Objective To examine the impact of fast-food and full-service restaurant consumption on total energy intake, dietary indicators and beverage consumption. Design Individual-level fixed effects estimation based on two non-consecutive 24-hour dietary recalls. Setting Nationally representative data from the 2003–2004, 2005–2006, and 2007–2008 National Health and Nutrition Examination Survey. Participants Children aged 2 to 11 (N=4717) and adolescents aged 12 to 19 (N=4699) Main Outcome Measures Daily total energy intake in kilocalories, intakes of grams of sugar, fat, saturated fat and protein and milligrams of sodium and total grams of sugar-sweetened beverages (SSBs), regular soda and milk consumed. Results Fast-food and full-service restaurant consumption, respectively, was associated with a net increase in daily total energy intake of 126 kcal and 160 kcal for children and 310 kcal and 267 kcal for adolescents and higher intakes of regular soda (+74g and +88g for children and +163g and +107g for adolescents) and SSBs generally. Fast-food consumption increased intakes of total fat (+7–8g), saturated fat (+2–5g) and sugar (+6–16g) for both age groups and sodium (+396mg) and protein (+8g) for adolescents. Full-service restaurant consumption was associated with increases in all nutrients examined. Additional key findings were 1) adverse impacts on diet were larger for lower-income children and adolescents; and, 2) among adolescents, increased soda intake was twice as large when fast food was consumed away from home than at home. Conclusions Fast-food and full-service restaurant consumption is associated with higher net total energy intake and poorer diet quality.

This paper reports the final 24-month outcomes of a randomized controlled trial evaluating the effect of additional therapeutic contact (ATC) as an adjunct to a community-based weight-management program for overweight and obese 13-16-year-olds. ATC involved telephone coaching or short-message-service and/or email communication once per fortnight. Adolescents were randomized to receive the Loozit group program-a two-phase behavioral lifestyle intervention with (n=73), or without (n=78), ATC in Phase 2. Adolescents/parents separately attended seven weekly group sessions (Phase 1), followed by quarterly adolescent sessions (Phase 2). Assessor-blinded, 24-month changes in anthropometry and metabolic health included primary outcomes body mass index (BMI) z-score and waist:height ratio (WHtR). Secondary outcomes were self-reported psychosocial and lifestyle changes. By 24 months, 17 adolescents had formally withdrawn. Relative to the Loozit program alone, ATC largely had no impact on outcomes. Secondary pre-post assessment of the Loozit group program showed mean (95% CI) reductions in BMI z-score (-0.13 (-0.20, -0.06)) and WHtR (-0.02 (-0.03, -0.01)) in both arms, with several metabolic and psychosocial improvements. Adjunctive ATC did not provide further benefits to the Loozit group program. We recommend that further work is needed to optimize technological support for adolescents in weight-loss maintenance. Australian New Zealand Clinical Trials Registry Number ACTRNO12606000175572.

Objective To summarise the literature on the economic burden of physical inactivity in populations, with emphases on appraising the methodologies and providing recommendations for future studies. Design Systematic review following the Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines (PROSPERO registration number CRD42016047705). Data sources Electronic databases for peer-reviewed and grey literature were systematically searched, followed by reference searching and consultation with experts. Eligibility criteria Studies that examined the economic consequences of physical inactivity in a population/population-based sample, with clearly stated methodologies and at least an abstract/summary written in English. Results Of the 40 eligible studies, 27 focused on direct healthcare costs only, 13 also estimated indirect costs and one study additionally estimated household costs. For direct costs, 23 studies used a population attributable fraction (PAF) approach with estimated healthcare costs attributable to physical inactivity ranging from 0.3% to 4.6% of national healthcare expenditure; 17 studies used an econometric approach, which tended to yield higher estimates than those using a PAF approach. For indirect costs, 10 studies used a human capital approach, two used a friction cost approach and one used a value of a statistical life approach. Overall, estimates varied substantially, even within the same country, depending on analytical approaches, time frame and other methodological considerations. Conclusion Estimating the economic burden of physical inactivity is an area of increasing importance that requires further development. There is a marked lack of consistency in methodological approaches and transparency of reporting. Future studies could benefit from cross-disciplinary collaborations involving economists and physical activity experts, taking a societal perspective and following best practices in conducting and reporting analysis, including accounting for potential confounding, reverse causality and comorbidity, applying discounting and sensitivity analysis, and reporting assumptions, limitations and justifications for approaches taken. We have adapted the Consolidated Health Economic Evaluation Reporting Standards checklist as a guide for future estimates of the economic burden of physical inactivity and other risk factors. InTRODuCTIOnPhysical inactivity is a global pandemic. Every year, physical inactivity causes more than 5 million deaths 1 and costs billions of dollars to societies around the world.2 To date, many countries have developed national physical activity plans; however, few have been fully implemented. 3 The substantial gap between policy and implementation may be due to a lack of resources, cross-sectoral partnership and clear strategies. Public health responses to address the pandemic of physical inactivity remain inadequate, uncoordinated and underfunded. 3 Economic analysis is essential to bridging the policy-implementation gap, increasing politica...

Seroadaptive behaviors have been widely described as preventive strategies among men who have sex with men (MSM) and other populations worldwide. However, causal links between intentions to adopt seroadaptive behaviors and subsequent behavior have not been established. We conducted a longitudinal study of 732 MSM in San Francisco to assess consistency and adherence to multiple seroadaptive behaviors, abstinence and condom use, whether prior intentions predict future seroadaptive behaviors and the likelihood that observed behavioral patterns are the result of chance. Pure serosorting (i.e., having only HIV-negative partners) among HIV-negative MSM and seropositioning (i.e., assuming the receptive position during unprotected anal sex) among HIV-positive MSM were more common, more successfully adhered to and more strongly associated with prior intentions than consistent condom use. Seroconcordant partnerships occurred significantly more often than expected by chance, reducing the prevalence of serodiscordant partnerships. Having no sex was intended by the fewest MSM, yet half of HIV-positive MSM who abstained from sex at baseline also did so at 12 month follow-up. Nonetheless, no preventive strategy was consistently used by more than one-third of MSM overall and none was adhered to by more than half from baseline to follow-up. The effectiveness of seroadaptive strategies should be improved and used as efficacy endpoints in trials of behavioral prevention interventions.