1. Portion Distortion Practice Makes Perfect Mike Schurig, MS, RD, LD, CDE Nemours Childrens Clinic Orlando CWD Dteam Contributor

2. Portion Distortion: Objectives At completion, participant will be familiar with: 1. Magnitude of the obesity epidemic 2. Body Mass Index as a weight status tool 3. Sources of Portion Distortion 4. Solutions for Portion Distortion: Decreasing Amounts and Increasing Better Foods 5. Portion Estimation Tools

3. Magnitude of the Problem: According to the Centers for Disease Control, 65% of American adults today are either overweight or obese. According to the Centers for Disease Control, 65% of American adults today are either overweight or obese. Healthcare costs associated with obesity are approximately $100 Billion per year !!! Healthcare costs associated with obesity are approximately $100 Billion per year !!!

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

6. Obesity Trends* Among U.S. Adults BRFSS, 1987 No Data <10% 10%–14% (*BMI 30, or ~ 30 lbs overweight for 5 4 person)

7. Obesity Trends* Among U.S. Adults BRFSS, 1989 No Data <10% 10%–14% (*BMI 30, or ~ 30 lbs overweight for 5 4 person)

8. Obesity Trends* Among U.S. Adults BRFSS, 1991 No Data <10% 10%–14% 15%–19% (*BMI 30, or ~ 30 lbs overweight for 5 4 person)

9. Obesity Trends* Among U.S. Adults BRFSS, 1993 No Data <10% 10%–14% 15%–19% (*BMI 30, or ~ 30 lbs overweight for 5 4 person)

10. Obesity Trends* Among U.S. Adults BRFSS, 1995 No Data <10% 10%–14% 15%–19% (*BMI 30, or ~ 30 lbs overweight for 5 4 person)

11. Obesity Trends* Among U.S. Adults BRFSS, 1997 No Data <10% 10%–14% 15%–19% 20 (*BMI 30, or ~ 30 lbs overweight for 5 4 person)

12. Obesity Trends* Among U.S. Adults BRFSS, 1999 No Data <10% 10%–14% 15%–19% 20 (*BMI 30, or ~ 30 lbs overweight for 5 4 person)

13. Obesity Trends* Among U.S. Adults BRFSS, 2001 No Data <10% 10%–14% 15%–19% 20%–24% 25% (*BMI 30, or ~ 30 lbs overweight for 5 4 person)

14. Obesity Trends* Among U.S. Adults BRFSS, 2004

15. BODY MASS INDEX(BMI) One of the MOST ACCURATE TOOLS for measuring WEIGHT STATUS in our society One of the MOST ACCURATE TOOLS for measuring WEIGHT STATUS in our society MEASURING IS THE SAME FOR CHILDREN AND ADULTS MEASURING IS THE SAME FOR CHILDREN AND ADULTS ASSESSING IS DIFFERENT, GENDER AND AGE SPECIFIC FOR CHILDREN ASSESSING IS DIFFERENT, GENDER AND AGE SPECIFIC FOR CHILDREN

16. MEASURING BODY MASS INDEX (BMI) CHILDREN AND ADULTS WEIGHT IN KG WEIGHT IN KG DIVIDED BY (HEIGHT IN METERS)SQUARED (HEIGHT IN METERS)SQUARED

17. Figure out Your Personal Body Mass Index

18. ASSESSING BODY MASS INDEX (BMI) CHILDREN

20. ASSESSING BODY MASS INDEX ADULTS <18.5 UNDERWEIGHT <18.5 UNDERWEIGHT 18.5-24.9 NORMAL WEIGHT 18.5-24.9 NORMAL WEIGHT 25-29.9 OVERWEIGHT 25-29.9 OVERWEIGHT 30> OBESE 30> OBESE 40> MORBID OBESITY 40> MORBID OBESITY

21. Portion Distortion Where are We Finding Bigger Portion Sizes Today??? Where are We Finding Bigger Portion Sizes Today??? Restaurants Restaurants Grocery Store Grocery Store Fast Food Fast Food

22. Confused ????

23. Restaurants Bigger portions and more food equates with value Bigger portions and more food equates with value Competition is fierce nowadays with more people eating out Competition is fierce nowadays with more people eating out

25. Grocery Stores Serving sizes have grown on average 46% since 1980 on 65% of edible food items in a grocery store. Serving sizes have grown on average 46% since 1980 on 65% of edible food items in a grocery store. Its cheaper to eat unhealthy Its cheaper to eat unhealthy National Grocers Institute Study, 2003. National Grocers Institute Study, 2003.

29. Bagel Small bagelLarge Bagel 3 inch 6 inch 3 inch 6 inch

31. French Fries Small friesLarge fries 2.4 ounces6.9 ounces

32. Fast Food Restaurants offer bigger portions at a marginal cost. Competition is fierce nowadays to increase revenue. Lack of planning and time makes fast food an easy substitute for more healthy meals at home

33. Would you like to supersize that???

37. The Problem with HUGE FOOD The Problem with HUGE FOOD An increase of just 100 CALORIES a day, when compounded over the course of a year, can result in a 14 POUND weight gain if not balanced out with EXERCISE. An increase of just 100 CALORIES a day, when compounded over the course of a year, can result in a 14 POUND weight gain if not balanced out with EXERCISE. Research has shown when people are served bigger portions, they eat more Research has shown when people are served bigger portions, they eat more and dont compensate for extra calories by eating less later in the day.

38. Stale popcorn doesnt deter big portion fans (Cornell study) Free popcorn served to movie-goers in different sized containers in Philadelphia Free popcorn served to movie-goers in different sized containers in Philadelphia ½ got fresh made popcorn; ½ got 14 day old stale popcorn (two sizes: med/large) ½ got fresh made popcorn; ½ got 14 day old stale popcorn (two sizes: med/large) Those that got fresh popcorn ate 43.5% more when given large container. Those that got fresh popcorn ate 43.5% more when given large container. Those that got stale popcorn ate 34% more when given a large container. Those that got stale popcorn ate 34% more when given a large container.

39. Diabetes Meal Planning More liberalized Meal Planning (Carb Counting), Newer insulins, CSII therapy can allow for an INCREASE IN FOOD CHOICES, BUT… More liberalized Meal Planning (Carb Counting), Newer insulins, CSII therapy can allow for an INCREASE IN FOOD CHOICES, BUT… demands a DECREASE IN PORTION SIZES

40. How To Portion Accurately Measuring Tools Measuring Tools Measuring cups Measuring cups Measuring spoons Measuring spoons Gram scales Gram scales Food Labels Food Labels Exchange Lists, Internet, Books Exchange Lists, Internet, Books Carb Factor (John Walsh, Pumping Insulin) Carb Factor (John Walsh, Pumping Insulin)

41. What is a Serving???

42. Making Sense of out the Nutrition Facts Food Label

43. Food Guide Pyramid

44. Portions vs. Servings Whats the Difference A SERVING is the amount of food you see listed on the Nutrition Facts Label or what is recommended for the different food groups on the Food Guide Pyramid A SERVING is the amount of food you see listed on the Nutrition Facts Label or what is recommended for the different food groups on the Food Guide Pyramid A PORTION is the amount of food you choose to put on your plate A PORTION is the amount of food you choose to put on your plate PORTIONS may actually contain several SERVINGS. PORTIONS may actually contain several SERVINGS.

45. Managing Portion Sizes In restaurants, share entrees, or ask the server to put ½ in a doggie bag before serving. In restaurants, share entrees, or ask the server to put ½ in a doggie bag before serving. Order lunch sized portions. Many restaurants serve 4-6 ounces of meat at lunch and 8-10 ounces of meat at dinner. Order lunch sized portions. Many restaurants serve 4-6 ounces of meat at lunch and 8-10 ounces of meat at dinner. Think quality, not quantity Think quality, not quantity Get real. Become aware of how much you are really eating. Food diaries help. Get real. Become aware of how much you are really eating. Food diaries help.

46. Managing Portion Sizes At home, use smaller plates and bowls. It will appear as if youre eating more. At home, use smaller plates and bowls. It will appear as if youre eating more. Check food labels for serving size. Make portion sizes are closer to serving sizes. Check food labels for serving size. Make portion sizes are closer to serving sizes. Buy smaller packages of candy, popcorn, and snacks. Buy smaller packages of candy, popcorn, and snacks. Portion controlled packages reduce temptation to eat more. Portion controlled packages reduce temptation to eat more.

47. Sugary Beverages Sugary drinks add empty calories and can contribute to weight-gain more than you think Sugary drinks add empty calories and can contribute to weight-gain more than you think Use Crystal Light or diet drinks to limit calories Use Crystal Light or diet drinks to limit calories Use smaller glasses(6oz) for any sugary beverage Use smaller glasses(6oz) for any sugary beverage Water is your best choice Water is your best choice Trivia Question? Trivia Question? Is Gatorade a healthy choice? Is Gatorade a healthy choice?

48. Simple Addition CokeGatoradeHawaiianPunch Calories per bottle 250200304 Calories in one year 91,25073,000110,960 Pounds Lost 26 pounds 21 pounds 32 pounds

49. Increase Your Activity Limit screen time Limit screen time Plan family activities-group hike, swim, or bike ride Plan family activities-group hike, swim, or bike ride Sign up for a gym membership Sign up for a gym membership Assign everyday chores like washing the car, mowing the lawn, raking, vacuuming, or making the beds Assign everyday chores like washing the car, mowing the lawn, raking, vacuuming, or making the beds Park far away, take the stairs, and start with several short 5 and 10 minute activities Park far away, take the stairs, and start with several short 5 and 10 minute activities

50. Grow up Healthy with Nemours Eat 5 or more servings of fruits and vegetables per day Watch 2 or fewer hours of screen time per day Get 1 or more hours of physical activity per day Drink almost no sugary beverages http://www.nemours.org

51. In Your Hands A handy method for measuring appropriate portions. A handy method for measuring appropriate portions. Serving of meat ~the size of your palm Serving of meat ~the size of your palm Pasta/Rice/Starchy vegetable ~ one cupped hand Pasta/Rice/Starchy vegetable ~ one cupped hand Vegetables- two fists Vegetables- two fists

52. Grab-n-Go Snacks Water or diet soda Water or diet soda Precooked chicken strips Precooked chicken strips Graham crackers Graham crackers Cut up fruit Cut up fruit Precut veggies w dip(LF) Precut veggies w dip(LF) Frozen grapes Frozen grapes Low fat yogurt Low fat yogurt Trail mix Trail mix Oatmeal Oatmeal Low-fat popcorn Low-fat popcorn Wheat thins w hummus Wheat thins w hummus Hard boiled egg Hard boiled egg Prewashed salad greens Prewashed salad greens Granola bars Granola bars Low fat cheese sticks Low fat cheese sticks Tuna Tuna

53. Skipping Meals Breakfast is the most important meal of the day Breakfast is the most important meal of the day Although, each and every meal and snack is important as it gives you the energy to think, play, and enjoy your life. Although, each and every meal and snack is important as it gives you the energy to think, play, and enjoy your life. Subjects that skipped breakfast had a higher BMI than those that consumed RTE cereal, hot cereal, or breads.* Subjects that skipped breakfast had a higher BMI than those that consumed RTE cereal, hot cereal, or breads.* *The Effect of Breakfast, Total Daily Energy Intake and Body Mass Index Journal of the American College of Nutrition, Vol. 22, No. 4, 296-302 (2003)

54. Slow Your Roll It takes about 15 to 20 minutes for someone to realize that they are full. It takes about 15 to 20 minutes for someone to realize that they are full. Slowing down while eating may help prevent overeating. Slowing down while eating may help prevent overeating. Put the fork down in between bites and take a sip of water. Make sure to chew food thoroughly. Put the fork down in between bites and take a sip of water. Make sure to chew food thoroughly.

55. Questions?