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

Portion DistortionPortion DistortionPractice Makes PerfectPractice Makes Perfect

Mike Schurig, MS, RD, LD, CDEMike Schurig, MS, RD, LD, CDE

Nemours Childrens Clinic OrlandoNemours Childrens Clinic Orlando

CWD Dteam ContributorCWD Dteam Contributor

Portion Distortion: ObjectivesPortion Distortion: ObjectivesAt completion, participant will be familiar with:At completion, participant will be familiar with:

1.1. Magnitude of the obesity epidemicMagnitude of the obesity epidemic

2.2. Body Mass Index as a weight status toolBody Mass Index as a weight status tool

3.3. Sources of Portion DistortionSources of Portion Distortion

4.4. Solutions for Portion Distortion: Decreasing Solutions for Portion Distortion: Decreasing Amounts and Increasing Better FoodsAmounts and Increasing Better Foods

5.5. Portion Estimation ToolsPortion Estimation Tools

Magnitude of the Problem:Magnitude of the Problem:

According to the Centers for Disease According to the Centers for Disease Control, 65% of American adults Control, 65% of American adults today are either overweight or today are either overweight or obese.obese.

Healthcare costs associated with Healthcare costs associated with obesity are approximately $100 obesity are approximately $100 Billion per year !!!Billion per year !!!

Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 1985BRFSS, 1985

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14%



No Data <10% 10%–14%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19% ≥20



No Data <10% 10%–14% 15%–19% ≥20



No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


Obesity Trends* Among U.S. Obesity Trends* Among U.S. AdultsAdults

BRFSS, 2004BRFSS, 2004

BODY MASS INDEX(BMI)BODY MASS INDEX(BMI)

One of the MOST ACCURATE TOOLS for One of the MOST ACCURATE TOOLS for measuring WEIGHT STATUS in our societymeasuring WEIGHT STATUS in our society

MEASURING IS THE SAME FOR CHILDREN MEASURING IS THE SAME FOR CHILDREN AND ADULTSAND ADULTS

ASSESSING IS DIFFERENT, GENDER AND ASSESSING IS DIFFERENT, GENDER AND AGE SPECIFIC FOR CHILDRENAGE SPECIFIC FOR CHILDREN

MEASURING MEASURING BODY MASS INDEX (BMI)BODY MASS INDEX (BMI)

CHILDREN AND ADULTSCHILDREN AND ADULTS

WEIGHT IN KGWEIGHT IN KG

DIVIDED BYDIVIDED BY

(HEIGHT IN METERS)SQUARED(HEIGHT IN METERS)SQUARED

Figure out Your Personal Figure out Your Personal Body Mass IndexBody Mass Index

ASSESSING ASSESSING BODY MASS INDEX (BMI)BODY MASS INDEX (BMI)

CHILDRENCHILDREN

7

BMI - for- Age Cutoff s

> 95th percentile Overweight

85th to <95th percentile Risk of overweight

< 5th percentile Underweight

ASSESSING ASSESSING BODY MASS INDEXBODY MASS INDEX

ADULTSADULTS

<18.5 UNDERWEIGHT<18.5 UNDERWEIGHT 18.5-24.9 NORMAL WEIGHT18.5-24.9 NORMAL WEIGHT 25-29.9 OVERWEIGHT25-29.9 OVERWEIGHT 30> OBESE30> OBESE 40> MORBID OBESITY40> MORBID OBESITY

Portion DistortionPortion Distortion

Where are We Finding Bigger Portion Sizes Where are We Finding Bigger Portion Sizes Today???Today???

RestaurantsRestaurants

Grocery StoreGrocery Store

Fast FoodFast Food

Confused ????Confused ????

RestaurantsRestaurants

Bigger portions and more food Bigger portions and more food equates with valueequates with value

Competition is fierce nowadays with Competition is fierce nowadays with more people eating outmore people eating out

Grocery StoresGrocery Stores

““Serving sizes have grown on Serving sizes have grown on average 46% since 1980 on 65% of average 46% since 1980 on 65% of edible food items in a grocery store.”edible food items in a grocery store.”

It’s cheaper to eat unhealthyIt’s cheaper to eat unhealthy National Grocers Institute Study, National Grocers Institute Study,

2003.2003.

BagelBagel

Small bagelSmall bagel Large BagelLarge Bagel

3 inch3 inch 6 inch 6 inch

French FriesFrench Fries

Small friesSmall fries Large friesLarge fries

2.4 ounces2.4 ounces 6.9 ounces6.9 ounces

Fast FoodFast 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 Would you like to supersize that???that???

The Problem with “The Problem with “HUGE HUGE FOODFOOD””

An increase of just An increase of just 100 CALORIES100 CALORIES a a day, when compounded over the course day, when compounded over the course of a year, can result in a of a year, can result in a 14 POUND14 POUND weight gain if not balanced out with weight gain if not balanced out with EXERCISEEXERCISE..

Research has shown when people are Research has shown when people are served bigger portions, they eat more served bigger portions, they eat more and don’t compensate for extra calories and don’t compensate for extra calories by eating less later in the day.by eating less later in the day.

Stale popcorn doesn’t deter Stale popcorn doesn’t deter big portion fans (Cornell big portion fans (Cornell

study)study) Free popcorn served to movie-goers in Free popcorn served to movie-goers in

different sized containers in Philadelphiadifferent sized containers in Philadelphia ½ got fresh made popcorn; ½ got 14 day ½ got fresh made popcorn; ½ got 14 day

old stale popcorn (two sizes: med/large)old stale popcorn (two sizes: med/large) Those that got fresh popcorn ate 43.5% Those that got fresh popcorn ate 43.5%

more when given large container.more when given large container. Those that got stale popcorn ate 34% Those that got stale popcorn ate 34%

more when given a large container.more when given a large container.

Diabetes Meal PlanningDiabetes Meal Planning

More liberalized Meal Planning (Carb More liberalized Meal Planning (Carb Counting), Newer insulins, CSII Counting), Newer insulins, CSII therapy can allow for an INCREASE IN therapy can allow for an INCREASE IN FOOD CHOICES, BUT…FOOD CHOICES, BUT…

demands a DECREASE IN PORTION demands a DECREASE IN PORTION SIZESSIZES

How To Portion AccuratelyHow To Portion Accurately

Measuring ToolsMeasuring Tools Measuring cupsMeasuring cups Measuring spoonsMeasuring spoons Gram scalesGram scales

Food LabelsFood Labels Exchange Lists, Internet, BooksExchange Lists, Internet, Books Carb Factor Carb Factor (John Walsh, Pumping Insulin)(John Walsh, Pumping Insulin)

What is a Serving???What is a Serving???

Making Sense of out the Nutrition Facts Food Label

Food Guide PyramidFood Guide Pyramid

Portions vs. ServingsPortions vs. ServingsWhat’s the DifferenceWhat’s the Difference

A A SERVINGSERVING is the amount of food you see is the amount of food you see listed on the Nutrition Facts Label or what listed on the Nutrition Facts Label or what is recommended for the different food is recommended for the different food groups on the Food Guide Pyramidgroups on the Food Guide Pyramid

A A PORTIONPORTION is the amount of food you is the amount of food you choose to put on your platechoose to put on your plate

PORTIONSPORTIONS may actually contain several may actually contain several SERVINGSSERVINGS..

Managing Portion SizesManaging Portion Sizes

In restaurants, share entrees, or ask the server to In restaurants, share entrees, or ask the server to put ½ in a doggie bag before serving.put ½ in a doggie bag before serving.

Order lunch sized portions. Many restaurants Order lunch sized portions. Many restaurants serve 4-6 ounces of meat at lunch and 8-10 serve 4-6 ounces of meat at lunch and 8-10 ounces of meat at dinner.ounces of meat at dinner.

Think quality, not quantityThink quality, not quantity

Get real. Become aware of how much you are Get real. Become aware of how much you are really eating. Food diaries help.really eating. Food diaries help.

Managing Portion SizesManaging Portion Sizes

At home, use smaller plates and bowls. At home, use smaller plates and bowls. It will appear as if you’re eating more.It will appear as if you’re eating more.

Check food labels for serving size. Check food labels for serving size. Make portion sizes are closer to serving Make portion sizes are closer to serving sizes.sizes.

Buy smaller packages of candy, Buy smaller packages of candy, popcorn, and snacks.popcorn, and snacks.

Portion controlled packages reduce Portion controlled packages reduce temptation to eat more.temptation to eat more.

Sugary BeveragesSugary Beverages

Sugary drinks add empty calories and can Sugary drinks add empty calories and can contribute to weight-gain more than you contribute to weight-gain more than you thinkthink

Use Crystal Light or diet drinks to limit caloriesUse Crystal Light or diet drinks to limit calories Use smaller glasses(6oz) for any sugary beverageUse smaller glasses(6oz) for any sugary beverage

Water is your best choiceWater is your best choice Trivia Question?Trivia Question?

Is Gatorade a healthy choice?Is Gatorade a healthy choice?

Simple AdditionSimple Addition

CokeCoke GatoradGatoradee

Hawaiian Hawaiian

PunchPunch

Calories Calories per per bottlebottle

250250 200200 304304

Calories Calories in one in one yearyear

91,25091,250 73,00073,000 110,960110,960

Pounds Pounds LostLost

26 26 poundspounds

21 21 poundspounds

32 pounds32 pounds

Increase Your ActivityIncrease Your Activity

Limit screen timeLimit screen time Plan family activities-group hike, swim, or Plan family activities-group hike, swim, or

bike ridebike ride Sign up for a gym membershipSign up for a gym membership Assign everyday chores like washing the car, Assign everyday chores like washing the car,

mowing the lawn, raking, vacuuming, or mowing the lawn, raking, vacuuming, or making the bedsmaking the beds

Park far away, take the stairs, and start with Park far away, take the stairs, and start with several short 5 and 10 minute activitiesseveral short 5 and 10 minute activities

Grow up Healthy with Grow up Healthy with NemoursNemours

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

http://www.nemours.org

In Your HandsIn Your Hands

A handy method for measuring A handy method for measuring appropriate portions.appropriate portions. Serving of meat ~the size of your palmServing of meat ~the size of your palm Pasta/Rice/Starchy vegetable ~ one Pasta/Rice/Starchy vegetable ~ one

cupped handcupped hand Vegetables- two fistsVegetables- two fists

Grab-n-Go SnacksGrab-n-Go Snacks Water or diet sodaWater or diet soda Precooked chicken Precooked chicken

stripsstrips Graham crackersGraham crackers Cut up fruitCut up fruit Precut veggies w Precut veggies w

dip(LF)dip(LF) Frozen grapesFrozen grapes Low fat yogurtLow fat yogurt Trail mixTrail mix

OatmealOatmeal Low-fat popcornLow-fat popcorn Wheat thins w Wheat thins w

hummushummus Hard boiled eggHard boiled egg Prewashed salad Prewashed salad

greensgreens Granola barsGranola bars Low fat cheese Low fat cheese

sticks sticks TunaTuna

Skipping MealsSkipping Meals

Breakfast is the most important meal of Breakfast is the most important meal of the daythe day

Although, each and every meal and Although, each and every meal and snack is important as it gives you the snack is important as it gives you the energy to think, play, and enjoy your life.energy to think, play, and enjoy your life.

Subjects that skipped breakfast had a Subjects that skipped breakfast had a higher BMI than those that consumed higher BMI than those that consumed RTE cereal, hot cereal, or breads.*RTE cereal, hot cereal, or breads.*

*The Effect of Breakfast , Total Daily Energy Intake and Body Mass IndexJournal of the American College of Nutrition, Vol. 22, No. 4, 296-302 (2003)

Slow Your RollSlow Your Roll

It takes about 15 to 20 minutes for It takes about 15 to 20 minutes for someone to realize that they are full.someone to realize that they are full.

Slowing down while eating may help Slowing down while eating may help prevent overeating.prevent overeating.

Put the fork down in between bites Put the fork down in between bites and take a sip of water. Make sure and take a sip of water. Make sure to chew food thoroughly.to chew food thoroughly.

Questions?Questions?

Documents

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