Increase Portion

Size Leading to
Obesity and Other
Chronic Diseases

The Dietetic Seniors

Najlaa Almohmadi, Michael Booth, Shauna Dixon,

Jackie Ferretti, Allyson Lods, Tafauria Williams, and
Hirut Yimer

Agenda
Pre-test
History of Changing Portion Size in the
USA Portion Size Then and Now

Portion Size and Obesity

Portion Size and Diabetes
Portion Size and Cardiovascular disease
Conclusion

Objectives
Present a brief history of changes in
US portion sizes.
Understand the relationship between
increased portion size and obesity
Demonstrate the correlation between
obesity and other chronic disease

Development of Fast Food

1940 - Dick and Maurice McDonalds BBQ joint on Route 66 in San Bernadino,
CA
Restaurant catered to driving young adults
Car hops deliver food on window trays

High Profits from sale of hamburgers spurred Speedee Service System an

assembly line for food
1954 Ray Kroc and the Multi-mixer for quick efficient milkshake production
By 1958 Kroc was granted permission to franchise in Des Plaines, Illinois,
The franchise model a central source of supply for food items and
standardized menu
Exmaples: Pizza Hut, Burger King, KFC, Taco Bell

Portion Sizes Then and Now

When McDonalds first started in 1955, its only hamburger
weighed around 1.6 ounces; now, the largest hamburger
patty weighs 8 ounces, an increase of 500 percent.
According to a 2007 paper published in the Journal of
Public Health Policy, portion sizes offered by fast food
chains are 2-5 times larger than when first introduced.
The average restaurant meal is four times larger than it was
in the 1950s.
The average adult is now 26 pounds heavier than 60 years
ago.

Portion Sizes Then and Now

http://www.foxnews.com/health/2012/05/25/cdc-foodportion-sizes-four-times-as-big-since-150.html

http://feelfitastic.com/wp-content/uploads/2013/08/AW2516_06_RM_01.jpg

http://4.bp.blogspot.com/-xxMYxn2rXAg/UT9wfjyu1EI/AAAAAAAAHaY/K4ZQ54v9gsk/s1600/portion-distortion+20+years+ago.png

http://eco-savy.com/wp-content/uploads/2013/04/healthy-food-portion-size-eco-savy.jpg

Portion Size vs. Serving Size

Here are a couple of important definitions from the
National Institutes of Health:
Portion is how much food you choose to eat at one
time, whether in a restaurant, from a package or in
your own kitchen. A portion is 100 percent under our
control. See if you can pass this quiz on adult portion
sizes.

Serving Size is the amount of food listed on a

products Nutrition Facts label. So all of the nutritional
values you see on the label are for the serving size the
manufacturer suggests on the package.
http://health.gov/dietaryguidelines/dga2
005/healthieryou/html/chapter5.html

The Impact of Portion Size

Whats on the menu? A review of the energy and nutritional
content of US chain restaurants
Wu and her team evaluated 28,433 regular menu items and 1,833
childrens menus at 245 restaurants around the country between
February and May 2010.
82% of US adults eating at least once a week
A whopping 96 percent Americas chain restaurant entrees fell
outside the range of the USDAs recommendations for fat,
saturated fat and sodium per meal
Increased consumption of food away from home is associated
with poorer diet quality and higher intakes of energy, fat, and
sodium

What is Obesity?
Obesity is a condition that is associated with
having an excess of body fat, defined by genetic
and environmental factors that are difficult to
control when dieting.
Obesity is classified as having a Body Mass
Index (BMI) of 30 or greater. BMI is a tool used
to measure obesity.

Obesity Rates In Children

http://www.phitamerica.org/Assets/PHIT+America+Digital+Assets/PHIT+America+2016/PHIT+America+Digital+Assets/Obesity+Sedentary+Crisis/obesity+by+c
ountry+2015.jpg

http://stateofobesity.org/rates/

Prevalence of Obesity
More than two-thirds (68.8 percent) of adults are considered to be
overweight or obese.

More than one-third (35.7 percent) of adults are considered to be obese.

More than 1 in 20 (6.3 percent) have extreme obesity.
Almost 3 in 4 men (74 percent) are considered to be overweight or obese.

The prevalence of obesity is similar for both men and women (about 36
percent).
About 8 percent of women are considered to have extreme obesity.

Prevalence of Obesity

Source: Ogden & Carroll, 2010; Flegal et al., 2012

**Data for 19601980 are for adults ages 20 to 74; data for 19882010 are for adults age 20 and older

Portion Size and Obesity

In the 1970s, around 47 percent of Americans were
overweight or obese; now 66 percent of us are. In
addition, the number of just obese people has doubled,
from 15 percent of our population to 30 percent.
Because energy content increases with portion size,
educational and other public health efforts to address
obesity should focus on the need for people to consume
smaller portions.(Young et al, 2002)
http://www.divinecaroline.com/self/wellness/portion-size-then-vs-now
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447051/

Illustrating the Correlation

What is the Research Saying?

Portion size is a key environmental driver of energy intake, and
larger-than-appropriate portion sizes could increase the risk of
weight gain.
The predisposition to overeat in response to large portions is
pervasive and occurs regardless of demographic characteristics,
such as socioeconomic status, age, body mass index, and sex.
Secular trends toward greater availability of large portions,
coupled with value-size pricing, effectively distorted consumption
norms and perceptions of what is an appropriate amount to eat.

It Affects Both Children and

Adults
A study by Jennifer Fischer and colleagues aimed to test the
effects of portion size and energy density on childrens food
and energy intakes at a meal.
The participants were ethnically diverse and were between 5
and 6 years of age. They were accompanied by their mothers.
Children consumed 33% more energy from the entrees when
served either the larger or the more energy-dense entrees than
when served the reference versions

It Affects Both Children and

Adults Contd
Nationally representative data for children indicate
that portion size alone accounted for 17 to 19% of
the variance in energy intake; in other words, larger
portions were associated with higher intakes. In
addition, children with a higher BMI consumed
portions of foods that were as much as 100%
larger than those consumed by children with a
lower BMI.

It Effects Both Normal and

Overweight Individuals
Research by Rolls et. al examined the effect of
portion size on intake during a single meal and
investigated whether the response to portion size
depended on which person, the subject or the
experimenter, determined the amount of food on
the plate.
The experiment used a between-subjects design
with repeated measures within each group.
Subjects came to the lab to each lunch- and entre
of macaroni and cheese. Presented with 1 of 4
portion sizes 500, 625, 750, or 1000 g.

Results
Subjects in both groups consumed
significantly greater amounts of the
lunch entre as portion size increased
Less than one-half (45%) of the
subjects reported that they noticed
differences in the portion sizes of the
macaroni and cheese that were
presented to them.
26 subjects reported that the amount
of macaroni and cheese offered was
appropriate. 23 subjects indicated that
the portion sizes were too large. 1
subject indicated that some portion
sizes were appropriate and some were
not, and 1 subject indicated that the
portion sizes were too small.

Making the Connection

In 1996 the average American family spent 40% of the food
dollar on meals purchased away from home, an increase from
26% spent in 1970.
Americans are now 40% more likely to consume meals from
restaurants 3 or more times a week as they were in the late
1980s

The Need for Education

In an article written by Marion Nestle, she states, I
emphasize calories (rather than fat or sugar) because in my
dealings with students, colleagues, the public, and the press
about the obesity epidemic, I encounter a surprising
conceptual gap: a virtual absence of intuitive understanding
that larger portions contribute more calories. Most people
seem to view a soft drink as a soft drink, no matter how big it
is.

Intervention
Livingstone and Pourshahidis article from the
American Society of Nutrition emphasize
Empowering through education to manage portion sizes.
Portion size labeling has the potential to help consumers
select more appropriate portion sizes
Meaningful dialogue with consumers is currently impeded by
the lack of a transparent and consistent message regarding
portion size, serving size, and reference portion

Interventions Cont
Vermeer and colleagues conducted a review to
identify possibilities for feasible and effective
interventions targeted at portion size.
Interventions targeted at food selection were
determined to be very effective because once a larger
portion is selected, over consumption is very likely.

Appropriate communication is key

Emphasize the rationale for the intervention: Ex. weight
control

Interventions should be multi-focused

Point of purchase
Dealing with a super size environment

Interventions Cont
There is increasing evidence that excessive food
portions, particularly of energy-dense foods, contribute
to the overconsumption of energy.
Telling people to simply eat less is not likely to be an
effective solution, because it is not just large portion sizes
that increase energy intake, but rather large portions of
energy-dense foods.
Large portions of foods low in energy density such as
vegetables, fruits, and broth-based soups an aid weight
management by providing satisfying portions with few
calories.
There is a need to deliver effective educational messages
that combine the principles of portion size and energy
density.

Obesity and Chronic Diseases

data:image/jpeg;base64,

What is Diabetes?
Diabetes is a problem with your body that
causes blood glucose levels to rise higher
than normal. This is also called
hyperglycemia. Type 2 diabetes is the most
common form of diabetes.
If you have type 2 diabetes your body does
not use insulin properly. This is called
insulin resistance.

Diabetes Incidence and Prevalence

Among children with type 2 diabetes, about
80% were obese.
In 2012, the prevalence of diabetes (type 1
plus type 2) was 14% for men and 11% for
women ages 20 years and older (more than
90% of total diabetes in adults is type 2).

Diabetes in the United States

http://health.gov/dietaryguidelines/2015/guidelines

Obesity Related to Diabetes

The incidence of obesity is increasing in the population
at large, and at a higher rate in minority populations.
Obesity increases the risk of developing other chronic
diseases such as hypertension, diabetes, coronary heart
disease, and several types of cancer.
Studies point toward that body mass index (BMI)
becomes relatively fixed by adolescence and that
children who are obese are likely to remain obese as
adults.

Obesity Related to Diabetes

Obesity and weight gain are associated with an
increased risk of diabetes.
In 2001, 3.4% of US adults were both obese and
had diabetes, an increase of 1.4% in 1991. Blacks
had the highest rate of diagnosed diabetes among
all race groups.
Increases in obesity and diabetes among US adults
continue in both sexes, all ages, all races, all
educational levels, and all smoking levels.

Why is this Important?

There are currently 16 million Americans with diabetes, but it
is projected that within 10 years, there will be 23 million
Americans with this disease.
Associated with the aging of the population, the dramatic
rise in the prevalence of obesity, and a more sedentary
lifestyle.
Childhood obesity has led to a marked increase in type 2
diabetes in adolescents and young adults.

Where is it Beginning?
Young-Hyman et. Al in 2012, examined the care
giver's perception of childrens weight related risk
in African American families.
111 families screened for diabetes prevention
completed a health awareness questionnaire and
physical assessment.
Nine percent of the children screened were normal
weight, 22% were heavy, 57% were obese, and 12%
were super-obese.

Where is it Beginning? Contd

Child's eating habits: 3% of parents reported their child ate too little.
32% stated their child ate just the right amount of food, and 65% stated
their child ate too much.
A slight majority of parents believed their child ate a well-balanced diet,
whereas 47% rated their child as eating the wrong foods.
Despite the large number of children who were extremely overweight,
only 11% of all children had ever been referred for medical evaluation
because of their weight. 8% of the children had received prior
treatment related to weight problems, and only 6% of the children had
ever received dietary services or been placed on a therapeutic diet

Insulin Resistance Related to

Diabetes
Insulin resistance is defined as a decreased
response of the peripheral tissues to insulin
action.

Individuals with insulin resistance are

predisposed to developing type 2 diabetes
mellitus.

Research Indicates
Mice from The Jackson Laboratory were put on
diets containing 10%, 45%, or 60% kcal from fat
To determine whether the upregulation of
macronutrients increase the development of
systematic insulin resistance.

Xu and et. Al, in 2003 tracked the expression

levels of these genes in white adipose tissue (WAT)
of mice with high-fat dietinduced obesity at
multiple time points for 26 weeks

Research Indicates Contd

The body weight increased steadily over this
period, as did the fasting blood glucose level,
although the latter remained within the normal
range (<120 mg/dl) until sometime after 16 weeks.
Observation an increase in expression of some of
these inflammation genes as early as 3 weeks on
high-fat diet

Eating Behaviors in Relation to

Diabetes
Portion sizes are an important topic in the discussion of
excessive energy intake and the increased risk for the
development of chronic diseases
Eating behaviors, such as eating speed, frequency of meals
and suboptimal food choices

Eating Behaviors in Relation to

Diabetes: Eating Speed

Eating fast has been found to lead to excess weight gain even when both fast
and slow groups consumed the same amount of energy
It has been suggested that fast eating speeds can independently lead to insulin
resistance

Eating Behaviors in Relation to

Diabetes: Eating Speed

Eating speed is associated with higher energy intake

Excess weight gain from excessive energy intake increased the risk for type 2
DM

Eating Behaviors in Relation to

Diabetes: Meal Frequency

There has been a drop in reported breakfast consumption, which is inversely

related to the Type 2 DM
Daily breakfast consumers were older, had a slightly lower BMI, smoked less,
were more physically active, consumed more cereal fibers, and drank less
coffee

Eating Behaviors in Relation to

Diabetes: Refined Carbohydrates

Increase in refined carbohydrate consumption and inadequate fiber intake in

the U.S. is paralleled in the epidemic of type 2 DM

Eating Behaviors in Relation to

Diabetes: Meat Consumption

The increased consumption of processed and unprocessed red

meat is followed by elevated risk of type 2 DM

Eating Behaviors in Relation to

Diabetes: Meat Consumption

Courtesy of healthy.gov

Eating Behaviors in Relation to

Diabetes: Meat Consumption

Courtesy of healthy.gov

Eating Behaviors in Relation to Diabetes:

Solid Fat Intake

Courtesy of healthy.gov

Cardiovascular Disease

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj55IfqgJbMAh

Obesity, Diabetes and Cardiovascular

Disease

http://puncritongsi.site.bz/jara/diseases-and-disorders-diabetes-37.php

Cardiovascular Disease
Cardiovascular disease CVD is the main cause of
death worldwide.
According to the CDC, each year approximately 1 in
every 4 deaths. (34.1%) Half of those patients are
over 60 years old.
D.C has the highest rank in the U.S

Cardiovascular Disease
Over 50 percent of the deaths due to heart disease
were in men.
Coronary heart disease (CHD) is now the most
common type of heart disease, killing over 370,000
people.
Deaths due to heart disease vary by race.

Introduction
CVD includes:
Hypertension
Atherosclerosis
Coronary heart disease
Peripheral Artery Disease
Ischemic Heart Disease
Heart failure

Risk Factors:

Research: Cardiovascular Disease

Risk Among Young Urban
Women
According to Giardina Elsa-Grace, 2015 who
conduct a research on 1,045 women aged 1849
years found that 595 women have one or more
risk factors for CVD.

Research: Cardiovascular Disease

Risk Among Young Urban
Women
According to Giardina Elsa-Grace, 2015 who
conduct a research on 1,045 women aged 1849
years found that 595 women has one or more
risk factor for CVD.

Hypertension
Silent

killer

140/80 or 120/90 mm hg or normal range

with hypertensive medication.
Increases the risk for:
Congestive heart failure
Kidney failure
Myocardial infarction
Stroke
Aneurysms

Hypertension in the United States

http://health.gov/dietaryguidelines/2015/guidelines

Research
Efficacy of Dietary Behavior Modification for
Preserving Cardiovascular Health and Longevity
by Pryde and Kannel published in 2010 in the
Cardiology Research and Practice Journal:
Performed a systematic review focused on large
trials
Evaluated Portion Control for Weight
Management
Evaluated 4 articles

Findings
According to Pederson et al, In 2007, they completed a
randomized trial of weight control in 130 participants with type 2
diabetes
When presented with greater portion sizes people tended to eat more but
reported the same level of satiation

In a study by Rolls et al. participants were given four different

portion sizes of macaroni and cheese on different days
Although consumption increased with the portion size, participants
reported similar levels of satiation and less than half noticed that portion
sizes change
Consumption of the largest portion as opposed to the smallest portion
amount to 30% more energy
Rolls et al. also examined how energy intake increases in both men and
women as the portion size of snack increases

Findings
In similar study by Rolls et al, participants were given
different sizes of sub sandwiches on 4 different days.
Participants ate more as the sandwich size increased

Findings Cont.
A study by Diliberti et. Al
showed similar effect in
participants who were
severed different
quantities on different
days in a restaurant,

Found an increased
consumption as portion
size increased

Research Conclusion
Prye and Kannel conclude that increased portion size appears
to make it difficult for people to determine how much is
being consumed and leads to excess calorie consumption.
Therefore, public awareness of the effect portion size can
have on weight control efforts is essential.

Summary
All in all, given the current research we can deduce that increased
portion sizes increases risk for obesity, cardiovascular disease, and
diabetes. The inter-workings of this relationship are due in part to
the fact that larger portions cause increased energy intake which
correlate with weight gain. Research has shown that with increased
rates of obesity the risk for development of non-communicable
diseases is greater. Nutrition education will be essential in
communicating effective interventions going forward and should
be tailored to the individual. In this way, we can be effective
clinicians and public health advocates making strides to evoke
positive behavior change within the population.

References
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Young, L. R., & Nestle, M. (2012). Reducing Portion Sizes to Prevent Obesity. American Journal
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