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September 15, 2004

Compensation for Energy Intake From Fast Food Among Overweight and Lean Adolescents—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(11):1304. doi:10.1001/jama.292.11.1304-c

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.