Trends of Portion Size and Trends of Portion Size and Obesity: What Healthcare Obesity: What Healthcare

providers should know!providers should know!

Amalie ShanksAmalie Shanks

Advisor: Geza BrucknerAdvisor: Geza Bruckner

ObjectivesObjectives

Examine obesity trends Examine obesity trends Is the prevalence of obesity really increasing?Is the prevalence of obesity really increasing? How long has it been going up? How long has it been going up?

Examine portion sizesExamine portion sizes portion vs servingportion vs serving Portion trends Portion trends

Food compositionFood composition Just what are we eating? Just what are we eating?

Patient EducationPatient Education What are the most effective tools needed to help What are the most effective tools needed to help

achieve and maintain healthy weights?achieve and maintain healthy weights?

Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 1985BRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 1990BRFSS, 1990

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 2003BRFSS, 2003

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 2004BRFSS, 2004

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 2005BRFSS, 2005

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 2006BRFSS, 2006

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

PORTIONSPORTIONS

Portion: How much we serve ourselves Portion: How much we serve ourselves OR how much we consume of a particular OR how much we consume of a particular food in one sittingfood in one sitting

Serving Size: corresponds with the Serving Size: corresponds with the nutrition information that is listed on the nutrition information that is listed on the food label or at mypyramid.gov food label or at mypyramid.gov

THE PROBLEMTHE PROBLEM

PORTIONS DO NOT EQUAL OUR PORTIONS DO NOT EQUAL OUR SERVINGS SIZE!!SERVINGS SIZE!!

EX: one 20 oz cola=2.5 servings EX: one 20 oz cola=2.5 servings

140 calories 3-inch diameter

Calorie Difference: 210 calories

350 calories 6-inch diameter

BAGELBAGEL 20 Years Ago Today

Calorie Difference: 165 Calories

250 Calories 20 ounces

85 Calories 6.5 ounces

SODASODA20 Years Ago Today

COFFEECOFFEE 20 Years Ago

Coffee(with whole milk and sugar)

Today

Mocha Coffee(with steamed whole milk and

mocha syrup)

45 calories 8 ounces

350 calories16 ounces

Calorie Difference: 305 calories

20 Years Ago Today

270 calories 5 cups

POPCORNPOPCORN

630 calories11 cups

Calorie Difference: 360 calories

CHOCOLATE CHIP COOKIECHOCOLATE CHIP COOKIE

20 Years Ago Today

55 calories 1.5 inch diameter

275 calories3.5 inch diameter

Calorie Difference: 220 calories

Larger Portions Equals More Larger Portions Equals More CaloriesCalories

participants were served the same menu participants were served the same menu for 2 days over 3 weeks with only the for 2 days over 3 weeks with only the portion size changing portion size changing

served 100%, 150% or 200% of baseline served 100%, 150% or 200% of baseline amounts amounts

study indicated that with larger portion study indicated that with larger portion sizes the amount consumed increased sizes the amount consumed increased

(ROLLS et all)(ROLLS et all)

Burger, Kern, and Coleman (2007) Burger, Kern, and Coleman (2007)

College age students were allowed to College age students were allowed to select their own portion sizes select their own portion sizes

in 10 of the 15 items students served in 10 of the 15 items students served themselves, the portions served were themselves, the portions served were larger than serving sizes larger than serving sizes

Portion Size and PackagingPortion Size and Packaging

male and female participants an afternoon snack of chips varying in male and female participants an afternoon snack of chips varying in packaging of 1.5, 3, 4.5 or 6 oz bags with 11 oz of water to drink packaging of 1.5, 3, 4.5 or 6 oz bags with 11 oz of water to drink come back on the same day for dinner which consisted of pasta with come back on the same day for dinner which consisted of pasta with tomato sauce, parmesan cheese, tossed salad, dressing, bread, tomato sauce, parmesan cheese, tossed salad, dressing, bread, butter, bite size chocolate bars, chocolate chip cookies, and water butter, bite size chocolate bars, chocolate chip cookies, and water RESULTS: Energy intake increasedRESULTS: Energy intake increased

FemalesFemales1.5 oz snack and dinner-consumed 4448.8 +/- 20.6 kJ 1.5 oz snack and dinner-consumed 4448.8 +/- 20.6 kJ 6 oz snack and dinner -consumed 5044+/-181.1 kJ 6 oz snack and dinner -consumed 5044+/-181.1 kJ

MalesMales1.5 oz snack and dinner-consumed 5786.3 +/-298.5 kJ 1.5 oz snack and dinner-consumed 5786.3 +/-298.5 kJ 6 oz snack and dinner-consumed 6406.5+/-306.0 KJ6 oz snack and dinner-consumed 6406.5+/-306.0 KJ

Portion Size and PresentationPortion Size and Presentation

Wansink Soup StudyWansink Soup Studysoup was served to participants in either a soup was served to participants in either a normal 16 oz soup bowl or a 16 oz normal 16 oz soup bowl or a 16 oz REFILLABLE soup bowl REFILLABLE soup bowl those with refillable bowls consumed 73% those with refillable bowls consumed 73% more more Underestimation of caloriesUnderestimation of calories Non refillable bowls=32.3Non refillable bowls=32.3 Refillable bowls=140.5Refillable bowls=140.5

Ice cream studyIce cream study

Wansink 2006 gave participants a bowl and Wansink 2006 gave participants a bowl and spoon and then asked to serve themselves their spoon and then asked to serve themselves their own serving of ice cream. own serving of ice cream.

Given a 17 oz or 34 oz bowl and either a 2 oz or Given a 17 oz or 34 oz bowl and either a 2 oz or 3 oz spoon. 3 oz spoon.

Once they served themselves they were given a Once they served themselves they were given a questionnaire questionnaire How many calories and ounces was their serving, How many calories and ounces was their serving, How full was the bowl (0-100%)How full was the bowl (0-100%) Did the bowl and spoon differ from what they normal Did the bowl and spoon differ from what they normal

used? used?

RESULTS:RESULTS: Larger bowls served and ate 31% more than what Larger bowls served and ate 31% more than what

they had estimatedthey had estimated Smaller bowls on average thought that they had Smaller bowls on average thought that they had

served themselves 3.8% more than what they had served themselves 3.8% more than what they had actually served themselvesactually served themselves

Larger spoons also served themselves 14.5% more Larger spoons also served themselves 14.5% more regardless of the bowl size. regardless of the bowl size.

Participants more than likely judged the amount Participants more than likely judged the amount of food they were about to consume based on of food they were about to consume based on how full the bowl was and/or by how big the how full the bowl was and/or by how big the scoop was on the spoonscoop was on the spoon

Portion Size and Energy DensityPortion Size and Energy Density

Energy density is the “amount of energy in Energy density is the “amount of energy in a given weight of food (kcal/g)” a given weight of food (kcal/g)”

food with high energy density would have food with high energy density would have more fat in it such as cookies or candy more fat in it such as cookies or candy bars bars

food low in energy density would have food low in energy density would have more water in its make up such as lettuce more water in its make up such as lettuce or celery or celery

Energy Density and ObesityEnergy Density and Obesity

FATS VS FRUITS AND VEGGIESFATS VS FRUITS AND VEGGIESUsed data from 1994-1996 Continuing Survey of Food intakes by Used data from 1994-1996 Continuing Survey of Food intakes by individuals where interviewers took a 24 hour recall of foods individuals where interviewers took a 24 hour recall of foods consumed on 2 nonconsecutive days consumed on 2 nonconsecutive days Those who consumed more than 9 servings of fruits and vegetables Those who consumed more than 9 servings of fruits and vegetables per day had lower energy intake regardless of whether their diet per day had lower energy intake regardless of whether their diet was high fat or low fatwas high fat or low fatThose who had a high fat diet with more than 9 servings/day still Those who had a high fat diet with more than 9 servings/day still had a lower energy dense dietary intake when compared to had a lower energy dense dietary intake when compared to participants on a low fat diet with low consumption of fruits and participants on a low fat diet with low consumption of fruits and vegetablesvegetablesPrevalence of obesity within the high and low fat dietary groups Prevalence of obesity within the high and low fat dietary groups

Both high and low fat diets, obesity prevalence was greater than 10% in Both high and low fat diets, obesity prevalence was greater than 10% in those groups consuming <9 servings/daythose groups consuming <9 servings/day

Both high fat and low fat diets, obesity was less than 10% in those Both high fat and low fat diets, obesity was less than 10% in those consuming >9 servings/day consuming >9 servings/day

RecomendationsRecomendations

Educate between portion size and serving Educate between portion size and serving sizesize www.mypyramid.govwww.mypyramid.gov

Teach them to read food labelsTeach them to read food labels

Estimating Portion SizesEstimating Portion Sizes

1 cup of cereal = a fist 1 cup of cereal = a fist

1/2 cup of cooked rice, pasta, or potato = 1/2 cup of cooked rice, pasta, or potato = 1/2 baseball 1/2 baseball

1 baked potato = a fist 1 baked potato = a fist

1 medium fruit = a baseball 1 medium fruit = a baseball

Estimating Portion SizesEstimating Portion Sizes

1/2 cup of fresh fruit = 1/2 baseball 1/2 cup of fresh fruit = 1/2 baseball

1 1/2 ounces of low-fat or fat-free cheese 1 1/2 ounces of low-fat or fat-free cheese = 4 stacked dice = 4 stacked dice

1/2 cup of ice cream = 1/2 baseball1/2 cup of ice cream = 1/2 baseball

2 tablespoons of peanut butter = a ping-2 tablespoons of peanut butter = a ping-pong ballpong ball

RecommendationsRecommendations

Food LogsFood Logs

Follow upFollow up

ReferRefer

InternetInternet www.Mypraymid.govwww.Mypraymid.gov www.Sparkpeople.comwww.Sparkpeople.com www.thedailyplate.comwww.thedailyplate.com

HonestyHonesty

ConclusionConclusion

There is no quick fix!There is no quick fix!

Educate to turn mindless eating Educate to turn mindless eating into mindful eatinginto mindful eating

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