The globally-renowned American fast food company, McDonald’s, has reportedly been using social media advertisements and price-based promotions to target children in lower-middle-income, developing countries. This “youth-oriented marketing” has serious ramifications on nutritional deficiencies in these countries, according to a new research.

Published in BMJ Nutrition Prevention and Health on Thursday, the study looked at advertising strategies used across 15 countries, including India, between September to December 2019.

The researchers divided these countries where McDonald’s operates into three income-based categories: “high income,” comprising the U.S.A., the U.K., the U.A..E., Australia, Canada, Portugal, and Panama; “upper-middle-income” that consists of Romania, Lebanon, Malaysia, Brazil, and South Africa; and “lower-middle-income,” which includes Indonesia, Egypt, and India.

The findings painted a disjointed picture. The researchers found that McDonald’s invested 154% more to market their food in lower-middle-income countries, compared to their higher-income counterparts. To put the number into perspective: in lower-middle-income countries, one in five social media posts promoted McDonald’s food; But in wealthier countries like the U.S., this proportion was one in eight.

“With access to healthy, nutritious food options already a challenge in many of these countries, the youth-focused marketing tactics may worsen existing public health problems there,” the researchers said. In India itself, more than 33 lakh children are malnourished, according to latest statistics. Access to affordable nutritious food, pre-existing illnesses, maternal care, education level, and many other dimensions work in tandem to form a public health crisis.

“This study offers early, but crucial, insights into the impact of advertising, a relatively neglected area of nutritional research,” nutritional advocate Sumantra Ray, executive director of the NNEdPro Global Center for Nutrition and Health in the U.K., who was not part of the research team, said in a press release.

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We already know that fast food is bad for our mental health, cardiovascular health, can lead to premature aging, lower our vitamin D levels, and cause cancer — besides, of course, inducing obesity. Reportedly, items on McDonald’s menu — including their fries — are now higher in salt, calories, and sugar than they were 30 years ago.

An article on Eat This, Not That also explains that what makes fast food seem almost “addictive” is the “overload of sodium.” “Many fast-food chains add flavor to their food by piling on the salt, even on so-called healthy menu items… As such, you could be taking in 75% or more of the recommended daily sodium in just one meal,” Toby Amidor, a nutritionist from New York explained.

The impact of fast food, when mixed with technology, is thus concerning. “As social media use grows, fast food companies’ social media ads may have unprecedented effects on dietary options, especially in lower-income countries,” the researchers wrote.

The present report also pointed out how the fast-food giant may further endorse and influence people’s purchasing decisions. While only 14% of the posts by the fast-food giant consisted of price-based promotions and free giveaways in high-income countries, the number was as high as 40% in lower-middle-income countries.

“Price is a key component of a marketing mix and is often used to aid consumer purchases, particularly among lower-income communities who may use price as a decision point,” the researchers wrote. In other words, the marketing tactic of discounted food and “happy meals” may be insidiously exacerbating public health issues.

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A Europe-based survey from earlier this year had also shed light on other marketing tactics fast food chains employ. “Be it a fizzy drink dance challenge on Instagram, product placement of packets of crisps snuck in a video game, or an appealing fast-food ad near a playground, it is simply impossible for children to ignore ads pushing foods they should only be eating occasionally,” Monique Goyens, director-general of the European consumer organization, BEUC, had explained. “The omnipresence of such persuasive ads make it seem normal to drink soda like one would drink water or snack on a pack of crisps instead of an apple.”

Experts note that, basically, fast food ads are designed in such a way that they appeal to kids on an emotional level, and are, generally, entertaining too — resulting not only in children responding to them as intended but also sharing their experiences with their peers.

Moreover, in 2018, Public Health England’s chief nutritionist Alison Tedstone explained that retailers selling high-calorie foods as “treats” further encouraged overconsumption.

A 2016 report stated that “there is unequivocal evidence that childhood obesity is influenced by marketing of foods and non-alcoholic beverages high in saturated fat, salt and/or free sugars, and a core recommendation of the WHO Commission on Ending Childhood Obesity is to reduce children’s exposure to all such marketing.”