Downsizing Supersizes

If New York City Mayor Michael Bloomberg’s proposal to ban sugary drinks larger than 16 ounces passes this month, health advocates hope obese New Yorkers and other Americans as well will get the push they need to go from supersized to healthy portions.

Since the 1970s, American waistlines have been steadily increasing in direct proportion with food portion sizes in restaurants, food stores, and homes. Many food items have increased two to five times in size. Outside the home, almost all food portion sizes have increased, some— such as sodas and cookies—up to eight times. These sizes also exceed U.S. Department of Agriculture (USDA) and U.S. Food and Drug Administration standard portions. Small wonder that 66 percent of Americans are now overweight or obese, compared to 47 percent 30 years ago.

Research supports Bloomberg’s reasoning about portion control. Studies show that we tend to consume in units; if the food package is large, we consume the entire amount. We also tend to eat more when served more. “The more food you have in front of you, the more you are likely to eat,” George A. Bray, M.D., chief of the Division of Clinical Obesity and Metabolism at Pennington Biomedical Research Center in Baton Rouge and a leading obesity researcher, told Endocrine News. “This will be heightened if the foods are ones that you particularly like.”

The psychology at work here contributes to overconsumption; people often don’t realize they are eating more and they don’t necessarily feel fuller. In a 2003 “bottomless bowl” study, 54 participants ate soup from either a normal bowl or a bowl rigged to inconspicuously and automatically refill. The refilling bowl subjects ate a whopping 73 percent more than those with the normal bowl. The researchers concluded that a large portion size sends a subliminal message to our brains that this is the accepted norm, making it appropriate, even expected, for us to consume that amount. Such visual cues also tend to reduce our reliance on our own self-monitoring systems. Importantly, this psychological mechanism affects most people, whether obese or not.

Knowing that our consumption patterns have a distinctly psychological nature in addition to the physiologic drive, has an upside. We can “trick” ourselves into eating less almost as easily as we succumb to overconsuming. Research presented in July at the Annual Meeting of the Society for the Study of Ingestive Behavior shows that cutting food into smaller pieces can reduce intake by creating the appearance of more food, which induces more rapid and increased satiety than single portions.

At the Hormone Health Network (www.hormone.org), health care providers offer a list of practical strategies for losing weight. A common theme among the items listed is changing what and how we eat, including eating less. Eating more slowly, for example, helps us eat less because it takes 20 minutes for the full signal from gut hormones, such as glucagon-like peptide-1 (GLP-1), cholecystokinin (CKK), and pancreatic polypeptide (PPY) among others, to reach the satiety center in the hypothalamus. Slowing down allows time for these hormones to do their work before those last forkfuls are taken.

In addition, said Caroline M. Apovian, M.D., director of the Nutrition and Weight Management Center at Boston Medical Center and professor of medicine at Boston University School of Medicine, “Eating slowly can increase the response of PYY and GLP-1 as compared to eating fast.” It can also reduce levels of the so-called “hunger hormone” ghrelin. “Compared with 15 chews, 40 chews results in lower caloric intake, lower postprandial ghrelin concentrations, and higher GLP-1 and CCK concentrations,” Apovian explained.

Other tips include getting adequate support, such as in a weight loss group, and keeping a food diary, both of which involve controlling portion size and, in turn, eating less.

And, we can benefit from plain and simple education as well to remedy the all-too-common disconnect between portion size and serving size. Using vessels that show measurements is becoming a popular strategy to reduce intake. Measuring serving sizes and seeing what a cup, for example, really contains is an eye-opening experience for many people who previously estimated the capacity of a cup to be considerably larger.

The Portion Plate® demarcates a plate or placemat into appropriate serving sizes and pictorially compares serving sizes in many food categories to everyday items to facilitate remembering these sizes (for instance, 1.5 ounces of hard cheese = 3 dice.) WebMD offers downloadable template versions of a Portion Size Plate® in various sizes that can be carried in wallets or stuck to the front of the fridge. The USDA also provides similar services as part of their MyPlate program (www.choosemyplate.gov/).

A similar strategy involves repackaging foods into smaller-volume containers, as Bloomberg seeks to do. If the supersize soda ban proposal becomes law and Big Apple residents shrink their drinks and their waistlines, it will be an inspiration for people across the nation to mind their plates.

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