How well is the effort to improve fast food and offer more healthful alternatives to kids really working?
A new study by Yale University researchers is raising that question.
They say that while healthy options for kids are available, restaurant servers rarely mention them to parents.
Yale calls this new study the most comprehensive look yet at the nutritional content and marketing of fast food to kids.
The results are jarring.
Some key findings include: restaurants don't guide people to healthier choices, children's exposure to fast food ads is increasing and companies actively target African American and Latino youth.
Of the more than 3,000 possible combinations of children's meals at eight different fast food restaurants, only 12 met nutrition criteria set by Yale for preschoolers and only 15 for older children.
"It's possible to get a healthy meal at a fast food restaurant but it's very difficult. You have to go in, you have to know exactly what you're looking for and you have to take the initiative to ask for it," said Marlene Schwartz, deputy director at Yale University's Rudd Center for Food Policy and Obesity.
Researchers sent people into 250 fast food restaurants across the country and found that when customers asked for kids meals, servers offered them the choice of healthy sides like apples only 6 to 8 percent of the time at McDonald's Burger King and Wendy's.
Healthy drink alternatives like milk were offered by servers just 26 to 28 percent of the time at McDonald's and Burger King.
Undercover at Fast Food Restaurant
ABC News went to a McDonald's in New York City with a hidden camera and asked for a kids meal.
The cashier offered a choice of a healthier drink but did not offer the option of apples instead of fries.
In an ideal world, Schwartz hoped that parents would choose apples over fries when offered the choice.
A visit to four other McDonald's yielded similar results.
In a statement McDonald's told ABC News: "We are proud of our menu and remain committed to offering our customers a wide variety of quality food and beverage choices that meet their dietary needs and tastes."
The new study says the problems go well beyond the point of purchase.
Children today are being hit by a "relentless" marketing assault, according to the report, which found that preschoolers see almost three fast food ads a day and teens see almost five.
"If you think that this company is basically getting to your child three times every single day that's a lot of time that your child is being exposed to a message that you may not want them to have," said Schwartz.
As for the advertising, McDonald's says that 100 percent of its children's advertising in the U.S. features dietary choices that fit within the 2005 USDA dietary guidelines for Americans.
The National Restaurant Association says: "The restaurant industry has been committed to providing a growing array of nutritious offerings for children.... The increasing number of healthful options in kids' meals ... is the number one food trend in quick service restaurants."
For more information about the study, visit: Fast Food FACTS.