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Linda Shiue

Linda Shiue
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I am an internal medicine physician practicing in the San Francisco Bay Area. I spend my free time with my husband and kids, reading everything in sight, eating, traveling, and cooking meals inspired by my travels. Disclaimer: Health information presented here is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. © 2010 Linda Shiue. All Rights Reserved.

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FEBRUARY 8, 2010 9:09AM

The F.D.A Wants To Supersize Serving Sizes- Should We Care?

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CDC PHIL image

The FDA has recently announced that it plans to overhaul nutrition labeling on packaged food in two ways.  The first is to bring key nutrition information, such as calorie content, to the front of the package.  The second is to redefine serving sizes.

FDA Nutrition Facts Label  

Many packaged foods obviously contain multiple servings, such as a bag of chips or a box of cereal.  Most people intuitively know this, but may not know that a serving of chips may be only 15 chips, or that a bowl of cereal should only be 3/4 cup.   Others are less obvious, such as a can of soup, which often contains two or more servings.  Few of us look carefully at the recommended serving size (often given in portions of cups or ounces) before digging in.  This is crucial, though, because the nutrition information some people may look at, such as calories, fat content, and possibly sodium content, is all listed per the recommended serving size. To make matters worse, serving sizes are not even standardized by different governmental bodies, according to Mark Andon, VP of nutrition at ConAgra foods, in a New York Times blog:

"there are different types of servings. The F.D.A. serving amounts differ from the U.S.D.A.’s My Pyramid food guideline, and both of those can differ substantially from the portion consumers serve themselves.  And serving size confusion goes beyond packaged food.  For example, the F.D.A. considers a serving of a raw apple to be 140 grams. However, the U.S.D.A. says we should eat 2 cups of fruit a day and a “small” apple (2.5 inch diameter) equals 1 cup. But consumers are unlikely to find such small apples at the grocery store; they will see big, beautiful shiny apples that are easily 3 inches or more in diameter and weigh closer to ½ pound each."

The problem is that in this country, our serving sizes have increased dramatically over the past few decades. This is known as "portion distortion" and has been linked, somewhat obviously, to the growing obesity epidemic.  (Remember Supersize Me? Documentarian Morgan Spurlock famously conducted an experiment on himself in this 2003 film. In the documentary, he ate three times a day at McDonald's, gained almost 25 pounds,  and as a consequence developed medical complications including liver abnormalities, heart palpitations, headaches and depression.)  While most of us have not increased our portion sizes nearly as dramatically or as quickly, few people can recognize a serving size when asked.  Restaurant portions are often double the recommended serving size.  A study in the Journal of the American Dietetic Association in 2003 showed that commercially available foods commonly had portions which were two to eight times the standard servings.  An easy way to approximate a balanced meal of appropriate portions is to look at a Healthy Choice frozen meal.  To many, that would not be enough for dinner, but that is what is currently considered the appropriate amount for the average adult.  If you visit other countries, you'll notice that even commonplace items like cans of soda are much smaller than what are routinely sold here.

The FDA's goal in updating serving sizes is to bring them in line with how Americans actually eat.  By being more realistic, the hope is that knowing how many calories you'd consume when you buy a packaged food product would stop you from doing so.

Does this make sense? It sounds like Supersizing.  Educating people, perhaps with graphics, about what the intended serving size is on the front of a package might be helpful in combating obesity, which is what this initiative is all about.  But adjusting portion sizes to match the American reality seems self-defeating.  It's analogous to the inflation of clothing sizes, which is at the point that you can be a size 0 and actually exist.  If we keep eating more, will the FDA need to continually readjust serving sizes?

___________________________________________________ 

Schwartz J, Byrd-Bredbenner C.J.  Portion distortion: typical portion sizes selected by young adults. Am Diet Assoc. 2006 Sep;106(9):1412-8.

Young LR, Nestle M. Expanding portion sizes in the US marketplace: implications for nutrition counseling.  J Am Diet Assoc. 2003 Feb;103(2):231-4.

MyPyramid.gov

 

 © Linda Shiue, 2010

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As I've come to discover, you're always on your game....and pose an interesting question about portion sizes. Also...I noticed the caloric content is usually based on a "diet" of 2000 calories a day. . .which seems a little high. But in the interests of full disclosure I read this while eating a homemade, EggMcMuffin. Only one slice of bacon and no cheese. Thanks Linda! ;)
People just love to kid themselves about the number of calories they are actually eating. I'm especially fond of the number of servings on a box of pasta -- usually four. Be real. Two servings tops and that's only if meatballs and sausages are part of the meal.
R
The “Serving Size” on the nutritional label has historically been a loophole to enable food marketers to make their products look better—lower in calories fat sugar and sodium—than they really are.

How many people actually consume only half a candy bar, 40 percent of a single-serve bottle or a quarter of an individual pack of chips?

How many people--or kids--eat only 3/4 cup of cereal?

Therefore, I agree with the FDA on this one. Knowing what a typical serving contains could help move us from these calorically dense processed foods to real food, and hopefully also to reasonable portions.

Let’s also make it simple: A small package is one serving. Let's not kid ourselves.
I think Dr. Ayala has it right...I don't think this is an exercise (no pun intended) to make people eat larger servings; it's an effort to be realistic.
I have to agree with Dr Ayala on this one. A shopper who takes the time to look at a label, is mainly just checking to see the calories, grams of sugar, fat, etc. falls into an acceptable range for them. These numbers often look acceptably low because the serving size doesn't match how people eat. For example, sometimes even a frozen dinner gets marked as 2 servings, when it is packaged to look like one meal on tray. Consumers don't think "well it says 2 servings, therefore my husband and I must share this." They look at an item, determine if it will satisfy them, maybe do a quick check of calories, etc. and ignore the "per serving" label.

It seems reasonable to expect that once the FDA adjusts the serving sizes to be more realistic with how people actually eat, consumers will be less likely to put certain items in their cart. The huge number of grams of sodium, fat, etc. will scare them away.
I think the label should have two columns - one for the "per serving" amount, and another for the "total for this package" amount. That will force people to realize that the package is more than one serving. Also it could reduce "rounding errors" - for example, if something has less than a half-gram of fat, it "rounds down" to zero, but if there are three servings in the package, that's 1.2 grams, which rounds to 1. People will see that "0 grams of fat" on the label does not equal "fat-free". Why don't they use "
Interesting, Linda. I am totally guilty of reading serving size and then ignoring it, like on a can of soup. But those aren't invisible calories.

One interesting note. When we living in France a couple of years back, we noticed that they were Americanizing their serving sizes in restaurants. I had mentally prepared for eating like a bird, but the plates were surprisingly large enough for a two people much of the time, and in places where you expect otherwise.

Sadly, we also noticed the flocking of Parisians to KFC and McDoo's for lunch and dinner. That was disappointing.

Now, if they'd only get cracking on the gluten free labeling!
The FDA is a useless appendage that serves corporations IMHO. The idea of tweaking serving sizes is like an existing parking lot being re-striped to fit more cars... hi, here are your shitty, smaller parking spaces. I noticed that a package of Top Ramen is intended to satisfy two people.

Stop touching, reading or even considering buying anything that you feel like you ought to read the label on. I feel semi-safe buying lettuce at the local health food store. Sometimes I'll look at the nutritional information on the side of a carton of cream as I make coffee and rationalize that a tablespoon of cream in my single cup of coffee isn't going to kill me too quickly.
People need to take responsibility for their portion sizes as well, and read the fine print. It's all about portion sizes and calories in versus calories used. After 26 years of being overweight, when I finally learned that, I lost the weight.
In Europe, all the nutrition information is per 100 grams. Often you will see a per serving column, too. It means comparisons are easy. It also means the serving size is left up to you.

What I find crazy about US serving sizes is the small bags of potato chips with 1+1/8 serving. I mean, come on, I am very good at mental math and I've never once bothered with either figuring out the calories or leaving an 1/8 of a bag of chips.

I find the food pyramid difficult because its idea of a serving is WAY off of mine. 8 servings of grain? I can't even slice my homemade bread thin enough for one slice to not be over a "serving".
It's not like the information isn't there in the existing food labels. This is only an issue because, in practice, people are incapable of doing arithmetic that any grade school child should be able to do. If a serving has 100 calories, and there are 3.5 servings in the package, and you eat the whole thing, it's not hard to know how many calories you've consumed. If someone can't be bothered do that calculation, it seems unlikely that they'd keep a running total of calories consumed over the course of the day.

You can put labels on the food. You can change agricultural subsidies. You can't make people take care of themselves.
I've always felt that the "serving size" was a sham that lets the companies get away with making the food look better than it is. I think correcting this in labeling where it is most egregious is a good idea. They should be realistic for what people are likely to eat. I like catnmus' idea that they should be listed by serving size and by entire package. That would likely provide the most clarity. At any rate, I don't think it's a matter of FDA super-sizing servings. It's a matter of making it more realistic and hopefully more controllable when the truth is laid out.
Sadly, many people don't even bother to read the labels, ingredients, calories, macronutrients, etc. on a food label. Changing the labels is not going to change people's eating habits.
Great topic! Sizes of standard items have dramatically increased over the years...a small french fry at McD's, a bagel, etc... Marion Nestle, Eric Schlosser, Michael Pollan, and others have tried to bring this to the attention of the American public. Glad that the FDA will give it a try too.

Rated!!
People starving all over the world and we're all busy about "portion control".
It's an interesting question, but I'd like to see two columns. One column should be standardized to a standard serving size, and while I think 8oz is a bit small, I think it only matters for comparison purposes. The second column should be the sum of all the package (to save multiplication by the servings-per-package). Then the reader can easily know to read the second column if they want the true effect and the first if they want to compare across-products. One virtue of keeping the standard size small is to emphasize the amount of extra that some things might contain. So if it's a Big Gulp, it might be hugely more. Two columns would put it in line with the way labels in grocery stores work where you get the cost per item in white and the cost-per-standard-serving in red (in most of the stores I go to) for easy comparison. That cost-per-standard-serving size sometimes looks nutty (like for saffron) but most of the time it's quite handy for easy comparison.
I think that manufacturers have intentionally misstated the size of portions.

For cold cereal I have a bowl that I use that is just right for about 1 1/4 cups of my favorite cereal, skim milk and a banana. If I eat that much of a high fiber cereal and some fruit I am not hungry during the morning at all. If I eat 3/4 cup of cereal I am hungry and end up eating something that has more calories, and probably more fat, than if I had gone ahead and eaten what I consider to be a full portion.

I also think that these falsely labeled servings work against us psychologically because they don't allow us to naturally develop a sense of what 'enough' actually is.

So I am thinking that the FDA has got this right.
I was going to say that making the portion size larger just provides license to eat more than an actual serving, but then I read Dr. Ayala's comment, which makes total sense. We have to count carbs around here for a diabetic family member (or, more accurately, I count them) so I am used to reading labels carefully, and I think they are mostly unrealistic. Who eats half a can of soup or 7 chips?!
Excellent points, quite informative, you're way ahead of the mainstream media on this one. "Portion distortion." I like that.
Thanks, everyone, for the very thoughtful comments. I like the two-column idea proposed by catnmus and Kent Pitman. It may be the best of both worlds way to alert people to what they are about to eat without having to do their own math. I am still uneasy with the idea of adjusting portion size to the mean-- what most people eat-- because it has been shown that what we have all gotten accustomed to eating over time has grown constantly. Just because everyone does it doesn't mean it's right. But I do agree that some recommended servings are unrealistic. I also agree that labeling a small packet as more than one serving is misleading. Ideally, I would like to see a public health campaign showing appropriate portion sizes (with pictures, so that you don't have to be literate or know arithmetic) so that the masses could be re-educated about appropriate portion size. Lots of food for thought :)
I think it's a good idea. The servings are not being "super-sized" so much as "real-sized." Even when I was a child (a skinny child!) I knew there was something wrong with calling half a cup of cereal a serving. After half a cup, at age seven, I was still ravenous. I needed at least a full cup to feel as if I'd had breakfast. And that's just one obvious example...
I agree with you. It makes no sense. Great report!