Identifying Barriers to Reducing Portion Size: A Qualitative Focus Group Study of British Men and Women.

Reducing portion size might reduce meal satisfaction, which could minimize adherence to portion size interventions. The present study sought to identify the perceived barriers for consumers to eat smaller portions. A secondary aim explored the relative contribution of enjoyment of taste and post-meal fullness as determinants of meal satisfaction. Focus groups (N = 42) evaluated consumers' feelings toward a small reduction in portion size. Thematic analysis of written free association tasks and open-ended group discussions revealed that most participants expected to feel hungry and unsatisfied, which motivated them to consume something else. However, others expected to feel comfortable, healthy, and virtuous. The acceptability of the reduced portion was also determined by meal characteristics (e.g., time and setting) and individual characteristics (e.g., predicted energy requirements). Compared to post-meal fullness, enjoyment of taste was perceived to be the more important determinant of meal satisfaction. In conclusion, interventions should present portion reduction as a marginal modification with little physiological consequence to energy reserves, while emphasizing the positive feelings (e.g., comfort, satisfaction, and self-worth) experienced after consuming a smaller portion. Additionally, focusing on taste enjoyment (rather than fullness) might be a useful strategy to maintain meal satisfaction despite a reduction in meal size.

Food portion size influences accompanying beverage selection in adults.

When trying to reduce food portion size, it is important that meal satisfaction is, as far as possible, preserved. Otherwise, individuals may select accompaniments to the meal (e.g., snacks, beverages) to achieve satisfaction and, in doing so, negate any benefit of the original portion size reduction. This study investigated whether varying portion sizes of food would influence choice of accompanying beverages. That is, when presented with a food portion size that is smaller or larger than their ideal, an individual may compensate by choosing a beverage based on its satiating and/or orosensory properties to balance the expected satiation and satisfaction of a meal. Data from an online interactive study (n = 93) was analysed using multilevel ordinal logistic regression models. Food portion size (100, 300, 500, 700, or 900 kcal) predicted beverage choice (water, low-energy sweetened beverage, high-energy sweetened beverage). For example, the sweetened beverages were more likely to be selected with small food portion sizes (p < .001). Participant ideal food portion size did not interact with this relationship. Participants appear to have recognised that sweetened beverages provide flavour and/or energy, and used them to compensate for a smaller meal. While switching to a low-energy beverage with an increased food portion size is advantageous for energy balance, choosing a high-energy beverage with a decreased food portion size is likely to be detrimental for those attempting to reduce energy intake and body weight.

Quality Indicators of Nutritional Care Practice in Elderly Care.

OBJECTIVES: The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes. DESIGN: Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2013/2014. The data represented 1154 individuals in 117 of 290 Swedish municipalities. MEASUREMENTS: Meal satisfaction (%) and adequate nutritional status, screened by the Mini Nutritional Assessment Short Form (MNA-SF), were the two outcome variables assessed through their association with population density of municipalities and residents' age, together with 12 quality indicators pertaining to structure and process domains in the Donabedian model of care. RESULTS: Meal satisfaction was associated with rural and urban municipalities, with the structure quality indicators: local food policies, private meal providers, on-site cooking, availability of clinical/community dietitians, food service dietitians, and with the process quality indicators: meal choice, satisfaction surveys, and 'meal councils'. Adequate nutritional status was positively associated with availability of clinical/community dietitians, and energy and nutrient calculated menus, and negatively associated with chilled food production systems. CONCLUSION: Municipality characteristics and structure quality indicators had the strongest associations with meal satisfaction, and quality indicators with local characteristics emerge as important for meal satisfaction. Nutritional competence appears vital for residents to be well-nourished.

Determinants of meal satisfaction in a workplace environment.

Workplace lunches are recurrent meal occasions that can contribute to the general well-being of employees. The objective of our research was to study which factors influence consumers' satisfaction with these meals by exploring the relative role of food-related, personal, situational factors. Using a longitudinal approach, we monitored a total of 71 participants compiled and experienced 519 meals from their workplace canteen buffet during a three-month period; in addition the composed lunches were photographed. Before and after the lunch choice period respondents filled in a questionnaire on several meal-related variables. A mixed modelling approach was used to analyse the data. Meal satisfaction was directly associated with a positive ambience and a positive evaluation of both the quality of the food eaten and the buffet assortment, whereas the meal's energy content did not contribute to meal satisfaction. Additionally, meal satisfaction was associated with a more positive mood, lower hunger level as well as feeling less busy and stressed after lunch. The buffet assortment, a more positive mood before lunch and mindful eating contributed to the perceived food quality, but not associated with the hunger level before lunch. Time available, mindful eating and eating with close colleagues were positively associated with perceived ambience. The results indicate that consumers' satisfaction with workplace meals can be increased by putting emphasis on the quality of food served, but equally important is the ambience in the lunch situation. Most of the ambience factors were related to available time and mental resources of the participants and the possibility to share the meal with close colleagues. These are factors that can be facilitated by the service provider, but not directly influenced.

Factors associated with nutritional decline in hospitalised medical and surgical patients admitted for 7 d or more: a prospective cohort study.

This prospective cohort study was conducted in eighteen Canadian hospitals with the aim of examining factors associated with nutritional decline in medical and surgical patients. Nutritional decline was defined based on subjective global assessment (SGA) performed at admission and discharge. Data were collected on demographics, medical information, food intake and patients' satisfaction with nutrition care and meals during hospitalisation; 424 long-stay (≥7 d) patients were included; 38% of them had surgery; 51% were malnourished at admission (SGA B or C); 37% had in-hospital changes in SGA; 19·6% deteriorated (14·6% from SGA A to B/C and 5% from SGA B to C); 17·4% improved (10·6% from SGA B to A, 6·8% from SGA C to B/A); and 63·0 % patients were stable (34·4% were SGA A, 21·3% SGA B, 7·3% SGA C). One SGA C patient had weight loss ≥5%, likely due to fluid loss and was designated as stable. A subset of 364 patients with admission SGA A and B was included in the multiple logistic regression models to determine factors associated with nutritional decline. After controlling for SGA at admission and the presence of a surgical procedure, lower admission BMI, cancer, two or more diagnostic categories, new in-hospital infection, reduced food intake, dissatisfaction with food quality and illness affecting food intake were factors significantly associated with nutritional decline in medical patients. For surgical patients, only male sex was associated with nutritional decline. Factors associated with nutritional decline are different in medical and surgical patients. Identifying these factors may assist nutritional care.