Portion Sizes of Ultra-Processed Foods in the United States, 2002 to 2021.

Objectives. To assess the US food industry's response to calls from public health authorities to reduce portion sizes by comparing current with past sizes of selected examples of single-serve ultra-processed packaged and fast foods. Methods. We obtained manufacturers' information about current portion sizes and compared it with sizes when first introduced and in 2002. Results. Few companies in our sample reduced portion sizes since 2002; all still sold portions of ultra-processed foods in up to 5-times-larger sizes than when first introduced. Conclusions. Policies and practices focused on reducing portion size could help discourage the consumption of excessive amounts of ultra-processed foods. (Am J Public Health. 2021;111(12):2223-2226. https://doi.org/10.2105/AJPH.2021.306513).

An ethnographic study exploring factors that minimize lunch waste in Tokyo elementary schools.

OBJECTIVE: To explore factors that minimize lunch waste in Tokyo elementary schools and to consider how such factors can be modified and applied in US schools. DESIGN: Focused ethnographic study using interviews, observation, participant observation and document review. Data were analysed using thematic analysis. SETTING: Tokyo, Japan. PARTICIPANTS: Five school dietitians participated in the study. Data collection methods included in-depth interviews, observation of nutrition education lessons, participant observation of school lunchtime and review of relevant school documents (e.g. lunch menus, food waste records). RESULTS: Five themes emerged from the analysis: (i) reinforcement of social norms to eat without waste; (ii) menu planning to increase exposure to unfamiliar and/or disliked foods; (iii) integration of food and nutrition education into the school curriculum; (iv) teacher lunchtime practices related to portion sizes, distributing leftover food and time management; and (v) engagement of students in reducing school lunch waste. Practical and tangible applications to US schools include measuring and reporting lunch waste to influence social norms, teaching students about the importance of reducing food waste, offering flexible school lunch portion sizes and providing students with meaningful opportunities to contribute to solving the problem of school lunch waste. CONCLUSIONS: Japan offers a model for minimizing school lunch waste through a holistic approach that includes factors that operate at and interact across multiple levels of society. Modifying and applying such an approach in US schools is worth considering given the urgent need to address food waste in order to support healthy diets and sustainable food systems.

Ratios of Food Amounts across Three Portion Size Categories on a Food Frequency Questionnaire in Men and Women.

BACKGROUND: For some quantitative food frequency questionnaire (QFFQ) items, data may be insufficient to set gram weights for multiple portion size (PS) categories. Ratios of food amounts across PS categories may be used to quantify these PS for less frequently consumed food items. OBJECTIVE: To explore the ratios of food amounts reported in 24-hour dietary recalls (24HDRs) by a sample of participants in a cohort study who chose the A (smallest) or C (largest) PS category on the QFFQ, relative to the food amounts for those who chose the B PS category. DESIGN: This study was conducted as a cross-sectional design. PARTICIPANTS/SETTING: Data were from participants (n=2,360) who completed three 24HDRs and the QFFQ in a calibration study of the Multiethnic Cohort Study in 1994-1997. MAIN OUTCOME MEASURES: Median food amounts were calculated from 24HDRs for participants who selected each PS category (A, smallest; B; and C, largest) of items on the QFFQ. A-to-B and C-to-B ratios were computed if reported by five or more people in the 24HDRs: A-to-B ratios for 68 items (men) and 88 items (women); C-to-B ratios for 93 items (men) and 79 items (women). STATISTICAL ANALYSES PERFORMED: The t test was used to compare the mean A-to-B ratios and C-to-B ratios as preset on the QFFQ with those from the 24HDRs and to examine sex differences. Analysis of variance was used to compare the mean ratios among race and ethnicity groups. RESULTS: Mean A-to-B and C-to-B ratios were 0.71±0.15 and 1.45±0.35 in men and 0.71±0.15 and 1.44±0.40 in women based on the 24HDRs. Compared with the original QFFQ PS (A-to-B ratio=0.5±0.07; C-to-B ratio=1.8±0.30), the ratios were closer to 1 both in men and women (P<0.001). There were no significant sex differences or racial or ethnic differences. CONCLUSIONS: These results provide guidance on appropriate ratios to use to set values for small and large PS categories on a QFFQ, particularly for items with insufficient information on usual PS.

Understanding price incentives to upsize combination meals at large US fast-food restaurants.

OBJECTIVE: To understand price incentives to upsize combination meals at fast-food restaurants by comparing the calories (i.e. kilocalories; 1 kcal = 4·184 kJ) per dollar of default combination meals (as advertised on the menu) with a higher-calorie version (created using realistic consumer additions and portion-size changes). DESIGN: Combination meals (lunch/dinner: n 258, breakfast: n 68, children's: n 34) and their prices were identified from online menus; corresponding nutrition information for each menu item was obtained from a restaurant nutrition database (MenuStat). Linear models were used to examine the difference in total calories per dollar between default and higher-calorie combination meals, overall and by restaurant. SETTING: Ten large fast-food chain restaurants located in the fifteen most populous US cities in 2017-2018. PARTICIPANTS: None. RESULTS: There were significantly more calories per dollar in higher-calorie v. default combination meals for lunch/dinner (default: 577 kJ (138 kcal)/dollar, higher-calorie: 707 kJ (169 kcal)/dollar, difference: 130 kJ (31 kcal)/dollar, P < 0·001) and breakfast (default: 536 kJ (128 kcal)/dollar, higher-calorie: 607 kJ (145 kcal)/dollar, difference: 71 kJ (17 kcal)/dollar, P = 0·009). Results for children's meals were in the same direction but were not statistically significant (default: 536 kJ (128 kcal)/dollar, higher-calorie: 741 kJ (177 kcal)/dollar, difference: 205 kJ (49 kcal)/dollar, P = 0·053). Across restaurants, the percentage change in calories per dollar for higher-calorie v. default combination meals ranged from 0·1 % (Dunkin' Donuts) to 55·0 % (Subway). CONCLUSIONS: Higher-calorie combination meals in fast-food restaurants offer significantly more calories per dollar compared with default combination meals, suggesting there is a strong financial incentive for consumers to 'upsize' their orders. Future research should test price incentives for lower-calorie options to promote healthier restaurant choices.

Differences in energy and nutritional content of menu items served by popular UK chain restaurants with versus without voluntary menu labelling: A cross-sectional study.

BACKGROUND: Poor diet is a leading driver of obesity and morbidity. One possible contributor is increased consumption of foods from out of home establishments, which tend to be high in energy density and portion size. A number of out of home establishments voluntarily provide consumers with nutritional information through menu labelling. The aim of this study was to determine whether there are differences in the energy and nutritional content of menu items served by popular UK restaurants with versus without voluntary menu labelling. METHODS AND FINDINGS: We identified the 100 most popular UK restaurant chains by sales and searched their websites for energy and nutritional information on items served in March-April 2018. We established whether or not restaurants provided voluntary menu labelling by telephoning head offices, visiting outlets and sourcing up-to-date copies of menus. We used linear regression to compare the energy content of menu items served by restaurants with versus without menu labelling, adjusting for clustering at the restaurant level. Of 100 restaurants, 42 provided some form of energy and nutritional information online. Of these, 13 (31%) voluntarily provided menu labelling. A total of 10,782 menu items were identified, of which total energy and nutritional information was available for 9605 (89%). Items from restaurants with menu labelling had 45% less fat (beta coefficient 0.55; 95% CI 0.32 to 0.96) and 60% less salt (beta coefficient 0.40; 95% CI 0.18 to 0.92). The data were cross-sectional, so the direction of causation could not be determined. CONCLUSION: Menu labelling is associated with serving items with less fat and salt in popular UK chain restaurants. Mandatory menu labelling may encourage reformulation of items served by restaurants. This could lead to public health benefits.

Cambios en la intención de compra de porciones de alimentos al aumentar el presupuesto en un ambiente simulado / Changes in the intention to purchase portions of food when the budget increases in a simulated environment

FUNDAMENTOS: El ingreso económico es un determinante clave en la elección de alimentos. El objetivo fue determinar el cambio en la intención de compra de porciones de alimentos cuando el presupuesto aumenta en un entorno de compra simulado. MÉTODOS: Estudio de intervención no aleatorizado en 70 adultos de 18 a 70 años responsables de las compras en el hogar. Se realizaron 2 compras no consecutivas de alimentos, en un supermercado online. Para cada compra se asignó un monto de dinero, primero de 87.220 CLP (134,2 USD) y segundo de 235.400 CLP (362,2 USD). Los participantes fueron clasificados según años de escolaridad. Los alimentos comprados se transformaron en porciones de consumo. RESULTADOS: La edad promedio fue de 42,1 +/- 13,5 años. Aquellos con ≤12 años de escolaridad aumentan la mediana de consumo de frutas y verduras en 1,7 porciones/día; de alimentos ricos en azúcares (ARA) 2,9 porciones/día y legumbres 2,1 porciones/semana cuando aumenta el presupuesto destinado a la compra, en comparación con los de mayor escolaridad que aumentan a 1,4 porciones / día de frutas y verduras; 2,2 porciones/día de ARA. Los participantes con mayor escolaridad tienen elecciones alimentarias más saludables con el monto 1 en comparación con los de menor escolaridad. CONCLUSIONES: Cuando aumenta el presupuesto para comprar alimentos, las familias tienden a elegir más alimentos saludables, independientemente del nivel educacional

BACKGROUND: The economic income is a key determinant the choice of food. The objective was to determine the change in intention to purchase food portions when the budget increases in a simulated purchase environment. METHODS: A non-randomized intervention study was conducted on 70 adults aged 18-70 years responsible for home purchases. Two non-consecutive purchases of food were made in an online supermarket. For each purchase, an amount of money was allocated, the first of CH $ 87,220 (USD $ 134.2) and the second of CH $ 235,400 (USD $ 362.2). The participants were classified according to years of schooling. The purchased foods were transformed into consumption portions. RESULTS:The mean age was 42.1 +/- 13.5 years. In those ≤12 years of schooling increase the median consumption of fruits and vegetables by 1.7 servings / day; of foods rich in sugars (ARA) 2.9 servings / day and legumes 2.1 servings / week when the budget allocated to the purchase increases, compared to those with higher schooling that increase to 1.4 servings / day of fruits and vegetables; 2.2 servings / day of ARA. Participants with higher education have healthier food choices with the amount 1 compared to those with less education. CONCLUSIONS: Families when they have a higher income tend to choose a greater amount of foods considered healthy, regardless of the educational level

Comparison between serving sizes of cakes and muffins sold in Australian supermarkets and coffee shop chains.

AIM: Cakes and muffins are commonly consumed discretionary foods that have increased significantly in portion size over the past decades. The present study aimed to (i) investigate serving sizes and energy per serving of cakes and muffins sold in supermarkets and coffee chains, (ii) compare to standard discretionary serves and (iii) propose feasible and appropriate serving size recommendations. METHODS: Serving sizes and energy content of cakes and muffins were collected from four major Australian supermarkets (n = 219) and eight coffee chains (n = 248) between March and April 2017 and classified into eight categories and compared using Mann-Whitney tests. Median energy per serving of cakes and muffins from supermarkets and coffee chains were compared to the Australian Dietary Guidelines standard serve of 600 kJ for discretionary food. RESULTS: The median serving size of cakes and muffins from supermarkets, 58 g (interquartile range, IQR: 47-83) and their energy content, 915 kJ (IQR: 745-1243) were significantly smaller compared with coffee chain equivalents, 148 g (IQR: 115-171, P < 0.001) and 1805 kJ (IQR: 1436-2004, P < 0.001), respectively. The majority of cakes and muffins exceeded the Australian Dietary Guidelines standard serve (78% from supermarkets and 99% from coffee chains). CONCLUSIONS: The larger servings of cakes and muffins sold in coffee chains contain nearly double the energy content of smaller servings sold in supermarkets. We recommend reference serving sizes for industry and food retail are set for this category, in combination with consumer education to guide consumers to select appropriate portion sizes.

Avoiding hunger or attaining fullness? Implicit goals of satiety guide portion selection and food intake patterns.

Although implicit theories have been studied in the context of personal traits, there has been limited investigation of their role in physiological domains such as appetite. Subjective feelings and affective states can function as goals and desired end states that individuals regulate their behaviors to attain. Likewise, different conceptualizations people maintain for the subjective experience of satiety (i.e., terminating hunger or attaining fullness) may also predict individual variations in eating behavior. We examined whether portion selection and food intake were guided by such implicit goals pertaining to the nature of satiety. Across 3 studies, we observed that individuals report distinct subjective requirements (degrees of fullness) to attain different states of satiety (stop hunger, feel comfortably full, feel completely full), suggesting that these states reflect independent goals or outcomes. Importantly, personal requirements to feel completely full (compared to stop hunger or feel comfortably full) were observed to be the strongest predictor of portion sizes selected in Study 1 (B = 1.17, p < .001) and Study 2 (B = 4.26, p = .004), and the quantity of energy consumed from a meal in Study 2 (B = 3.07, p = .01). Yet, experimentally activating a situational goal to stop hunger (vs. feel full) produced the selection of smaller portion sizes, F(1, 41) = 5.64, p = .02, and personal requirements to stop hunger to become the dominant predictor of portion selection patterns in Study 3 (B = 0.43, p = .005). These findings reveal that eating behaviors of modern consumers may be guided by a predominant goal to attain the subjective experience of complete fullness, although this implicit goal may be malleable to situational demands.

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.