ENVIRONMENTAL FACTORS THAT INCREASE THE FOOD INTAKE AND CONSUMPTION VOLUME OF UNKNOWING CONSUMERS

Internal and external cues of meal cessation: the French paradox redux?

OBJECTIVE

Our objective was to investigate whether people who use internal cues of satiation when eating a meal are likely to weigh less than people who instead rely on external cues. In addition to exploring the role that internal and external cues play in meal cessation, this study raises an overlooked explanation of the French paradox.

RESEARCH METHODS AND PROCEDURES

A demographically-matched student sample of 133 Parisians and 145 Chicagoans completed a brief survey on meal cessation that asked the extent to which they agreed with statements associated with internal cessation cues and statements with external cessation cues. Their answers to these were compared across BMI levels and across countries.

RESULTS

Normal-weight people indicated that they were more likely to be influenced by internal cues of meal cessation (p = 0.043), while overweight people indicated that they were more influenced by external cues (p = 0.005). Similarly, while the French were influenced by internal cues of meal cessation (p < 0.001), Americans were more influenced by external cues (p < 0.001).

DISCUSSION

This research revisits Schachter's externality hypothesis and suggests that one's over-reliance on external cues may prove useful in offering a partial explanation of why BMI might vary across people and potentially across cultures. Relying on internal cues for meal cessation, rather than on external cues, may improve eating patterns over the long term.

Package unit size and amount of food: do both influence intake?

OBJECTIVE

Large portions increase intake and are hypothesized to contribute to the obesity epidemic. However, it is unclear if portion size affects intake through changes in the unit size of available food or the overall amount of food available for consumption. Thus, this study examined the independent effects of package unit size and amount of food on intake. It was hypothesized that both variables would influence intake.

RESEARCH METHODS AND PROCEDURES

Non-obese (BMI <30 kg/m(2)), non-smoking, unrestrained, college-aged men (n = 12) and women (n = 16) who regularly consumed (>or=3 times/wk) snack foods were randomly assigned to one of four groups crossing package unit size (small vs. large) and amount of food (small vs. large). Participants were given a box with 4 snack foods (potato chips, cheese crackers, cookies, and candy) packaged according to their assigned group to take home and eat over 3 days. Dependent variables were energy and gram intake of provided snack foods.

RESULTS

An effect of amount of food was found (p < 0.01). A 100% increase in the amount of food provided produced an 81% increase in energy consumed from the snack foods [small amount, 21,037.6 +/- 10,852 kJ (5,028 +/- 2,596 kcal) vs. large amount, 11,640.7 +/- 4,914.1 kJ (2,782 +/- 1,174 kcal)]. No effect of package unit size was found.

DISCUSSION

These results suggest that the amount of food available to eat strongly influences intake.

Social influences on formula intake via suckling in 7 to 14-week-old-infants

To investigate social influences on human suckling behavior, 25 healthy, full term, 7 to 14-week-old infants were each bottle-fed their own formula twice by their mother and once in each of four experimental conditions: (a) held, provided social interaction; (b) held, without interaction; (c) not held, provided interaction; (d) not held, without interaction. Volume intake (VI), Total Sucks, infant gaze direction, and time elapsed since the last feeding were determined. There were three major findings: (1) social interaction increased VI; (2) VI was linearly related to the time since the last feeding in held infants; (3) Total Sucks and VI were both highly correlated with privation length when infants did not look at the feeder and when fed by the mother. Thus, social influences exert strong immediate impacts on suckling. Accordingly, suckling functions to obtain both nutrition from and social information about the feeder.

The influence of the media environment on physical activity: looking for the big picture

The Influence of the Media Environment on Physical Activity: Looking for the Big Picture Media consumption is expected to continue to increase well into the future. With this in mind the author suggests opportunities to influence the media environment for the purposes of promoting physical activity. A research agenda focused on media consumption, media content, commercial considerations, promoting physical activity through the media, partnerships with industry, positioning, dissemination of proven methods, and environmental change is proposed.

Counting bones: environmental cues that decrease food intake

At an all-you-can eat buffet in a sports bar, it was tested whether people would eat less if they knew how much they had already eaten. 50 graduate students (34 women; M age = 24.1 yr.) were seated at 21 tables randomly assigned to be bussed (leftover wings removed) or unbussed (wings left on table). The 31 students at the bussed tables ate more than those at the unbussed tables (7 wings vs. 5.5 wings), with the effect being stronger for men than women. In distracting eating environments, environmental cues may provide an effective means of reducing consumption. Implications for controlling alcohol intake were also noted.

Using a smaller plate did not reduce energy intake at meals

In three cross-over experiments, we examined the effect on energy intake of changing the size of the plate used at a meal. On separate days, adults were served the same lunch menu but were given a different-sized plate. In the first study, 45 participants used each of three plate sizes (17, 22, or 26 cm) and served the main course from a large dish. In the second study, 30 participants received an equal amount of food presented on each of the two larger plates. In the third study, 44 participants used each of the three plates and selected from a buffet of five foods matched for energy density. Results showed that plate size had no significant effect on energy intake. The mean differences in intake using the smallest and largest plates in the three studies were 21+/-13 g, 11+/-13 g, and 4+/-18 g, respectively, equivalent to <142 kJ (34 kcal) and not significantly different from zero. Participants in the third study made significantly more trips to the buffet when they were given the smallest plate. These findings show that using a smaller plate did not lead to a reduction in food intake at meals eaten in the laboratory.

Fine as North Dakota wine: Sensory expectations and the intake of companion foods

Taste expectations can influence taste evaluations. It is not known, however, whether the environmental cues that influence taste expectations--such as suggestible names and brand labels--can have a referred impact on the intake volume of companion foods. Adult diners who ordered a prix-fixe restaurant meal were given a complimentary glass of wine that had been relabeled to induce either favorable ("new from California") or unfavorable ("new from North Dakota") taste expectations. An analysis of plate waste indicated that those who believed they had been drinking California wine ate 12% more of their meal than those who instead believed they drank North Dakota wine. In combination with a sensory-based lab study, these results show that environmental cues--such as label-induced sensory expectations--can have a far-reaching impact on the food intake of companion foods.

The influence of a verbal prompt on school lunch fruit consumption: a pilot study

Background:

This study evaluated an environmental intervention intended to increase consumption of the fruit serving among elementary school children participating in the National School Lunch Program (NSLP).

Methods:

Children's fruit consumption was measured in two schools by observation. In the intervention school, cafeteria workers provided the verbal prompt, "Would you like fruit or juice with your lunch?" as the children stood in line in front of the fruit serving options. The control school had the same fruit and 100% juice options available, but the cafeteria workers did not provide a verbal prompt to take a fruit serving. Two variables were assessed: (1) Did children leave the lunch line with a fruit serving on their trays? and (2) Did they subsequently eat the fruit serving?

Results:

The average percentage of children who took a fruit serving was 60% in the control school and 90% in the intervention school. In both schools, approximately 80% of children ate the fruit on their tray. As a result, nearly 70% of the children in the intervention school consumed a fruit serving at lunch, while fewer than 40% did so in the control school.

Conclusion:

A simple verbal prompt appears to have a significant impact on the likelihood that children will take, and subsequently consume, a fruit serving as part of their purchased school lunch. If these findings are replicated, policymakers may consider adding verbal prompts to the serving policy of the NSLP in an effort to increase fruit consumption among school children.

Sense or no-sense: The nurse as embodied ethnographer

Researching in familiar environments brings about challenges as nurses are learned to tune out their senses to give expert nursing care, and contemporary nursing research using observations has been criticized for being disembodied--not often using senses other than sight. This article draws on experiences from a fieldwork study of palliative and aged care environments to show how a deliberate use of the senses can enhance the richness of nursing research and open up new avenues for investigation. Examples from a reflexive fieldwork journal are presented to demonstrate how sensate experiences was used in a reflexive process that led into areas that otherwise might have remained unexplored. The authors argue that the interplay between sensate experiences and analytical logic can bring the background to the foreground and provide new ways of making the familiar unfamiliar. In making sense of what residing in health care environments might mean, an embodied research activity is fruitful.

Effects of age on children's intake of large and self-selected food portions

OBJECTIVE

Whether developmental periods exist in which children become particularly sensitive to environmental influences on eating is unclear. This research evaluated the effects of age on intake of large and self-selected portions among children 2 to 9 years of age.

RESEARCH METHODS AND PROCEDURES

Seventy-five non-Hispanic white children 2 to 3, 5 to 6, and 8 to 9 years of age were seen at a dinner meal in reference, large, and self-selected portion size conditions in which the size of an entrée was age-appropriate, doubled, and determined by the child, respectively. Weighed food intake data were collected. Entrée bite size and bite frequency were assessed. Height and weight measurements were obtained.

RESULTS

The effect of age on children's intake of the large portion was not significant. Entrée consumption was 29% greater (p < 0.001) and meal energy intake was 13% greater (p < 0.01) in the large portion condition than in the reference condition. Increases in entrée consumption were attributable to increases in average bite size (p < 0.001). Neither child weight nor maternal weight predicted children's intake of large portions. Self-selection resulted in decreased entrée (p < 0.05) and meal energy (p < 0.01) only among those children who ate more when served the large portion.

DISCUSSION

The results of this research confirm that serving large entrée portions promotes increased intake at meals among 2- to 9-year-old children. These findings suggest that any age-related differences in children's response to large portions are likely to be smaller than previously suspected.

Actions necessary to prevent childhood obesity: creating the climate for change

Childhood obesity has become a public health epidemic, and currently a battle exists over how to frame and address this problem. This paper explores how public policy approaches can be employed to address obesity. We present the argument that obesity should be viewed as the consequence of a "toxic environment" rather than the result of the population failing to take enough "personal responsibility." In order to make progress in decreasing the prevalence of obesity, we must shift our view of obesity away from the medical model (which focuses on the individual) to a public health model (which focuses on the population). At the same time, we must be sensitive to the problem of weight bias. Potential obstacles to taking a public policy approach are identified, as well as suggestions on how to overcome them.

The effect of the Thanksgiving holiday on weight gain

BACKGROUND

More people than ever are considered obese and the resulting health problems are evident. These facts highlight the need for identification of critical time periods for weight gain. Therefore the purpose was to assess potential changes that occur in body weight during the Thanksgiving holiday break in college students.

METHODS

94 college students (23.0 +/- 4.6 yrs, 72.1 +/- 14.0 kg, 172.6 +/- 9.3 cm, 24.0 +/- 3.9 kg/m2) reported to the human body composition laboratory at the University of Oklahoma following a 6-hour fast with testing occurring prior to, and immediately following the Thanksgiving holiday break (13 +/- 3 days). Body weight (BW) was assessed using a balance beam scale while participants were dressed in minimal clothing. Paired t-tests were used to assess changes in BW pre and post Thanksgiving holiday with additional analysis by gender, body mass index (BMI), and class standing (i.e. undergraduate vs. graduate).

RESULTS

Overall, a significant (P < 0.05) increase in BW was found between pre (72.1 kg) and post (72.6 kg) Thanksgiving holiday. When stratified by gender and class standing a significant (P < 0.05) increase in body weight was observed between the pre and post Thanksgiving holiday in males (0.6 kg), females (0.4 kg) and graduate students (0.8 kg). When participants were classified by BMI as normal or as overweight/obese, a significant 1.0 kg BW gain was found (P < 0.05) in the overweight/obese (>/=25 kg/m2) group compared to a non significant 0.2 kg gain in the normal group (<25 kg/m2).

CONCLUSION

These data indicate that participants in our study gained a significant amount of BW (0.5 kg) during the Thanksgiving holiday. While an increase in BW of half a kilogram may not be cause for alarm, the increase could have potential long-term health consequences if participants retained this weight gain throughout the college year. Additionally, because the overweight/obese participants gained the greatest amount of BW, this group may be at increased risk for weight gain and further obesity development during the holiday season.

The effect of single serving versus entire package nutritional information on consumption norms and actual consumption of a snack food

OBJECTIVE

Increasing serving sizes have been identified as contributors to the obesity epidemic. Researchers suggest that consumers are in need of cues that provide norms for the appropriate amount of food to consume. The impact of one potential cue, the provision of nutritional information for a single serving as well as the entire package ("dual-column labels") versus single-serving nutritional information only ("single-column labels"), was investigated on the consumption of a snack food for dieters and nondieters.

DESIGN

In a between-subjects experimental design, participants were provided with a snack food product and nutrition label. After the opportunity for consumption, they were provided with a survey instrument.

SETTING

The study took place in a classroom setting.

PARTICIPANTS

Undergraduate students were randomly assigned to the single-column versus dual-column label treatment groups and were classified as dieters (n = 45) or nondieters (n = 67) based on self-reported dieting behavior.

INTERVENTION

Participants were exposed to either a single-column or dual-column nutrition label.

MAIN OUTCOME MEASURES

Perceptions of consumption norms; use, importance, and understanding of nutrition labels; and the actual amount consumed by each individual were measured.

ANALYSIS

Analysis of variance was used to analyze data from the study.

RESULTS

Nondieting participants, but not dieting participants, ate significantly less when exposed to the dual-column label compared to the single-column label (P < .05). Although there was a significant difference in the amount consumed by dieters and nondieters in the case of the single-column label (P < .05), the presence of a dual-column label attenuated this effect. In addition, dieters reported paying greater attention to (P < .01), better perceived the necessity of (P < .01), and had better understanding of (P < .05) label information than nondieters. In addition, dieters considered the provided serving to be more adequate than nondieters (P < .05).

IMPLICATIONS FOR RESEARCH AND PRACTICE

Compared to standard, single-column labels, dual-column nutritional labels have a greater impact on the snack food consumption of nondieters.

Effects of binge eating on satiation, satiety, and energy intake of overweight children

BACKGROUND

Children who report episodes of binge eating gain more weight than do children not reporting binge eating. However, how binge eating affects children's food intake at meals is unknown.

OBJECTIVE

We compared the energy intake and postmeal satiety of children with and without a history of binge eating during buffet meals.

DESIGN

Sixty overweight children aged 6-12 y were categorized into those reporting past binge-eating episodes (n = 10) and those reporting no such episodes (n = 50). Children selected lunch twice from a multiple-item, 9835 kcal, buffet meal: after an overnight fast and after a standardized breakfast. Children ate ad libitum, until they reported they were full. The main outcome measures were energy intake during meals and duration of postmeal satiety, after adjustment for covariates, including age, race, sex, socioeconomic status, and body composition.

RESULTS

After the overnight fast, children in the binge-eating group consumed more energy [x (+/-SD): 1748 +/- 581 compared with 1309 +/- 595 kcal; P = 0.04] and exhibited a shorter satiety duration (194 +/- 84 compared with 262 +/- 89 min; P = 0.03) than did children in the non-binge-eating group. After the standardized breakfast, binge-eating children reported a shorter satiety duration (75 +/- 62 compared with 132 +/- 62 min; P = 0.01) and consumed more energy at the postbreakfast meal (1874 +/- 560 compared with 1275 +/- 566 kcal; P = 0.004).

CONCLUSION

The ability to consume large quantities of palatable foods, coupled with decreased subsequent satiety, may play a role in the greater weight gain found in binge-eating children.

Food intake and reward mechanisms in patients with schizophrenia: implications for metabolic disturbances and treatment with second-generation antipsychotic agents

Obesity is highly prevalent among patients with schizophrenia and is associated with detrimental health consequences. Although excessive consumption of fast food and pharmacotherapy with such second-generation antipsychotic agents (SGAs) as clozapine and olanzapine has been implicated in the schizophrenia/obesity comorbidity, the pathophysiology of this link remains unclear. Here, we propose a mechanism based on brain reward function, a relevant etiologic factor in both schizophrenia and overeating. A comprehensive literature search on neurobiology of schizophrenia and of eating behavior was performed. The collected articles were critically reviewed and relevant data were extracted and summarized within four key areas: (1) energy homeostasis, (2) food reward and hedonics, (3) reward function in schizophrenia, and (4) metabolic effects of the SGAs. A mesolimbic hyperdopaminergic state may render motivational/incentive reward system insensitive to low salience/palatability food. This, together with poor cognitive control from hypofunctional prefrontal cortex and enhanced hedonic impact of food, owing to exaggerated opioidergic drive (clinically manifested as pain insensitivity), may underlie unhealthy eating habits in patients with schizophrenia. Treatment with SGAs purportedly improves dopamine-mediated reward aspects, but at the cost of increased appetite and worsened or at least not improved opiodergic capacity. These effects can further deteriorate eating patterns. Pathophysiological and therapeutic implications of these insights need further validation via prospective clinical trials and neuroimaging studies.

Meal size, not body size, explains errors in estimating the calorie content of meals

BACKGROUND

Although most people underestimate the calories they consume during a meal or during the day, calorie underestimation is especially extreme among overweight persons. The reason for this systematic bias is unknown.

OBJECTIVE

To investigate whether the association between calorie underestimation and body mass reflects a tendency for all persons to underestimate calories as the size of a meal increases.

DESIGN

Overweight and normal-weight adults estimated the number of calories of a fast-food meal they had ordered and eaten (study 1) or of 15 fast-food meals that were chosen by the experimenter (study 2) in a randomized, controlled trial. Their estimations were compared with the actual number of calories of the meals.

SETTING

Study 1 was a field study conducted in fast-food restaurants in 3 medium-sized midwestern U.S. cities. Study 2 was conducted in a laboratory at a major U.S. research university.

PARTICIPANTS

Study 1 involved 105 lunchtime diners (average body mass index [BMI], 24.2 kg/m2 [range, 17.2 to 33.5 kg/m2]). Study 2 involved 40 undergraduate students (average BMI, 23.2 kg/m2 [range, 16.1 to 32.3 kg/m2]).

MEASUREMENTS

Participants were asked to estimate the number of calories in a fast-food meal they had ordered and eaten (study 1) or in 15 sizes of the same fast-food meal (study 2). The actual number of calories in the meals in the field study was obtained by unobtrusively recording the food that was ordered (identified from the wrappings and containers). Weight and height were self-reported.

RESULTS

Although participants strongly underestimated the number of calories in larger meals (by -38.0% in study 1 and by -22.6% in study 2), they almost perfectly estimated the number of calories in smaller meals (by -2.9% in study 1 and by 3.0% in study 2). After the authors controlled for body weight-related differences in meal size, the calorie estimations of normal-weight and overweight participants were identical in both studies.

LIMITATIONS

These studies examined fast-food meals. Weight and height were self-reported. There were too few observations to distinguish between obese (BMI > or =30 kg/m2) and overweight (BMI >25 kg/m2 but <30 kg/m2) participants.

CONCLUSIONS

Greater underestimation of calories by overweight persons is a consequence of their tendency to consume larger meals. Calorie underestimation is related to meal size, not body size.

Ice cream illusions bowls, spoons, and self-served portion sizes

BACKGROUND

Because people eat most of what they serve themselves, any contextual cues that lead them to over-serve should lead them to over-eat. In building on the size-contrast illusion, this research examines whether the size of a bowl or serving spoon unknowingly biases how much a person serves and eats.

METHODS

The 2 x 2 between-subjects design involved 85 nutrition experts who were attending an ice cream social to celebrate the success of a colleague in 2002. They were randomly given either a smaller (17 oz) or a larger (34 oz) bowl and either a smaller (2 oz) or larger (3 oz) ice cream scoop. After serving themselves, they completed a brief survey as their ice cream was weighed. The analysis was conducted in 2003.

RESULTS

Even when nutrition experts were given a larger bowl, they served themselves 31.0% more (6.25 vs 4.77 oz, F(1, 80) = 8.05, p < 0.01) without being aware of it. Their servings increased by 14.5% when they were given a larger serving spoon (5.77 vs 5.04 oz, F(1, 80)=2.70, p = 0.10).

CONCLUSIONS

People could try using the size of their bowls and possibly serving spoons to help them better control how much they consume. Those interested in losing weight should use smaller bowls and spoons, while those needing to gain weight--such as the undernourished or aged--could be encouraged to use larger ones. Epidemiologic implications are discussed.

Unit bias. A new heuristic that helps explain the effect of portion size on food intake

People seem to think that a unit of some entity (with certain constraints) is the appropriate and optimal amount. We refer to this heuristic as unit bias. We illustrate unit bias by demonstrating large effects of unit segmentation, a form of portion control, on food intake. Thus, people choose, and presumably eat, much greater weights of Tootsie Rolls and pretzels when offered a large as opposed to a small unit size (and given the option of taking as many units as they choose at no monetary cost). Additionally, they consume substantially more M&M's when the candies are offered with a large as opposed to a small spoon (again with no limits as to the number of spoonfuls to be taken). We propose that unit bias explains why small portion sizes are effective in controlling consumption; in some cases, people served small portions would simply eat additional portions if it were not for unit bias. We argue that unit bias is a general feature in human choice and discuss possible origins of this bias, including consumption norms.

Eating for pleasure or just wanting to eat? Reconsidering sensory hedonic responses as a driver of obesity

Pleasure from foods can stimulate "non-homoeostatic" eating, and might therefore also potentially contribute toward obesity. However, obesity is not reliably associated with heightened hedonic responses to foods. This apparent discrepancy may reflect the differentiation between "liking" and "wanting". Supporting this, behavioural and neurophysiological data on responsiveness to food-related cues indicate that obesity may be associated with increased motivation for food consumption, without necessarily any greater explicit pleasure derived from the orosensory experience of eating. This distinction may have important implications for further research, and applications in commercial and public health approaches to modifying energy intakes.

Evolutionary and anthropological perspectives on optimal foraging in obesogenic environments

The nutrition transition has created an obesogenic environment resulting in a growing obesity pandemic. An optimal foraging approach provides cost/benefit models of cognitive, behavioral and physiological strategies that illuminate the causes of caloric surfeit and consequent obesity in current environments of abundant food cues; easy-access and reliable food patches; low processing costs and enormous variety of energy-dense foods. Experimental and naturalistic observations demonstrate that obesogenic environments capitalize on human proclivities by displaying colorful advertising, supersizing meals, providing abundant variety, increasing convenience, and utilizing distractions that impede monitoring of food portions during consumption. The globalization of fast foods propels these trends.

Shaping the context of health: a review of environmental and policy approaches in the prevention of chronic diseases

Given the growing attention on how environmental and policy interventions can affect chronic disease burden, our objectives are to describe (a) effective and promising interventions to address tobacco use, physical activity, and healthy eating and (b) lessons learned from the literature and practice experience in applying environmental and policy approaches. A total of 17 interventions were reviewed, organized across 3 domains affecting the physical environment/access, economic environment, and communication environment. Many of these interventions are effective. Several lessons are important to consider, such as the need to start with environmental and policy approaches, intervene comprehensively and across multiple levels, make use of economic evaluations, make better use of existing analytic tools, understand the politics and local context, address health disparities, and conduct sound policy research.

Listening to music while eating is related to increases in people's food intake and meal duration

The relationship of listening to music while eating with food consumption in the natural environment was assessed in 78 college students. They recorded their food intake along with environmental factors such as meal duration, music, including speed and volume, location, number of people present and the time of day in a detailed diet diary for 7 consecutive days. The data show that the presence of music is associated with higher food intake. Within subject comparisons revealed higher food and fluid intake and longer meal duration while listening to music but no significant differences in music speed or volume. The likelihood of listening to music appeared to be associated with the environmental variables of the number of people present and the time of day. The presence of music appears to be one of a set of environmental factors that influences food and fluid intake in the natural world.

The office candy dish: proximity's influence on estimated and actual consumption

OBJECTIVE AND PURPOSE

Although there is increasing interest in how environmental factors influence food intake, there are mixed results and misunderstandings of how proximity and visibility influence consumption volume and contribute to obesity. The objective of this paper is to examine two questions: first, how does the proximity and salience of a food influence consumption volume? Second, are proximate foods consumed more frequently because they are proximate, or are they consumed more frequently because people lose track of how much they eat?

RESEARCH METHODS AND PROCEDURES

The 4-week study involved the chocolate candy consumption of 40 adult secretaries. The study utilized a 2 x 2 within-subject design where candy proximity was crossed with visibility. Proximity was manipulated by placing the chocolates on the desk of the participant or 2 m from the desk. Visibility was manipulated by placing the chocolates in covered bowls that were either clear or opaque. Chocolates were replenished each evening, and placement conditions were rotated every Monday. Daily consumption was noted and follow-up questionnaires were distributed and analyzed.

RESULTS

There were main effects for both proximity and visibility. People ate an average of 2.2 more candies each day when they were visible, and 1.8 candies more when they were proximately placed on their desk vs 2 m away. It is important to note, however, that there was a significant tendency for participants to consistently underestimate their daily consumption of proximately placed candies (-0.9) and overestimate their daily consumption of less proximately placed candies (+0.5).

DISCUSSION

These results show that the proximity and visibility of a food can consistently increase an adult's consumption of it. In addition, these results suggest that people may be biased to overestimate the consumption of foods that are less proximate, and to underestimate those that are more proximate. Knowing about these deviation tendencies is important for those attempting effectively monitor their consumption of fat and sugar.

The meaning of food in our lives: a cross-cultural perspective on eating and well-being

Humans are biologically adapted to their ancestral food environment in which foods were dispersed and energy expenditure was required to obtain them. The modern developed world has a surplus of very accessible, inexpensive food. Amid the enormous variety of different foods are "super" foods, such as chocolate, which are particularly appealing and calorie dense. Energy output can be minimal to obtain large amounts of food. In terms of education (eg, in nutrition and risk-benefit thinking) and environment design, modern cultures have not kept pace with changes in the food world. Overweight and worrying about food result from this mismatch between human biological predispositions and the current food environment. The French have coped with this mismatch better than Americans. Although at least as healthy as Americans, they focus more on the experience of eating and less on the health effects of eating. They spend more time eating, but they eat less, partly because of smaller portion sizes. French traditions of moderation (versus American abundance), focus on quality (versus quantity), and emphasis on the joys of the moment (rather than making life comfortable and easy) support a healthier lifestyle. The French physical environment encourages slow, moderate social eating, minimal snacking, and more physical activity in daily life.

Barriers to medical nutrition therapy in black women with type 2 diabetes mellitus

PURPOSE

The purpose of this study was to explore food purchasing, preparation, and consumption among black women with type 2 diabetes mellitus (T2DM) in an urban setting to assess barriers to medical nutrition therapy recommendations.

METHODS

A telephone survey was developed to assess shopping habits, the use of community resources for food supplementation, use of restaurant/fast-food establishments, dining habits, food purchasing and consumption, and food preparation methods. This 38-item questionnaire provided both frequencies and trends regarding participants' dietary habits.

RESULTS

Black women identified ways in which their participation in a culturally competent intervention of diabetes care and education helped them to change dietary behaviors. The most common areas of change included purchasing, preparation, and portion size. Barriers to medical nutrition therapy identified included low income, time constraints, competing demands, and knowledge deficits.

CONCLUSIONS

Culturally sensitive diabetes interventions are an effective way to overcome some of the barriers to medical nutrition therapy. Feedback provided by this survey suggests that identification of more affordable healthy food resources in the community is necessary. In addition, access issues such as transportation to grocery stores should be on the agenda for public policy issues. Finally, alternate sites for nutrition education, such as a supermarket forum, warrant further investigation.

Bad popcorn in big buckets: portion size can influence intake as much as taste

OBJECTIVE

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.

DESIGN, SETTING, AND PARTICIPANTS

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.

OUTCOME MEASURES AND RESULTS

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.

CONCLUSIONS AND IMPLICATIONS

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.

A review of family and social determinants of children's eating patterns and diet quality

With the growing problem of childhood obesity, recent research has begun to focus on family and social influences on children's eating patterns. Research has demonstrated that children's eating patterns are strongly influenced by characteristics of both the physical and social environment. With regard to the physical environment, children are more likely to eat foods that are available and easily accessible, and they tend to eat greater quantities when larger portions are provided. Additionally, characteristics of the social environment, including various socioeconomic and sociocultural factors such as parents' education, time constraints, and ethnicity influence the types of foods children eat. Mealtime structure is also an important factor related to children's eating patterns. Mealtime structure includes social and physical characteristics of mealtimes including whether families eat together, TV-viewing during meals, and the source of foods (e.g., restaurants, schools). Parents also play a direct role in children's eating patterns through their behaviors, attitudes, and feeding styles. Interventions aimed at improving children's nutrition need to address the variety of social and physical factors that influence children's eating patterns.

Obesity and the incidence of chronic diseases in Spain: a seemingly unrelated probit approach

Western societies can reduce avoidable mortality and morbidity by better understanding the relationship between obesity and chronic disease. This paper examines the empirical association between obesity and the incidence of heart disease, diabetes, hypertension, and elevated cholesterol. We analyze a broadly representative Spanish dataset, the 1999 Survey on Disabilities, Impairments and Health Status, using a health production theoretical framework together with a seemingly unrelated probit model approach that controls for unobserved heterogeneity and endogeneity. Its findings provide evidence of a positive and significant, although specification-dependent, association between obesity and the prevalence of all chronic illness examined.

Bottomless bowls: why visual cues of portion size may influence intake

OBJECTIVE

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.

RESEARCH METHODS AND PROCEDURES

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.

RESULTS

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.

DISCUSSION

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.

The more food young adults are served, the more they overeat

Young and Nestle suggested that the increase in the portion size of food products evident in the United States during the past 20 years may be responsible for the epidemic of overweight and obesity. They based their conclusion on statistical correlations. The purpose of the present study was to provide experimental evidence to support their proposal. Cornell undergraduate students were given access to a buffet lunch on Monday, Wednesday, and Friday and were told this was a test of flavor enhancers. They were instructed to eat as much or as little as they wanted. On the same days of the following week, the subjects were divided into 3 groups. Each group was served either 100%, 125%, or 150% of the amount of food they had consumed the previous week. When larger amounts were served, significantly greater amounts of food were consumed. Each of the 4 foods that comprised the meal (soup, pasta, breadsticks, ice cream) increased significantly in proportion to the portion size. The data clearly support the hypothesis proposed by Young and Nestle and support the powerful role that environment plays in determining energy intake and potential increases in body weight.