the parents are also obese, it is same disciplinary challenge as parents who smoke and want to raise non-smokers. The “do as I say but not as I do” approach to parenting usually fails.

  3. Lynn says:

    To Cathy,
    I am 57 and not only was my mother strict about snacks but we climbed trees and ran around constantly. On my wedding day, I weighed only 87lbs and I was actually normal and healthy but was advised to gain weight for pregnancy. My sister and brother were also thin. My mother had a weight problem but did not want us to develop it and we were afraid of it from a very young age. We also did not want to give up playing in order to go in and eat. Food was for survival only.

  4. Lynn says:

    I recently read an article about a study that concluded that children under 12 actually take in more calories in sit-down restaurants than in fast food joints but that reverses itself in the teen years. That may be because teens eat fast food with other teens and the parents no longer supervise. Teens also don’t want to be lectured about bad health habits and parents who overeat appear to be hypocrites if they try to discipline their children’s food habits.
    If we want more parents to stay home and cook, we have to be more like the inhabitants of Quebec. At least the last time that I was there, most business closed at dinner hour for the night but ethnic food stalls and other food stores stayed open so that families on the way home from work could purchase food to cook. Department stores did not have evening hours; food stores and restaurants did.
    Holidays in America now cater to a large contingent who would rather be out shopping than home cooking and even if a family gets together, everyone is busy texting someone else. The food court in the mall is probably the vendor that gets the most business; after the electronics store.

  5. thedoc says:

    We lost a couple of generations of home cooks- and open more restaurants than grocery stores. Our grocery stores are filled with processed foods, and those of us lucky to get fresh from the farm to table are lucky indeed

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