WHAT'S KNOWN ON THIS SUBJECT:There are positive health benefits for children who consume ready-to-eat cereals for breakfast; however, cereal companies market their high-sugar products extensively to children, which causes concern that eating these products contributes to unhealthy levels of added sugar in children's diets. WHAT THIS STUDY ADDS:Results demonstrate the potential negative effects of serving high-sugar cereal to children and how it affects their consumption of cereal, added sugar, and fruit during breakfast. In addition, they demonstrate that children like and will eat low-sugar cereals as an alternative.abstract OBJECTIVES: To test (1) whether children will consume low-sugar ready-to-eat (RTE) cereals and (2) the effects of serving high-versus low-sugar cereals on the consumption of cereal, refined sugar, fresh fruit, and milk. PARTICIPANTS AND METHODS:Using an experimental design, we randomly assigned children (n ϭ 91) who were attending summer day camp to receive a breakfast that included either the choice of 1 of 3 high-sugar cereals (high-sugar condition) or low-sugar cereals (lowsugar condition), as well as low-fat milk, orange juice, bananas, strawberries, and sugar packets. Participants served themselves and completed a background questionnaire after eating. Researchers measured the amount and calories consumed of each food. RESULTS:In both conditions, children reported "liking" or "loving" the cereal they chose. Children in the low-sugar cereal condition consumed, on average, slightly more than 1 serving of cereal (35 g), whereas children in the high-sugar condition consumed significantly more (61 g) and almost twice the amount of refined sugar in total (24.4 vs 12.5 g). Milk and total calories consumed did not differ significantly between conditions, but children in the low-sugar condition were more likely to put fruit on their cereal (54% vs 8%) and consumed a greater portion of total calories from fresh fruit (20% vs 13%). CONCLUSIONS:Compared with serving low-sugar cereals, high-sugar cereals increase children's total sugar consumption and reduce the overall nutritional quality of their breakfast. Children will consume low-sugar cereals when offered, and they provide a superior breakfast option.

Summary What is already known about this subject Food and beverage advertising contributes to childhood obesity. Display advertising on children's web sites is a prominent technique used to promote food to children. Industry self‐regulation has not substantially improved food marketing to children in other media, such as television and food company web sites. What this study adds More than 3 billion display advertisements for food and beverages were viewed on popular children's web sites from July 2009 to June 2010. Three‐quarters of these advertisements promoted brands that food companies identified as healthier dietary choices to be included in child‐directed food advertising. However, 84% of these ads promoted products high in fat, sugar and/or sodium. Background Food marketing contributes to childhood obesity. Food companies commonly place display advertising on children's web sites, but few studies have investigated this form of advertising. Objectives Document the number of food and beverage display advertisements viewed on popular children's web sites, nutritional quality of advertised brands and proportion of advertising approved by food companies as healthier dietary choices for child‐directed advertising. Methods Syndicated Internet exposure data identified popular children's web sites and food advertisements viewed on these web sites from July 2009 through June 2010. Advertisements were classified according to food category and companies' participation in food industry self‐regulation. The percent of advertisements meeting government‐proposed nutrition standards was calculated. Results 3.4 billion food advertisements appeared on popular children's web sites; 83% on just four web sites. Breakfast cereals and fast food were advertised most often (64% of ads). Most ads (74%) promoted brands approved by companies for child‐directed advertising, but 84% advertised products that were high in fat, sugar and/or sodium. Ads for foods designated by companies as healthier dietary choices appropriate for child‐directed advertising were least likely to meet independent nutrition standards. Conclusions Most foods advertised on popular children's web sites do not meet independent nutrition standards. Further improvements to industry self‐regulation are required.

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