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Bad Popcorn in Big Buckets: Portion Size Can Influence Intake as Much as Taste
Abstract
It is often believed that people overeat the foods they like. We investigated whether environmental cues such as packaging and container size are so powerful that they can increase our intake of foods that are less palatable.
In a 2 x 2 between-subjects design, 158 moviegoers in Philadelphia (57.6% male; 28.7 years) were randomly given a medium (120 g) or a large (240 g) container of free popcorn that was either fresh or stale (14 days old). Following the movie, consumption measures were taken, along with measures of perceived taste.
Moviegoers who were given fresh popcorn ate 45.3% more popcorn when it was given to them in large containers. This container-size influence is so powerful that even when the popcorn was disliked, people still ate 33.6% more popcorn when eating from a large container than from a medium-size container.
Even when foods are not palatable, large packages and containers can lead to overeating. The silver lining of these findings may be that portion size can also be used to increase the consumption of less preferred healthful foods, such as raw vegetables.
... Since 1960, the size of the average dinner plate has increased by 36% (8). Based on some studies, a positive correlation was seen between dishware size or plate and the amount of food consumption portion (10)(11)(12)(13). Recently, obesity has been rapidly increasing and, has become a major health problem worldwide. ...
... While some studies (15,37,38 ) reported that plate size did not have any effect on the perception of food portion size. On the other hand, other studies (9)(10)(11)(12)(13)39) showed that increasing plate size leads people to eat more food. One study has presented that half of the study participants notified that they tended to eat until they 'clean their plates'. ...
... One study indicated that participants who served themselves cereal in a larger bowl ate 30% more cereal and underestimated their portion size by 14% compared with those given smaller bowls (40). Wansink et al. (11) reported a similar relationship between glass size and amounts of drinking beverages. Another study indicated that in comparison with wide glasses, tall and slender glasses cause to consume more quantity of beverages (41). ...
... Increased portion sizes significantly increase people's food consumption and energy intake (Diliberti et al., 2004;Rolls et al., 2006;Rolls et al., 2004a,b;Rolls et al., 2002;Wansink and Kim, 2005). It also contributes to increased food waste at the post-consumer stage (Freedman and Brochado, 2010). ...
... 2.2 The portion size effect on food consumption The positive association between portion size and food intake has been well-established in previous studies (Diliberti et al., 2004;Fisher et al., 2007;Rolls et al., 2006;Rolls et al., 2004a,b;Rolls et al., 2002;Wansink and Kim, 2005), and has been observed among people of various demographic characteristics (Fisher et al., 2007;Rolls et al., 2007). Meta-analysis results indicated that the effect of portion size could be moderated by gender, age, weight status, and mindfulness of the subjects (Zlatevska et al., 2014). ...
The restaurant industry’s increased portion sizes have led to accusations that they contribute to food overconsumption. Reducing excessive food portions in restaurants, however, may be considered risky by foodservice operators concerned about consumers’ perceived value of the food. Two quasi-experiments were conducted examining how changes in portion and plate size would affect restaurant consumers’ perceived reasonable price of food and their willingness to pay. A two-by-two, between-subject factorial design was used in study 1 (n = 101) with plate size (small & medium) and portion size (regular & reduced) as independent variables. Study 2 used a between subject design with three experimental conditions: large portion, medium portion, and small portion (n = 71). Results showed that the impact of a reduced portion size on consumers' perceived value of the food depended on the consumers' perceived quality of the food and their purchase intention.
... The Small Plate Movement (www.smallplatemovement.org) is founded on the premise that smaller plates lead us to eat less, but the evidence on the effect of plate size 1 is greatly disputed. Some researchers report that smaller plates reduce consumption (Wansink and Kim 2005;Wansink, Payne, and Werle 2008;Van Kleef et al. 2012;Wansink and Van Ittersum 2013). But many others report finding no effect (Rolls et al. 2004(Rolls et al. , 2007Shah et al. 2011;Yip et al. 2013;Libotte et al. 2014). ...
... The problem is that the size manipulation is confounded with the number manipulation, a feature of "partitioning" studies that can have paradoxical and contradictory effects (Zlatevska et al. 2014;Holden and Zlatevska 2015). and Pliner 2009), and also volume whether reported as bowl size (Ahn et al. 2010) or package size (Wansink and Kim 2005). Second and in line with an observation by Libotte et al. (2014), we distinguished between whether the plate being manipulated was the serving plate (e.g., Wansink 1996) or the consumption plate (e.g., Rolls et al. 2007). ...
The literature on whether varying plate size has an effect on consumption is mixed and contradictory. This meta-analysis of 56 studies from 20 papers shows that varying the size of the container holding food (e.g., plate or bowl) has a substantial effect on amount self-served and/or consumed (Cohen’s d 5 .43). More generally, we found a doubling of plate size increased the amount self-served or amount consumed by 41%. Our analysis resolves the various
contradictions of past reviews: we found that the plate-size effect had a substantial effect on amount self-served (d = .51) and on amount consumed when the portion was self-served (d = .70) or manipulated along with (confounded with) plate size (d = 48). However, plate size had no effect on amount consumed when the portion size was held constant (d = .03). Overall, plate size had a stronger effect when participants were unaware that they were participating in a food study (d = .76).
... In personal-consumption contexts, it is reasonable to argue that one should attempt to match, as best as possible, his or her purchase amount with his or her intended consumption. Underpurchasing will leave the individual hungry, whereas overpurchasing will leave excess food, which often leads to greater-than-intended consumption (i.e., overconsumption; Wansink and Kim 2005) and waste. Of course, excess food can also be stored for future consumption, but merely increasing the chance of overconsumption and waste is nonnormative. ...
... personalconsumption) group contexts, then it is plausible that they may also consume and/or waste more as well, even if their initial intended consumption is uninfluenced by the context. On the one hand, people tend to consume what is available, even when doing so is objectively unappealing (Wansink and Kim 2005). Thus, overconsumption is a likely outcome when food is overly abundant (Roberto, Pomeranz, and Fisher 2014;Wansink and Chandon 2014), despite one's best intentions. ...
Overconsuming and wasting food are disadvantageous for consumers and society as a whole and, therefore, are topics of great relevance. This research identifies food-based collaborative consumption (CC) as a hitherto unrecognized cause of overpurchasing, overconsuming, and wasting food. Food-based CC, which involves members of a group contributing to and taking from a collective pool of food, is a common social practice (e.g., potlucks) and a widely adopted format by the restaurant industry (e.g., family-style and tapas dining). A combination of interviews, behavioral studies, and online experiments show that consumers purchase significantly more food per person in CC (vs. personal-consumption) group contexts, resulting in overconsumption and waste. This is shown to be the result of both generosity motives and cognitive errors (specifically, failing to account for the reciprocal nature of CC). However, inflated purchase amounts in CC contexts can be reduced (i.e., consumer well-being can be improved) by (1) having consumers explicitly focus on the amount they expect to take from others and (2) providing antiwaste persuasive messages at the point of purchase.
... Out of these 15 studies, 12 found a significant relationship between package downsizing and a lower actual or intended consumption. Two studies in children aged between 3 and 7 years [37] and six studies in adults reported a significantly lower consumption when snacks or drinks (including alcoholic and nonalcoholic drinks) were provided in a smaller compared to a larger package [32,[38][39][40]42,43]. Four studies found adult participants' intention to consume was significantly lower when snacks were provided in a smaller than a larger package [41,45,46]. ...
... Three studies found that the effects of a smaller single package on reducing consumption or intention to consume was more prominent among males than females [40,45], but five other studies did not observe any difference between genders [37,41,44,47]. Four studies using popcorn observed the tendency to overeat from a larger package was more prominent when children [37] and adults [42,43] were offered their preferred snacks (for example, fresh popcorn) compared to not preferred (for example, stale popcorn); however, this was not observed in one study in adults [39]. Compared with exposure to non-diet-related material (such as a travel magazine), exposure to diet-related material (such as a weight loss and fitness magazine) prior to eating resulted in reduced intake from the larger single package and diminished the package size effect [41]. ...
The single-serve packaging of discretionary foods is becoming increasingly popular, but evidence is limited on whether smaller package sizes can reduce food intake. The aim of this scoping review is to assess the effect of reducing the package size of energy-dense, nutrient-poor (EDNP) snacks and drinks on consumption, intentions, and perception, and to examine the effects of potential moderators or mediators. The search was conducted in six selected databases and grey literature sources, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for the scoping review process (PRISMA-ScR) guidelines. After screening 5562 articles, 30 articles comprising 47 intervention studies were included. Twelve of 15 studies found a significant effect in lowering the actual or intended consumption when a single smaller package was offered compared with a single larger package. When the total serving size was held constant between varying package conditions, such as a multipack, single package, or unpackaged, the results on the actual and intended consumption were inconsistent and varied according to the presence of moderators. Overall, these findings suggest that an overall reduction in the size of a single package is a more promising strategy than providing multipacks to reduce consumption. Changes to the current food environment to promote single smaller packages of EDNP snacks and drinks are necessary to support the better selection of appropriate portion sizes and reduce consumption.
... Potentially the movie served as a distraction which increased food intake as shown in previous studies with adults (Ogden et al., 2013) as well as with children (Del Torro & Greenberg, 1989;Dietz & Gortemaker, 1985). Wansink also showed that while adults watched a movie little attention was given to the actual taste of the food they were served (Wansink & Kim, 2005). Although the increased consumption due to a distractor such as a movie imposes a potential health issue with discretionary foods, in the case of vegetables it might serve as a health benefit. ...
... This finding of a detrimental effect on cancer risk may be due to chance, given the number of multiple comparisons for the individual whole grain food sources that were conducted in these analyses, and warrants confirmation in future studies with larger sample sizes. This can also be attributed to the marketing and purchase of large portion sizes of this snack food or to the butter, salt, and sugar that are typically added to microwave popcorn (38), which can lead to overeating and consequently obesity, an established risk factor for these cancers (39). However, in this cohort, adjustment for energy intake and measures of body adiposity did not alter these findings. ...
Case-control studies suggest that higher whole grain and lower refined grain intakes are associated with reduced cancer risk, but longitudinal evidence is limited. The objective of this prospective cohort study is to evaluate associations between whole and refined grains and their food sources in relation to adiposity-related cancer risk. Participants were adults from the Framingham Offspring cohort (N = 3,184; ≥18 yr). Diet, measured using a food frequency questionnaire, medical and lifestyle data were collected at exam 5 (1991–95). Between 1991 and 2013, 565 adiposity-related cancers were ascertained using pathology reports. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals for associations of whole and refined grains with risk of adiposity-related cancers combined and with risk of breast and prostate cancers in exploratory site-specific analyses. Null associations between whole and refined grains and combined incidence of adiposity-related cancers were observed in multivariable-adjusted models (HR: 0.94; 95% CI: 0.71–1.23 and HR: 0.98; 95% CI: 0.70–1.38, respectively). In exploratory analyses, higher intakes of whole grains (oz eq/day) and whole grain food sources (servings/day) were associated with 39% and 47% lower breast cancer risk (HR: 0.61; 95% CI: 0.38–0.98 and HR: 0.53; 95% CI: 0.33–0.86, respectively). In conclusion, whole and refined grains were not associated with adiposity-related cancer risk. Whole grains may protect against breast cancer, but findings require confirmation within a larger sample and in other ethnic groups.
... El ambiente y la disposición de los alimentos pueden disminuir o aumentar consumo y es un factor clave del comportamiento de las personas y de la condición de obesidad (Wansink, 2005). Este concepto de control de porciones se enmarca con el sesgo de anclaje. ...
Las disciplinas creativas tienen entre otras características aportar una mirada integral a las problemáticas complejas de las comunidades y brindar herramientas de comunicación efectivas y de alta recordación. En el caso de la salud, el diseño se ha centrado en mejorar ambientes y artefactos para hacer más confortable y segura la vida de las personas, contribuyendo al desarrollo de una cultura material que impacta directamente en la salud y bienestar de las comunidades. En el caso de usar el diseño para buscar alternativas a la problemática del sobre peso y la obesidad, se debe entender los factores que desencadenan esta condición, entre los cuales se encuentran los mecanismos de pensamiento de las personas y el porque de sus comportamientos y hábitos poco saludables. Este libro tienen como objetivo exponer una serie de aproximaciones y estrategias creativas para reducir el sobre peso tomando como referencia conceptual la economía del comportamiento. Se espera que sea e ayuda tanto a profesionales de la salud como a pacientes que quieran buscar opciones de apoyo a sus tratamientos; de igual manera se quiere motivar a investigadores en salud y diseño para que exploren alternativas creativas e innovadoras para mejorar la vida de las personas vinculando áreas como el diseño a actividades que propenden por mejorar su calidad de vida.
... For example, gave study participants soup with a normal bowl or a self-refilling bowl, and found that those that ate soup from the self-refilling bowl ate 73% more soup. In randomized controlled experiments, comparable studies found that quantities of food consumed increased with increases in portion sizes of popcorn (Wansink and Kim 2005), ice cream , sandwiches (Rolls et al. 2004a), packaged snacks (Rolls et al. 2004b), and all meals over a 2-day period (Rolls et al. 2006(Rolls et al. , 2007. It seems that individuals consume more with larger portion sizes simply 5.3 ROLE OF THE FOOD INDUSTRY 125 because they are unaware of the size of the serving they are consuming (Chandon and Wansink 2007b). ...
... For both men and women of varying ages and body weights, experimental studies have consistently shown that increasing food portion sizes increases voluntary energy intake. Increased energy intakes occur when American adults are served larger portions of a range of foods, including caloric beverages [1], baked pasta dishes [2], fresh or stale popcorn [3], cookies, yoghurt, garlic bread and chicken stir-fry meals [4]. The association between larger portion sizes and increased energy intake has been shown to be true for foods served as a unit (e.g., a deli-type sandwich) [5], for pre-packaged snack foods (e.g., potato chips) [6] and for foods of amorphous shape (e.g., macaroni and cheese) [7]. ...
Reduction in portion size, particularly for energy-dense foods, is increasingly addressed in healthy eating guidelines in a bid to tackle the obesity epidemic. The effect of portion size on other aspects of dietary quality, such as nutrient intakes, is less studied. The aim of the current work was to investigate associations between food portion sizes and key indicators of dietary quality, namely energy-adjusted intakes of saturated fat, dietary fibre, sodium, calcium, iron, folate and vitamin D, and dietary energy density (DED), in Irish adults on the days the foods were consumed. Data from the Irish National Adult Nutrition Survey (2008–2010) (n = 1274, 18–64 years, 4-day semi-weighed record) were used for the analysis. DED was lower on the days larger portions of boiled potatoes, fruit, vegetables and baked beans were consumed, and higher on the days larger portions of white bread, ready-to-eat breakfast cereals (RTEBCs), frying meats, cheese, butter, biscuits, chocolate and sugar-sweetened beverages were consumed. Micronutrient intakes were higher on the days larger portions of brown bread, RTEBCs, vegetables and low-fat spreads were consumed, and lower on the days larger portions of white bread, butter, biscuits, chocolate, sugar-sweetened beverages and beer/cider were consumed, with the exception of folate. The study identifies foods for which larger portion sizes may be associated with positive dietary attributes, as well as the opposite. It provides an important evidence base from which more specific dietary guidance on food portion sizes might be developed for Irish adults.
... Size is an important part of the packaging that can provide more information. From the research conducted by Aerts & Smits (2017) and Wansink & Kim (2005) size gives effect to the consumption of a product. Likewise, the research conducted by Makanjuola & Enujiugha (2015) stated that the greater the product is, the greater the impression. ...
Research on smoked fish packaging has only focused on its functional side to increase product life. Meanwhile, research on smoked fish packaging design that focuses on improving and expanding markets has never existed. Until now, smoked fish was sold without packaging even though the amount of production continued to increase. The purpose of this study was to determine consumer preferences for the design of smoked fish packaging. With the recognition of these preferences, it is expected that the smoked fish industry players can apply it so that it can increase the sale value and the number of sales. This study uses focus group discussion as a qualitative method and conjoint analysis as a quantitative method. Color, material, shape, size, brand, and additional information is the attribute chosen at the focus group discussion as a representation of smoked fish packaging to determine the level of its preference. The results of this study indicate that brands have the highest preference compared to others (importance values 30.303%).
... In a study conducted in a movie theater, adult consumers were given a medium or a large pack of popcorn that was either fresh or stale. People ate respectively 45.3% and 33% more of fresh and stale popcorn when it was given to them in large containers, indicating that perceived taste and quality had little impact on how much popcorn was eaten, while the package size was the best predictor for intake (Wansink & Kim, 2005). Interestingly, Aerts and Smits (2017) have recently replicated this experiment with children (age 3-7). ...
... This protocol was adopted to improve the ecological validity of the study, although it poses an additional challenge when comparing current and previous findings. A study from Wansink and Kim [35] have shown that, in an eating scenario with distractions, individuals pay less attention to sensory cues, e.g., food texture. Hypothetically, diminished attention to food sensory cues can lead to variation in perceived satiation and food intake. ...
Food texture plays a critical role in influencing an individual’s perceived satiation and ad libitum intake. It remains unclear, however, whether such textural changes can also affect snack consumption. This study aimed to address this question by testing for changes in perceived satiation and ad libitum intake of two types of potato chips with varying hardness. In addition, the observed effect was compared across gender groups. With a crossover design, 74 participants (31 females and 43 males) performed a food consumption task for two types of chips produced from potatoes that were either untreated or treated with pulsed electric fields (PEF) technology. Sensory analyses indicated that these two types of chips had comparable hedonic value, despite a clear textural difference. Across sexes, the results revealed a significant difference in perceived satiation for the two types of chips (p = 0.009), but not in intake. By contrast, analyses of males alone revealed that male participants rated PEF-treated chips to be more satiating than the control chips and correspondingly consumed less (p < 0.05). Overall, findings from the study suggest that modifications of food texture can be a helpful tool in reducing energy intake from snack consumption. The contrasting results from different gender groups highlight the importance of considering gender effects in studies of eating behaviour.
... While laboratory interventions demonstrate cause and effect associations they tend to show small, although robust effects, but may not be representative of everyday life contexts. To address this limitation, field studies have been conducted in leisure centres, restaurants or social venues 66,134,135 as environments more reflective of human behaviour. However field studies are also susceptible to being affected by confounding factors due to non-controlled environmental effects, such as exposure to marketing cues, food smells, peer pressure and price effects. ...
Context:
Overestimation or underestimation of portion size leads to measurement error during dietary assessment.
Objective:
To identify portion size estimation elements (PSEEs) and evaluate their relative efficacy in relation to dietary assessment, and assess the quality of studies validating PSEEs.
Data selection and extraction:
Electronic databases, internet sites, and cross-references of published records were searched, generating 16 801 initial records, from which 334 records were reviewed and 542 PSEEs were identified, comprising 5% 1-dimensional tools (eg, food guides), 46% 2-dimensional tools (eg, photographic atlases), and 49% 3-dimensional tools (eg, household utensils). Out of 334 studies, 21 validated a PSEE (compared PSEE to actual food amounts) and 13 compared PSEEs with other PSEEs.
Conclusion:
Quality assessment showed that only a few validation studies were of high quality. According to the findings of validation and comparison studies, food image-based PSEEs were more accurate than food models and household utensils. Key factors to consider when selecting a PSEE include efficiency of the PSEE and its applicability to targeted settings and populations.
... Each of these features can have a direct impact on how consumers interact with the food. Packaging can be designed either to encourage more frequent or less frequent consumption, as well as greater or lesser quantity consumption in a sitting (Wansink and Kim, 2005). Similarly, marketing of a good can influence social norms surrounding the use of a good, as well as the frequency of purchase. ...
Behavioral economic based interventions have shown some promise in leading food consumers of all ages to healthier diets. Such interventions face unique challenges in addressing the diets of SNAP recipients. First, current law prohibits differential treatment of SNAP recipients and other grocery store customers. Thus, the nudges cannot narrowly target those participating in SNAP. Second, SNAP participants make the majority of their qualifying purchases in grocery stores which are already heavily loaded with behavioral nudges. Not only must nudges compete for attention within the store, but they must be at least weakly beneficial to the store owner. We discuss examples that demonstrate the possibility of meeting these seemingly strict criteria, and the potential for using such nudge interventions as a part of SNAP.
... This 'portion size effect' persists even when food remains uneaten at the end of a meal (Rolls et al., 2002), suggesting that the phenomenon is not simply due to plate clearing. The amount served influences intake of amorphous foods (e.g., pasta bake) (Rolls et al., 2002), foods served in discrete units, such as sandwiches , prepackaged snacks (Raynor & Wing, 2007) and even unpalatable foods, such as stale popcorn (Wansink & Kim, 2005). ...
... Perhaps the high number of hours watching TV that subjects already reported before confinement have not allowed us to detect this influence. Moreover, in the literature, it has been demonstrated that, when distracted (e.g., by watching movies or TV), individuals often overconsume and are not necessarily cognizant of the dietary quality of the snacks eaten (18). Nowadays, COVID-19 has spread to several countries around the world and is presently a major global concern. ...
Background:
coronavirus disease 2019 (COVID-19) can induce an exaggerated inflammatory response. Vitamin D is a key modulator of the immune system. We hypothesized that vitamin D deficiency (VDD) could increase the risk of developing severe COVID-19 infection.
Methods:
patients with confirmed COVID-19 seen at the emergency department of our hospital with recent measurements of 25(OH)D were recruited. We explored the association of vitamin D deficiency (VDD), defined as 25-hydroxyvitamin D < 20 ng/mL, with a composite of adverse clinical outcomes.
Results:
we included 80 patients, of which 31 (39 %) presented the endpoint. VDD tended to predict an increased risk of developing severe COVID-19 after adjusting for age, gender, obesity, cardiac disease, and kidney disease [OR 3.2 (95 % CI: 0.9-11.4), p = 0.07]. Age had a negative interaction with the effect of VDD on the composite outcome (p = 0.03), indicating that the effect was more noticeable at younger ages. Furthermore, male gender was associated with VDD and with severe COVID-19 at younger ages.
Conclusions:
in this retrospective study, vitamin D deficiency showed a signal of association with severe COVID-19 infection. A significant interaction with age was noted, suggesting VDD may have a greater impact in younger patients. These findings should be confirmed in larger, prospective, adequately powered studies.
... However, this was only true for vinegar-containing drinks; sham feeding of the vinegar drink did not induce the same effect despite being rated as unpleasant. The satiating effect of unpalatable food on satiation was also examined by others (48,49). Although Darzi et al. (14) suggest that the GER may play a role in inducing nausea by influencing gut peptides GLP-1 and PYY, more recent evidence suggests that sight, food taste, and odors influence satiety, satiation, or both (50). ...
Research suggests that the active ingredient in vinegar, acetic acid, may reduce appetite, thereby reducing energy consumption. This article aims to assess the effect of vinegar or acetic acid on appetite measures and subsequent food intake in humans. This was conducted as a systematic literature review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All participants were considered, regardless of age or health status. A search using MedLine (Ovid), PubMed, CINAHL Plus, Web of Science, and Cochrane Library between January and April 2021 resulted in 12 studies. Outcomes included appetite, measured using an appetite rating scale or visual analog scale; satiation, measured as food intake of intervention meal; and satiety, measured as the amount of food intake after vinegar or acetic acid consumption. Some short-term interventions indicate that vinegar containing at least 24.6 mmol acetic acid, when consumed alongside a meal containing solid foods, acutely suppresses appetite up to 120 min postprandially as well as ad libitum food intake 3 and 24 h after vinegar consumption. However, longer exposure vinegar interventions suggest that vinegar does not affect overall energy intake. Further research is needed to determine whether oral vinegar consumption may lead to long-term appetite reduction, decrease energy intake, and aid in weight loss.
... Visual perception and differentiation also affect the portion perception. The data obtained as a result of recent studies indicate that big portions are usually believed to be smaller portions whereas small portions are assumed to be more (Rolls et al., 2002;Wansink and Kim, 2005). ...
Purpose- The aim of this study was to evaluate the perception & knowledge of standard
food/meal portion size and related factors in young adults.
Design/Methodology/approach - The present study was conducted on 1000 volunteer young
adults, consisting of 504 males and 496 females (18 and 28 years). Portion size of food/meal,
amount of food measuring utensils and also nutritional knowledge were evaluated via a
questionnaire and some visual materials.
Findings - Knowledge of portion sizes, amount of food each utensil holds and nutrition was
evaluated via a questionnaire and some visual materials. Knowledge of portion size with respect
to food groups, meals and food measuring utensils and nutritional knowledge scores differed
based on body mass indexes (BMI)(p<0.05). Females had on mean a higher nutritional
knowledge score than males (2.04±1.32,1.94±1.17 points, respectively). The probability of
having knowledge about food measuring utensils was 1.413-fold greater for individuals who
had been previously educated about nutrition(p<0.05). Students of the faculty of health sciences
had higher mean scores for all portion scores (p<0.05).
Originality/value: The study findings highlighted that portion knowledge and perception of
young adults were affected by gender, BMI, enrolled faculty, and nutritional knowledge status.
This is the first study, through which the portion knowledge and perception subcomponents
(food, meal, and measuring utensils) are evaluated, indicating each subcomponent to be affected
by distinct factors
... These larger portions inflate consumers' norm perceptions; the size of food offerings is a central determinant of normal portion sizes (Versluis & Papies, 2016;Wansink & Ittersum, 2007). These biased perceptions then prompt consumers to eat more than recommended (Diliberti, Bordi, Conklin, Roe, & Rolls, 2004;Jeffery et al., 2007;Rolls, Roe, Meengs, & Wall, 2004) as detailed in the vast research on this pervasive effect of portion sizes on consumption (Chandon & Wansink, 2007;Rolls, Morris, & Roe, 2002;Scheibehenne, Todd, & Wansink, 2010;Tangari, Burton, Cho, & Thyroff, 2010;Wansink & Kim, 2005;Wansink, van Ittersum, & Painter, 2006) such that doubling portion sizes results in 35% increases in consumption, according to a recent meta-analysis (Zlatevska, Dubelaar, & Holden, 2014). Mitigating portion size effects therefore represents an important pursuit, especially in light of the current obesity epidemic (World Health Organization, 2016). ...
Point of purchase interventions may curb portion size effects and overconsumption by consumers. This study determines whether adding smaller portion sizes to a retailer's assortment unobtrusively encourages consumers to buy smaller portions. Therefore, a field experiment with meat sausage as focal product, was conducted over the course of a month in a branch of a large European retailer, generating receipts of each individual shopping trip. The product sales data revealed slightly more sales of the two smaller portions in terms of units (52%), versus the default, larger portion (48%), resulting in a pertinent reduction in total volumes sold in kg. Furthermore, a two-way ANOVA comparing sales at the individual level before and during the intervention for the experimental store versus eight control stores showed a reduction in the volume of meat sold during the intervention period in the experimental store. Moreover, the results of a one-way ANOVA indicated that smaller portion buyers do not compensate by buying more other products within the same product category. The finding that adding smaller portions to a default choice architecture can nudge consumers towards buying smaller sized items, has important implications for retailers and public policy makers involved in promoting healthy and sustainable consumer behavior.
... Interestingly, this impact has been observed with packaged snacks (35), energy-dense casseroles (36,40), unit foods like sandwiches (44) and beverages (45), and even with low energy-dense foods like fruits and vegetables. Additionally, the effect of PS has been also observed in restaurants and offices (46,47), even if participants were served unpalatable foods (48) or with manipulation of plate size (49). To systematically assess the effect of PS on energy intake, several studies were conducted (Table I). ...
Introduction:
The purpose of this narrative review is to provide evidence for the impact of food portion sizes on the development of obesity in children and adolescents. Strategies are needed on portion size estimation and on the relationship of portion size with certain health problems such as obesity, insulin resistance, and emotional eating in all age groups, in order to provide information for parents, teachers, and health professionals aiming to promote healthy eating. A wide range of controlled laboratory studies have found that portion size (PS) had the strongest effect on the amount of food consumed. The effect of PS on total energy intake has been already observed with different types of foods and beverages, especially with energy-dense foods. The influence of large PS was persistent and happened regardless of demographic characteristics such as age, gender, income level, or body mass index. Although a direct causal link between PS and obesity remains controversial, some health and dietetics organizations recommend to moderate PS, especially for energy-dense foods. Research studies in both laboratory and free-living contexts are needed to determine the causal link between increased PS, obesity, and related metabolic complications in children and adolescents.
... (2) more is eaten from larger containers [82]; and more is eaten in response to advantageous price incentives offered by fast-food companies. Higher-calorie combination meals in fast-food restaurants offer significantly more calories per dollar compared to regular meals, suggesting there is a strong financial incentive for consumers to 'upsize' their orders [83]. ...
The intent of this review is to survey physiological, psychological, and societal obstacles to the control of eating and body weight maintenance and offer some evidence-based solutions. Physiological obstacles are genetic and therefore not amenable to direct abatement. They include an absence of feedback control against gaining weight; a non-homeostatic relationship between motivations to be physically active and weight gain; dependence of hunger and satiation on the volume of food ingested by mouth and processed by the gastrointestinal tract and not on circulating metabolites and putative hunger or satiation hormones. Further, stomach size increases from overeating and binging, and there is difficulty in maintaining weight reductions due to a decline in resting metabolism, increased hunger, and enhanced efficiency of energy storage. Finally, we bear the evolutionary burden of extraordinary human capacity to store body fat. Of the psychological barriers, human craving for palatable food, tendency to overeat in company of others, and gullibility to overeat when offered large portions, can be overcome consciously. The tendency to eat an unnecessary number of meals during the wakeful period can be mitigated by time-restricted feeding to a 6–10 hour period. Social barriers of replacing individual physical work by labor-saving appliances, designing built environments more suitable for car than active transportation; government food macronutrient advice that increases insulin resistance; overabundance of inexpensive food; and profit-driven efforts by the food industry to market energy-dense and nutritionally compromised food are best overcome by informed individual macronutrient choices and appropriate timing of exercise with respect to meals, both of which can decrease insulin resistance. The best defense against overeating, weight gain, and inactivity is the understanding of factors eliciting them and of strategies that can avoid and mitigate them.
... Whereas MD draws on evidence that overconsumption is motivated automatically through external stimuli (e.g., presence of food, container size, plate size; Wansink & Kim, 2005;Wansink, Painter, & Lee, 2006;Wansink & Park, 2001;Wansink & Sobal, 2007), both MD and ME rest on the science showing that overconsumption is also driven by internal cues (e.g., emotions, cognitions; Garaulet et al., 2012;Ozier et al., 2008). Developers of both components also agree that inability to recognize the automatic effect of cues on eating decisions produces "mindless eating," which is associated with overeating and weight gain (Barkeling, King, Naslund, & Blundell, 2007;Wansink, 2010;Wansink, Payne, & Chandon, 2007), and both concur that individuals need to increase awareness of internal experience to shift behavior patterns. ...
Objective
Mindfulness-informed cognitive behavioral interventions for obesity are promising. However, results on the efficacy of such treatments are inconsistent which in part may be due to their substantially different methods of practice. This study is the first direct comparison of two theoretically distinct mindfulness-based weight loss approaches: increasing awareness of homeostatic/innate physiological cues versus hedonic/externally-driven cues for eating.
Methods
Overweight adults were randomized to one of three group-based workshops: Mindful Eating (ME; n = 21), Mindful Decision-Making (MD; n = 17), or active standard behavioral control (SC; n = 19). Outcome measures included percent weight change and reduction in caloric intake from baseline to 6 weeks.
Results
Differences in weight loss and calorie reduction did not differ significantly among groups. However, the difference in weight loss between the MD and ME groups trended towards significance, with medium-large effect sizes.
Conclusions
Results provide modest preliminary evidence for the utility of mindful decision-making strategies over mindful eating for short-term weight loss and calorie reduction.
... Guests are not only insulted when their requests are ignored, but also fear the physical consequences of the large amount of food they are repeatedly served. As studies have shown, large portions lead people to consume more food than they would have otherwise, even if this food is disliked (Wansink 2005). While Sara "made herself too full," she knows that this wouldn't have happened had the volunteers listened to her request for less food. ...
http://deepblue.lib.umich.edu/bitstream/2027.42/107796/1/webcourt.pdf
... However, eating is often not initiated by conscious deliberations but rather is based on habits or triggered automatically by the environment (Allan, Querstret, Banas, & de Bruin, 2017;Stok et al., 2017). Studies showed that environmental characteristics such as portion sizes highly influence food intake, often without conscious awareness (Ello-Martin, Ledikwe, & Rolls, 2005;Rozin, Kabnick, Pete, Fischler, & Shields, 2003;Wansink & Kim, 2005;Wansink, Painter, & North, 2005;Zlatevska, Dubelaar, & Holden, 2014). Research has therefore focused on possibilities for altering people´s food environments to induce behavior changes. ...
... To date, research has focussed on the impact of various packaging features such as size (Aerts & Smits, 2017), images on the package (Neyens et al., 2015), and package shape (Koo & Suk, 2016) on food intake. There appears to be a strong link between packaging cues and food intake, independent of the food quality and even liking of foods on some occasions (Keller et al., 2012;Rolls et al., 2004;Wansink & Kim, 2005). In contrast, other studies have failed to show any effect of packaging cues on amount eaten (Eykelenboom et al., 2018;Versluis et al., 2015). ...
Chronic, excess energy intake contributes to overweight and obesity. Solutions are needed to guide consumers towards portion control, especially for high energy density (HED), palatable foods. Food packaging, a key element of the eating environment, offers a potential solution. To investigate whether packaging design influences measured food intake, a systematic search was undertaken in four electronic databases (Ovid Medline; Ovid PsycInfo; Ovid Embase and Web of Science) across the previous decade. This process yielded 1671 discrete papers, of which 23 articles containing 40 relevant studies were retrieved. Most (n = 36) of the manipulated packaging features influenced consumption quantity with the largest effect sizes observed for packaging which guided consumers either by on-pack cues or structural features. For example, images on the front of the pack, packaging size, as well as partitioning and resealability all helped to reduce food intake. However, individual differences and attentional focus mediate packaging effects. Overall, packaging features can help to limit intake of HED foods and increase intake of nutrient-dense foods (e.g., carrots). Future studies on packaging for portion control (downsizing) might benefit from long term, randomised control trials to test effects outside of the laboratory context and applied to everyday consumer usage.
... Werblow et al. also reported a satisfactory attitude of athletes toward nutrition [40]. Several studies reported attitude as a strong predictor of performance and most of the athlete reported to believe a healthy diet as the important predictor of sports performance [41,42,43]. However, in the current study attitude was not significantly associated with nutrition knowledge and practice and no studied determinants were found to impact on attitude. ...
Background
Nutrition is an important predictor of an athlete's performance. It is more important for particularly those athletes who are in the growing stage (adolescents). This study aimed to assess their current level of knowledge, attitude, and practices (KAP) of nutrition and to predict potential factors impacting their level of these KAP.
Methods
A cross-sectional study was conducted among adolescent trainee athletes selected conveniently from 11 sports departments (e.g. cricket, football, hockey, etc.) of Bangladesh Krira Shikkha Protishtan (BKSP). A semi-structured interviewer-administered questionnaire was used for data collection. Anthropometric measurements (e.g. height, weight, BMI, BF %) were taken using appropriate methods. The data were analyzed using R (v3.6.1) and Python Jupyter Notebook. Descriptive statistics, t-test, analysis of variance (ANOVA), and logistic regression were used to determine the relationship between dependent and independent variables.
Results
A total number of 260 participants were enrolled in this study, most of them (86%) were male. Their mean age was 15.50 ± 1.83 ranging from 12-19 years. More than half of the participants had good nutrition knowledge (n = 149, 57.3%). Fifty-seven percent of participants had a positive attitude (n = 146) and 57.69% (n = 150) had a good level of practices regarding nutrition. Age (p = 0.007), gender (p = 0.004), department of training (p = 0.0034), and duration of sports training (p = 0.004) of participants were significantly associated with knowledge, while only age and BMI were significantly associated with practices. Athletes with less body fat were more likely to have good nutrition practice behavior (AOR 0.895; 95% CI 0.83, 0.96; p < 0.05) and nutrition knowledge was positively associated with nutrition practice (AOR 2.335; 95% CI 1.405, 3.88; p = 0.001).
Conclusion
Knowledge, attitude, and practices level observed among many of our participants was satisfactory. Previous nutrition training was found as a potentially modifiable factor of good nutrition knowledge and good nutrition knowledge was found to be a predictor of good practice score. Thus, it is necessary to provide appropriate nutrition information to adolescent athletes through proper educational training and intervention on a regular basis.
... Estudo mostra que ao dobrar o tamanho da embalagem, os indivíduos consumem cerca de 30% a mais 8,9 . Um exemplo clássico para esse dado é o estudo envolvendo a disponibilização de dois tipos de pipocas (boas e velhas) em dois tipos embalagens (grande e pequenas) em um cinema -o estudo mostrou que a quantidade consumida teve interferência equivalente pelo sabor e pelo tamanho da embalagem 10 . Estudos mostram a correlação entre a disponibilidade de alimento e o seu consumo 8,[11][12][13][14] . ...
O objetivo deste estudo foi analisar os argumentos de persuasão da publicidade de alimentos, relacionadas à emoção e à praticidade, apresentadas em televisão brasileira. Trata-se de um estudo descritivo e exploratório com abordagem qualitativa em que analisou dez exemplos de comerciais que foram selecionados através do acompanhamento de dois canais aberto de por sete dias em períodos sorteados aleatoriamente, no ano de 2017. A análise mostrou que o discurso recorre a argumentos relacionados a solução de problemas da vida cotidiana, associando às demandas de sentimentos que têm na alimentação a oferta de afeto relacionado principalmente a papéis familiares. Os personagens principais são mulheres em contextos familiares ou em circunstâncias comuns da rotina, que expressam pressa ou automatismo das funções na tarefa de preparar a alimentação. O alimento é oferecido como solução para as preocupações da vida prática e das frustações, induzindo o consumo pela promessa de solucionar problemas objetivos e subjetivos.
... Furthermore, our interviewed subjects increased TV hours during confinement, although it was not directly related to the self-reported weight gain reported in our survey. Perhaps the high number of hours of TV that the subjects already reported before confinement has not allowed us to detect this influence [19]. ...
PurposeThe COVID-19 pandemic could exacerbate the risk factors for weight gain in patients with previous bariatric surgery. The aim of this study was to evaluate factors related to weight gain during lockdown in patients with a sleeve gastrectomy.Materials and MethodsA group of 48 obese subjects with previous bariatric surgery was enrolled. After a 7-week confinement, a telephone interview was conducted. In this phone call, self-reported body weight gain and different factors were recorded. In order to obtain the basal and pre-surgical data, biochemical and anthropometric parameters were recorded from electronic medical record.ResultsThe mean age was 45.3±8.0 years (range: 23–61) and the mean body mass index (BMI) was 32.5±7.5 kg/m2 (range: 28.6–34.2). Gender distribution was 38 females (79.2%) and 10 males (20.8%). The increase in self-reported body weight was 3.8±2.1 kg during the 7 weeks of confinement. And the self-reported body weight gain was lower in subjects with regular exercise (4.6±0.9 vs 1.1±0.3 kg; p=0.02). The number of face-to-face visits to the nutrition office that did not attend was 0.61±0.81 (range: 0–4) per patient. In the multiple regression analysis with self-reported body weight gain as a dependent variable, the physical activity (minutes/week) remained as a protective factor with a beta coefficient of −0.09 (95% CI: −0.001 to 0.016; p=0.03) and number of face-to-face appointments in the nutrition consultation missed as a risk factor with a beta coefficient of 9.65 (95% CI: 1.17–18.12; p=0.03).Conclusions
The increase in self-reported body weight is associated with a decrease in physical activity and the loss of face-to-face visits to the Nutrition Unit.
... While laboratory interventions demonstrate cause and effect associations they tend to show small, although robust effects, but may not be representative of everyday life contexts. To address this limitation, field studies have been conducted in leisure centres, restaurants or social venues 66,134,135 as environments more reflective of human behaviour. However field studies are also susceptible to being affected by confounding factors due to non-controlled environmental effects, such as exposure to marketing cues, food smells, peer pressure and price effects. ...
Portion sizes for certain foods have been increasing dramatically in recent years alongside obesity rates, concurring with the phenomenon of the portion size effect (more is consumed when more is offered). Portion size may be defined based on different purposes such as for dietary assessment, or therapeutic advice or food labelling, resulting in a variety of measurement methods and specifications. This situation has resulted in disagreements on establishing portion size recommendations by manufacturers, food distributors, restaurants, health professionals and policy makers, contributing to confusion amongst consumers on the amounts of food to be consumed, and potentially increasing the likelihood of overeating and other obesity-related behaviours. Such variability is also reflected in the research field making comparison across studies on portion size difficult. The aim of this review is to provide an overview of definitions and methods used in research to evaluate portion-size related outcomes, including methods to estimate amounts consumed by individuals as part of dietary assessment; methods to analyse cognitive mechanisms related to portion size behaviour; and methods to evaluate the impact of portion size manipulations as well as individual plus environmental factors on portion size behaviour. Special attention has been paid to behavioural studies exploring portion size cognitive processes given the lack of previous methodological reviews in this area. This information may help researchers, clinicians and other stakeholders to establish clearer definitions of portion size in their respective areas of work and to standardise methods to analyse portion size effects.
... Therefore, this paper suggests that mindful eating behaviour determines the nature of an eating behaviour, and decision making for mindful eating determines the nature of decisions prior to eating, such as assessing hunger and satiety, as well as the environmental factors such finding a quiet place to eat, eating without any distraction, or anything that will prepare the individual to eat more mindfully. Decision-making for mindful eating can be an evaluation of emotional hunger or craving, as well as the potential of external factors influencing eating such as the larger serving size (Wansink and Kim, 2005) -all being decision making that is functioning outside the eating experience -which in association to mindful eating behaviours could form a mindfulness-based eating intervention as seen in some literature, and the closest description of mindful eating (Kristeller, 2015). Intrinsically when someone adopts a mindfulness meditation practice, they are not calling 'mindfulness meditation' their motivation, or, the quiet environment that they chose for their practice, as those are the factors that influence the practice outside of the foundational elements of the practice itself. ...
Background
Mindful eating has exceeded two decades of scientific enquiry but defining mindful eating has proven to be quite challenging.
Aim
The inability to clearly define mindful eating led to variations in the description in academic and clinical literature, different psychometric tools and the development of a field that is lacking the preciseness that is needed to advance mindful eating – and the associated interventions – onto a level that is simple to comprehend and implement in practice.
Methods
Drawing from traditional and contemporary mindfulness and mindful eating literature, this manuscript will attempt to define and describe mindful eating in the context of eating behaviours.
Results
The review of the literature has resulted in challenging areas around the main principles that should be included in defining the term mindful eating, and highlights the distinction between mindfulness and mindful eating, as well as behaviour and decision making within the context of mindful eating.
Conclusion
In a field that is lacking transparency and methodological rigour, mindful eating behaviour is detailed as a new beginning in conducting precise experimental research and evidence-based interventions for clinical and non-clinical use.
... Moreover, in the literature, it has been demonstrated that, when distracted (e.g., by watching movies or TV), individuals often overconsume and are not necessarily cognizant of the dietary quality of the snacks eaten (18). Nowadays, COVID-19 has spread to several countries around the world and is presently a major global concern. ...
Introduction:
Objective: the COVID-19 pandemic, by restricting population mobility, may exacerbate the risk factors for weight gain associated with physical inactivity and increased consumption of calorie-dense foods. The aim of this cross-sectional study was to evaluate the risk factors related to self-reported body weight gain among obese subjects. Methods: the study involved a population of 284 adult obese subjects. After a 7-week confinement period starting on March 17, a telephone interview (May 4 through 7) was conducted. In this phone call, self-reported body weight gain and a number of factors were recorded. In order to obtain the baseline data of this population, biochemical and anthropometric parameters were collected from electronic medical records. Results: mean age was 60.4 ± 10.8 years (range: 23-71) and mean body mass index (BMI) was 35.4 ± 4.7 kg/m2 (range: 30.6-41.2). Gender distribution was 211 females (74.3 %) and 73 males (25.7 %). Self-reported body weight gain was 1.62 ± 0.2 kg. Among patients who reported doing a lot of exercise self-reported body weight gain was lower (1.62 ± 0.2 vs 1.12 ± 0.3 kg; p = 0.02). Regarding eating habits, patients recognized snacking in 17 % of the sample. Patients who reported snacking had higher self-reported body weight gains (2.60 ± 0.36 vs 1.30 ± 0.17 kg; p = 0.001). The remaining variables did not influence self-reported body weight gain. In the multiple regression analysis with self-reported body weight gain as dependent variable, adjusted for age, sex, and physical activity, the snaking habit remained a risk factor: beta = 1.21 (95 % CI: 1.11-2.13; p = 0.01). Conclusions: the lockdown decreed during SARS-CoV-2 pandemic has produced an increase in self-reported body weight among obese subjects, which was related to the habit of taking snacks.
... Food, medications, physical inactivity, toxins, and viruses interact with genetics to interfere with energy balance and contribute to obesity [9]. Weight gain is fostered in some by non-homeostatic eating (defined as eating reflexively in response to factors other than caloric need or hunger) , and includes mindless eating, reward-based eating, and stress eating [10][11][12], which are especially common during periods of chronic stress [13][14][15]. The drive to eat non-homeostatically is primed by strong neurobiological signals involving reward and stress systems [10]. ...
Background:
Pregnancy is a time of high risk for excessive weight gain, leading to health-related consequences for mothers and offspring. Theory-based obesity interventions that target proposed mechanisms of biobehavioral change are needed, in addition to simply providing nutritional and weight gain directives. Mindfulness training is hypothesized to reduce stress and non-homeostatic eating behaviors - or eating for reasons other than hunger or caloric need. We developed a mindfulness-based intervention for high-risk, low-income overweight pregnant women over a series of iterative waves using the Obesity-Related Behavioral Intervention Trials (ORBIT) model of intervention development, and tested its effects on stress and eating behaviors.
Methods:
Overweight pregnant women (n = 110) in their second trimester were enrolled in an 8-week group intervention. Feasibility, acceptability, and facilitator fidelity were assessed, as well as stress, depression and eating behaviors before and after the intervention. We also examined whether pre-to-post intervention changes in outcomes of well-being and eating behaviors were associated with changes in proposed mechanisms of mindfulness, acceptance, and emotion regulation.
Results:
Participants attended a mean of 5.7 sessions (median = 7) out of 8 sessions total, and facilitator fidelity was very good. Of the women who completed class evaluations, at least half reported that each of the three class components (mindful breathing, mindful eating, and mindful movement) were "very useful," and that they used them on most days at least once a day or more. Women improved in reported levels of mindfulness, acceptance, and emotion regulation, and these increases were correlated with reductions in stress, depression, and overeating.
Conclusions:
These findings suggest that in pregnant women at high risk for excessive weight gain, it is both feasible and effective to use mindfulness strategies taught in a group format. Further, increases in certain mindfulness skills may help with better management of stress and overeating during pregnancy.
Trial registration:
ClinicalTrials.gov NCT01307683 , March 8, 2011.
The main target of this paper is to show a behavioral economics approach to –some– public policies from a descriptive and a normative point of view. To meet the target, (i) the paper summarizes two cognitive biases: the status quo bias and the endowment effect, and then shows how these biases could affect the effectiveness of public policies in some relevant contexts: the availability of human organs for transplantation; people's bad eating habits; and environmental resources management. In addition, (ii) the paper suggests some strategies (nudges) about how behavioral economics could inform policy maker to design or to improve the public policies in each of those referred contexts.
Various physiological and psychological factors are thought to be important in determining energy intake and meal control. This thesis focuses on two such factors: dietary learning and individual differences in interoception (the ability to detect internal bodily signals). Chapters 4 and 5, focus primarily on flavour-nutrient learning, which refers to instances where associations develop between a foods orosensory properties (e.g., flavour, texture) and the post-ingestive consequences of consumption (e.g., satiety, pleasure). Some weak evidence was observed for this form of learning, with individuals believing a flavour was more rewarding if it had previously been paired with a high rather than low-energy dairy breakfast. These studies also revealed that individuals may form dietary associations where they experience a sense of surprise satiety after eating. Specifically, individuals who felt fuller than they had initially anticipated, showed a large change in how filling they expected the food to be in the future. This ‘surprise satiety’ finding is exciting as the concept of surprise does not appear to have been applied to dietary learning before. The second theme of research focused on the role individual differences in interoception (the ability to detect internal bodily signals) may have upon different dietary behaviours (chapters 5-9). This revealed little evidence to suggest that interoceptive variability might influence: dietary learning (chapter 5), decisions individuals make about portion size (chapter 6), whether the negative effects of consuming large meals on post-prandial cognitive function are anticipated (chapter 7), the propensity to exhibit different eating traits (external, emotional and restrained eating) (chapter 8), and whether having a strong sense of internal bodily signals and being able to form a clear memory for foods eaten combine, to reduce later intake and attentional biases towards foods (chapter 9). In conclusion, unanticipated fullness appears to be an exciting prospect for future research in human dietary learning. In contrast, there was little evidence to suggest that individual variation in interoception might influence eating behaviours.
The purpose of this study is to examine the effects of package changes for product redesign on purchase by consumers. To measure the effects of different types of package changes and product redesign, we used single-source data of some tea-based beverages for which packages were changed in product redesign. The data include purchase data before and after the packages were changed. Using these data, package changes and product redesign were classified into three types, and the effect of each on consumer purchase of the redesigned product was measured. The three types are as follows: redesign of the label along with a new blend; redesign of the label and bottle shape along with a new blend; and redesign of the label and bottle shape with an increased volume. The results showed that a package change affected consumer purchase, and that the influence of package changes differed depending on which design elements were changed. Consumers purchased the redesigned products more when the label was redesigned along with a new blend, compared to when there was no redesign. However, they purchased the product less when the label and bottle shape were changed along with a new blend and increased volume, compared to when there was no change. In addition, the lifestyle of consumers affects redesigned product purchase, and the effects of label and shape redesign with a new blend and increased volume are different. Therefore, the effects of package changes differs among types of redesign.
Tüketici Davranışı ve Pazarlama Stratejileri: 8. Baskı
Background: How does a parent’s action at home sabotage the way their child eats when they are not at home? This two-part study explored which parental behaviors at home were most correlated with 75 preschooler’s requests for larger servings of snacks when away from home and away from parental scrutiny.Methods: Primary meal providers of three- to five-year old children completed surveys describing how they served food and snacks at home (such as whether they were always available in any amount a child wanted) and a wide range of questions about snacking habits of their children. Two weeks later, their children were met (without their parents present) and asked to indicate how much Froot Loops (a popular pre-sweetened cereal) they wanted for their morning snack. Correlations between how much they served and household snacking behaviors were then explored.Results: Boys who were often required to clean their plates at home requested more cereal during snack time when away from home (p<0.05), and daughters who were able to snack at home whenever at home whether they wanted also requested more (p<0.05). Girls who were frequently given fruit as a snack at home requested less presweetened cereal when away from home (p<0.01).Conclusions: Parent actions in the home might have an unexpected impact on how much of less healthy foods children request when they away from such parental oversight. Care must be taken so a parent does not win a food battle at home just to lose any away-from-home food war.
The sensory eating experience is a significant determinant of control of food consumption, frequently ascribed to the favorable hedonic reaction affiliated with some sensory signals. But palatability is just one component of the sensory experience. Before, during, and after eating, sensory signals based on the vision, aroma, texture, and palate of food are functional. These perceptual signals also influence the guidance of energy intake beyond their role in preferences. The focus of this chapter is to look at sensory food behavior drivers and highlight latest developments in our knowledge of how to use certain sensory features to encourage better control of food intake. We recognize the function of pictorial and odor signs in recognizing nourishment in the surroundings, regulating food selection and eating cognition, and highlighting how textures and flavors affect diet quantity and satiety growth postconsumption.
There has been dramatic weight gain among college students during their collegiate years. A food diary can give much insight of a college student’s life. The purpose of this study is to analyze the food intake of college-aged students taking in factors such as the size of meal, the foods being eaten, the location of the meal, and if the meal was eaten with others. The results of this study suggest that being male, eating breakfast, and eating more snacks relative to the number meals increases daily caloric intake. On the other hand, being female and eating more meals at home will result in a lower daily caloric intake.
Many studies document the benefits of presenting smaller quantities of products, particularly when differences in quantity relate to availability or popularity. However, we know less about the effects of quantity differences in contexts unrelated to scarcity, such as when products are depicted in ads, special displays, or online retailing settings. The present research builds on extant literature by investigating a previously unexplored question: How do product perceptions differ depending on whether consumers view a single unit in isolation, versus as one unit among identical product replicates? Five experiments demonstrate that presenting multiple product replicates as a group (vs. presenting a single item) increases product efficacy perceptions because it leads consumers to perceive products as more homogeneous and unified around a shared goal. That is, consumers perceive greater product entitativity when viewing a group of product replicates. As a result, the perceived and actual ability of products to deliver that function (i.e., product efficacy) increases.
İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri
Görüntüleme Yöntemleri
Sempozyum Dizisi No: 69 • Ocak 2010; s. 9 - 31
ÇOCUK ve ADOLESANDA OBEZİTE
Prof.Dr.Emel Gür
TANIM ve EPİDEMİYOLOJİ
Obezite, erişkin ve çocuklarda sık rastlanan, önemli bir halk sağlığı sorunudur. Çocukluk çağı obezitesi özellikle gelişmiş ülkelerde olmakla beraber bütün dünyada artan bir prevalansa sahiptir. Çocukluk çağında başlayan obezitenin erişkin yaşlarda da devam ettiğini gösteren çok sayıda çalışma vardır. Obezite hem çocukluk, hem de erişkin dönemde neden olduğu sorunlar ve erişkin dönemde yüksek morbidite ve mortalite oranları nedeniyle önlenmesi ve tedavi edilmesi gereken bir durumdur.
Tanım
Obezite, genetik ve çevresel faktörlerin etkileşimi sonucu ortaya çıkan multifaktöriyel ve kompleks bir hastalıktır ve önemli fiziksel, sosyal sorunlara yol açmaktadır.
Dünya Sağlık Örgütü tarafından yapılan tanımlamaya göre obezite; vücut kompozisyonunda insan sağlığını olumsuz şekilde etkileyecek düzeyde yağ miktarının artışıdır. Diğer bir deyimle obezite; vücuttaki yağ dokusunun yağsız vücut kitlesine oranının artmasıdır, yani vücut ağırlığına yansıyan yağ dokusu fazlalığıdır.
Sınıflandırma
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A- Etyopatogeneze göre sınıflandırma;
1- Eksojen obezite (Basit obezite): Beslenme ile ilgili nedenlere bağlıdır, altta yatan önemli bir patoloji yoktur.
2- Endojen obezite (Sekonder obezite):Endokrin, metabolik hastalıklar ya da genetik sendromlarla birlikte görülür. Altta yatan nedene göre; boy kısalılğı, mental retardasyon, hipertansyon, majör ve minör anomaliler birlikte bulunabilir.
B- Obezitenin başlama yaşına göre sınıflandırma:
1- Çocukluk dönemi obezitesi
a- İnfantil obezite (süt çocuğu obezitesi): 0-2 yaş arasında rastlanır.Erişkindönemde obeziteyeyolaçmaoranı%10-20’dir.
b- Çocukluk yaş grubu obezitesi: 6-10 yaş arası görülür, %40 oranında erişkin döneme yansır.
c- Adolesan obezitesi: 11-18 yaş grubunda görülür, %75-80 oranında erişkin dönemde devam eder.
2- Erişkin dönem obezitesi: 18 yaş sonrası görülen obezite, önemli oranda morbidite ve mortaliteye yol açar.
Obezite Fenotipleri
Obezite ; vücuttaki fazla yağ dokusunun dağılımı ve anatomik özelliklerine göre başlıca dört tipte görülür.
1- Jeneralize obezite: Yağ dokusu tüm vücuda eşit oranda dağılmıştır. 2- Android (trunkal) obezite: Yağ dokusu gövdenin üst bölümünde
lokalize olmuştur.
3- Gynoid obezite: Yağ dokusu pelvik ve glutea-femoral bölgede lokalizedir.
4- Visseral (intra abdominal) obezite: Yağ dokusu intra abdominal bölgede lokalizedir. Çocuklarda değişkenlik göstermekle birlikte
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subkutan dokuda birikim söz konusudur. Bel çevresi önemli tanı kriteridir. Yüksek bel çevresi; BKİ 25 ile 34.9 kg/m2 arasında olan erişkinlerde hiperlipidemi, hipertansiyon, hiperinsülizm, tip II diabet yüksek insidansı ile yakın ilişkilidir.
Obezite Tanı Kriterleri
Obezite tanı kriterleri; ucuz, güvenilir, kolay uygulanır, tekrarlanabilir, değişikliklere duyarlı, yağ dokusu miktarını belirleyici, morbidite ve mortalite hakkında bilgi verici özellikte olmalıdır. Obeziteyi değerlendirirken vücuttaki yağ dokusu ile yağsız dokunun oranlarının belirlenmesi önemlidir. Vücuttaki yağın ölçümü için günümüzde direkt ve indirekt yöntemler kullanılmaktadır.
Obezitenin Ölçüm Yöntemleri
1- Vücuttaki Yağın Direkt Ölçümü
a. Sualtı tartımı ile vücut dansitesinin hesaplanması: “Altın standart” olarak kabul edilmektedir. Farklı dansitede olan yağsız doku ile yağ dokusu su altı tartımı ile belirlenmektedir. Ancak bazı hastalarda, özellikle çocuklarda uygulanması çok zordur.
b. Toplam vücut suyunun izotop dilüsyonu ile saptanması: 2 veya 3 değerlikli hidrojen izotopu kullanılarak izotop dilüsyonu metodu ile total vücut sıvısı saptanabilmektedir. Yağsız doku kitlesindeki su miktarı sabit (%72) kabul edilerek hesaplama yapılır.
c. Toplam vücut potasyumunun ölçülmesi: potasyum vücutta yağsız doku kompartmanında bulunduğu için vücut potasyumunun ölçümü yağsız doku kitlesi hakkında fikir vermektedir.
d. Nötron aktivasyon : Ekstrasellüler sıvı ve öğeler nötron aktivasyon tekniği ile bulunur.
e. Vücudun biyoelektriksel iletkenliğinin saptanması(TOBEC:total body electrical conductivity) Elektromanyetik alanda yag dokusu
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ve sıvı kompartmanın yanıtlarının farklı olması vücut yağının ölçümüne olanak saglar.
f. Ultrasonografi: Subkutan yag depolanmasını gösterir
g. Manyetik rezonans görüntüleme: Visseral ve subkutan yag depolanmasını gösterir.
h. Dual enerji x-ray absorpsiyonunun değerlendirilmesi (DEXA):Dokularda fotonların veya X ısınlarının absorpsiyonları farklıdır. Absorpsiyon farklılıklarının ölçümü vücut kompozisyonunu belirlemede altın standarttır.
ı. BodPod vücut kompozisyon sistem: Vücut ağırlıgının hidrostatik ölçümü basınç farkı hesaplanarak yapılır. Kişi 450 L bir su yatagına oturtulup, olusan basınç farkları ölçülerek, vücut volümü hesaplanır ve vücut dansiteside hesaplanır.
Vücut yağının direkt ölçüm yöntemleri; uygulama zorluğu, pahalı olması, araştırmalarla sınırlı olması, bazı yöntemlerin radyasyon riski taşıması v.s nedenlerle obezite tanısında özellikle çocuklarda kullanılmamaktadır.
2. Vücuttaki Yağın İndirekt Ölçümü
Antropometrik ölçümler kolay, hızlı, pratik ve ucuz oldukları için obezite tanısında sıklıkla kullanılan yöntemlerdir. Bunlar arasında en sık kullanılanlar boya göre ağırlık (rölatif ağırlık),çevre ölçümleri, cilt kıvrım kalınlıkları ve vücut kitle indeksidir
a. Boya göre ağırlık (Rölatif Ağırlık-RA)
Çocuklar obezite açısından değerlendirilirken çocuğun ağırlığı, ideal ağırlık ile karşılaştırılmaktadır. İdeal ağırlığın belirlenmesinde her ülkenin kendi standartlarının kullanılması gerekmektedir. Yaş ve cinsiyete göre düzenlenmiş boy ve vücut ağırlığını içeren tablolardan yararlanılarak çocuğun boy yaşına uygun ağırlığı bulunur. Boyunun 50 persentilde olduğu yaşın 50 persentildeki ağırlığı o çocuğun ideal ağırlığıdır. Çocuğun
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ölçülen ağırlığının ideal ağırlığına oranlanması ile rölatif ağırlık saptanır.
(Rölatif ağırlık= hastanın ölçülen ağırlığı/ ideal ağırlığı ağırlığı x 100)
Rölatif ağırlığın %110-120 arasında olması fazla tartılı (overweight), %120’nin üzerinde olması obezite kabul edilmektedir.
b. Vücut kitle indeksi (VKİ), “Body Mass Index” (BMI)
Vücut kitle indeksi obezitenin değerlendirilmesi için kullanılan en pratik ve günümüzde en kabul gören yöntemdir. Ölçülen ağırlığın (kg) boyun (m) karesine oranıdır (VKİ= ağırlık (kg) / boy2(m2) . VKİ çocuklarda yaşa ve cinse göre değişkenlik gösterir. Yaşa ve cinse göre VKİ persentilleri belirlenmiştir. Bu tabloya göre Yaş ve cinsiyete göre belirlenmiş çizelgelerde 85 ila 95 persentil arası fazla tartılı, 95.persentil üzerinde kalan vakalar obez olarak değerlendirilmektedir. Ancak bu tanım persentillerin elde edildiği topluma özgü olup ülkeler arası karşılaştırmalarda pek elverişli değildir. Örneğin; ABD çocuklarının 82. persentil değeri, Brezilya çocuklarının yaklaşık 95. persentil değerine ve İngiliz çocuklarının yaklaşık 90 persentil değerine uymaktadır. Bu yüzden dört kıta (Asya, Avrupa, Kuzey ve Güney Amerika) çocuklarından elde edilen veriler birleştirilerek 2-18 yaş arası uluslar arası VKİ değerleri elde edilmiş ve çocukluk çağı obezitesi için bu ölçütlerin kullanılması önerilmiştir (IOTF: International Obesity Task Force).
b.Çevre ölçümleri
Çevre ölçümleri vücut dansitesi, yağsız vücut dokusu, yağ dokusu kitlesi, total vücut protein kitlesi ve enerji depolarının göstergesidir. En sık üst orta kol, bel, kalça, uyluk ve baldır çevreleri kullanılır. Bel çevresi abdominal yağının değerlendirilmesinde en pratik ölçüm yöntemidir. Bel/ kalça oranı, yağ dağılımını belirler ve abdominal obezitenin tanısında önemlidir. Yağın abdominal bölgede ve iç organlarda toplanması, Tip ll diyabetes mellitus, hiperlipidemi, hipertansiyon, koroner arter hastalığı
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ile yakın ilişkili olan insülin direncine yol açmaktadır.
c.Cilt kıvrım kalınlıkları
Obezitede yağın bir kısmı cilt altında toplanır. Cilt altı yağ dokusunu belirlemek için cilt kıvrım kalınlığı ölçümü yapılır. Ölçüm kaliper denen özel aletlerle yapılır. En sık kullanılanlar “Harpenden” ve “Lange” kaliperleridir. Cilt kıvrımları aletin uçları arasında tutulur ve kalınlık göstergeden okunur. Triseps, biseps, subskapular ve suprailiak bölgelerde ölçüm yapılabilmektedir. Yaygın olarak kullanılan triseps cilt kıvrım kalınlığı ölçümüdür. Yaşa göre belirtilen persentillere göre 85 persentil üzerindeki ölçümler obezite olarak değerlendirilmektedir.
Obezite Prevalansı
Yapılan çok sayıda çalışmada çocukluk çağı obezitesinin prevalansının son yıllarda artmakta olduğu gösterilmiştir. Ancak veri toplanmasında kullanılan metodların farklılığı sonuçların karşılaştırılmasında ve değerlendirilmesinde zorluklar yaratmaktadır.
Tüm dünyada 144 ülkede gerçekleşen 450 ulusal çalışmanın analizi sonucunda ; 35 milyonu gelişmekte olan ülkelerde olmak üzere 43 milyon okul öncesi dönemi çocuğunun fazla tartılı ve obez, 92 milyon çocuğun ise fazla tartılı olma riski taşıdığı belirlenmiştir. Bu çocuklarda fazla tartılı olma ve obezite prevalansının 1990 yılında %4.2’den, 2010 yılında %6.7’ye ulaştığı, 2020 yılı için bu oranın %9.1’e ulaşacağı ve 60 milyon çocuğun fazla tartılı ve obez olacağı tahmin edilmektedir. Afrika için çocukluk çağı fazla tartılı olma ve obezite oranı 2010 yılı için %8.5 olup, 2020 yılında bu oranın %12.7’ye yükselmesi beklenmektedir. Asya kıtasında yaşayan çocuklarda fazla tartılı ve obez çocuk oranı 2010 yılı için %4.9 (18 milyon) bulunmuştur. Gelişmekte olan ülkelerde okul çocukluğu ve adolesan dönemde fazla tartılı ve obez çocuk oranları Tablo I’de görülmektedir.
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Gelişmiş ülkelerde değişik yaş gruplarında kız ve erkek çocuklarında fazla tartılı olma ve obezite prevalansları Tablo II’de görülmektedir.
ABD’de gerçekleştirilen beslenme ve sağlık taramaları (NHANES) obezite prevalansı hakkında güvenilir bilgiler vermektedir.ABD’de çocuk ve adolesanlarda (2-19 yaş) obezite prevalansı 2007-2008 yıllarında %16.9 düzeyine ulaşmış olup, en hızlı artışı 1976-1980 ve 1999-2000 yılları arasında göstermiş (%5.5 ve %13.9).Buna karşın, 1999-2000 ve 2007-2008 yılları arasında önemi bir artış kaydedilmemiştir (%13.9 ve %16.9)(Tablo III).
İngiltere’de 1995 yılında %11.5 olan obezite oranı, 2007 yılı itibarıyla %16.5 düzeyine ulaşmıştır. Fazla tartılı ve obez çocuk oranı ise %24.5’den %30.4 düzeyine yükselmiştir (Tablo IV).
Ülkemizde çocuk ve adolesanlarda obezite sıklığını araştıran ulusal bazda bir çalışma olmamakla birlikte lokal ve bölgesel düzeyde yapılan çeşitli çalışmalar bulunmaktadır.
Neyzi ve ark.1966-68 yılları arasında İstanbul’da üç bin çocukta yaptığı araştırmada obezite oranını kızlarda %9.2, erkeklerde %11.2 düzeyinde bulmuş, sosyoekonomik düzeyle doğru orantılı olarak obezite sıklığının arttığını göstermiştir.
Gür E. ve ark. İstanbul’da yedi ilçe, 14 ilköğretim okulunda, 6-16 yaşlar arasındaki1583 çocukta fazla tartılı çocuk oranını %10.7, obezite sıklığını ise %7.3 bulmuştur.
Ankara’da Şimşek F. Ve ark. 6-17 yaş grubunda 1510 çocukta obezite oranını%4.8 bulmuştur.
Ankara’da Cinaz ve ark.’nın 6-14 yaş arası 12.600 okul çocuğunu kapsayan geniş saha çalışmasında ise obezite prevalansı %7.5, fazla tartılı çocuk prevalansı %6.3 olmak üzere toplam %13.8 olarak saptanmıştır. Obezite sıklığı ırk, yaş ve cinsiyete göre farklılık
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göstermektedir.
Öner N ve ark. Edirne’de 1217 yaş grubu 989 çocukta fazla tartılı olma sıklığını kızlarda %10.6, erkeklerde %11.3, obezite oranlarını ise sırasıyla; %2.1 ve %1.6 düzeyinde saptamıştır.
Düzce’deŞimşek E. ve ark. çalışmalarında6-17 yaş arası 6924 çocukta fazla tartılı çocuk oranını %10.3, obezite oranını %6.1 saptamış, kırsal alanda sıklığın azaldığını göstermişlerdir.
İzmir’de Kalkan ve ark. 6-10.5 yaşları arasında 4548 çocukta obezite oranını %9.1 düzeyinde saptamıştır.
Semiz S ve ark. Denizli’de 6-17 yaş grubunda 850 çocukta fazla tartılı çocuk ve obezite oranını sırasıyla; %11.6 ve %1.4 olarak belirlemiştir.
Antalya’da Türkkahraman D ve ark. 2455 6-17 yaş grubu çocuklarda fazla tartılı ve obezite oranlarını %14.3 ve %3.6 düzeyinde bulmuştur.
Elazığ’da Pirinççi E. ve ark. 6-11 yaş grubunda, 1782 kız ve 1860 erkek çocukta yaptıkları çalışmada fazla tartılı çocuk oranının %13.5, obezite oranının %1.6 olduunu göstermiştir.
Ülkemizde obesite sorununun İstanbul, Ankara, İzmir gibi büyük şehirlerde daha yaygın olduğu, kırsal alanlarda daha az rastlandığı gözlemlenmektedir.
Başlıca gelişmiş ülkeler olmak üzere, tüm dünyada obezite oranları erişkinlerde olduğu gibi çocuklarda da dramatik bir artış göstermektedir.Yapılan çalışmalar çocukluk döneminde başlayan obezitenin önemli bir oranda erişkin döneme yansıdığını göstermektedir. Tip II diyabet, dislipidemi, hipertansiyon ve kardiyovasküler hastalıklara yol açabilen, yüksek oranda morbidite ve mortaliteye neden olan obezitenin önlenmesi, erken dönemde tanınması ve tedavi edilmesi
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koruyucu sağlık politikalarının başında yer almalıdır.
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Tablo I-Gelişmekte olan Ülkeler ve cinsiyete göre fazla tartılı ve obezite prevalansı
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Ülke Yıl Yaş Erkek Kız Metod
———————————————————————————————
Meksika
Çek Cum.
Macaristan
Hindistan
Kore
Türkiye
2006 10-17 2005 5-17
1993 10-15 2004 9-15 2003 7-17
2001 12-17 1995 11-17
30.5 31.5 IOTF 23.2 15.3 IOTF 17.8 15.9 IOTF
15.7 12.9 85 th cent. 16.3 10.0 IOTF 11.4 10.3 IOTF
9.8 8.2 IOTF Kaynak:International Association for the Study of Obesity
Slovak Cum. ———————————————————————————————
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Tablo II- Gelişmiş Ülkeler ve cinsiyete göre fazla tartılı ve obezite prevalansı
———————————————————————————————
Ülke Yıl Yaş Erkek Kız Metod
———————————————————————————————
ABD İspanya Kanada İtalya
Yeni Zelanda Avusturalya İngiltere Yunanistan Portekiz Belçika Irlanda İrlanda Avusturya İzlanda Norveç Almanya Fransa
İsveç
Finlandiya
İsviçre
Japonya
Hollanda
2003 6-17 35.1 2000 13-14 35.0 2004 12-17 32.3 2006 8-9 32.4 2000 11-12 30.0 2007 9-13 25.0 2004 5-17 29.0 2003 13-17 29.6 2002 7-9 29.5 1998 5-15 27.3 2005 2-11 27.0 2005 2-15 23.0 2007 8-12 22.5 1998 9 22.0 1996 10 21.0 2003 5-17 20.4 2000 7-9 17.9 2001 6-11 17.6 1999 12-16 17.2 2007 6-13 16.7 1996 6-14 16.2 2003 5-17 14.7 1996 5-16 14.1
36.0 IOTF 32.0 IOTF 25.8 IOTF 34.0 IOTF 30.0 IOTF 30.0 IOTF 29.3 IOTF 16.1 IOTF 34.3 IOTF 26.7 85th cent. 26.0 IOTF 28.0 IOTF 16.7 90th cent. 25.5 IOTF 21.0 IOTF 20.1 IOTF 18.2 IOTF 27.4 IOTF 10.1 IOTF 13.1 CDC 14.3 IOTF 18.0 IOTF 15.3 IOTF
Danimarka ———————————————————————————————
Kaynak:International Association for the Study of Obesity
Tablo III- Yıllara göre ABD’de çocuk ve adolesanlarda (2-19 yaş) obezite prevalansı
Yaş (yıl) NHES 1963–1965
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1966-
19702 NHANES 1971–1974 NHANES 1976–1980
NHANES 1988–1994 NHANES 2003–2004
Total - 5.0 16.9
2–5 - 5.0 10.4
6–11 4.2 4.0 19.6
12–19 4.6 6.1 18.1
NHANES 1999–2000 NHANES 2005–2006
5.5 10.0 13.9 5.0 7.2 10.3 6.5 11.3 15.1 5.0 10.5 14.8
NHANES 2001–2002 NHANES 2007–2008
15.4 17.1 15.5 10.6 13.9 11.0 16.3 18.8 15.1 16.7 17.4 17.8
Kaynak: Ogden C, Carrol M. Prevalence of obesity among children and adolescents: United States, Trends 1963-1965 throught 2007-2008. Divison of health and nutrition examination surveys.
Tablo IV- Yıllara göre İngiltere’de çocuklarda obezite ve fazla tatılı/obez çocuk prevalansı
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Obez % 11.5 11.9 12.6 13.4 15.1 14.3 15.0 17.0 16.6 18.8 18.3 16.0 16.5
Fazla
Tartılı 24.5 24.9 25.6 27.5 29.0 26.8 30.1 30.8 31.2 34.0 32.6 29.7 106
30.4
ve obez %
Kaynak: Health Survey for England
İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri Görüntüleme Yöntemleri Sempozyum Dizisi No: 69 • Ocak 2010; s. 9 - 31 ÇOCUK ve ADOLESANDA OBEZİTE Prof.Dr.Emel Gür TANIM ve EPİDEMİYOLOJİ Obezite, erişkin ve çocuklarda sık rastlanan, önemli bir halk sağlığı sorunudur. Çocukluk çağı obezitesi özellikle gelişmiş ülkelerde olmakla beraber bütün dünyada artan bir prevalansa sahiptir. Çocukluk çağında başlayan obezitenin erişkin yaşlarda da devam ettiğini gösteren çok sayıda çalışma vardır. Obezite hem çocukluk, hem de erişkin dönemde neden olduğu sorunlar ve erişkin dönemde yüksek morbidite ve mortalite oranları nedeniyle önlenmesi ve tedavi edilmesi gereken bir durumdur. Tanım Obezite, genetik ve çevresel faktörlerin etkileşimi sonucu ortaya çıkan multifaktöriyel ve kompleks bir hastalıktır ve önemli fiziksel, sosyal sorunlara yol açmaktadır. Dünya Sağlık Örgütü tarafından yapılan tanımlamaya göre obezite; vücut kompozisyonunda insan sağlığını olumsuz şekilde etkileyecek düzeyde yağ miktarının artışıdır. Diğer bir deyimle obezite; vücuttaki yağ dokusunun yağsız vücut kitlesine oranının artmasıdır, yani vücut ağırlığına yansıyan yağ dokusu fazlalığıdır. Sınıflandırma 95 A- Etyopatogeneze göre sınıflandırma; 1- Eksojen obezite (Basit obezite): Beslenme ile ilgili nedenlere bağlıdır, altta yatan önemli bir patoloji yoktur. 2- Endojen obezite (Sekonder obezite):Endokrin, metabolik hastalıklar ya da genetik sendromlarla birlikte görülür. Altta yatan nedene göre; boy kısalılğı, mental retardasyon, hipertansyon, majör ve minör anomaliler birlikte bulunabilir. B- Obezitenin başlama yaşına göre sınıflandırma: 1- Çocukluk dönemi obezitesi a- İnfantil obezite (süt çocuğu obezitesi): 0-2 yaş arasında rastlanır.Erişkindönemde obeziteyeyolaçmaoranı%10-20’dir. b- Çocukluk yaş grubu obezitesi: 6-10 yaş arası görülür, %40 oranında erişkin döneme yansır. c- Adolesan obezitesi: 11-18 yaş grubunda görülür, %75-80 oranında erişkin dönemde devam eder. 2- Erişkin dönem obezitesi: 18 yaş sonrası görülen obezite, önemli oranda morbidite ve mortaliteye yol açar. Obezite Fenotipleri Obezite ; vücuttaki fazla yağ dokusunun dağılımı ve anatomik özelliklerine göre başlıca dört tipte görülür. 1- Jeneralize obezite: Yağ dokusu tüm vücuda eşit oranda dağılmıştır. 2- Android (trunkal) obezite: Yağ dokusu gövdenin üst bölümünde lokalize olmuştur. 3- Gynoid obezite: Yağ dokusu pelvik ve glutea-femoral bölgede lokalizedir. 4- Visseral (intra abdominal) obezite: Yağ dokusu intra abdominal bölgede lokalizedir. Çocuklarda değişkenlik göstermekle birlikte 96 subkutan dokuda birikim söz konusudur. Bel çevresi önemli tanı kriteridir. Yüksek bel çevresi; BKİ 25 ile 34.9 kg/m2 arasında olan erişkinlerde hiperlipidemi, hipertansiyon, hiperinsülizm, tip II diabet yüksek insidansı ile yakın ilişkilidir. Obezite Tanı Kriterleri Obezite tanı kriterleri; ucuz, güvenilir, kolay uygulanır, tekrarlanabilir, değişikliklere duyarlı, yağ dokusu miktarını belirleyici, morbidite ve mortalite hakkında bilgi verici özellikte olmalıdır. Obeziteyi değerlendirirken vücuttaki yağ dokusu ile yağsız dokunun oranlarının belirlenmesi önemlidir. Vücuttaki yağın ölçümü için günümüzde direkt ve indirekt yöntemler kullanılmaktadır. Obezitenin Ölçüm Yöntemleri 1- Vücuttaki Yağın Direkt Ölçümü a. Sualtı tartımı ile vücut dansitesinin hesaplanması: “Altın standart” olarak kabul edilmektedir. Farklı dansitede olan yağsız doku ile yağ dokusu su altı tartımı ile belirlenmektedir. Ancak bazı hastalarda, özellikle çocuklarda uygulanması çok zordur. b. Toplam vücut suyunun izotop dilüsyonu ile saptanması: 2 veya 3 değerlikli hidrojen izotopu kullanılarak izotop dilüsyonu metodu ile total vücut sıvısı saptanabilmektedir. Yağsız doku kitlesindeki su miktarı sabit (%72) kabul edilerek hesaplama yapılır. c. Toplam vücut potasyumunun ölçülmesi: potasyum vücutta yağsız doku kompartmanında bulunduğu için vücut potasyumunun ölçümü yağsız doku kitlesi hakkında fikir vermektedir. d. Nötron aktivasyon : Ekstrasellüler sıvı ve öğeler nötron aktivasyon tekniği ile bulunur. e. Vücudun biyoelektriksel iletkenliğinin saptanması(TOBEC:total body electrical conductivity) Elektromanyetik alanda yag dokusu 97 ve sıvı kompartmanın yanıtlarının farklı olması vücut yağının ölçümüne olanak saglar. f. Ultrasonografi: Subkutan yag depolanmasını gösterir g. Manyetik rezonans görüntüleme: Visseral ve subkutan yag depolanmasını gösterir. h. Dual enerji x-ray absorpsiyonunun değerlendirilmesi (DEXA):Dokularda fotonların veya X ısınlarının absorpsiyonları farklıdır. Absorpsiyon farklılıklarının ölçümü vücut kompozisyonunu belirlemede altın standarttır. ı. BodPod vücut kompozisyon sistem: Vücut ağırlıgının hidrostatik ölçümü basınç farkı hesaplanarak yapılır. Kişi 450 L bir su yatagına oturtulup, olusan basınç farkları ölçülerek, vücut volümü hesaplanır ve vücut dansiteside hesaplanır. Vücut yağının direkt ölçüm yöntemleri; uygulama zorluğu, pahalı olması, araştırmalarla sınırlı olması, bazı yöntemlerin radyasyon riski taşıması v.s nedenlerle obezite tanısında özellikle çocuklarda kullanılmamaktadır. 2. Vücuttaki Yağın İndirekt Ölçümü Antropometrik ölçümler kolay, hızlı, pratik ve ucuz oldukları için obezite tanısında sıklıkla kullanılan yöntemlerdir. Bunlar arasında en sık kullanılanlar boya göre ağırlık (rölatif ağırlık),çevre ölçümleri, cilt kıvrım kalınlıkları ve vücut kitle indeksidir a. Boya göre ağırlık (Rölatif Ağırlık-RA) Çocuklar obezite açısından değerlendirilirken çocuğun ağırlığı, ideal ağırlık ile karşılaştırılmaktadır. İdeal ağırlığın belirlenmesinde her ülkenin kendi standartlarının kullanılması gerekmektedir. Yaş ve cinsiyete göre düzenlenmiş boy ve vücut ağırlığını içeren tablolardan yararlanılarak çocuğun boy yaşına uygun ağırlığı bulunur. Boyunun 50 persentilde olduğu yaşın 50 persentildeki ağırlığı o çocuğun ideal ağırlığıdır. Çocuğun 98 ölçülen ağırlığının ideal ağırlığına oranlanması ile rölatif ağırlık saptanır. (Rölatif ağırlık= hastanın ölçülen ağırlığı/ ideal ağırlığı ağırlığı x 100) Rölatif ağırlığın %110-120 arasında olması fazla tartılı (overweight), %120’nin üzerinde olması obezite kabul edilmektedir. b. Vücut kitle indeksi (VKİ), “Body Mass Index” (BMI) Vücut kitle indeksi obezitenin değerlendirilmesi için kullanılan en pratik ve günümüzde en kabul gören yöntemdir. Ölçülen ağırlığın (kg) boyun (m) karesine oranıdır (VKİ= ağırlık (kg) / boy2(m2) . VKİ çocuklarda yaşa ve cinse göre değişkenlik gösterir. Yaşa ve cinse göre VKİ persentilleri belirlenmiştir. Bu tabloya göre Yaş ve cinsiyete göre belirlenmiş çizelgelerde 85 ila 95 persentil arası fazla tartılı, 95.persentil üzerinde kalan vakalar obez olarak değerlendirilmektedir. Ancak bu tanım persentillerin elde edildiği topluma özgü olup ülkeler arası karşılaştırmalarda pek elverişli değildir. Örneğin; ABD çocuklarının 82. persentil değeri, Brezilya çocuklarının yaklaşık 95. persentil değerine ve İngiliz çocuklarının yaklaşık 90 persentil değerine uymaktadır. Bu yüzden dört kıta (Asya, Avrupa, Kuzey ve Güney Amerika) çocuklarından elde edilen veriler birleştirilerek 2-18 yaş arası uluslar arası VKİ değerleri elde edilmiş ve çocukluk çağı obezitesi için bu ölçütlerin kullanılması önerilmiştir (IOTF: International Obesity Task Force). b.Çevre ölçümleri Çevre ölçümleri vücut dansitesi, yağsız vücut dokusu, yağ dokusu kitlesi, total vücut protein kitlesi ve enerji depolarının göstergesidir. En sık üst orta kol, bel, kalça, uyluk ve baldır çevreleri kullanılır. Bel çevresi abdominal yağının değerlendirilmesinde en pratik ölçüm yöntemidir. Bel/ kalça oranı, yağ dağılımını belirler ve abdominal obezitenin tanısında önemlidir. Yağın abdominal bölgede ve iç organlarda toplanması, Tip ll diyabetes mellitus, hiperlipidemi, hipertansiyon, koroner arter hastalığı 99 ile yakın ilişkili olan insülin direncine yol açmaktadır. c.Cilt kıvrım kalınlıkları Obezitede yağın bir kısmı cilt altında toplanır. Cilt altı yağ dokusunu belirlemek için cilt kıvrım kalınlığı ölçümü yapılır. Ölçüm kaliper denen özel aletlerle yapılır. En sık kullanılanlar “Harpenden” ve “Lange” kaliperleridir. Cilt kıvrımları aletin uçları arasında tutulur ve kalınlık göstergeden okunur. Triseps, biseps, subskapular ve suprailiak bölgelerde ölçüm yapılabilmektedir. Yaygın olarak kullanılan triseps cilt kıvrım kalınlığı ölçümüdür. Yaşa göre belirtilen persentillere göre 85 persentil üzerindeki ölçümler obezite olarak değerlendirilmektedir. Obezite Prevalansı Yapılan çok sayıda çalışmada çocukluk çağı obezitesinin prevalansının son yıllarda artmakta olduğu gösterilmiştir. Ancak veri toplanmasında kullanılan metodların farklılığı sonuçların karşılaştırılmasında ve değerlendirilmesinde zorluklar yaratmaktadır. Tüm dünyada 144 ülkede gerçekleşen 450 ulusal çalışmanın analizi sonucunda ; 35 milyonu gelişmekte olan ülkelerde olmak üzere 43 milyon okul öncesi dönemi çocuğunun fazla tartılı ve obez, 92 milyon çocuğun ise fazla tartılı olma riski taşıdığı belirlenmiştir. Bu çocuklarda fazla tartılı olma ve obezite prevalansının 1990 yılında %4.2’den, 2010 yılında %6.7’ye ulaştığı, 2020 yılı için bu oranın %9.1’e ulaşacağı ve 60 milyon çocuğun fazla tartılı ve obez olacağı tahmin edilmektedir. Afrika için çocukluk çağı fazla tartılı olma ve obezite oranı 2010 yılı için %8.5 olup, 2020 yılında bu oranın %12.7’ye yükselmesi beklenmektedir. Asya kıtasında yaşayan çocuklarda fazla tartılı ve obez çocuk oranı 2010 yılı için %4.9 (18 milyon) bulunmuştur. Gelişmekte olan ülkelerde okul çocukluğu ve adolesan dönemde fazla tartılı ve obez çocuk oranları Tablo I’de görülmektedir. 100 Gelişmiş ülkelerde değişik yaş gruplarında kız ve erkek çocuklarında fazla tartılı olma ve obezite prevalansları Tablo II’de görülmektedir. ABD’de gerçekleştirilen beslenme ve sağlık taramaları (NHANES) obezite prevalansı hakkında güvenilir bilgiler vermektedir.ABD’de çocuk ve adolesanlarda (2-19 yaş) obezite prevalansı 2007-2008 yıllarında %16.9 düzeyine ulaşmış olup, en hızlı artışı 1976-1980 ve 1999-2000 yılları arasında göstermiş (%5.5 ve %13.9).Buna karşın, 1999-2000 ve 2007-2008 yılları arasında önemi bir artış kaydedilmemiştir (%13.9 ve %16.9)(Tablo III). İngiltere’de 1995 yılında %11.5 olan obezite oranı, 2007 yılı itibarıyla %16.5 düzeyine ulaşmıştır. Fazla tartılı ve obez çocuk oranı ise %24.5’den %30.4 düzeyine yükselmiştir (Tablo IV). Ülkemizde çocuk ve adolesanlarda obezite sıklığını araştıran ulusal bazda bir çalışma olmamakla birlikte lokal ve bölgesel düzeyde yapılan çeşitli çalışmalar bulunmaktadır. Neyzi ve ark.1966-68 yılları arasında İstanbul’da üç bin çocukta yaptığı araştırmada obezite oranını kızlarda %9.2, erkeklerde %11.2 düzeyinde bulmuş, sosyoekonomik düzeyle doğru orantılı olarak obezite sıklığının arttığını göstermiştir. Gür E. ve ark. İstanbul’da yedi ilçe, 14 ilköğretim okulunda, 6-16 yaşlar arasındaki1583 çocukta fazla tartılı çocuk oranını %10.7, obezite sıklığını ise %7.3 bulmuştur. Ankara’da Şimşek F. Ve ark. 6-17 yaş grubunda 1510 çocukta obezite oranını%4.8 bulmuştur. Ankara’da Cinaz ve ark.’nın 6-14 yaş arası 12.600 okul çocuğunu kapsayan geniş saha çalışmasında ise obezite prevalansı %7.5, fazla tartılı çocuk prevalansı %6.3 olmak üzere toplam %13.8 olarak saptanmıştır. Obezite sıklığı ırk, yaş ve cinsiyete göre farklılık 101 göstermektedir. Öner N ve ark. Edirne’de 1217 yaş grubu 989 çocukta fazla tartılı olma sıklığını kızlarda %10.6, erkeklerde %11.3, obezite oranlarını ise sırasıyla; %2.1 ve %1.6 düzeyinde saptamıştır. Düzce’deŞimşek E. ve ark. çalışmalarında6-17 yaş arası 6924 çocukta fazla tartılı çocuk oranını %10.3, obezite oranını %6.1 saptamış, kırsal alanda sıklığın azaldığını göstermişlerdir. İzmir’de Kalkan ve ark. 6-10.5 yaşları arasında 4548 çocukta obezite oranını %9.1 düzeyinde saptamıştır. Semiz S ve ark. Denizli’de 6-17 yaş grubunda 850 çocukta fazla tartılı çocuk ve obezite oranını sırasıyla; %11.6 ve %1.4 olarak belirlemiştir. Antalya’da Türkkahraman D ve ark. 2455 6-17 yaş grubu çocuklarda fazla tartılı ve obezite oranlarını %14.3 ve %3.6 düzeyinde bulmuştur. Elazığ’da Pirinççi E. ve ark. 6-11 yaş grubunda, 1782 kız ve 1860 erkek çocukta yaptıkları çalışmada fazla tartılı çocuk oranının %13.5, obezite oranının %1.6 olduunu göstermiştir. Ülkemizde obesite sorununun İstanbul, Ankara, İzmir gibi büyük şehirlerde daha yaygın olduğu, kırsal alanlarda daha az rastlandığı gözlemlenmektedir. Başlıca gelişmiş ülkeler olmak üzere, tüm dünyada obezite oranları erişkinlerde olduğu gibi çocuklarda da dramatik bir artış göstermektedir.Yapılan çalışmalar çocukluk döneminde başlayan obezitenin önemli bir oranda erişkin döneme yansıdığını göstermektedir. Tip II diyabet, dislipidemi, hipertansiyon ve kardiyovasküler hastalıklara yol açabilen, yüksek oranda morbidite ve mortaliteye neden olan obezitenin önlenmesi, erken dönemde tanınması ve tedavi edilmesi 102 koruyucu sağlık politikalarının başında yer almalıdır. KAYNAKLAR 1- Cinaz P. Obezite. Clinic Pediatri 2007;2(6):18-27. 2- Duerenberg P., Weststrate JA, Seidell JC.Body mass index as a measureof body fatness. Age and sex spesific prediction formulas. British J Nutr1991;65:105-11. 3- Günöz H., Büyükdevrim A. 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Geneva, World Health Organ Teach Rep Ser.2000;894:1-253. !8- Chhatwal J., Verma M., Riar SK. Obesity among pre-adolescent and adolescents of a developing country (India). Asia Pac J Clin Nutr2004;13(3):231-5 Tablo I-Gelişmekte olan Ülkeler ve cinsiyete göre fazla tartılı ve obezite prevalansı ——————————————————————————————— Ülke Yıl Yaş Erkek Kız Metod ——————————————————————————————— Meksika Çek Cum. Macaristan Hindistan Kore Türkiye 2006 10-17 2005 5-17 1993 10-15 2004 9-15 2003 7-17 2001 12-17 1995 11-17 30.5 31.5 IOTF 23.2 15.3 IOTF 17.8 15.9 IOTF 15.7 12.9 85 th cent. 16.3 10.0 IOTF 11.4 10.3 IOTF 9.8 8.2 IOTF Kaynak:International Association for the Study of Obesity Slovak Cum. ——————————————————————————————— 104 Tablo II- Gelişmiş Ülkeler ve cinsiyete göre fazla tartılı ve obezite prevalansı ——————————————————————————————— Ülke Yıl Yaş Erkek Kız Metod ——————————————————————————————— ABD İspanya Kanada İtalya Yeni Zelanda Avusturalya İngiltere Yunanistan Portekiz Belçika Irlanda İrlanda Avusturya İzlanda Norveç Almanya Fransa İsveç Finlandiya İsviçre Japonya Hollanda 2003 6-17 35.1 2000 13-14 35.0 2004 12-17 32.3 2006 8-9 32.4 2000 11-12 30.0 2007 9-13 25.0 2004 5-17 29.0 2003 13-17 29.6 2002 7-9 29.5 1998 5-15 27.3 2005 2-11 27.0 2005 2-15 23.0 2007 8-12 22.5 1998 9 22.0 1996 10 21.0 2003 5-17 20.4 2000 7-9 17.9 2001 6-11 17.6 1999 12-16 17.2 2007 6-13 16.7 1996 6-14 16.2 2003 5-17 14.7 1996 5-16 14.1 36.0 IOTF 32.0 IOTF 25.8 IOTF 34.0 IOTF 30.0 IOTF 30.0 IOTF 29.3 IOTF 16.1 IOTF 34.3 IOTF 26.7 85th cent. 26.0 IOTF 28.0 IOTF 16.7 90th cent. 25.5 IOTF 21.0 IOTF 20.1 IOTF 18.2 IOTF 27.4 IOTF 10.1 IOTF 13.1 CDC 14.3 IOTF 18.0 IOTF 15.3 IOTF Danimarka ——————————————————————————————— Kaynak:International Association for the Study of Obesity Tablo III- Yıllara göre ABD’de çocuk ve adolesanlarda (2-19 yaş) obezite prevalansı Yaş (yıl) NHES 1963–1965 105 1966- 19702 NHANES 1971–1974 NHANES 1976–1980 NHANES 1988–1994 NHANES 2003–2004 Total - 5.0 16.9 2–5 - 5.0 10.4 6–11 4.2 4.0 19.6 12–19 4.6 6.1 18.1 NHANES 1999–2000 NHANES 2005–2006 5.5 10.0 13.9 5.0 7.2 10.3 6.5 11.3 15.1 5.0 10.5 14.8 NHANES 2001–2002 NHANES 2007–2008 15.4 17.1 15.5 10.6 13.9 11.0 16.3 18.8 15.1 16.7 17.4 17.8 Kaynak: Ogden C, Carrol M. Prevalence of obesity among children and adolescents: United States, Trends 1963-1965 throught 2007-2008. Divison of health and nutrition examination surveys. Tablo IV- Yıllara göre İngiltere’de çocuklarda obezite ve fazla tatılı/obez çocuk prevalansı 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Obez % 11.5 11.9 12.6 13.4 15.1 14.3 15.0 17.0 16.6 18.8 18.3 16.0 16.5 Fazla Tartılı 24.5 24.9 25.6 27.5 29.0 26.8 30.1 30.8 31.2 34.0 32.6 29.7 106 30.4 ve obez % Kaynak: Health Survey for England
Snacking is a common eating behaviour, but there is little objective data about children’s snacking. We aimed to determine the frequency and context of children’s snacking (n = 158; mean age = 12.6 years) by ethnicity, gender, socioeconomic deprivation and body mass index (BMI) children. Participants wore wearable cameras that passively captured images of their surroundings every seven seconds. Images (n = 739,162) were coded for snacking episodes, defined as eating occasions in between main meals. Contextual factors analysed included: snacking location, food source, timing, social contact and screen use. Rates of total, discretionary (not recommended for consumption) and healthful (recommended for consumption) snacking were calculated using negative binomial regression. On average, children consumed 8.2 (95%CI 7.4, 9.1) snacks per day, of which 5.2 (95%CI 4.6, 5.9) were discretionary foods/beverages. Children consumed more discretionary snacks than healthful snacks in each setting and at all times, including 15.0× more discretionary snacks in public spaces and 2.4× more discretionary snacks in schools. Most snacks (68.9%) were sourced from home. Girls consumed more total, discretionary and healthful snacks than boys, and Māori and Pacific consumed fewer healthful snacks than New Zealand (NZ) Europeans. Results show that children snack frequently, and that most snacking involves discretionary food items. Our findings suggest targeting home buying behaviour and environmental changes to support healthy snacking choices.
Prior research suggests that the influence of marketing cues on consumers’ behavior can occur as a result of either system 1 processes (i.e., associative, intuitive, impulsive processes) or system 2 processes (i.e., rule‐based, analytic, reflective processes). We demonstrate that how people express a behavior can influence whether the behavior reflects predominantly system 1 or system 2 processing. Specifically, we propose a process—mode of expression congruence effect, whereby less deliberate behaviors (e.g., physically grabbing something) are relatively more sensitive to system 1 processing, while more deliberate behaviors (e.g., writing down one’s preference) are relatively more sensitive to system 2 processing. Six studies provide support for process—mode of expression congruence, showing that the magnitude and direction in which an environmental cue influences a consumer’s behavior can depend on the deliberateness of the mode of expression.
Energy intake is the product of portion size (PS)-the energy content of an ingestive event-and ingestive frequency (IF)-the number of ingestive events per unit time. An uncompensated alteration in either PS or IF would result in a change in energy intake and body weight if maintained over time. The objective of this meta-analysis was to assess the independent effects of PS and IF on energy intake and body weight among healthy adults in randomized controlled trials (RCTs). A total of 9708 articles were identified in PubMed, Web of Science, Cochrane, and CINAHL databases. The articles were divided among 10 researchers; each article was screened for eligibility by 2-3 independent reviewers. Exclusion criteria included: populations <19 y and >65 y, unhealthy populations (i.e. participants with an acute or chronic disease), assessments <24 h and <4 wk in duration for trials investigating energy intake or body weight, respectively. Controlled feeding trials (i.e. fixed energy intake) that manipulated IF and PS in the same study intervention (IF/PS) were evaluated separately and for the body weight outcome only. Twenty-two studies (IF = 4, PS = 14, IF/PS = 4) met the inclusion criteria. There was an insufficient number of studies to assess the effect of IF, PS, or IF/PS on body weight. There was heterogeneity in the effect sizes among all comparisons (I2 ≥75%). Consuming larger portion sizes was associated with higher daily energy intake [295 kcal (202, 388), n = 24; weighted mean differences (WMD) (95% CI), n = comparisons], and increased frequency of ingestive events was associated with higher energy intake [203 kcal (76, 330), n = 10]. Results from RCTs support that larger PS and greater IF are both associated with higher energy consumption. However, there is insufficient information to determine chronic effects on body weight. This protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42018104757.
An increasingly popular trend in recent years has been the growing number of dining-in-the-dark restaurants. This raises a number of interesting questions relating to gastrophysics and the new sciences of the table. First, and most relevant in the context of this book, does food really taste better if you turn the lights off? Second, does dining in the dark really provide any meaningful insights into how the blind experience food, as the owners of such restaurants would have us believe? We argue that one can see the increasing popularity of dine-in-the-dark restaurants as highlighting a growing shift in emphasis from the meal itself to the overall dining experience. This discussion will then raise a potential problem. Once it is realized just how important the ‘everything else’ really is, is there not a danger that restaurateurs, etc. will stop thinking/caring so much about the quality of the food that they serve and instead devote too many of their resources to creating the ‘perfect’ atmosphere/experience? In this chapter, we also look at how the absence of vision (either complete or partial, as in the case of colour blindness) affects our perception of food and drink. We think it unlikely that anyone will have their perfect meal while sitting in a dine-in-the-dark restaurant. That said, studying this increasingly popular dining trend nevertheless provides food for thought when considering how to deliver the most memorable of dining experiences.
Packaging influences usage behavior long after it has influenced purchase. Managers of consumer packaged goods and public policy officials have, therefore, questioned whether a package's size influences usage volume. Although often assumed, it has never been supported. Four laboratory studies and a final study in a Laundromat identity circumstances in which larger package sizes encourage greater use than do smaller package sizes. Unit cost is a key factor mediating this relationship. After noting useful implications for decisions regarding package size portfolios, sales promotions, and public policy, the author concludes by identifying other important but overlooked factors that increase usage volume and provide research opportunities.
Because larger food portions could be contributing to the increasing prevalence of overweight and obesity, this study was designed to weigh samples of marketplace foods, identify historical changes in the sizes of those foods, and compare current portions with federal standards.
We obtained information about current portions from manufacturers or from direct weighing; we obtained information about past portions from manufacturers or contemporary publications.
Marketplace food portions have increased in size and now exceed federal standards. Portion sizes began to grow in the 1970s, rose sharply in the 1980s, and have continued in parallel with increasing body weights.
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.
Package size, plate shape, lighting, socializing, and variety are only a few of the environmental factors that can influence the consumption volume of food far more than most people realize. Although such environmental factors appear unrelated, they generally influence consumption volume by inhibiting consumption monitoring and by suggesting alternative consumption norms. For researchers, this review suggests that redirecting the focus of investigations to the psychological mechanisms behind consumption will raise the profile and impact of research. For health professionals, this review underscores how small structural changes in personal environments can reduce the unknowing overconsumption of food.
Using self-refilling soup bowls, this study examined whether visual cues related to portion size can influence intake volume without altering either estimated intake or satiation.
Fifty-four participants (BMI, 17.3 to 36.0 kg/m2; 18 to 46 years of age) were recruited to participate in a study involving soup. The experiment was a between-subject design with two visibility levels: 1) an accurate visual cue of a food portion (normal bowl) vs. 2) a biased visual cue (self-refilling bowl). The soup apparatus was housed in a modified restaurant-style table in which two of four bowls slowly and imperceptibly refilled as their contents were consumed. Outcomes included intake volume, intake estimation, consumption monitoring, and satiety.
Participants who were unknowingly eating from self-refilling bowls ate more soup [14.7+/-8.4 vs. 8.5+/-6.1 oz; F(1,52)=8.99; p<0.01] than those eating from normal soup bowls. However, despite consuming 73% more, they did not believe they had consumed more, nor did they perceive themselves as more sated than those eating from normal bowls. This was unaffected by BMI.
These findings are consistent with the notion that the amount of food on a plate or bowl increases intake because it influences consumption norms and expectations and it lessens one's reliance on self-monitoring. It seems that people use their eyes to count calories and not their stomachs. The importance of having salient, accurate visual cues can play an important role in the prevention of unintentional overeating.
Background
Many studies have examined rapidly changing trends in U.S. dietary intake, but not as they correspond to other health inequalities among black and white Americans. The purpose of this study was to explore 30-year trends in diet quality and to examine whether income or education is the key socioeconomic factor linked with these shifts.
External cues such as packaging and container size can powerfully and unknowingly increase how much food a person consumes. Do they still, however, stimulate consumption as the perceived favorability of a food declines? This was examined with popcorn in a theatre setting. Moviegoers who had rated the popcorn as tasting relatively unfavorable ate 61% more popcorn if randomly given a large container than a smaller one. Moviegoers who had rated the popcorn as relatively favorable ate 49% more when the container size was increased (and were likely to eat greater amounts if accompanied with a person of the opposite sex). One reason for this increase was that consumers had more difficulty monitoring how much they ate from large containers. Implications for raising the consumption levels of healthy, but unfavorable foods are investigated. (C) 2001 Elsevier Science Ltd. All rights reserved.
This study was undertaken to quantify the relationship between palatability ratings and food consumption and to determine whether the initial rate of eating was affected by changes in food palatability without a change in nutrient content. Both men and women were given small samples of foods at a brief exposure taste test and asked to rate how much they liked or disliked them on a 9-point scale (like extremely to dislike extremely). Those who gave at least a 2-point difference in rating between a banana colada frozen yogurt drink with and without adulteration with cumin were given these foods to eat to satiety on non-consecutive days, and the same 9-point scale was used to rate these foods after they had been eaten as meals. Cumin was used as an adulterant because it is not intrinsically unpalatable, but is not liked by many individuals in yogurt-based foods. Intake was approximately 100 g different for every unit of difference on the scale, and higher for liked than disliked food. Intake was significantly different between the adulterated and unadulterated meals. The percentage of variance explained by the difference in palatability was 34% of the total variance but was 67% of the variance within subjects. Correlation between intake and ratings were poor across subjects for both palatability levels (i.e. adulterated and unadulterated). The initial rate of eating was significantly higher under the better liked than under the less liked food. These results indicate that quantification of effects of hedonic ratings on intake within subjects is possible, but that hedonic ratings may not be good discriminators of intake differences between subjects. The initial rate of eating reflects partly on palatability.
The energy density (ED; kcal/g) of an entrée influences children's energy intake (EI), but the effect of simultaneously changing both ED and portion size of an entrée on preschool children's EI is unknown. In this within-subject crossover study, 3-to 5-year-old children (30 boys, 31 girls) in a daycare facility were served a test lunch once/week for 4 weeks. The amount and type of vegetables and cheeses incorporated into the sauce of a pasta entrée were manipulated to create two versions that varied in ED by 25% (1.6 or 1.2 kcal/g). Across the weeks, each version of the entrée was served to the children in each of two portion sizes (400 or 300 g). Lunch, consumed ad libitum, also included carrots, applesauce, and milk. Decreasing ED of the entrée by 25% significantly (P < 0.0001) reduced children's EI of the entrée by 25% (63.1 ± 8.3 kcal) and EI at lunch by 17% (60.7 ± 8.9 kcal). Increasing the proportion of vegetables in the pasta entrée increased children's vegetable intake at lunch by half of a serving of vegetables (P < 0.01). Decreasing portion size of the entrée by 25% did not significantly affect children's total food intake or EI at lunch. Therefore, reducing the ED of a lunch entrée resulted in a reduction in children's EI from the entrée and from the meal in both portion size conditions. Decreasing ED by incorporating more vegetables into recipes is an effective way of reducing children's EI while increasing their vegetable intake.
Many studies have examined rapidly changing trends in U.S. dietary intake, but not as they correspond to other health inequalities among black and white Americans. The purpose of this study was to explore 30-year trends in diet quality and to examine whether income or education is the key socioeconomic factor linked with these shifts.
The 1965 Nationwide Food Consumption Survey and the 1994-1996 Continuing Survey of Food Intake by Individuals were used and included, respectively, 6476 and 9241 respondents who were aged > or =18 years. The Revised Diet Quality Index (DQI-R), an instrument that provides a summary assessment of a diet's overall healthfulness, was also used.
Between 1965 and 1996, improvements were found in both the overall DQI-R and its components across all education levels, with the exception of calcium intake. Conversely, improvements linked with income effects were inconsistent and less clear. In 1965, the effect of college attendance resulted in a 1.8 point higher DQI-R, higher calcium intake, and increased servings of fruits and vegetables. In 1994-1996, there were consistently improved diets for the overall DQI-R and its components, particularly among college attendees.
Diet quality has improved across both race and socioeconomic status groupings between 1965 and 1994-1996; however, education provides a much clearer differentiation. Education efforts must be emphasized to eliminate disadvantages in diet quality.
The objective of this study was to determine how the portion size of a packaged snack affects energy intake of the snack and of the subsequent meal. On five separate days, 60 subjects (34 women and 26 men) ate an afternoon snack and dinner in individual cubicles. For each snack, subjects were served one of five packages of potato chips (28, 42, 85, 128, or 170 g), which they consumed ad libitum directly from the unlabelled, opaque package. Subjects returned to the lab three hours later for a standard dinner, which was also consumed ad libitum. Results showed that snack intake increased significantly as the package size increased for both males and females (p < 0.001). The combined energy intake from snack and dinner also increased as the package size increased. On average, when served the largest snack package compared to the smallest, subjects consumed an additional 596 kJ (143 kcal) at snack and dinner combined. Results from this study demonstrate that short-term energy intake increases with increasing package size of a snack. These data suggest that the availability of large packages of energy-dense snacks may be one of the environmental influences associated with excess energy intake.
Environmental factors that unknowingly influence the consumption and intake of consumers
- Wansink
Wansink B. Environmental factors that unknowingly influence the con-sumption and intake of consumers. Annu Rev Nutr. 2004;24:455-479.
Mindless Eating:The Hidden Persuaders that Make Us Lose and GainWeight. NewYork:Bantam-Dell
- B Wansink