- Email: [email protected]
Addressing Public Demand and Perceptions
15.
16.
17.
18. 19.
sweetened with aspartame or high-fructose corn syrup on food intake and body weight. Am J Clin Nutr. 1990;51:963-969. Raben A, Vasilaras TH, Moller AC, Astrup A. Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects. Am J Clin Nutr. 2002;76:721-729. Holt SH, Sandona N, Brand-Miller JC. The effects of sugar-free vs sugar-rich beverages on feelings of fullness and subsequent food intake. Int J Food Sci Nutr. 2000;51:59-71. Lavin JH, French SJ, Read NW. The effect of sucroseand aspartame-sweetened drinks on energy intake, hunger and food choice of female, moderately restrained eaters. Int J Obes Relat Metab Disord. 1997; 21:37-42. DellaValle DM, Roe LS, Rolls BJ. Does the consumption of caloric and non-caloric beverages with a meal affect energy intake? Appetite. 2005;44:187-193. Almiron-Roig E, Drewnowski A. Hunger, thirst, and
20.
21.
22.
23.
24.
energy intakes following consumption of caloric beverages. Physiol Behav. 2003;79:767-773. Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition, and hunger. J Psychosom Res. 1985;29:71-83. Zung WWK. Zung self-rating depression scale and depression status inventory. In: Sartorius N, Ban TA, eds. Assessment of Depression. Berlin, Germany: Springer-Verlag; 1986:221-231. Garner DM, Olsted MP, Bohr Y, Garfinkel PE. The Eating Attitudes Test: Psychometric features and clinical correlates. Psychol Med. 1982;12:871-878. Pennington JAT, Douglass JS, eds. Bowes & Church’s Food Values of Portions Commonly Used. 18th ed. Baltimore, MD: Lippincott, Williams & Wilkins; 2005. Hetherington MM, Rolls BJ. Methods of investigating human eating behavior. In: Toates F, Rowland N, eds. Feeding and Drinking. Amsterdam, the Netherlands: Elsevier Science Publishers BV; 1987:77-109.
APPLICATION
Addressing Public Demand and Perceptions
I
n American society, it seems undeniable that portion size can often dictate the amount of both food and beverage consumption in individuals. Due in large part to economic causes, the entire food industry—from restaurants to cookbooks—is inundated with portions beyond the federal recommendations, all suggesting that consumer demand is not dwindling and that increased portion sizes are continuing to contribute to the current obesity epidemic (1,2). In relating packaging and portion sizes to consumption, it is well supported by Rolls and colleagues, as well as in other research, that the size of a package or container can increase intake, as can the size of serving portions in kitchens and in restaurants (3-5). Such increases occur even when the energy density of the food or beverage is altered (3,6,7). This suggests that the impact of portion size on intake may be related as much to perception as it is to physiological factors. For instance, over half of American adults generally claim that they attempt to eat until they “clean their plates” (8). For these individuals, there is a visual cue established, and they eat or drink until they reach that benchmark. It is also important to note that consistently being presented with larger portions can have a deceiving effect on energy intake even for those who do not regularly “clean their plates.” Individ-
This article was written by Lee T. Murphy, MS, MPH, RD, community nutritionist, Knox County Health Department, Knoxville, TN. doi: 10.1016/j.jada.2006.10.020
1990
December 2006 Volume 106 Number 12
uals who instead intend to eat one half or three quarters of what they are served are also likely to over-consume if given a larger portion size at the outset (9). A recent industry survey concluded that the food industry itself is unlikely to produce smaller packages or containers simply to encourage lower food consumption. As government efforts to reduce portion size through the use of regulations or incentives are not likely to succeed due to the lack of political and economic feasibility at this time, the survey also noted that consumer demand for smaller packages will exert the strongest influence on industry decisions (10). Therefore, public education efforts must address consumer demand as well as societal views as to what is a “normal” serving. The food, beverage, restaurant, leisure, entertainment, and recreation industries can all be instrumental in halting the current trend. While the qualities of meals eaten outside the home may differ, most are typically high in calories, low in key nutrients, and served in large portion sizes. Given that the trend of eating out is expected to continue increasing, these stated venues, in particular, should consider further expanding more healthful meal options and reasonable serving sizes through the inclusion of fruits, vegetables, and low-calorie beverages, and by providing general nutrition information at the pointof-purchase that will help consumers make informed decisions about food and drink selections—specifically, in regard to the provided portion sizes (11). Food and beverage industries should also develop product and packaging innovations that address total energy and nutrient density for comprehensible serving sizes to
help consumers make more healthful choices (11). If a consumer is likely to partake in an entire package of a certain food or beverage, for instance, this recommendation could translate into listing nutrition information for both a “standard” serving and for the total amount contained in the full-portioned package. Of paramount importance among these efforts are public education strategies by food and nutrition professionals to increase awareness of the oversized portions that are readily available to both children and adults in all outlets, and offering skills to manage the discrepancy between true hunger and the perception of needing/desiring to consume a designated amount. For some individuals, such strategies could include more efficiently tuning in to their hunger cues, or voluntarily choosing smaller plate or cup sizes in all food environments. Encouraging increased consumption of low-energy-density foods for satiety could also help to reduce caloric load, while maintaining food weight/volume. Education efforts to sway the large public demand for enormous portions are perhaps most critical in curbing the current trend, as well as increasing awareness of not having to “get the best deal” economically, but rather considering the health aspect as the greater concern. By incorporating both economic and health considerations into educational initiatives, among other coordinated efforts, public perceptions and demand may be positively altered toward a more healthful societal concept of eating behavior. References 1. Young LR, Nestle M. The contribution of expanding portion sizes to the US obesity epidemic. Am J Public Health. 2002;92:246-249. 2. Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977-1998. JAMA. 2003;289:450-453.
3. Flood JE, Roe LS, Rolls BJ. The effect of increased beverage portion size on energy intake at a meal. J Am Diet Assoc. 2006;106:1984-1990. 4. Wansink, B. Can package size accelerate usage volume? J Market. 1996;60:1-14. 5. Rolls BJ, Morris EL, Roe LS. Portion size of food affects energy intake in normal-weight and overweight men and women. Am J Clin Nutr. 2002;76: 1207-1213. 6. Kral TVE, Roe LS, Meengs JS, Wall DE, Rolls BJ. Increasing the portion size of a packaged snack increases energy intake. Appetite. 2002;39:86. 7. Ello-Martin JA, Roe LS, Meengs JS, Wall DE, Robinson TE. Increasing the portion size of a unit food increases energy intake. Appetite. 2002;39:74. 8. American Institute for Cancer Research Survey. International Communications Research; 2006. Available at: http://www.aicr.org/site/DocServer/2006_portion_ survey_data.pdf?docID⫽461. Accessed August 8, 2006. 9. Wansink B, Painter JE, North J. Bottomless bowls: Why visual cues of portion size may influence intake. Obesity Res. 2005;13:93-100. 10. Whitaker RD, Esposito D, Ohls JC. Addressing childhood obesity by reducing portion sizes in the food industry: A strategic analysis. Princeton, NJ: Mathematica Policy Research; 2004. Available at: http:// www.rwjf.org/portfolios/resources/grantsreport.jsp? filename⫽049916.htm&iaid⫽138#int_biblio. Accessed August 8, 2006. 11. Institute of Medicine. Fact Sheet: Industry Can Play a Role in Preventing Childhood Obesity. 2004. Available at: http://www.iom.edu/Object.File/Master/22/ 613/fact%20sheet%20-%20industry%20finalBitticks. pdf. Accessed August 8, 2006.
December 2006 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1991
16.
17.
18. 19.
sweetened with aspartame or high-fructose corn syrup on food intake and body weight. Am J Clin Nutr. 1990;51:963-969. Raben A, Vasilaras TH, Moller AC, Astrup A. Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects. Am J Clin Nutr. 2002;76:721-729. Holt SH, Sandona N, Brand-Miller JC. The effects of sugar-free vs sugar-rich beverages on feelings of fullness and subsequent food intake. Int J Food Sci Nutr. 2000;51:59-71. Lavin JH, French SJ, Read NW. The effect of sucroseand aspartame-sweetened drinks on energy intake, hunger and food choice of female, moderately restrained eaters. Int J Obes Relat Metab Disord. 1997; 21:37-42. DellaValle DM, Roe LS, Rolls BJ. Does the consumption of caloric and non-caloric beverages with a meal affect energy intake? Appetite. 2005;44:187-193. Almiron-Roig E, Drewnowski A. Hunger, thirst, and
20.
21.
22.
23.
24.
energy intakes following consumption of caloric beverages. Physiol Behav. 2003;79:767-773. Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition, and hunger. J Psychosom Res. 1985;29:71-83. Zung WWK. Zung self-rating depression scale and depression status inventory. In: Sartorius N, Ban TA, eds. Assessment of Depression. Berlin, Germany: Springer-Verlag; 1986:221-231. Garner DM, Olsted MP, Bohr Y, Garfinkel PE. The Eating Attitudes Test: Psychometric features and clinical correlates. Psychol Med. 1982;12:871-878. Pennington JAT, Douglass JS, eds. Bowes & Church’s Food Values of Portions Commonly Used. 18th ed. Baltimore, MD: Lippincott, Williams & Wilkins; 2005. Hetherington MM, Rolls BJ. Methods of investigating human eating behavior. In: Toates F, Rowland N, eds. Feeding and Drinking. Amsterdam, the Netherlands: Elsevier Science Publishers BV; 1987:77-109.
APPLICATION
Addressing Public Demand and Perceptions
I
n American society, it seems undeniable that portion size can often dictate the amount of both food and beverage consumption in individuals. Due in large part to economic causes, the entire food industry—from restaurants to cookbooks—is inundated with portions beyond the federal recommendations, all suggesting that consumer demand is not dwindling and that increased portion sizes are continuing to contribute to the current obesity epidemic (1,2). In relating packaging and portion sizes to consumption, it is well supported by Rolls and colleagues, as well as in other research, that the size of a package or container can increase intake, as can the size of serving portions in kitchens and in restaurants (3-5). Such increases occur even when the energy density of the food or beverage is altered (3,6,7). This suggests that the impact of portion size on intake may be related as much to perception as it is to physiological factors. For instance, over half of American adults generally claim that they attempt to eat until they “clean their plates” (8). For these individuals, there is a visual cue established, and they eat or drink until they reach that benchmark. It is also important to note that consistently being presented with larger portions can have a deceiving effect on energy intake even for those who do not regularly “clean their plates.” Individ-
This article was written by Lee T. Murphy, MS, MPH, RD, community nutritionist, Knox County Health Department, Knoxville, TN. doi: 10.1016/j.jada.2006.10.020
1990
December 2006 Volume 106 Number 12
uals who instead intend to eat one half or three quarters of what they are served are also likely to over-consume if given a larger portion size at the outset (9). A recent industry survey concluded that the food industry itself is unlikely to produce smaller packages or containers simply to encourage lower food consumption. As government efforts to reduce portion size through the use of regulations or incentives are not likely to succeed due to the lack of political and economic feasibility at this time, the survey also noted that consumer demand for smaller packages will exert the strongest influence on industry decisions (10). Therefore, public education efforts must address consumer demand as well as societal views as to what is a “normal” serving. The food, beverage, restaurant, leisure, entertainment, and recreation industries can all be instrumental in halting the current trend. While the qualities of meals eaten outside the home may differ, most are typically high in calories, low in key nutrients, and served in large portion sizes. Given that the trend of eating out is expected to continue increasing, these stated venues, in particular, should consider further expanding more healthful meal options and reasonable serving sizes through the inclusion of fruits, vegetables, and low-calorie beverages, and by providing general nutrition information at the pointof-purchase that will help consumers make informed decisions about food and drink selections—specifically, in regard to the provided portion sizes (11). Food and beverage industries should also develop product and packaging innovations that address total energy and nutrient density for comprehensible serving sizes to
help consumers make more healthful choices (11). If a consumer is likely to partake in an entire package of a certain food or beverage, for instance, this recommendation could translate into listing nutrition information for both a “standard” serving and for the total amount contained in the full-portioned package. Of paramount importance among these efforts are public education strategies by food and nutrition professionals to increase awareness of the oversized portions that are readily available to both children and adults in all outlets, and offering skills to manage the discrepancy between true hunger and the perception of needing/desiring to consume a designated amount. For some individuals, such strategies could include more efficiently tuning in to their hunger cues, or voluntarily choosing smaller plate or cup sizes in all food environments. Encouraging increased consumption of low-energy-density foods for satiety could also help to reduce caloric load, while maintaining food weight/volume. Education efforts to sway the large public demand for enormous portions are perhaps most critical in curbing the current trend, as well as increasing awareness of not having to “get the best deal” economically, but rather considering the health aspect as the greater concern. By incorporating both economic and health considerations into educational initiatives, among other coordinated efforts, public perceptions and demand may be positively altered toward a more healthful societal concept of eating behavior. References 1. Young LR, Nestle M. The contribution of expanding portion sizes to the US obesity epidemic. Am J Public Health. 2002;92:246-249. 2. Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977-1998. JAMA. 2003;289:450-453.
3. Flood JE, Roe LS, Rolls BJ. The effect of increased beverage portion size on energy intake at a meal. J Am Diet Assoc. 2006;106:1984-1990. 4. Wansink, B. Can package size accelerate usage volume? J Market. 1996;60:1-14. 5. Rolls BJ, Morris EL, Roe LS. Portion size of food affects energy intake in normal-weight and overweight men and women. Am J Clin Nutr. 2002;76: 1207-1213. 6. Kral TVE, Roe LS, Meengs JS, Wall DE, Rolls BJ. Increasing the portion size of a packaged snack increases energy intake. Appetite. 2002;39:86. 7. Ello-Martin JA, Roe LS, Meengs JS, Wall DE, Robinson TE. Increasing the portion size of a unit food increases energy intake. Appetite. 2002;39:74. 8. American Institute for Cancer Research Survey. International Communications Research; 2006. Available at: http://www.aicr.org/site/DocServer/2006_portion_ survey_data.pdf?docID⫽461. Accessed August 8, 2006. 9. Wansink B, Painter JE, North J. Bottomless bowls: Why visual cues of portion size may influence intake. Obesity Res. 2005;13:93-100. 10. Whitaker RD, Esposito D, Ohls JC. Addressing childhood obesity by reducing portion sizes in the food industry: A strategic analysis. Princeton, NJ: Mathematica Policy Research; 2004. Available at: http:// www.rwjf.org/portfolios/resources/grantsreport.jsp? filename⫽049916.htm&iaid⫽138#int_biblio. Accessed August 8, 2006. 11. Institute of Medicine. Fact Sheet: Industry Can Play a Role in Preventing Childhood Obesity. 2004. Available at: http://www.iom.edu/Object.File/Master/22/ 613/fact%20sheet%20-%20industry%20finalBitticks. pdf. Accessed August 8, 2006.
December 2006 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1991