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Food Portion Patterns and Trends among U.S. Children and Adolescents and the Relationship to Total Eating Occasion Size, 1977-2006
The “supersizing” of foods in the context of the obesity epidemic
Little is known about an increasing trend of larger portion sizes in the United States. Increased portions of energy-dense foods, promoted by bigger-package-unit sizes and good-value meals, might be pushing the energy intakes beyond requirements, representing a higher risk for childhood obesity1,2.
Larger portions sizes of energy-dense foods might be even more problematic among older children and adolescents. As children age, physiological cues such as hunger and satiety that help them self regulate their energy intake exert less influence, predisposing them to overeat in an environment of excess caloric availability and limited Energy expenditure3-6.
Our research investigated:
- if portion sizes of energy dense foods have increased from 1977 to 2006 7; and
- if a larger portion size of a certain food increases the energy intake at a meal during which that food was consumed8.
We also explored socioeconomic and age-specific patterns and trends in portion sizes from 1977-78 to 2003-06 in the United States.
We studied 31,337 children and adolescent ages 2-18 from four U.S. nationally representative surveys of dietary intake data9-13. We grouped children and adolescents in three age groups (i.e. 2-6-year-olds, 7-12-year-olds and 13-18-year-olds) and we also created three groups of race/ethnicity (i.e. non-Hispanic white, non-Hispanic African-American and Hispanic) and parent education (i.e. more than 12 years of education or less than 12 years of education). Dietary intake data from two 24-hour recalls was averaged to get per-capita estimates.
We defined a portion size as the amount of kcals, grams or milliliters from a certain food or beverage consumed at a given eating occasion. We
calculated mean portion sizes of selected foods and beverages (i.e. salty snacks, desserts, soft-drinks, fruit-drinks, French-fries, burgers, pizza and Mexican-food) and mean energy intake at eating occasions during which each selected food was consumed. Then, kcal from each selected food was divided by the total energy intake at a meal during which each food was consumed. If the proportion of the meal energy intake comprised by each food increased from 1977 to 2006, we concluded that a larger portion size of a food affected the energy intake at eating occasions.
Portion sizes of energy dense foods have increased
In 2003-2006, energy dense foods (e.g. salty snacks, desserts, fries, soft drinks, burgers, pizza, etc) represented around 38% of the daily Energy intake among adolescents 13-18 years old; 35% of the daily intake among 7-12 year-olds and 28% of the daily intake of 2-6 year-olds. Overall, portion sizes of all selected foods increased significantly from 1977 to 2006, except desserts. The increases in portion sizes of pizza were particularly pronounced in the last decade.
Energy intake is affected by larger portion sizes, especially among older children
In all age groups, we found larger portion sizes of pizza in parallel with higher energy intake at eating occasions during which pizza was consumed. Pizza was the only significant contributor to the increased energy intake among young children aged 2-6 years old. In children 7-12 years old, soft drinks and burgers together with pizza were significant contributors to the increased intake at eating occasions. Importantly, adolescents’ energy intake at eating occasions was affected by all selected foods, in line with previous findings suggesting that older children might be more susceptible to larger portion sizes than younger children. Energy intake at eating occasions was also significantly affected by larger portion sizes of pizza, especially markedly among non-Hispanic African American and Hispanic and the group of low parent education compared to the other groups.
Our results provide a new perspective of the effect of larger portion sizes on the total energy intake at meals. In the context of the growing obesity epidemic in the U.S. and worldwide, we identified selected energy-dense foods that have increased in portion size over the 30-year period studied. These selected foods are also important contributors of the increased energy intake at eating occasions. This research supports the need to consider targeted intervention and policy efforts that look specifically at selected foods (e.g. pizza, soft drinks) to reduce the energy intake of children and adolescents.
- McConahy, K.L., et al., Food portions are positively related to energy intake and body weight in early childhood. J Pediatr, 2002. 140(3): p. 340-7.
- Ledikwe, J.H., J.A. Ello-Martin, and B.J. Rolls, Portion sizes and the obesity epidemic. J Nutr, 2005. 135(4): p. 905-9.
- Birch, L.L. and M. Deysher, Caloric compensation and sensory specific satiety: evidence for self regulation of food intake by young children. Appetite, 1986. 7(4): p.323-31.
- Birch, L.L. and J.O. Fisher, Development of eating behaviors among children and adolescents. Pediatrics, 1998. 101(3 Pt 2): p. 539-49.
- Orlet Fisher, J., B.J. Rolls, and L.L. Birch, Children’s bite size and intake of an entree are greater with large portions than with age-appropriate or self-selected portions. Am J Clin Nutr, 2003. 77(5): p. 1164-70.
- Fisher, J.O., Effects of age on children’s intake of large and self-selected food portions. Obesity (Silver Spring), 2007. 15(2): p. 403-12.
- Piernas, C. and B.M. Popkin, Food portion patterns and trends among U.S. children and the relationship to total eating occasion size, 1977-2006. J Nutr, 2011. 141(6): p. 1159-64.
- Piernas, C. and B.M. Popkin, Increased portion sizes from energy-dense foods affect total energy intake at eating occasions in US children and adolescents: patterns and trends by age group and sociodemographic characteristics, 1977-2006. Am J Clin Nutr, 2011. 94(5): p. 1324-32.
- U.S. Department of Agriculture, A.R.S., Beltsville Human Nutrition Research Center, Food Surveys Research Group (Beltsville, MD). and C.f.D.C.a.P. U.S. Department of Health and Human Services, National Center for Health Statistics (Hyattsville, MD). What We Eat in America, NHANES 2005-2006. 2005.
- U.S. Department of Agriculture, A.R.S., Beltsville Human Nutrition Research Center, Food Surveys Research Group (Beltsville, MD). and C.f.D.C.a.P. U.S. Department of Health and Human Services, National Center for Health Statistics (Hyattsville, MD). What We Eat in America, NHANES 2003-2004. 2003.
- U.S. Department of Agriculture, A.R.S., Beltsville Human Nutrition Research Center, Food Surveys Research Group (Beltsville, MD). . Continuing Survey of Food Intakes by Individuals 1994-96, 1998 and Diet and Health Knowledge Survey 1994-96: Documentation (csfii9498_documentationupdated.pdf). Retrieved 05/06/2009 from USDA Agricultural Research Service, Food Surveys Research Group website: http://www.ars.usda.gov/Services/docs.htm?docid=14521.
- U.S. Department of Agriculture, A.R.S., Beltsville Human Nutrition Research Center, Food Surveys Research Group (Beltsville, MD). Continuing Survey of Food Intakes by Individuals 1989-91 and Diet and Health Knowledge Survey 1989-91: Documentation (csfii8991_documentation.pdf). Retrieved 05/06/2009 from USDA Agricultural Research Service, Food Surveys Research Group website: http://www.ars.usda.gov/Services/docs.htm?docid=14541.
- Rizek, R., The 1977-78 Nationwide Food Consumption Survey. Fam Econ Rev, 1978. 4: p. 3-7.