Portion Distortion Sponsored by: Eating smaller portions is one of the easiest ways to cut back on calories – but it can also be the most challenging Sponsored by:

Which Plate Did You Choose? Buy a stack of regular “dinner-size” paper plates (8-10”) Buy a stack of small “dessert-size” paper plates (~ 6”) Set both stacks on a table when patients walk in; have them choose a plate but don’t tell them what it is for Make sure everyone has a pen, pencil, or marker

Look at Your Plate as a Pie Chart… Please draw on your plate the amount of each food group you would eat: Protein Vegetables Complex Carbohydrates Ask your group of patients to draw on the plate how they would divide up the portions of the following food groups onto their plate for a meal: Protein Veggies Complex Carbs

Look at Your Plate as a Pie Chart… Surgical Patients: Vegetables: ¼ to ½ Protein: ½ Complex Carbs: 1/8 to ¼ Use a smaller plate if portion size is difficult for you Non-Surgical Patients Vegetables: 2/3 to 1/2 Protein: 1/6 to 1/4 Complex Carbs: 1/6 to 1/4 Use a smaller plate if portion size is difficult for you Talk about pre-op (non-surgical) the plate is different from post-op and how you progress over time it converts more to pre-op/non-surgical as intake increases over time Fill-up on protein Eat lots of veggies Incorporate complex/healthy carbs (fruit, whole-grains, dairy, etc.)

Portion Distortion Quiz “Put on your thinking caps!” Portions acquired from: The National Heart, Lung, and Blood Institute; a division of the National Institute of Health

Serving of Almonds… Bag A, Bag B, or Bag C ??? Ask what is a serving of almonds? Have pre-prepared in different zip log bags: Bag A – ½ serving (1/2 oz = 14 nuts) Bag B – 1 serving (1 oz = 28 nuts) Bag C – 2 servings (2 oz = 56 nuts)

Let’s Get Nuts About Nuts Almonds, Dry Roasted, No Salt Added 1 Serving = 1 oz 24-28 medium kernels 169 Calories 15 g Fat 5.5 g Carbohydrates 3.3 g Fiber 1.4 g Sugar 6.3 g Protein Discuss what 1 ounce looks like: the flat part of the palm of the hand (without fingers); not rounded, not overflowing, etc. Discuss that almonds are a good source of protein and healthy fat; but like always must be consumed in moderation

Bagel 20 Years Ago Today 140 calories 3-inch diameter Talk about how bagels used to be the size of hockey pucks and now are as big as our plates 140 calories 3-inch diameter How many calories are in this bagel?

Calorie Difference: 210 calories Bagel 20 Years Ago Today Our bagels now are 200 calories bigger than 20 yrs ago. 200 calories per day extra (not accounted for) is 20 pounds gained by next year! 140 calories 3-inch diameter 350 calories 6-inch diameter Calorie Difference: 210 calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out What would you have to do to burn that extra 200 calories? Rake leaves for approximately how long? How long will you have to rake leaves in order to burn the extra 210 calories?*   *Based on 130-pound person

Calories In = Calories Out Almost an hour If you rake the leaves for 50 minutes you will burn the extra 210 calories.* *Based on 130-pound person

Cheeseburger Today 20 Years Ago 333 calories How many calories are in today’s cheeseburger?

Cheeseburger Today 20 Years Ago 333 calories 590 calories Burgers these days are HUGE! Some have as many as 1000 calories/burger 333 calories 590 calories Calorie Difference: 257 calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to lift weights in order to burn the extra 257 calories?* *Based on 130-pound person

Calories In = Calories Out You would have to do strength-training for approximately 90 minutes to shed those extra burger calories. If you lift weights for 1 hour and 30 minutes, you will burn approximately 257 calories.* *Based on 130-pound person

Spaghetti and Meatballs 20 Years Ago Today 500 calories 1 cup spaghetti with sauce and 3 small meatballs How many calories do you think are in today's portion of spaghetti and meatballs?

Spaghetti and Meatballs Calorie Difference: 525 calories 20 Years Ago Today Today’s spaghetti dinner is about how many calories most WLS pts eat in one day! 500 calories 1 cup spaghetti with sauce and 3 small meatballs 1,025 calories 2 cups of pasta with sauce and 3 large meatballs Calorie Difference: 525 calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to houseclean in order to burn the extra 525 calories?* *Based on 130-pound person

Calories In = Calories Out Personally, I don’t like to clean house any extra than I have to; I think I will stick to a smaller portion! If you houseclean for 2 hours and 35 minutes, you will burn approximately 525 calories.* *Based on 130-pound person

French Fries 20 Years Ago Today 210 Calories 2.4 ounces How many calories are in today’s portion of fries?

Calorie Difference: 400 Calories French Fries 20 Years Ago Today The standard size of french fries has increased by 4.5 ounces. That means our new serving could have fed almost 3 people 20 yrs ago! 210 Calories 2.4 ounces 610 Calories 6.9 ounces Calorie Difference: 400 Calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to walk leisurely in order to burn those extra 400 calories?* *Based on 160-pound person

Calories In = Calories Out I think I will take that portion from 20 yrs ago and then I would only have to walk about 20 minutes! If you walk leisurely for 1 hour and 10 minutes you will burn approximately 400 calories.* *Based on 160-pound person

Soda 20 Years Ago Today 85 Calories 6.5 ounces How many calories are in today’s portion?

Calorie Difference: 165 Calories Soda 20 Years Ago Today 85 Calories 6.5 ounces 250 Calories 20 ounces Calorie Difference: 165 Calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to work in the garden to burn those extra calories?* *Based on 160-pound person

Calories In = Calories Out If you work in the garden for 35 minutes, you will burn approximately 165 calories.* *Based on 160-pound person

Turkey Sandwich 20 Years Ago Today 320 calories How many calories are in today’s turkey sandwich?

Calorie Difference: 500 calories Turkey Sandwich 20 Years Ago Today This turkey sub is again almost a whole day’s worth of calories for a WLS pt! 320 calories 820 calories Calorie Difference: 500 calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to ride a bike in order to burn those extra calories?* *Based on 160-pound person

Calories In = Calories Out If you ride a bike for 1 hour and 25 minutes, you will burn approximately 500 calories.* *Based on 160-pound person

Mocha Coffee (with steamed whole milk and mocha syrup) 20 Years Ago Coffee (with whole milk and sugar) Today Mocha Coffee (with steamed whole milk and mocha syrup) The Starbucks craze…. 45 calories 8 ounces How many calories are in today's coffee?

Mocha Coffee (with steamed whole milk and mocha syrup) 20 Years Ago Coffee (with whole milk and sugar) Today Mocha Coffee (with steamed whole milk and mocha syrup) And this isn’t even one of the really bad choices at Starbucks!!! Some drinks come in at almost 500 calories or more! 45 calories 8 ounces 350 calories 16 ounces Calorie Difference: 305 calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to walk in order to burn those extra 305 calories?*   *Based on 130-pound person

Calories In = Calories Out Or just choose one of the healthier versions with skim milk, sugar-free syrup, and no whip! If you walk 1 hour and 20 minutes, you will burn approximately 305 calories.* *Based on 130-pound person

Muffin 20 Years Ago Today 210 calories 1.5 ounces How many calories are in today’s muffin?

Muffin 20 Years Ago Today 210 calories 500 calories 1.5 ounces Calorie Difference: 290 calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to vacuum in order to burn those extra 290 calories?* *Based on 130-pound person

Calories In = Calories Out If you vacuum for 1 hour and 30 minutes you will burn approximately 290 calories.* *Based on 130-pound person

Pepperoni Pizza 20 Years Ago Today 500 calories How many calories are in two large slices of today’s pizza?

Pepperoni Pizza 20 Years Ago Today 500 calories 850 calories And this is just plain pepperoni! 500 calories 850 calories Calorie Difference: 350 calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out Emphasize: walking AND carrying clubs (no golf cart)! How long will you have to play golf (while walking and carrying your clubs) in order to burn those extra 350 calories?* *Based on 160-pound person

Calories In = Calories Out If you play golf (while walking and carrying your clubs) for 1 hour you will burn approximately 350 calories.* *Based on 160-pound person

Chicken Caesar Salad 20 Years Ago Today Many people think salads are healthy. Let’s take a look! How many calories are in today’s chicken Caesar salad? 390 calories 1 ½ cups

Chicken Caesar Salad 20 Years Ago Today 3 ½ cups 390 calories Almost 800 calories for a SALAD! Again that is almost a whole day’s worth of calories in one meal! Ask the group to name the components of the salad that make it less healthy? Croutons Fatty/Creamy Dressing Cheese 390 calories 1 ½ cups 790 calories 3 ½ cups Calorie Difference: 400 calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to walk the dog in order to burn those extra 400 calories?*   *Based on 160-pound person

Calories In = Calories Out If you walk the dog for 1 hour and 20 minutes, you will burn approximately 400 calories.* *Based on 160-pound person

Popcorn 20 Years Ago Today 270 calories How many calories 5 cups are in today’s large popcorn? We all know movie popcorn is not healthy, but just how bad is it?

Popcorn 20 Years Ago Today 270 calories 630 calories 11 cups 5 cups And there are probably portions even bigger than this these days! This part of the presentation was taken from the NIH: NHLBI website in 2003/2004. Calorie Difference: 360 calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to do water aerobics in order to burn the extra 360 calories?* *Based on 160-pound person

Calories In = Calories Out If you do water aerobics for 1 hour and 15 minutes you will burn approximately 360 calories.* *Based on 160-pound person

Cheesecake 20 Years Ago Today How many calories are in 260 calories today’s large portion of cheesecake? 260 calories 3 ounces

Cheesecake 20 Years Ago Today 260 calories 640 calories 3 ounces 400 calories!!!!! And the portion size has more than doubled! 260 calories 3 ounces 640 calories 7 ounces Calorie Difference: 380 calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to play tennis in order to burn those extra 380 calories?* *Based on 130-pound person

Calories In = Calories Out If you play tennis for 55 minutes you will burn approximately 380 calories.* *Based on 130-pound person

Chocolate Chip Cookie 20 Years Ago Today 55 calories 1.5 inch diameter How many calories are in today’s large cookie?

Chocolate Chip Cookie 20 Years Ago Today 55 calories 275 calories Again, 200 calories. One of these cookies per day (not accounted for) and you will be 20 pounds heavier next year. 55 calories 1.5 inch diameter 275 calories 3.5 inch diameter Calorie Difference: 220 calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to wash the car to burn those extra 220 calories?* *Based on 130-pound person

Calories In = Calories Out If you wash the car for 1 hour and 15 minutes you will burn approximately 220 calories.* *Based on 130-pound person

Chicken Stir Fry 20 Years Ago Today 435 calories 2 cups How many calories are in today’s chicken stir fry?

Chicken Stir Fry 20 Years Ago Today 435 calories 2 cups 865 calories Another meal that is almost as much as you are supposed to eat in one day as a WLS pt! 435 calories 2 cups 865 calories 4 ½ cups Calorie Difference: 430 calories

Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out How long will you have to do aerobic dance to burn those extra 430 calories?* *Based on 130-pound person

Calories In = Calories Out If you do aerobic dance for 1 hour and 5 minutes you will burn approximately 430 calories.* *Based on 130-pound person

What Is Being Served These Days? Most meals eaten out these days are often enough for two or sometimes even three So, what can we do? Order kids meals Split with someone Take ½ or more home for another meal or two

What Is Wrong With This Picture? As we age, our metabolism slows, often as well as their energy expenditure This means that you should try to consume less than you did when you were younger However, if you eat out often, you may be consuming more than you need A result of this process is often weight gain which can lead to an increased risk of many diseases Diseases such as CHF, CHD, stroke, cancers, DM, kidney failure, etc.

What Can You Do About This? Split a meal with someone Box up half of meal as soon as it comes to the table for a later meal Order less – such as an appetizer as your entrée

What Can You Do About This? When eating out… Choose a regular hamburger – save ~ 150 calories Have the small fries – save ~ 300 calories Order the fruit or veggie sub for fries – save ~ 500 calories Order water – save ~ 150-300 calories

What Can You Do About This? When eating at home… Don’t eat from the bag – portion it out Buy single portions of snack foods Use half the amount you usually do of condiments (sour cream, butter, mayo, cheese, cream cheese)

What Is A Normal Portion Size? There are several ways to determine correct portion sizes: Use other objects to judge the correct size Learn the correct portion size and measure it out each meal Personally I think the first of the two is easier…

Objects – Grain Products Fist = 1 cup of cereal flakes CD = 1 pancake or slice of bread ½ Baseball = ½ cup cooked rice, pasta, or potato Tennis ball = 1 cup cooked rice or pasta Bar of Soap = 1 piece of cornbread Computer mouse = 1 small baked potato Cupped hand = about 1-2 oz of pretzels Hockey puck = average bagel Cupcake wrapper = ½ cup cooked rice Nickel – 1 serving spaghetti (uncooked)

Objects – Vegetables and Fruit Baseball = 1 cup of salad greens or 1 medium fruit ½ Baseball = ½ cup fresh fruit Large Egg = ¼ cup raisins Light bulb = grapes Average Woman’s Fist = 1 cup or 1 medium whole fruit

Objects – Dairy Products 4 stacked dice = 1 ½ oz of cheese ½ Baseball = ½ cup of ice cream or yogurt 4 dice or 1 domino = 1 oz cheese CD = slice of cheese

Objects – Protein Group Deck of Cards = 3 oz meat, fish, or poultry The palm of your hand (without fingers) = 3 oz of cooked meat or poultry Checkbook = 3 oz grilled or baked fish Ping Pong Ball = 2 tbsp peanut butter Cupped hand = about 1-2 oz of nuts or pretzels

Objects – Miscellaneous Items One die = 1 tsp butter, margarine, or spreads Golf ball = 2 tbsp peanut butter, jam, or salad dressing Packet of dental floss = 1 oz chocolate Thumb from knuckle joint up (man’s) = tsp to tbsp of PNB Whole thumb = 1 oz of cheese or meat Fingertip from joint up = about 1 tsp Stamp = 1 tsp butter or margarine

Actual Portion Sizes – Grains Brown Rice, Oatmeal: ½ cup = 1 oz Popcorn: 3 cups = 1 oz WW Cereal Flakes: 1 cup = 1 oz WW Bread: 1 slice = 1 oz WW Crackers: 5 = 1oz Cornflakes: 1 cup = 1 oz Crackers (Saltines): 7 = 1 oz White Rice: 1 cup = 2 oz

Actual Portion Sizes – Vegetables Raw Baby Spinach: 1 cup = ½ cup Broccoli: ½ cup = ½ cup Romaine Lettuce: 1 cup = ½ cup Baby Carrots: 1 cup = 1 cup Baked Sweet Potato: 1 large = 1 cup Cooked Pinto Beans: ½ cup = ½ cup veg OR 2 oz meat and beans Corn: ½ cup = ½ cup Baked Potato: 1 medium = 1 cup Green Beans, cooked: ½ cup = ½ cup

Actual Portion Sizes – Fruit Banana: 1 large (8”) = 1 cup Grapes: 1 med bunch (~ 50) = 1 ½ cups Orange: 1 small = ½ cup OJ: ½ cup = ½ cup Raisins: ¼ cup = ½ cup Strawberries: ½ cup = ½ cup

Actual Portion Sizes – Dairy Milk: 8 oz = 1 cup Yogurt: 8 oz = 1 cup Cheddar Cheese, shredded: 1/3 cup = 1 cup Swiss Cheese: 2 slices (3/4 oz each) = 1 cup Chocolate Pudding (made with milk): ½ cup = ½ cup Frozen Yogurt: 1 small serving (1/2 cup) = ½ cup

Actual Portion Sizes – Meat & Beans Ham: 6 thin slices = 2 oz Pork Chop: 4 oz cooked without bone = 4 oz Chicken Breast: 1 small half cooked = 3 oz Salmon: 8 oz cooked = 8 oz Shrimp: 7 medium = 2 oz cooked Almonds: 1 oz (~ 25) = 2 oz + 2 tsp oil Walnuts: 1 oz (~ 9) = 2 oz + 2 tsp oil

Think About Choices… Pasta vs. Potato (180 vs. 57 calories) 1 Medium Bunch Grapes (~ 50) vs. ¼ cup Raisins Fruit vs. Juice – more eating pleasure Milk vs. Coke – added nutrients Regular Bread vs. Light Bread Why would you choose foods that contain a lot of calories in a small portion size Also consider lower calorie options of foods (i.e. – low fat milk, light juice, light bread, etc.) Pasta & Potato – similar portion sizes but varied calorie difference. Potato probably has more nutrients too Grapes & Raisins – good demonstration: Have a serving size of grapes in a bag Have a serving size of raisins in a bag Obviously grapes look bigger and more filling Same food, just one is dehydrated Volumetrics = choose these type foods to fill full Fruit vs. Juice – same food group but very different nutritionally Plus feel fuller from eating solid food vs. drinking liquid Milk vs. Coke – same portion size is about the same calories (skim milk) However, milk has more nutrition (protein, Vit D, Calcium, etc.) While coke provides nothing Regular bread vs. light bread – get same portion size of for less calories if use light bread

How Many Portions Do You Need A Day?

Guidelines For Servings/Day… Calories Grains (oz) Veg (c) Fruits (c) Milk (c) Pro (oz) F, 25 yo, <30 min 1800 6 2.5 1.5 3 5 F, 25 yo, >60 min 2400 8 2 6.5 M, 25 yo, <30 min 2600 9 3.5 M, 25 yo, >60 min 3000 10 4 7 F, 50 yo, <30 min F, 50 yo, >60 min 2200 M, 50 yo, <30 min M, 50 yo, >60 min 2800 These amounts are representative of a healthy population. Individuals most commonly living independently and not bed-ridden. This is not intended for WLS pts

Bariatric Guidelines For Servings/Day… Calories Grains (oz) Veg (c) Fruits (c) Milk (c) Pro (oz) Female, <30 min 1000 3 1.5 1.25 2 9 Female, >60 min 1200 11 Male, <30 min 1100 4 10 Male, >60 min 1400 5 2.5 13 These amounts are representative of a healthy population. Individuals most commonly living independently and not bed-ridden. Talk to your clinician about what amounts and servings are right for you.

Bariatric Portion Sizes Grains: ¼ cup mashed potatoes Veggies: ¼ cup green beans ¼ cup carrots Fruit: 4 oz juice ½ peach, apple, or banana Milk: 1 slice cheese 1 cheese stick ¼ cup cottage cheese Protein: 1 oz meat ½ hard boiled egg or whole egg white

More Information For more in-depth, personalized information related to your age, gender, activity level visit: www.mypryamid.gov See a registered dietitian

Thank You! Happy Eating!