In 2009, fast food restaurants agreed to include healthy foods in advertising targeted at children in order to combat the obesity epidemic in the US. Now, a new study examining children’s reactions to such ads suggests the healthy message is lost in unclear depictions of the foods.

It would be an easy mistake for anyone to make; a young girl watches a TV screen displaying peeled apple slices in what looks like a french fry container. Though the bit of cardboard has a small apple on the front, it is essentially a repurposed french fry box.

“And I see some… are those apple slices?” the girl asks. The researcher replies that she is unable to help her, that the young girl must say whatever she thinks she sees.

“I think they’re french fries,” the girl decides.

The research team, from Dartmouth-Hitchcock Norris Cotton Cancer Center in New Hampshire, presented children between the ages of 3 and 7 with images from fast food TV ads that appeared on the Cartoon Network, Nickelodeon and other cable networks aimed at children.

The ads aired between July 2010 and June 2011, after the fast food industry agreed to focus on healthier foods in marketing targeted at children.

The study, published in JAMA Pediatrics, reveals that up to one half of children did not recognize milk when they were shown images of it from McDonald’s and Burger King ads. Additionally, only 10% of the children determined the sliced apples in Burger King’s ads were apples and not french fries.

The implications of this study are important for children’s health, as the Centers for Disease Control and Prevention (CDC) reveal that childhood obesity has more than doubled in children in the US over the past 30 years.

And from 1980 to 2012, the percentage of children between the ages of 6 and 11 years old who were obese increased from 7% to 18%.

According to the CDC, childhood obesity has a range of instant and long-term health effects. For example, some immediate effects include high cholesterol or high blood pressure. Yesterday, Medical News Today reported that 1 in 3 children in the US has high cholesterol.

In the long term, obese children are more likely to become obese adults, putting them at risk for heart disease, type 2 diabetes, stroke and cancer.

Though it is a step in the right direction that fast food companies have agreed to include healthier foods in their ads, if the message is misleading, then what good does it ultimately serve in the fight against this public health epidemic?

Dr. James Sargent, lead study author and co-director of the Cancer Control Research Program at Norris Cotton Cancer Center, says:

Burger King’s depiction of apple slices as ‘Fresh Apple Fries’ was misleading to children in the target age range. The advertisement would be deceptive by industry standards, yet their self-regulation bodies took no action to address the misleading depiction.”

The team notes that of four healthy foods shown to the children, only McDonald’s apple slices were recognized as an apple product by a majority of them.

A video of the children in the study can be seen below:

Dr. Sargent and colleagues previously conducted a study that illustrated how big fast food chains build brand awareness by highlighting rewards in the form of toys or movie links, despite their own guidelines discouraging the practice.

“The fast food industry spends somewhere between $100 to 200 million dollars a year on advertising to children,” says Dr. Sargent. “Ads that aim to develop brand awareness and preferences in children who can’t even read or write, much less think critically about what is being presented.”

The authors conclude their study by noting that although televised fast food ads showing apple slices misled children, neither the government nor self-regulatory bodies took any action.

Medical News Today recently reported on a study that suggested obese teens with a high salt intake are at risk of accelerated cellular aging.