Currently browsing posts about: Portion sizes

My once-a-month (first Sunday) Q and A column in the San Francisco Chronicle deals with recent city initiatives.

Q:Why do municipalities continue to try to tell us what to eat or drink through taxes (the 1-cent soda tax on the Richmond ballot in November) or outright bans (eliminating super-size soft drinks, proposed by Mayor Michael Bloomberg in New York)?  Richmond residents could just buy their sodas in neighboring towns, and 1 cent seems hardly enough to influence anyone. New Yorkers could just buy two drinks if they want more. Isn’t this all rather silly?

A: Silly? On the contrary. These are dead-serious attempts to address the health problems caused by obesity through “environmental” change – changing the context in which we make food choices.

By now, health officials are well aware that asking individuals to take responsibility for making their own healthy food choices hasn’t got a prayer of success in the face of a marketing environment that encourages people to eat everywhere, all day long, in very large portions and at relatively low cost.

This is the default food environment, where it’s useless to tell people they need to eat less and expect them to do it. They can’t. Instead, it makes sense to try to change the food environment to make healthy choices the easy choices.

Healthy by design?

Suppose, for example, that all kids’ meals at fast-food restaurants were healthy by design and automatically provided milk or water.

You could still order a soda for your kid, but you would have to ask for it – and pay extra. If you are like most people, you won’t bother. That’s why the default matters.

Cities are trying to change the default. One change may or may not make a difference – we don’t know that yet. But changing the default might well make healthy choices easier in schools, fast-food restaurants and other institutions.

Bloomberg’s proposal in New York, to ban sodas larger than 16 ounces, is one such step. From my standpoint, 16 ounces is generous. It’s two full servings and provides about 50 grams of sugars, 200 calories and 10 percent of daily calories for someone who consumes 2,000 calories a day.

Portion sizes used to be a lot smaller. Decades ago, Coca-Cola advertised 16-ounce bottles as “big” and enough to serve three over ice.

If we could recognize that larger portions have more calories – and act on this knowledge – we might have an easier time maintaining weight. But we can’t, at least not easily.

The Richmond soda tax proposal recognizes that more than half of Richmond schoolchildren are overweight or obese. This percentage is higher than in other areas of Contra Costa County.

Even more striking, city officials estimate that two-thirds of Richmond adolescents consume more than 400 calories a day from soft drinks.

Kids who habitually drink sugary sodas tend to have worse diets, to be fatter and to display more risk factors for chronic diseases than kids who don’t.

This makes sugar-sweetened beverages an obvious target for environmental approaches to obesity prevention. Sugary sodas have calories but no nutrients. They are consumed in large amounts. They are highly correlated with obesity and health risks. They are “liquid candy.”

Sugary drinks should be once-in-a-while treats, not daily fare.

Richmond officials hope that the tax will encourage healthier choices. They deliberately set the proposed tax small so it would not unduly burden low-income residents.

One penny per ounce – 16 cents on a 16-ounce soda – may not be enough to change behavior, but it sends a clear message: It’s less expensive to drink water, and it’s healthier to reduce soda intake.

Funding programs

The Richmond proposal has one other critically important feature. It specifies that soda tax revenue will be used to fund city programs to address and reduce childhood obesity, especially in low-income areas where obesity rates are high.

These experiments are worth national attention. They may well do some good for individuals, and I can’t see how they would cause harm in any way except, perhaps, to the economic interests of soda companies.

Soda companies are taking these initiatives seriously. They are pouring millions of dollars into lobbying and community campaigns against both proposals.

Both have elicited plenty of public discussion, much of it focused on the rights of individuals versus the public health interests of government.

What I like about these initiatives is that they do not infringe on individual rights – people can buy as much soda as they want. The proposals simply try to make the default food environment slightly more conducive to healthy choices.

I’m hoping both proposals go forward. I can’t wait to see how they play out.

The amazing New York City Health Department, almost unique in its interest in public health and willingness to do what it can to improve the health of New Yorkers, adds another campaign to its collection of hard hitters.  This one is on the need to reduce portion sizes.

The subway campaign posters in Spanish and English.  Here’s an example in Spanish.

I especially like this campaign because much of the work on increasing portion sizes in the food supply was launched by my former doctoral student, now Dr. Lisa Young.  See:

• Young LR, Nestle M, The contribution of expanding portion sizes to the US obesity epidemic. American Journal of Public Health, 2002. 92(2): p. 246-9.
• Young LR, Nestle M, Expanding portion sizes in the US marketplace: implications for nutrition counseling. Journal of the American Dietetic Association, 2003. 103(2): p. 231-4.

Larger portions do three things:

• They have more calories, obviously.
• They induce people to eat more calories
• They induce people to underestimate the number of calories they are eating

All of these induce people to eat more than they need or should.

The expansion of portion sizes alone is sufficient to explain rising rates of obesity.

The Health Department’s campaign makes sense.  Let’s hope it helps.

Update, January 10: The American Beverage Association doesn’t like the ads much, according to Crain’s:

Portion control is indeed an important piece of the solution to obesity,” said said Stefan Friedman, New York spokesman for the American Beverage Association, in a statement. “But instead of utilizing scare tactics, the beverage industry is offering real solutions like smaller portioned containers and calorie labels that show the number of calories in the full container, right up front, to help people chose products and sizes that are right for them and their families.

And if you think the New York City ads are tough and hard-hitting, try these “Strong4Life ads from the state of Georgia.  Shocking people out of complacency?  Or just shocking?

Update, January 25: The New York Times reports that the shocking photograph of an overweight man with a leg amputation was “photoshopped” from a stock photo.

This is unfortunate, as it opens the Health Department up to unnecessary criticism:

The American Beverage Association, which opposes the city’s efforts against sodas and fast food, called the advertisement overwrought. “This is another example of the ‘What can we get away with?’ approach that shapes these taxpayer-funded ad campaigns,” Chris Gindlesperger, the association’s director of communications, said in a statement.

I’ve collected a few video bits and other such things.  Can’t wait to share them:

• The New York City Film Festival is coming June 23 – 27.  Not to be missed.
• Standup comic Brian Regan explains portion sizes.
• Hip Hop artist D-Nick (The Microphone Misfit) raps about Abnormality in our food system.
• Last but certainly not least, Stephen Colbert riffs on the benefits of corporate sponsorships, beginning with KFC’s partnership with the Susan Komen foundation.  If you aren’t interested in the bit on worms, start watching at 01:15.

Enjoy!  Happy Mother’s Day!

As readers of this blog know by now, I very much admire and enjoy the work of Brian Wansink, the Cornell professor who studies environmental cues (like portion size) that trigger overeating.

In his latest publication, he teamed up with his brother, a professor of religion at Virginia Wesleyan, to analyze the sizes of the plates, foods, and meals illustrated in classic paintings of the Last Supper created from the year 1000 to 2000.

According to their analysis, portion sizes began expanding in about 1400.

Alas, their data points end in the 1700s.

Were they really not able to find modern depictions?

Art historians: get to work!

Professor Wansink talks about this study in the Atlantic Food Channel.  And for a more recent look at the increase in portion sizes, see the paper I wrote with Lisa Young in the American Journal of Public Health.

European candy makers have been responding to concerns about obesity by taking their ordinary chocolate bars and packaging them so the pack contains two pieces, instead of just one.  Do people eat just one?  According to Dutch researchers, they do not.

Candy eaters “still perceive the entire package as one unit instead of two, because they come in the same wrapper. This also makes them less storable.”

Suggestion: how about making smaller candy bars to begin with?

I received a flurry of “you should have attended the meeting before you said anything” messages in response to my post yesterday about the FTC forum.  They said the table that I posted did not have footnotes attached and I also had missed a key point about RACC (reference amounts commonly consumed): they are likely to be larger than current FDA serving sizes, meaning that the amounts of sugars and salt will have to be reduced to qualify.

Guilty as charged.  RACC, as I mentioned yesterday, is a new term to me.  This is because – how could anyone have missed this – I was unaware of the FDA’s Federal Register notice of April 4, 2005: “Serving sizes of products that can reasonably be consumed at one eating occasion; Updating of reference amounts customarily consumed; Approaches for recommending smaller portion sizes.”

This notice was the result of concerns about the serving sizes that had been established when the FDA issued final food labeling regulations in 1993.  Then, the FDA established serving sizes for 129 product categories for adult foods and 11 categories for infant and toddler foods.  These were derived from information about amounts commonly consumed reported in food consumption surveys from the late 1970s and late 1980s.

Either people ate a lot less back then or they were lying, or both.  As my former doctoral student, now Dr. Lisa Young, discovered during her doctoral research, standard portion sizes – half a cup of ice cream or one 2 or 3-ounce slice of pizza, for example – are smaller (sometimes much smaller) than what people seem to be actually eating.

The FDA knew this.  In 2003, it appointed an Obesity Working Group to advise the agency about several issues, among them whether to update the RACCs.  The Group filed its report in 2004.  With respect to serving size, it recommended:

* In the short-term, that FDA encourage manufacturers immediately to take advantage of the flexibility in current regulations on serving sizes that allows food packages to be labeled as a single-serving if the entire content of the package can reasonably be consumed at a single-eating occasion.

* In the long-term, that FDA develop two separate ANPRMs [Advance Notice of Proposed Rulemaking].  The first would solicit comment on whether to require additional columns within the nutrition label to list the quantitative amounts and %DV of the entire package on those products and package sizes that can reasonably be consumed at one eating occasion or, alternatively, declare the whole package as a single serving. This ANPRM would also solicit information on products and package sizes that can reasonably be consumed at one eating occasion.  The second ANPRM would solicit comments on which, if any, RACCs of food categories appear to have changed the most over the past decade and therefore need to be updated.

On that basis, the FDA’s 2005 Federal Register notice asked for comments about whether:

• Consumers might “think that an increase in serving size on food labels means more of the food should be eaten.”
• Manufacturers might repackage products in larger sizes to avoid labeling a package as a single serving.
• Manufacturers might reduce the size of single-serving packages to reduce the apparent content of undesirable nutrients.

That was nearly five years ago.  If anything further happened, I cannot find it in the Federal Register. Getting to these questions at last was apparently the point of the FTC forum.

I am told that panelists suggested raising the RACC serving size of kids’ cereals to 50 grams rather than the current 30 grams.  If so, this would require cereal companies to reduce the amount of sugars in their products.   Aha!  That could explain why, as I discussed in a previous post, General Mills chose to put its full-page ads in newspapers promising to drop the sugars to single digits.  General Mills must think changes in the RACC for cereals will require it to lower the sugars in order to be able to advertise to kids under the voluntary guidelines. Given how long the FDA’s processes take, it is understandable why General Mills failed to say when it would implement its promist.  I am also told that the salt cut-point is open for comment.

For those of us who were not at the Forum and prefer to see such things in writing, how about releasing the footnotes to that chart and giving us some examples of the proposed changes to the RACC?  Also, how about setting up a mechanism so interested people can file official comments on the proposals?  Both would help people offer more informed comments on how the FDA should handle the serving size issues.

Update, December 20: Thanks to Ellen Fried for providing a link to some food industry opinion on what all this is about and another an in-the-know source that says the proposed standards are to be published in the Federal Register and opened for further public comment in January.  The project is to be finished by July.  Ellen points out that this procedure seems administratively complicated for standards that are not regulations; they are voluntary. Do the FTC and FDA really have to go through all this to issue what is simply guidance?  Or is something else going on here that I’m not getting?

I’m still in awe of Melissa Clark’s “mature and restrained” recipe for Almond Birthday Cake with Sherry-Lemon Butter Cream. She says the recipe yields 8 servings.  But she surely must mean 24.

I used the USDA’s handy food composition data base to add up the calories: 1,060 per slice!

Yum.