|
||||||
|
|
|
|
|||||||||||
|
|||||||||||||
| ||||||||||||||||||||||||||||
When patients comment, "Doc, I've gained some weight," a logical response is, "Eat less and forego desserts." In other words, control portions.
Following this advice is difficult when challenged by bounteous buffets and
super-sized sandwiches. And it's advice that does not appear to be helping
Americans take an adequate bite out of their caloric intake, since obesity
prevalence rates in the U.S. increased from <20% in all 50 states in 1995
to <20% in only 4 states in 2005, with 17 states showing rates
25%.1
"People tend to eat a consistent weight or volume of food," says Barbara Rolls, PhD, director of The Laboratory for the Study of Human Ingestive Behavior at The Pennsylvania State University in University Park. "So just telling people to eat less is not effective," since they often end up feeling deprived.
Plus, the concept of portion control is one many people don't understand, says American Dietetic Association (ADietA) spokesperson Katherine Tallmadge, RD, LD, a weight-loss and nutrition expert with a private practice in Washington, D.C.
|
CONFUSION OVER PORTIONS AND SERVINGS
Dish size affects the amount of food one serves oneself, and familiarity with large single-unit food containers and restaurant portions leads people to misinterpret hefty portions as appropriate individual servings.2–4 The only way to really be sure of the amount one eats, Tallmadge says, is to read food labels and to measure portions.
Food labels are valuable tools for managing the amount and type of foods one eats, concurs ADietA spokesperson Marissa Moore, RD, LD, a contract nutrition program coordinator with the Centers for Disease Control and Prevention. Labels provide important data on serving size, servings per container, and nutrients that may be particularly important for patients monitoring weight, diabetes, or hypertension.
Yet the ability to interpret current food labels correlates highly with an individual's literacy and math skills. Even people with higher education levels struggle to interpret food labels.5
Registered dietitians can help patients decipher food labels, keep track of their eating habits, and learn how best to weigh and measure their food intake while maintaining a balanced diet.
Tallmadge, who counsels patients to weigh and measure out single servings of various foods at home to familiarize themselves with the size of 3 oz of meat, 1/2 c of vegetables, or 8 oz of a beverage, says, "Patients' eyeballs are often opened when they try this" (see sidebar).
|
Knowing what a serving looks like can help patients control portions when dining out. "Portion sizes in restaurants are double or triple what you would serve yourself at home," Tallmadge says. "Appetizer portions are often equal to what you might eat at home as a main course."
ENCOURAGE HEALTHY, SATIATING FOODS
"Eating for optimal health, optimal nutrition, and weight management are the same thing," Rolls says. "A physician should be the first to explain this."
"Help people see the things they can eat," suggests Moore, by recommending foods that maintain fullness from few calories but create a balanced diet. Fruits high in water content and high-fiber vegetables are weight-management gems.
Eating a whole cup of melon or berries helps control the appetite with only 50–60 calories, and using sliced avocado, packed with monounsaturated fats and fiber, instead of a slice of cheese reduces the saturated fat content of a sandwich and promotes the feeling of fullness, Moore says.
Whole grains and lean proteins also satiate with few calories. And to limit intake of high-calorie snacks, Moore suggests buying or creating single portions of nuts, fresh fruit, applesauce, and light yogurt for work and travel.
Tallmadge advises people "to spend some time learning about the foods
you eat," since successful weight loss and healthy nutrition stem from
controlling one's environment. 
Serving Sizes
Equating servings of common foods with the size of common objects may help people better monitor their food intake. For instance, a single serving of salad greens or piece of fruit is the size of a baseball, while a single serving of cooked rice, pasta, or ice cream (1/2 cup) is the size of half a baseball. A single serving of cereal flakes (1 cup) or baked potato is the size of a fist.
A pancake the size of a compact disc, a chunk of corn bread the size of a bar of soap, or a stack of cheese cubes the height of four dice equals a serving, while a serving of margarine equals the size of one die, and a serving of peanut butter is the size of a Ping-Pong ball. A serving of fish is the size of a personal checkbook, and a 3-oz serving of meat is approximately the size of a deck of cards.
Moore adds that a serving of almonds or other medium-sized nuts is about 23 pieces.
Source: National Heart, Lung, and Blood Institute Serving Size Card. Available online at http://hp2010.nhlbihin.net/portion/servingcard7.pdf. Accessed November 8, 2006.
Incorporate "Volumetrics": Increase Satiety and Nutrients, Decrease Calories
Clinicians must convince patients that healthy eating and eating for weight management are the same, and they should encourage patients to track their eating patterns to identify areas needing improvement, says Barbara Rolls, PhD, director of The Laboratory for the Study of Human Ingestive Behavior at Penn State.
Rolls advocates an eating plan compatible with the U.S. Dietary Guidelines that emphasizes increased consumption of water-rich foods—vegetables, fruits, broth-based soups, and salads—and reduced fats wherever possible, all within one's favorite meals.
|
"Completely changing eating habits and cutting out whole food groups is not sustainable and not healthy," she says.
Her research shows that eating water-rich foods increases satiety and reduces caloric intake more effectively than drinking water with a meal; that eating a large, first-course salad reduces the overall caloric intake of a meal; and that diets of water-rich foods and reduced fats are more effective for weight loss than diets of reduced fats alone.1–3
In addition, Rolls has found that people are more responsive to positive messages than to restrictive ones.3 "Eat more fruits and vegetables, salads, and broth-based soup" is a message people understand, find easy, and like to hear, she claims.
Rolls' eating plan identifies foods according to energy density—low–energy-density foods, such as fruits and vegetables, broth-based soups, low- or nonfat milk, grains, beans and legumes, low-fat meats, and low-fat mixed dishes like chili and spaghetti have fewer calories per ounce than high–energy-density foods such as crackers, chips, chocolate, nuts, butter, and oils.4
Eating larger quantities of low–energy-density foods, taking in small amounts of high–energy-density foods, and completing one's balanced diet with medium–energy-density foods such as cheeses, salad dressings, or other meats and breads provide "bigger portions for the same number of calories," Rolls says.
Footnotes
Read more on portion distortion or download a serving-size card from the National Heart, Lung, and Blood Institute at http://hp2010.nhlbihin.net/portion/keep.htm.
Are you or your patients interested in the calorie and nutrient contents of about 13,000 foods? Click on the U.S. Department of Agriculture's link for the "What's In the Foods You Eat?" search tool at http://www.ars.usda.gov/main/site_main.htm?modecode=12355000. Watch this site for the future release of two-dimensional, life-sized computer-generated drawings depicting typical portions of actual foods and beverages and designed to help people estimate the quantity of foods consumed.
The American Diabetes Association's (ADA's) microwaveable Portion Control Plate with a snap-on lid and information card helps make it easy to determine what is a healthy portion of food. Available online at the ADA bookstore: http://store.diabetes.org.
References
2. Wansink B, van Ittersum K, Painter JE: Ice cream illusions: Bowls, spoons, and self-served portion sizes. Am J Prev Med 31: 240–243, 2006.[Medline]
3. Schwartz J, Byrd-Bredbenner C: Portion distortion: Typical portion sizes selected by young adults. J Am Diet Assoc 106: 1412–1418, 2006.[Medline]
4. Wansink B, Chandon P: Meal size, not body size, explains errors in
estimating the calorie content of meals. Ann Intern
Med 145:326–332, 2006.
5. Rothman RL, Housam R, Weiss H, et al.: Patient understanding of food labels: The role of literacy and numeracy. Am J Prev Med 31:391–398, 2006.[Medline]
1. Rolls BJ, Bell EA, Thorwart ML: Water incorporated into a food but
not served with a food decreases energy intake in lean women. Am J
Clin Nutr 70:448–455, 1999.
2. Rolls BJ, Roe LS, Meengs JS: Salad and satiety: Energy density and portion size of a first-course salad affect energy intake at lunch. J Am Diet Assoc 104:1570–1576, 2004.[Medline]
3. Ello-Martin JA, Roe LS, Rolls BJ: A diet reduced in energy density results in greater weight loss than a diet reduced in fat (Abstract). Obes Res 12:A23, 2004.
4. Rolls BJ: The Volumetrics Eating Plan: Techniques and Recipes for Feeling Full on Fewer Calories. New York, HarperCollins Publishers Inc., 2005, pp.8 , 16–17.
CiteULike 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
| ||||||||||||||||||||||||||||
|
||||||
|
| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
