Currently browsing posts about: Portion sizes

My former doctoral student and now colleague Lisa Young has been tracking the increase in portion sizes of junk foods for more than 20 years.  Our latest report has just come out in the American Journal of Public Health: Portion Sizes of Ultra-Processed Foods in the United States, 2002 to 2021.

At first introduction, most companies offered products in just 1 size; that size is smaller than or equal to the smallest size currently available. For example, the original size of a Coca-Cola bottle was 6.5 ounces; today it comes in 6 sizes marketed as single servings; these range from 7.5 ounces to 24 ounces, 4 of which have been introduced since 2002.

Since 2002, McDonald’s has reduced the sizes of its french fries and eliminated its “supersize” french fries and soda, but still offers quart-sized sodas and double burgers. While McDonald’s and Burger King decreased the size of their largest portion of french fries, they increased the sizes of their smallest portions. While Burger King reduced the sizes of it’s hamburger sandwiches, since 2002 they added a triple Whopper.

• Have more calories (if only this were intuitively obvious, but it is not)
• Encourage people to eat more
• Confuse people about how much they are eating

Our recommendations:

We think it is time to also consider caps and other legislatively mandated national policy options to require the food industry to make smaller food portions more available, convenient, and inexpensive:

•  offer consumers price incentives for smaller portions of ultra-processed foods,

•  discontinue the largest sizes of ultra-processed packaged foods and fast-food portions, and

•  restrict marketing of large portions of ultra-processed foods, especially those targeted to children and minorities.

Our article is accompanied by an editorial by Carlos Monteiro and Geoffrey Cannon, the inventors of the term, “ultra-processed”: Yes, Food Portion Sizes and People Have Become Bigger and Bigger. What Is to Be Done? 

Their point: reducing portion sizes is unlikely to work internationally.

In such countries, reduced portion sizes of ultra-processed foods would at best have limited effect, and most likely would be counterproductive if they were marketed to promote their consumption. Generally, the most rational guideline, for global as well as personal health and well-being, is to protect and promote minimally processed foods and freshly prepared meals and to discourage the consumption of ultra-processed foods altogether, together with statutory measures including fiscal policies and actions. These measures should make fresh and minimally processed foods cheaper and more available. Ultra-processed foods should be made more expensive and less available, if at all, especially in canteens and hospitals, other health settings, and in and near schools. Cosmetic additives should be banned or highly taxed.

We have much work to do.

Lisa Young, author of Finally Full, Finally Slim, has long argued that portion control is the key to maintaining healthy weight.

Now, the industry-funded (see list here) British Nutrition Foundation has issued a “handy” guide to appropriate portion sizes.

I put “handy” in quotes because the system is based on hand measurements.

The guide tells you how many servings you are supposed to have each day from each of the major food groups, and how to tell the serving size for a very long list of foods.

I find all of this hugely complicated, and don’t think you should need to learn what looks like a guide to sign language to know how to eat.

I’m especially suspicious because the Nutrition Foundation is an industry-sponsored group and it is very much in the interest of the food industry to have you take full responsibility for controlling your own food intake.  If you eat too much, it’s your fault for not learning this system.

How about food companies making and serving smaller portions?  Nope.  It’s up to you to take greater personal responsibility for what you eat.

Try this for yourself and see what I mean.

• The guide is here.
• The full list of portion sizes is here.
• A one-page summary is here.

Lisa R. Young.  Finally Full, Finally Slim: 30 Days to Permanent Weight Loss One Portion at a Time.  Center Street, 2019.

I don’t usually write about diet books, but Lisa Young did her doctorate with me and I have followed her subsequent career with great interest.  She has taught for years in my NYU department and has a lively private practice counseling clients about weight loss and other nutrition issues.

Her book explains what works best with her clients.  She must be fun to work with.  The writing is warm, friendly, and to the point.  Her advice is easy and sensible: eat what you like (especially of healthy foods), just not too much.   She is generous with tips about how to deal with parties, restaurants, and other challenging situations, what she categorizes as “slices of advice,” “bite-size goodies,” and “wedges of wisdom.”

Her main focus is on portion control:

Portion control is like a classic wardrobe: It never goes out of style.  It’s not a trendy fad but a proven method for healthful living.  When you enjoy balanced meals and nutritious foods in appropriate portion sizes, you can get off the weight-loss merry-go-found.  So go ahead and enjoy a glass of wine or an occasional ice cream cone (a single scoop!).  Eat brown rice, quinoa, and other healthy carbs.  It’s not only okay.  It’s the best way to achieve long-term weight loss and maintenance.

Good advice, and easy to take.

No wonder its getting such great press.

• She’s on the cover of the January 2 New York Post, with much more about the book on pages 25, 26, and 27.
• Here’s an interview Lisa did in September.
• And here’s one she just did with Diet Detective.

The FDA is taking comments on its proposals to revamp the food label through August 1, 2014 (instructions are at bottom of post).

I’ve already filed comments on Added Sugars and on whether Vitamin D should be added to food labels.

And I just filed further comments on the FDA’s proposals for the Nutrition and Supplement Facts Labels.  If you would like to read what I said, click here.

I’ve also filed comments on the FDA’s Serving Size proposals.

These proposals are highly technical and tough to slog through, so I tried to deal with the big picture.

July 27, 2014

TO:                  FDA

FROM:           Marion Nestle, Professor of Nutrition, Food Studies and Public Health, New York University

RE:                  Comments: Serving size proposals, Docket No. FDA-2004-N-0258

In addressing the question of how to change serving size designations on food labels, FDA is faced with an impossible dilemma .  Serving sizes, which are supposed to be based on amounts typically consumed from packaged products, are invariably perceived as recommendations for dietary intake.

To comment on each of the bold-face, italicized points:

• Typically consumed:  This information derives from dietary intake surveys which invariably underestimate actual intake, often by 30% to 40%.

• Packaged foods: Food labels only appear on packaged foods.  RACC amounts on packaged foods are often much lower than amounts served in restaurants or fast-food places (pizza is an obvious example).  It is unclear whether amounts reported as consumed are from packages (with Nutrition Facts labels) or are from restaurants or fast-food places where portion sizes can be much higher than those for foods in packages.

• Recommendation:  Substantial anecdotal information suggests that people view labeled serving sizes as what they should be eating.  They view the serving sizes as meaningless compared to the portion sizes of foods they are accustomed to eating.

What is well established is that overall calorie intake has increased since RACCs were established in 1993 and marketplace portion sizes have also increased.

Therefore, any increase in RACC runs the risk of being interpreted as a validation of current portion sizes and as a recommendation to eat more.

On the other hand, larger portions have more calories.  These must appear on the label.

To address this dilemma, FDA should:

• Make dual-column labeling mandatory for all food and beverage packages likely to be consumed in one sitting.
• Require total calories in the package to be displayed on the front of the package.
• Include a footnote explaining that the serving size is not meant as a recommendation

INSTRUCTIONS FOR FILING COMMENTS

The FDA provides:

• All necessary information in one place.
• A short guide and checklist

File comments here

• Nutrition and Supplement Facts Label: Docket FDA-2012-N-1210  Comment here now
• Serving Sizes: Docket FDA-2004-N-0258  Comment here now

The New York State Court of Appeals issued a decision this morning on the Portion Cap Rule:

PIGOTT, J.:
We hold that the New York City Board of Health, in adopting the “Sugary Drinks Portion Cap Rule”, exceeded the scope of its regulatory authority. By choosing among competing policy goals, without any legislative delegation or guidance, the Board engaged in law-making and thus infringed upon the legislative jurisdiction of the City Council of New York.

Although the decision applies to the Portion Cap Rule, it has a much larger meaning.

The ruling means the Court does not accept the idea that health departments have the right to set health policy for city residents.  I suspect we will be seeing the implications of this ruling for a long time to come.

The city health commissioner, Mary Bassett, issued a brief statement:

Today’s ruling does not change the fact that sugary drink consumption is a key driver of the obesity epidemic, and we will continue to look for ways to stem the twin epidemics of obesity and type 2 diabetes by seeking to limit the pernicious effects of aggressive and predatory marketing of sugary drinks and unhealthy foods.

This doesn’t sound like the city will appeal to the U.S. Supreme Court, but maybe it’s too early to say.

I will post additional comments later, as they come in.  Stay tuned.

Additions:

As I just told a reporter, ”

The key issue here is whether health departments have the right to set policy to protect the health of citizens under their jurisdiction.  This court says no, but this seems precedent-setting. The medical community most definitely should support measures to improve the environment of food choice.  Changing the behavior of individuals is extremely difficult and rarely successful; it works much better to improve the environment so it’s easier for individuals to make healthier choices.

On the court decision: The vote was 4 to 2, with one abstention.   Here’s a quotation from Judge Susan Read’s dissenting opinion:

What petitioners have truly asked the courts to do is to strike down an unpopular regulation, not an illegal one…To sum up, if the People of the City or State of New York are uncomfortable with the expansive powers first bestowed by the New York State Legislature on the New York City Board of Health over 150 years ago, they have every right and ability to call on their elected representatives to effect change. This Court, however, does not…The majority fails to advance any persuasive argument why the judiciary should step into the middle of a debate over public health policy and prohibit the Board from implementing a measure designed to reduce chronic health risks associated with sugary beverages just because the Council has not chosen to act in this area.

The New York Times also quotes from this dissent:

In a blistering dissent of the opinion, Judge Susan P. Read wrote that the ruling ignored decades of precedent in which the Board of Health was given broad purview to address public health matters, such as regulating the city’s water supply and banning the use of lead paint in homes.  The opinion, Judge Read wrote, “misapprehends, mischaracterizes and thereby curtails the powers of the New York City Board of Health to address the public health threats of the early 21st century.”  One justice in the majority, Judge Sheila Abdus-Salaam, seemed to share those concerns, writing in a separate concurrence that “no one should read today’s decision too broadly.”

It’s always amusing to hear what the Washington Legal Foundation, which filed an amicus brief supporting the soda industry’s position, has to say:

New York City’s misguided soda ban was arbitrary, paternalistic, and profoundly inconsistent with separation-of-powers principles. The Court’s decision to strike it down vindicates fundamental constitutional values, protects consumer freedom, and encourages sound regulatory policies.

Jane Delgado of the National Alliance for Hispanic Health’s issued a statement:

 We are deeply disappointed that the court today limited the power of the NYC Board of Health to
act on behalf of the health of New Yorkers… The portion cap rule is the right policy for New York City and communities throughout the nation facing the rise of chronic diseases, such as diabetes.

I’m in Washington, DC this week on a bit of book tour for Eat, Drink, Vote (see Appearances for schedule).

At my Politics & Prose bookstore event last night, I got asked why I think the food environment matters so much in dietary choice.  Isn’t food choice a matter of personal responsibility?

It is, of course, but the food environment greatly influences personal choice.

Two examples:

Large portions: just about anyone presented with a large portion of food with eat more from it, take in more calories (larger portions have more calories!), and underestimate the calories consumed by a much greater proportion than from a smaller amount.

Salt intake: Because 80% or so of salt in the American diet comes from processed and restaurant foods, people eating in restaurants have no control over the amount of salt they take in.

To make it easier for people to take in fewer calories and less salt requires changes in the food environment: serve smaller portions and reduce the salt in restaurant foods.

FDA: Get to work!

I attended the brief appeals hearing yesterday at which lawyers for the New York City Department of Health (DOH) and the American Beverage Association (ABA) presented final arguments for and against the DOH 16-ounce soda cap initiative (for recap, see previous post).

The judges challenged the DOH lawyer on jurisdiction, judicial precedents, scientific basis, efficacy, rationality, and triviality.  One said “Do you need a PhD in public health to know that sugary drinks aren’t good for you?”

Another kept referring to the initiative as a ban: “It would mean sodas cannot be sold…”

The big issues raised by ABA:

• Does DOH have jurisdiction?
• Is the cap rational?
• Does the soda cap adequately balance public health, personal liberty, and economic factors (i.e., beverage companies’ “rights” to sell as much sugar water as they can get away with)?

DOH argues that it does have jurisdiction and that there is plenty of precedent.

DOH also argues that the proposed 16-ounce cap is well supported by research and makes good sense.

I find DOH Commissioner Tom Farley entirely rational—and persuasive—when he talks about these issues.

Reporters from the Associated Press and the New York Times must have been there too.  Both noted that the judges were much tougher on the DOH attorney than on the one from the ABA.   The DOH attorney seemed to have trouble responding to questions about precedents.  Did she not read the DOH’s impressive “plenty of precedent” piece?  

Obesity—and its type 2 diabetes consequences—are problems requiring action.  I’d like to see the soda cap tried.

But despite Commissioner Farley’s optimistic statements to reporters, this hearing didn’t make the possibility sound hopeful.

And here’s CDC’s reminder of what this is all about:

Politics, they say, makes strange bedfellows.  I can understand why the New York Times would do a front-page investigative report on how soda companies engage minority groups as partners while slamming Mayor Bloomberg for overreaching with his soda cap initiative.

But can someone please explain the Daily News?   Here’s yesterday’s front page:

This was followed by two pages of “Soda plan struck down; our cups runneth over” and other gleeful responses to the judge’s soda cap decision.

But then there’s this astonishing editorial.  Explain, please.

Judge drinks the Kool-Aid

In putting Mayor Bloomberg’s soda ban on ice, Manhattan Supreme Court Justice Milton Tingling did a huge disservice to the health and welfare of hundreds of thousands of New Yorkers.

Tingling concluded that the prohibition against selling sugared beverages in containers larger than 16 ounces was both arbitrary and beyond the authority of the Board of Health, which approved the regulations.

The only thing arbitrary here was Tingling’s ruling. More, the judge was the only party who was guilty of overreaching.

At heart, he simply substituted his judgment as to sound public policy for the board’s — an action that’s beyond a judge’s proper purview.

Most amazingly, Tingling held that the board had acted rationally in voting the portion cap as one method of trying to rein in the city’s epidemic of obesity and obesity-related diseases.

He bought the indisputable premise that the board was right to draw connections among high soda consumption, obesity and diabetes, which are debilitating New Yorkers young and old.

But then the judge threw that over by stating the obvious fact that the board did not have the power to ban supersized sugar drinks everywhere, only in establishments regulated by the Health Department.

Because the public could get a 32-ounce cup at, say, a 7-Eleven, but not at restaurants, he in effect deemed the ban to be an ill-designed contraption destined to fail. But who is Milton Tingling to say that? No one.

His fundamental error was to consider the regulation from the point of view of vendors who were hoping to get out from under it.

Those covered by the ban claimed they were the victims of capriciously unequal treatment and shifted Tingling’s concern away from the pressing rationale for a regulation that would have been broadly applied.

There’s nothing arbitrary about the consequences of drinking large quantities of sodas and other overly sweetened beverages.

The correlation in certain communities among consuming soda, becoming obese and contracting related diseases are certain.

The neighborhoods with the highest obesity rates — Harlem, the South Bronx, central Brooklyn — have the largest percentages of people who are likely to drink more than one sugar-sweetened beverage each day.

All too predictably, people in low-income areas such as Bedford-Stuyvesant and East New York, Brooklyn — places where soda consumption is highest — are four times as likely to die from diabetes as residents of the more affluent upper East Side, where people generally consume far fewer sugary drinks.

No matter.

Tingling attended to the arguments of businesses looking after their own financial interests over the demands of public health — while at the same time declaring that the Board of Health is barred from taking into account the substantial economic costs generated by obesity.

Ultimately, Tingling bought into the all-or-nothing argument — the same line of thinking that killed an earlier Bloomberg proposal that would have barred people from buying sugary sodas with food stamps.

The U.S. Department of Agriculture killed that experiment, asserting that it would be unfair and unproductive to target only a limited population in such a test. So Bloomberg tried to go bigger, and Tingling shot him down.

If bringing down a serious threat is a rational goal, as Tingling wrote, then you do it as best you can, even incrementally.

A halfway measure is better than no measure and is certainly not arbitrary.

Bloomberg vows an appeal.

Here’s hoping that Tingling’s judicial superiors recognize that pursuing public health is not just rational, it’s imperative. 

Afterthought: compare this to the Times’ editorial:

There are better ways for Mr. Bloomberg to use his time and resources to combat obesity.  One is to push Gov. Andrew Cuomo and the State Legislature to impose a penny-per-ounce tax on sugary drinks…the big-drinks ban was ill conceived and poorly constructed from the start.