Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: We agree with Dr Cheng that fast
food may be contributing to the rapidly increasing prevalence of childhood
obesity in China and perhaps other developing nations as well.1
Dr Pisarik addresses 2 points. First he compares energy intake between
the lean and overweight subjects in our research (study 2) and concludes that
the overweight adolescents compensated for excess energy intake on fast food
days by eating less on non–fast food days. As we discussed in the article,
we believe that direct comparison of energy intake between groups is problematic
because of the well-recognized phenomenon of underreporting among overweight/obese
participants.2,3 Our comparison
between studies provides evidence that this effect was present in study 2.
Regarding Pisarik's second point, we agree that the standardized feeding protocol
in study 1 did not fully mimic a usual food court experience. However, we
note again that the dietary composition, marketing practices, and pricing
structure of fast food are specifically designed to foster a maximum of energy
consumption in a minimum of time.
Ebbeling CB, Ludwig DS. Compensation for Energy Intake From Fast Food Among Overweight and Lean Adolescents—Reply. JAMA. 2004;292(11):1304. doi:10.1001/jama.292.11.1304-c