Trends of Portion Size and Obesity: What Healthcare providers should know! Amalie Shanks Advisor: Geza Bruckner

Objectives 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 sizes portion vs serving portion vs serving Portion trends Portion trends Food composition Just what are we eating? Just what are we eating? Patient Education What are the most effective tools needed to help achieve and maintain healthy weights? What are the most effective tools needed to help achieve and maintain healthy weights?

Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 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. Adults BRFSS, 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. Adults BRFSS, 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. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

PORTIONS Portion: How much we serve ourselves OR how much we consume of a particular food in one sitting Serving Size: corresponds with the nutrition information that is listed on the food label or at mypyramid.gov

THE PROBLEM PORTIONS DO NOT EQUAL OUR SERVINGS SIZE!! EX: one 20 oz cola=2.5 servings

140 calories 3-inch diameter Calorie Difference: 210 calories 350 calories 6-inch diameter BAGEL 20 Years Ago Today

Calorie Difference: 165 Calories 250 Calories 20 ounces 85 Calories 6.5 ounces SODA 20 Years AgoToday

COFFEE COFFEE 20 Years Ago Coffee (with whole milk and sugar) Today Mocha Coffee (with steamed whole milk and mocha syrup) 45 calories 8 ounces 350 calories 16 ounces Calorie Difference: 305 calories

20 Years AgoToday 270 calories 5 cups POPCORN 630 calories 11 cups Calorie Difference: 360 calories

CHOCOLATE CHIP COOKIE 20 Years Ago Today 55 calories 1.5 inch diameter 275 calories 3.5 inch diameter Calorie Difference: 220 calories

Larger Portions Equals More Calories participants were served the same menu for 2 days over 3 weeks with only the portion size changing served 100%, 150% or 200% of baseline amounts study indicated that with larger portion sizes the amount consumed increased (ROLLS et all)

Burger, Kern, and Coleman (2007) College age students were allowed to select their own portion sizes in 10 of the 15 items students served themselves, the portions served were larger than serving sizes

Portion Size and Packaging 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 come back on the same day for dinner which consisted of pasta with tomato sauce, parmesan cheese, tossed salad, dressing, bread, butter, bite size chocolate bars, chocolate chip cookies, and water RESULTS: Energy intake increased Females Females 1.5 oz snack and dinner-consumed / kJ 6 oz snack and dinner -consumed 5044+/ kJ Males Males 1.5 oz snack and dinner-consumed / kJ 6 oz snack and dinner-consumed / KJ

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

Ice cream study Wansink 2006 gave participants a bowl and spoon and then asked to serve themselves their own serving of ice cream. Given a 17 oz or 34 oz bowl and either a 2 oz or 3 oz spoon. Once they served themselves they were given a 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 used? Did the bowl and spoon differ from what they normal used?

RESULTS: Larger bowls served and ate 31% more than what they had estimated Larger bowls served and ate 31% more than what they had estimated Smaller bowls on average thought that they had served themselves 3.8% more than what they had actually served themselves Smaller bowls on average thought that they had served themselves 3.8% more than what they had actually served themselves Larger spoons also served themselves 14.5% more regardless of the bowl size. Larger spoons also served themselves 14.5% more regardless of the bowl size. Participants more than likely judged the amount of food they were about to consume based on how full the bowl was and/or by how big the scoop was on the spoon

Portion Size and Energy Density Energy density is the “amount of energy in a given weight of food (kcal/g)” food with high energy density would have more fat in it such as cookies or candy bars food low in energy density would have more water in its make up such as lettuce or celery

Energy Density and Obesity FATS VS FRUITS AND VEGGIES Used data from Continuing Survey of Food intakes by individuals where interviewers took a 24 hour recall of foods consumed on 2 nonconsecutive days Those who consumed more than 9 servings of fruits and vegetables per day had lower energy intake regardless of whether their diet was high fat or low fat Those who had a high fat diet with more than 9 servings/day still had a lower energy dense dietary intake when compared to participants on a low fat diet with low consumption of fruits and vegetables Prevalence of obesity within the high and low fat dietary groups Both high and low fat diets, obesity prevalence was greater than 10% in those groups consuming <9 servings/day Both high and low fat diets, obesity prevalence was greater than 10% in those groups consuming <9 servings/day Both high fat and low fat diets, obesity was less than 10% in those consuming >9 servings/day Both high fat and low fat diets, obesity was less than 10% in those consuming >9 servings/day

Recomendations Educate between portion size and serving size Teach them to read food labels

Estimating Portion Sizes 1 cup of cereal = a fist 1/2 cup of cooked rice, pasta, or potato = 1/2 baseball 1 baked potato = a fist 1 medium fruit = a baseball

Estimating Portion Sizes 1/2 cup of fresh fruit = 1/2 baseball 1 1/2 ounces of low-fat or fat-free cheese = 4 stacked dice 1/2 cup of ice cream = 1/2 baseball 2 tablespoons of peanut butter = a ping- pong ball 2 tablespoons of peanut butter = a ping- pong ball

Recommendations Food Logs Follow up ReferInternet

Conclusion There is no quick fix! Educate to turn mindless eating into mindful eating

References Bibliography Anderson, Patricia M and Butcher, Kristin F. Childhood obesity: Trends and Potential causes. Future of the Children. 16(2006): Burger K, Kern M, Coleman K. Characterisitcs of Self-Selected Portion Size in Young Adults. Journal of ther American Dietetic Association. 2007; 107: Calorie Count. February Available at: CDCa. About BMI for children and teens. Available at: on December 1, CDCb. Overweight and Obesity. Available at: Accessed on December 1, Daggett LM, Rigdon KL.Daggett LM, Rigdon KL. A computer-assisted instructional program for teaching Daggett LM, Rigdon KL. portion size versus serving size. Journal of Community Health Nursing Spring;23(1): Kral, Tanja V.E., Rolls, Barbara J. Energy density and portions size: their independent and combined effects on energy intake. Physiology and Behavior. 2004;82: Ledikwe, JH., Blanck, HM, Khan, LK, Serdula, MK, Seymour, JD, Tohill, BC, and Rolls, BJ. Dietary energy density is associated with energy intake and weight status in US adults. American Journal of Clinical Nutrition. 2006;83: My Pyramid Plan. Available at Accessed on February 27, Neilsen SJ, Popkin BM. Patterns and Trends in Food Portion Sizes, JAMA January; vol 289(4): Dale, Dale C. and Federman, Daniel D. “Obesity”. ACP Medicine 3rd Edition. Volume 1: Dale, Dale C. and Federman, Daniel D. “Obesity”. ACP Medicine 3rd Edition. Volume 1: Raynour, Hollie A, Wing, Rena R. Package Unit Size and Amount of Food: Do Both Influence Intake?. Obesity. 2007: September:15(9): Rolls, b, Roe D, Meengs J. Salad and Satiety: Energy Density and Portion Size of a First-Course Salad affect Energy Intake. Journal of American Dietetic Association. 2004, 104: Rolls B, Roe D, Meengs J. Larger Portion Sizes Lead to a Sustained Increase in Energy Intake over 2 Days. Journal of American Dietetic Association. 2006;106: Spark People. Available at Accessed February 27, Wansinck, Brain, Ittersum, Koert van, Painter, James E. Ice Cream Illusions: Bowls, Spoons, and Self-Served Portion Sizes. American Journal of Preventive Medicine. 2006:31-3: Wansink, Brian, Painter, James E., North, Jill. Bottomless Bowls: Why Visual Cues of Portion Size May Influence Intake. Obesity Research. January 2005:13(1): 93–100. Weight Control Information Network. Just Enough for You About Food Portions. August Available at: Accessed November 25, Wikipedia. Food Energy. Available at : Accessed February 29, Young LR, Nestle M.Young LR, Nestle M. Expanding portion sizes in the US marketplace: Young LR, Nestle M. implications for nutrition counseling. Journal American Diet Association Feb;103(2):231-4 Young LR, Nestle M.Young LR, Nestle M. Portion sizes and obesity: responses of fast-food companies. Journal of Public Health Policy Jul;28(2): Young LR, Nestle M.