Children's familiarity with snack foods changes expectations about fullness

The effects of snack foods of different energy density on self-served portions and consumption in preschool children

It is recommended that preschoolers serve themselves their own food portions; however, it is unclear what factors influence the amount they select for consumption, and particularly how their selected portions are influenced by food properties such as energy density, volume, and weight. We offered preschool children snacks differing in energy density (ED) and investigated the effects on the amounts they served and then consumed. In a crossover design, 52 children aged 4-6 y (46% girls; 21% overweight) ate an afternoon snack on 2 days in their childcare classrooms. Before each snack time, children served the amount they would like to eat of 4 snacks presented in equal volumes but differing in ED (higher-ED: pretzels, cookies; lower-ED: strawberries, carrots). Across the 2 sessions, children were given their self-served amount of either pretzels (3.9 kcal/g) or strawberries (0.3 kcal/g) and intake was measured. Later, children tasted all 4 snacks and rated liking. Results showed that the portions children served themselves were influenced by their liking ratings (p = 0.0006), but after accounting for liking, the volumes they served were similar for all 4 foods (p = 0.27). At snack time, children ate a greater proportion of self-served strawberries (92 ± 4%) than pretzels (73 ± 4%; p = 0.0003), but because of the ED difference they consumed 55 ± 4 kcal more from pretzels than strawberries (p < 0.0001). The difference in snack intake by volume was not attributable to liking ratings (p = 0.87). That children served a consistent volume of similarly-liked snacks suggests that their portions were affected more by visual cues than by weight or energy content. Despite eating a greater volume of lower-ED strawberries, children consumed more energy from the higher-ED pretzels, highlighting the contribution of energy density to children's energy intake.

The Role of Dishware Size in the Perception of Portion Size in Children and Adolescents with Obesity

Purpose: The influence of dishware on portion size perception in children and adolescents is inconclusive. This study investigated how children and adolescents with both obesity and a normal weight perceived portion size in different sized and shaped dishware items. Methods: The study included 60 children and adolescents with overweight and obesity (OBE) and 27 children and adolescents with normal weight (NW) aged from 9 to 17 years. The participants estimated quantities in three pairs of drinking glasses, one pair of bowls and two pairs of plates which varied in size and shape. The children were instructed to state intuitively which portion they would choose for big or small thirst/hunger. Thereafter they were asked to determine the exact amount by answering which dishware item contained the larger/smaller portion (cognitive evaluation). Results: There were no substantial differences in the intuitive evaluation of portion sizes between OBE and NW. During the cognitive evaluation, OBE estimated the amount of water in the glasses more correctly compared to NW (61% vs. 43%; p = 0.008); OBE estimated the amount of lentils in the bowls and on the plates significantly less correctly (39%) compared to NW (56%; p = 0.013). Conclusions: Habit formation and environmental stimuli might play a greater role in estimating food amounts in dishware than the child’s and adolescent’s body weight.

Effects of Apple Form on Energy Intake During a Mid-Afternoon Snack: A Preload Paradigm Study in School-Aged Children

Consuming foods with a form or a texture that requires longer oral processing is a way to decrease food intake. Although this approach is promising for leveraging healthier eating patterns in adults, it has never been explored in children. This study evaluated whether starting a mid-afternoon snack by eating either apple segments or applesauce would modify hunger and subsequent food intake during this meal. Forty-four children (8-10 years old) participated in two videotaped mid-afternoon snacks, during which they received one of the two forms of apple as a food preload followed 10 min later by ad libitum consumption of sweetened cottage cheese. They self-reported their level of hunger throughout consumption, and the weight of cottage cheese consumed was determined at the end of the snack. Children's chewing capabilities and eating traits were parent-reported. Eating a raw apple increased oral exposure time and decreased bite size compared to eating applesauce. However, neither the reported hunger nor consecutive food intake were modified. Regardless of the meal, children eating fast had a higher ad libitum energy intake. The individual eating rate for the cottage cheese was correlated with the eating rate observed for applesauce but not for apple segments, the latter being associated with children's chewing difficulties. This study suggests that the form of a fruit offered at the start of a mid-afternoon snack does not impact food intake; the findings clearly call for more exploration of satiation mechanisms related to food texture properties among children and indicate the need to consider children's oral processing skills.

The serving temperature effect: Food temperature, expected satiety, and complementary food purchases

We show that the temperature at which foods and beverages are served impacts consumers' complementary purchases, defined as additional foods and beverages purchased for a consumption episode. Across a series of studies, including field studies and controlled laboratory experiments, we show that consumers choose more complementary food items when they consume or intend to consume a food or beverage served cold rather than hot. This occurs because cold consumables are expected to be less satiating compared to hot consumables. Serving temperatures that increase complementary purchasing may enhance the firm's bottom line, but could add unnecessary calories to the meal, and thus is of interest to both consumers and managers.

A review of evidence supporting current strategies, challenges, and opportunities to reduce portion sizes

Although there is considerable evidence for the portion-size effect and its potential impact on health, much of this has not been successfully applied to help consumers reduce portion sizes. The objective of this review is to provide an update on the strength of evidence supporting strategies with potential to reduce portion sizes across individuals and eating contexts. Three levels of action are considered: food-level strategies (targeting commercial snack and meal portion sizes, packaging, food labels, tableware, and food sensory properties), individual-level strategies (targeting eating rate and bite size, portion norms, plate-cleaning tendencies, and cognitive processes), and population approaches (targeting the physical, social, and economic environment and health policy). Food- and individual-level strategies are associated with small to moderate effects; however, in isolation, none seem to have sufficient impact on food intake to reverse the portion-size effect and its consequences. Wider changes to the portion-size environment will be necessary to support individual- and food-level strategies leading to portion control.

Development and Preliminary Testing of the Food Choice Priorities Survey (FCPS): Assessing the Importance of Multiple Factors on College Students' Food Choices

Understanding factors that influence food choice may help improve diet quality. Factors that commonly affect adults' food choices have been described, but measures that identify and assess food choice factors specific to college students are lacking. This study developed and tested the Food Choice Priorities Survey (FCPS) among college students. Thirty-seven undergraduates participated in two focus groups ( n = 19; 11 in the male-only group, 8 in the female-only group) and interviews ( n = 18) regarding typical influences on food choice. Qualitative data informed the development of survey items with a 5-point Likert-type scale (1 = not important, 5 = extremely important). An expert panel rated FCPS items for clarity, relevance, representativeness, and coverage using a content validity form. To establish test-retest reliability, 109 first-year college students completed the 14-item FCPS at two time points, 0-48 days apart ( M = 13.99, SD = 7.44). Using Cohen's weighted κ for responses within 20 days, 11 items demonstrated moderate agreement and 3 items had substantial agreement. Factor analysis revealed a three-factor structure (9 items). The FCPS is designed for college students and provides a way to determine the factors of greatest importance regarding food choices among this population. From a public health perspective, practical applications include using the FCPS to tailor health communications and behavior change interventions to factors most salient for food choices of college students.

The Impact of Nutrition and Health Claims on Consumer Perceptions and Portion Size Selection: Results from a Nationally Representative Survey

Nutrition and health claims on foods can help consumers make healthier food choices. However, claims may have a ‘halo’ effect, influencing consumer perceptions of foods and increasing consumption. Evidence for these effects are typically demonstrated in experiments with small samples, limiting generalisability. The current study aimed to overcome this limitation through the use of a nationally representative survey. In a cross-sectional survey of 1039 adults across the island of Ireland, respondents were presented with three different claims (nutrition claim = “Low in fat”; health claim = “With plant sterols. Proven to lower cholesterol”; satiety claim = “Fuller for longer”) on four different foods (cereal, soup, lasagne, and yoghurt). Participants answered questions on perceived healthiness, tastiness, and fillingness of the products with different claims and also selected a portion size they would consume. Claims influenced fillingness perceptions of some of the foods. However, there was little influence of claims on tastiness or healthiness perceptions or the portion size selected. Psychological factors such as consumers’ familiarity with foods carrying claims and belief in the claims were the most consistent predictors of perceptions and portion size selection. Future research should identify additional consumer factors that may moderate the relationships between claims, perceptions, and consumption.

Research into food portion size: methodological aspects and applications

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.

Brain response to food cues varying in portion size is associated with individual differences in the portion size effect in children

Large portions promote intake of energy dense foods (i.e., the portion size effect--PSE), but the neurobiological drivers of this effect are not known. We tested the association between blood oxygen level dependent (BOLD) brain response to food images varied by portion size (PS) and energy density (ED) and children's intake at test-meals of high- and low-ED foods served at varying portions. Children (N = 47; age 7-10 years) participated in a within-subjects, crossover study consisting of 4 meals of increasing PS of high- and low-ED foods and 1 fMRI to evaluate food images at 2 levels of PS (Large, Small) and 2 levels of ED (High, Low). Contrast values between PS conditions (e.g., Large PS - Small PS) were calculated from BOLD signal in brain regions implicated in cognitive control and reward and input as covariates in mixed models to determine if they moderated the PSE curve. Results showed a significant effect of PS on intake. Responses to Large relative to Small PS in brain regions implicated in salience (e.g., ventromedial prefrontal cortex and orbitofrontal cortex) were positively associated with the linear slope (i.e., increase in intake from baseline) of the PSE curve, but negatively associated with the quadratic coefficient for the total meal. Responses to Large PS High ED relative to Small PS High ED cues in regions associated with cognitive control (e.g., dorsolateral prefrontal cortex) were negatively associated with the linear slope of the PSE curve for high-ED foods. Brain responses to PS cues were associated with individual differences in children's susceptibility to overeating from large portions. Responses in food salience regions positively associated with PSE susceptibility while activation in control regions negatively associated with PSE susceptibility.

Undervalued and ignored: Are humans poorly adapted to energy-dense foods?

In many species the capacity to accurately differentiate the energy density (kcal/g) of foods is critical because it greatly improves efficiency in foraging. In modern humans this ability remains intact and is expressed in a selective preference for types of fruit and vegetables that contain more calories. However, humans evolved consuming these low energy-dense foods (typically < 1.75 kcal/g) and it remains unclear whether they can also discriminate more energy-dense foods that now feature in modern Western diets. In two experiment participants (both N = 40) completed four tasks that assessed the 'value' of different sets of 22 foods that ranged in energy density (0.1 kcal/g-5.3 kcal/g and range 0.1 kcal/g to 6.2 kcal/g in Experiment 1 and 2, respectively). In Experiment 1 three measures (expected fullness, calorie estimation, and food choice), and in foods less than approximately 1.5 kcal/g (typically fruits and vegetables), the relationship between perceived value and energy density is linear. Above this, we observed clear compressive functions, indicating relative and progressive undervaluation of higher energy-dense foods. The fourth task (rated liking) failed to provide evidence for any relationship with energy density. In Experiment 2 the same pattern was replicated in measures of expected fullness, and in two different assessments of subjective calorie content. Consistent with the concept of 'evolutionary discordance,' this work indicates that modern human physiology is poorly adapted to evaluate foods that have a historically unusual (high) energy density. This has implications both for our understanding of how 'modern' energy-dense foods affect choice and energy intake, and for strategies aimed at removing calories from highly energy-rich foods.

Portion Size: Latest Developments and Interventions

PURPOSE OF REVIEW

The aim of this review is to provide an overview of (1) underlying mechanisms of the effect of portion size on energy intake, (2) external factors explaining the portion size effect and (3) interventions and measurements aimed at food portion size.

RECENT FINDINGS

Previous studies have shown that portion sizes have increased in recent decades. Many experimental studies have been conducted to unravel the mechanisms underlying the portion-size effect on food intake (e.g. the appropriateness mechanism, the 'unit bias' mechanism, the 'previous experience/expectation' mechanism, the 'visual cue' mechanism and the 'bite size' mechanism). In addition, external factors have been found to drive food portion selection and consumption (e.g. value for money, mindless eating, levels of awareness, estimation bias. Research on several interventions (ranging from 'providing information' to 'eliminating choice') have been conducted, but remain scarce, especially intervention studies in which portion size is a key focus in weight loss. Moreover, only three new instruments with respect to portion control behavior have been developed. There is considerable evidence for the portion-size effect on energy intake. However, the work on interventions targeting portion size and measurements for portion control behavior are limited. Moreover, from the literature it is not yet clear what type of interventions work best, for whom and in what context.

Expectations of food satiation and satiety reviewed with special focus on food properties

Expectations of satiation are beliefs about the extent to which food is expected to deliver fullness and expectation of satiety relates to the extent to which food is expected to give respite from hunger and to inhibit further eating.

The effects of potatoes and other carbohydrate side dishes consumed with meat on food intake, glycemia and satiety response in children

BACKGROUND

The effect of carbohydrate (CHO) foods on blood glucose (BG) is ranked by their glycemic index (GI). Boiled and mashed potatoes (BMPs) are ranked as high GI foods, whereas pasta and rice have moderate GI rankings. The objective of this study was to compare ad libitum consumption of common CHO dishes consumed with meat on meal-time food intake and post-meal satiety, BG, insulin and gut hormones in 11- to 13-year-old normal weight children.

METHODS

Two randomized crossover studies were conducted. At weekly intervals, children (experiment 1: 12 males (M), 8 females (F); experiment 2: 6M, 6 F) received in random order 1 of 5 CHO side dishes of rice, pasta, BMP, fried French fries (FFF) or baked French fries (BFF) eaten freely together with a fixed amount of lean beef (100 g). In experiment-1, food intake over 30 min and subjective appetite were measured for 120 min. In experiment-2, the same outcomes were measured along with BG, plasma insulin and gut hormones.

RESULTS

The results for boys and girls were pooled as sex was not a factor. In both experiments, children consumed 30-40% less calories at meals with BMP (P<0.0001) compared with all other treatments, which were similar. BMP increased satiety, expressed as a change in appetite per kilocalorie, more than all other treatments (P<0.0001). FFF resulted in the lowest (P<0.0001) glucose and insulin at meal end and post-meal and peptide YY (PYY) post-meal. Blood measures were similar among all other treatments.

CONCLUSIONS

The physiological functions of CHO foods consumed ad libitum at meal time on food intake, appetite, BG, insulin and gut hormone responses in children is not predicted by the GI.

Sensory influences on food intake control: moving beyond palatability

The sensory experience of eating is an important determinant of food intake control, often attributed to the positive hedonic response associated with certain sensory cues. However, palatability is just one aspect of the sensory experience. Sensory cues based on a food's sight, smell, taste and texture are operational before, during and after an eating event. The focus of this review is to look beyond palatability and highlight recent advances in our understanding of how certain sensory characteristics can be used to promote better energy intake control. We consider the role of visual and odour cues in identifying food in the near environment, guiding food choice and memory for eating, and highlight the ways in which tastes and textures influence meal size and the development of satiety after consumption. Considering sensory characteristics as a functional feature of the foods and beverages we consume provides the opportunity for research to identify how sensory enhancements might be combined with energy reduction in otherwise palatable foods to optimize short-term energy intake regulation in the current food environment. Moving forward, the challenge for sensory nutritional science will be to assess the longer-term impact of these principles on weight management.

Energy-dense snacks can have the same expected satiation as sugar-containing beverages

Sugar-sweetened beverages (SSBs) are thought to be problematic for weight management because energy delivered in liquid form may be less effective at suppressing appetite than solid foods. However, little is known about the relative 'expected satiation' (anticipated fullness) of SSBs and solid foods. This is relevant because expected satiation is an important determinant of portion selection and energy intake. Here, we used a method of constant stimuli to assess the expected satiation of test meals that were presented in combination with different caloric and non-caloric beverages (500 ml) (Experiment 1 and 2), as well as with high-energy solid snack foods (Experiment 2). All energy-containing beverages and snack foods were presented in 210 kcal portions. Both experiments found that expected satiation was greater for meals containing caloric versus non-caloric beverages (201.3 ± 17.3 vs. 185.4 ± 14.1 kcal in Experiment 2; p < 0.05). Further, Experiment 2 showed that this difference was greater in participants who were familiar with our test beverages, indicating a role for learning. Notably, we failed to observe a significant difference in expected satiation between any of the caloric beverages and snack foods in Experiment 2 (range: 192.5-205.2 kcal; p = 0.87). This finding suggests that it may be more appropriate to consider beverages and solid foods on the same continuum, recognizing that the expected satiation of some solid foods is as weak as some beverages.

So Many Brands and Varieties to Choose from: Does This Compromise the Control of Food Intake in Humans?

The recent rise in obesity is widely attributed to changes in the dietary environment (e.g., increased availability of energy-dense foods and larger portion sizes). However, a critical feature of our "obesogenic environment" may have been overlooked - the dramatic increase in "dietary variability" (the tendency for specific mass-produced foods to be available in numerous varieties that differ in energy content). In this study we tested the hypothesis that dietary variability compromises the control of food intake in humans. Specifically, we examined the effects of dietary variability in pepperoni pizza on two key outcome variables; i) compensation for calories in pepperoni pizza and ii) expectations about the satiating properties of pepperoni pizza (expected satiation). We reasoned that dietary variability might generate uncertainty about the postingestive effects of a food. An internet-based questionnaire was completed by 199 adults. This revealed substantial variation in exposure to different varieties of pepperoni pizza. In a follow-up study (n= 66; 65% female), high pizza variability was associated with i) poorer compensation for calories in pepperoni pizza and ii) lower expected satiation for pepperoni pizza. Furthermore, the effect of uncertainty on caloric compensation was moderated by individual differences in decision making (loss aversion). For the first time, these findings highlight a process by which dietary variability may compromise food-intake control in humans. This is important because it exposes a new feature of Western diets (processed foods in particular) that might contribute to overeating and obesity.

Mind over platter: pre-meal planning and the control of meal size in humans

It is widely accepted that meal size is governed by psychological and physiological processes that generate fullness towards the end of a meal. However, observations of natural eating behaviour suggest that this preoccupation with within-meal events may be misplaced and that the role of immediate post-ingestive feedback (for example, gastric stretch) has been overstated. This review considers the proposition that the locus of control is more likely to be expressed in decisions about portion size, before a meal begins. Consistent with this idea, we have discovered that people are extremely adept at estimating the ‘expected satiety' and ‘expected satiation' of different foods. These expectations are learned over time and they are highly correlated with the number of calories that end up on our plate. Indeed, across a range of foods, the large variation in expected satiety/satiation may be a more important determinant of meal size than relatively subtle differences in palatability. Building on related advances, it would also appear that memory for portion size has an important role in generating satiety after a meal has been consumed. Together, these findings expose the importance of planning and episodic memory in the control of appetite and food intake in humans.

Expected Satiety: Application to Weight Management and Understanding Energy Selection in Humans

Recent advances in the approaches used to quantify expectations of satiation and satiety have led to a better understanding of how humans select and consume food, and the associated links to energy intake regulation. When compared calorie for calorie some foods are expected to deliver several times more satiety than others, and multiple studies have demonstrated that people are able to discriminate between similar foods reliably and with considerable sensitivity. These findings have implications for the control of meal size and the design of foods that can be used to lower the energy density of diets. These methods and findings are discussed in terms of their implications for weight management. The current paper also highlights why expected satiety may also play an important role beyond energy selection, in moderating appetite sensations after a meal has been consumed, through memory for recent eating and the selection of foods across future meals.

Effects of meal variety on expected satiation: evidence for a 'perceived volume' heuristic

Meal variety has been shown to increase energy intake in humans by an average of 29%. Historically, research exploring the mechanism underlying this effect has focused on physiological and psychological processes that terminate a meal (e.g., sensory-specific satiety). We sought to explore whether meal variety stimulates intake by influencing pre-meal planning. We know that individuals use prior experience with a food to estimate the extent to which it will deliver fullness. These 'expected satiation' judgments may be straightforward when only one meal component needs to be considered, but it remains unclear how prospective satiation is estimated when a meal comprises multiple items. We hypothesised that people simplify the task by using a heuristic, or 'cognitive shortcut.' Specifically, as within-meal variety increases, expected satiation tends to be based on the perceived volume of food(s) rather than on prior experience. In each trial, participants (N = 68) were shown a plate of food with six buffet food items. Across trials the number of different foods varied in the range one to six. In separate tasks, the participants provided an estimate of their combined expected satiation and volume. When meal variety was high, judgments of perceived volume and expected satiation 'converged.' This is consistent with a common underlying response strategy. By contrast, the low variety meals produced dissociable responses, suggesting that judgments of expected satiation were not governed solely by perceived volume. This evidence for a 'volume heuristic' was especially clear in people who were less familiar with the meal items. Together, these results are important because they expose a novel process by which meal variety might increase food intake in humans.

Mechanisms of the portion size effect. What is known and where do we go from here?

Childhood obesity is a persistent problem worldwide, and of particular concern in the United States. Clarifying the role of the food environment in promoting overeating is an important step toward reducing the prevalence of obesity. One potential contributor to the obesity epidemic is the increased portion sizes of foods commonly served. Portion sizes of foods served both at home and away from home have dramatically increased over the past 40 years. Consistently, short-term studies have demonstrated that increasing portion size leads to increased food intake in adults and children, a phenomenon known as the portion size effect. However, the mechanisms underlying this effect are poorly understood. Understanding these mechanisms could assist in clarifying the relationship between portion size and weight status and help inform the development of effective obesity interventions. First, we review the role of visual cues, such as plate size, unit, and utensil size as a potential moderator of the portion size effect. In addition, we discuss meal microstructure components including bite size, rate, and frequency, as these may be altered in response to different portion sizes. We also review theories that implicate post-ingestive, flavor-nutrient learning as a key moderator of the portion size effect. Furthermore, we present preliminary data from an ongoing study that is applying neuroimaging to better understand these mechanisms and identify modifiable child characteristics that could be targeted in obesity interventions. Our tentative findings suggest that individual differences in cognitive (e.g. loss of control eating) and neural responses to food cues may be critical in understanding the mechanisms of the portion size effect. To advance this research area, studies that integrate measures of individual subject-level differences with assessment of food-related characteristics are needed.

Episodic memory and appetite regulation in humans

Psychological and neurobiological evidence implicates hippocampal-dependent memory processes in the control of hunger and food intake. In humans, these have been revealed in the hyperphagia that is associated with amnesia. However, it remains unclear whether ‘memory for recent eating’ plays a significant role in neurologically intact humans. In this study we isolated the extent to which memory for a recently consumed meal influences hunger and fullness over a three-hour period. Before lunch, half of our volunteers were shown 300 ml of soup and half were shown 500 ml. Orthogonal to this, half consumed 300 ml and half consumed 500 ml. This process yielded four separate groups (25 volunteers in each). Independent manipulation of the ‘actual’ and ‘perceived’ soup portion was achieved using a computer-controlled peristaltic pump. This was designed to either refill or draw soup from a soup bowl in a covert manner. Immediately after lunch, self-reported hunger was influenced by the actual and not the perceived amount of soup consumed. However, two and three hours after meal termination this pattern was reversed - hunger was predicted by the perceived amount and not the actual amount. Participants who thought they had consumed the larger 500-ml portion reported significantly less hunger. This was also associated with an increase in the ‘expected satiation’ of the soup 24-hours later. For the first time, this manipulation exposes the independent and important contribution of memory processes to satiety. Opportunities exist to capitalise on this finding to reduce energy intake in humans.