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McDonald's disproportionately targeted children in poorer countries with social media advertising, a study found.

Across 15 official McDonald's Instagram accounts around the world, 14.5% and 12.4% of posts from September to December 2019 were targeted towards young app users in upper-middle-income countries and higher-income countries, respectively, as they featured a picture of a child or adolescent.

In comparison, 22.0% of posts were targeted this way to underage audiences in lower-middle income countries, Omni Cassidy, PhD, of NYU School of Global Public Health in New York City, and colleagues reported in .

Children and adolescents are gaining more weight during the COVID-19 pandemic; the estimated proportion of U.S. kids with obesity rose from 19.3% in August 2019 to 22.4% in August 2020, according to estimates from the CDC.

McDonald's is the largest fast food chain in the world, and it operates in 118 countries with nearly 40,000 restaurants across the globe. McDonald's has official Instagram accounts in 62 countries, according to Cassidy's group.

"Exposure to fast food ads through social media may place vulnerable groups -- particularly those in lower-income countries -- at increased risk for obesity and diet-related chronic conditions," the study authors wrote. "By targeting certain subsets through child-targeted ads and price promotions, McDonald's social media ads may exacerbate healthcare issues in the most vulnerable countries in the world."

Cassidy and colleagues found that the promotion of healthy habits was generally low across McDonald's country-specific Instagram accounts, though accounts for richer countries were more likely to portray healthy habits. have also shown that fast food companies tend to advertise healthier products in wealthier countries compared to in lower-income countries, the authors said.

On Instagram, McDonald's marketing tactics for lower-middle income countries featured more frequent posts, free giveaways, and price promotions.

In contrast, the company relied more on celebrity and influencer endorsements in richer countries. However, this finding could have been skewed by the high use of celebrity endorsements in South Africa in particular, where 93.3% of posts included such an endorsement, the study authors said.

The present study looked at 849 posts from McDonald's Instagram advertising from September to December 2019 for 15 countries. The countries were grouped by 2019 World Bank classifications:

• Higher-income countries: the U.S., Australia, Canada, the U.K., United Arab Emirates, Portugal, and Panama
• Upper-middle-income countries: Romania, Lebanon, Malaysia, Brazil, and South Africa
• Lower-middle income countries: Indonesia, Egypt, and India

Instagram accounts had, on average, 2.1 million followers each for those targeting lower-middle income countries, 3.5 million for those targeting upper-middle-income countries, and 4.4 million for those targeting higher-income countries.

The study sample represented approximately 25% of all McDonald's official Instagram accounts. As such, Cassidy and colleagues acknowledged a major limitation of their study was uneven sampling, meaning that the data may not be extrapolated to represent all countries with McDonald's.

They also noted that McDonald's chains operate differently in various countries.

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