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When I was a kid, McDonaldland wasn't a playground- it was a fictional place in Saturday morning TV ads. I was enthralled with those ads: the outrageous-looking puppets, the colorful sets, evoked a Disney-like magic. Unbeknown to 8 year-old me, McDonald's was sued by the producers of another Saturday morning program, H.R. Pufnstuf, because McDonaldland looked a lot like their show. McDonald's lost the suit, and its TV land disappeared. Then, as now, kids were bombarded by advertisements for toys and food. Ad makers realized that kids are easily swayed and could use them to get to the parents, who had the money. One of the earliest to realize this was Walt Disney himself, airing a TV show in 1954 called Disneyland. Besides cartoons and live-action dramas, every episode had updates on Disneyland itself, then under construction. The show built enthusiasm, and when Disneyland opened it was jam-packed, and remains so today. Parents' desire to have healthy kids, and the ad-created desire of kids to go to these colorful places to play and eat, creates a battleground at home. Parents want good nutrition for their children; children want to eat the really yummy stuff. Kids' weapons- perserverance, pleading, and whining. Parents' defense against this- authority, and knowledge that too much of a good thing is bad for children. However, this defense is undermined by the competing parental desire to please their kids and see smiles instead of frowns. The key to winning the battle is two-fold. First, know you're in charge. You can refuse to get caught arguing about where to go and what to eat. I would say to my kids, literally, "this is not an argument," shutting off discussion about eating out. You also have control of the wallet and the car. The second key is knowing the consequences of losing the battle. You want your kids to grow up, not grow wide. You don't want high-fat, low fiber diets that cause cramps and constipation. And the evidence is mounting that these diets in kids lead to premature high blood pressure, heart attacks, and strokes as adults. Besides the McDonaldland advertising campaign discussed above, as a kid I liked the food too. About once a year my parents would allow a quarter-pounder, fries, and a shake. It was delicious, and every store offered the exact same food and flavor. Thanks to manufacturing and food science, wherever we went, McDonalds' nationwide offered the same yummy menu. For instance, why are all McDonald's fries so tasty? Until 1990, it was because they were fried in oil and beef tallow. That year McDonald's bowed to public pressure to reduce the saturated fat in its food and switched to pure vegetable oil. To retain that beef flavor though, they added a manufactured, beef-flavored chemical. Uniform deliciousness isn't the only reason fast food has been so successful. It's also inexpensive. In 1948, the McDonald brothers, Dick and Mac, invented their "Speedee Service System," to make their California hamburger stand more profitable. This kitchen automation, designed to be operated by minimum-wage workers, cut food prep costs. Then under McDonald's empire builder Ray Kroc, the hyper-efficient kitchen was supported by central manufacturing of food products, delivered by 18-wheeler. "Dining out" was now an option affordable for every family, not just the rich, and not just once a year. Finally, fast food is successful because...it's fast. No waiting a half hour for your entree; burgers and fries are in the sack in minutes. These three advantages to fast food- speed, cost, and deliciousness, help explain why poverty and obesity go together. Most impoverished families I see in the Emergency Department are headed by single moms who often work two jobs. It's harder for them to spend the time and money to shop for and prepare home-made, healthy meals. Their kids love fast food, it's affordable and quickly available- meal is done! Obesity used to be a sign of wealth- only the wealthy could afford to eat too much. Now, the poor can also be obese, with the high-fat and sugar content of manufactured food. Their kids suffer the consequences- abdominal pain, constipation, diabetes, high blood pressure, and early risk of heart disease. So it behooves parents to take control of their kids' diets, to avoid ruining their bodies. As a kid, I loved eating at McDonald's, but only once a year. That's about the right amount!