Portion Distortion Practice Makes Perfect Mike Schurig MS

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

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. 5. Solutions for Portion Distortion: Decreasing Amounts and Increasing Better Foods Portion Estimation Tools

Magnitude of the Problem: n n 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 !!!

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

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

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

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

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

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

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

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

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

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

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

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

Figure out Your Personal Body Mass Index

ASSESSING BODY MASS INDEX (BMI) CHILDREN

ASSESSING BODY MASS INDEX ADULTS n n n <18. 5 UNDERWEIGHT 18. 5 -24. 9 NORMAL WEIGHT 25 -29. 9 OVERWEIGHT 30> OBESE 40> MORBID OBESITY

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

Confused ? ?

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

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

Bagel Small bagel 3 inch Large Bagel 6 inch

French Fries Small fries Large fries 2. 4 ounces 6. 9 ounces

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

Would you like to supersize that? ? ?

The Problem with “HUGE FOOD” n n 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 and don’t compensate for extra calories by eating less later in the day.

Stale popcorn doesn’t deter big portion fans (Cornell study) n n 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) 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.

Diabetes Meal Planning n 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

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

What is a Serving? ? ?

Making Sense of out the Nutrition Facts Food Label

Food Guide Pyramid

Portions vs. Servings What’s the Difference n n n 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 PORTIONS may actually contain several SERVINGS.

Managing Portion Sizes n n 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. Think quality, not quantity Get real. Become aware of how much you are really eating. Food diaries help.

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

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

Simple Addition Coke Gatorade Hawaiian Punch Calories 250 per bottle 200 304 Calories in one year Pounds Lost 91, 250 73, 000 110, 960 26 pounds 21 pounds 32 pounds

Increase Your Activity n n n Limit screen time Plan family activities-group hike, swim, or bike ride Sign up for a gym membership 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

Grow up Healthy with Nemours n n http: //www. nemours. org 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

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

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

Skipping Meals n n n 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. 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)

Slow Your Roll n n n It takes about 15 to 20 minutes for someone to realize that they are full. 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.

Questions?