Weight Loss and Control About Food Portions
Have you noticed that the size of muffins, candy bars, and soft drinks has grown over the years? How about portions of restaurant foods like pasta dishes, steaks, and french fries? As portion sizes grow, people tend to eat more-often more than they need to stay healthy. Larger food portions have more calories. Eating more calories than you need may lead to weight gain. Too much weight gain can put you at risk for weight-related diseases like type 2 diabetes, heart disease, and some cancers. Managing your weight calls for more than just choosing a healthful variety of foods like vegetables, fruits, grains (especially whole grains), beans, and low-fat meat, poultry, and dairy products. It also calls for looking at how much and how often you eat. This brochure shows you how to use serving sizes to help you eat just enough for you. What's the difference between a portion and a serving?A "portion" is how much food you choose to eat, whether in a restaurant, from a package, or in your own kitchen. A "serving" is a standard amount set by the U.S. Government, or sometimes by others for recipes, cookbooks, or diet plans. There are two commonly used standards for serving sizes: The United States Department of Agriculture (USDA) Food Guide Pyramid is a healthy eating plan for people ages 2 and over. It shows the recommended number of servings to eat from each of five food groups every day to meet your nutrition needs, and it defines serving sizes. (For more information, see The Food Guide Pyramid under Additional Reading.) The Food and Drug Administration (FDA) Nutrition Facts Label is printed on most packaged foods. It tells you how many calories and how much fat, carbohydrate, sodium, and other nutrients are in one serving of the food. The serving size is based on the amount of food people say they usually eat in one sitting. This size is often different than the serving sizes in the Food Guide Pyramid. How do I know how big my portions are?For foods that don't have a Nutrition Facts label, such as ground beef, use a kitchen scale to measure the food in ounces (according to the Food Guide Pyramid, one serving of meat, chicken, turkey, or fish is 2 to 3 ounces). The portion size that you are used to eating may be equal to two or three standard servings. Take a look at this Nutrition Facts label for cookies. The serving size is two cookies, but if you eat four cookies, you are eating two servings-and double the calories, fat, and other nutrients in a standard serving. To see how many servings a package contains, check the "servings per container" listed on the Nutrition Facts label. You may be surprised to find that small containers often have more than one serving inside. Learning to recognize standard serving sizes can help you judge how much you are eating. When cooking for yourself, use measuring cups and spoons to measure your usual food portions and compare them to standard serving sizes from Nutrition Facts labels for a week or so. Put the measured food on a plate before you start eating. This will help you see what one standard serving of a food looks like compared to how much you normally eat. Another way to keep track of your portions is to use a food diary. Writing down when, what, how much, where, and why you eat can help you be aware of the amount of food you are eating and the times you tend to eat too much. The chart below shows what 1 day of a person's food diary might look like. After reading the food diary, you can see that this person chose sensible portion sizes for breakfast and lunch-she ate to satisfy her hunger. She had a large chocolate bar in the afternoon for emotional reasons-boredom, not in response to hunger. If you tend to eat when you are not hungry, try doing something else, like taking a break to walk around the block or call a friend, instead of eating. By 8 p.m., this person was very hungry and ate large portions of higher-fat, higher-calorie foods. If she had made an early evening snack of fruit or pretzels, she might have been less hungry at 8 p.m. and eaten less. She also may have eaten more than she needed because she was at a social event, and was not paying attention to how much she was eating. Through your diary, you can become aware of the times and reasons you eat too much, and try to make different choices in the future.
How can I control portions at home?You do not need to measure and count everything you eat for the rest of your life-just long enough to recognize standard serving sizes. Try these other ideas to help you control portions at home: Take a standard serving out of the package and eat it off a plate instead of eating straight out of a large box or bag. Avoid eating in front of the TV or while busy with other activities. Pay attention to what you are eating and fully enjoy the smell and taste of your foods. Eat slowly so your brain can get the message that your stomach is full. Take seconds of vegetables or salads instead of higher-fat, higher-calorie parts of a meal such as meats or desserts. When cooking in large batches, freeze food that you will not serve right away. This way, you won't be tempted to finish eating the whole batch before the food goes bad. And you'll have ready-made food for another day. Freeze in single-meal-sized containers. Try to eat three sensible meals at regular times throughout the day. Skipping meals may lead you to eat larger portions of high-calorie, high-fat foods at your next meal or snack. Eat breakfast every day. Keep snacking to a minimum. Eating many snacks throughout the day may lead to weight gain. When you do have a treat like chips, cookies, or ice cream, eat only one serving, eat it slowly, and enjoy it! Is getting more food for your money always a good value?Have you noticed that it only costs a few cents more to get a larger size of fries or soft drink? Getting a larger portion of food for just a little extra money may seem like a good value, but you end up with more food and calories than you need. Before you buy your next "value combo," be sure you are making the best choice for your health and your wallet. If you are with someone else, share the large-size meal. If you are eating alone, skip the special deal and just order what you need. How can I control portions when eating out?Research shows that the more often a person eats out, the more body fat he or she has. Try to prepare more meals at home. Eat out and get take-out foods less often. When you do eat away from home, try these tips to help you control portions: Share your meal, order a half-portion, or order an appetizer as a main meal. Take half or more of your meal home. You can even ask for your half-meal to be boxed up before you begin eating so you will not be tempted to eat more than you need. Stop eating when you begin to feel full. Focus on enjoying the setting and your friends or family for the rest of the meal. Avoid large beverages, such as "supersize" soft drinks. They have a large number of calories. Order the small size, choose a calorie-free beverage, or drink water with a slice of lemon. When traveling, bring along nutritious foods that will not spoil such as fresh fruit, small cans of fruit, peanut butter and jelly (spread both thin) sandwiches, whole grain crackers, carrot sticks, air-popped popcorn, and bottled water. If you stop at a fast food restaurant, choose one that serves salads, or order the small burger with lettuce and tomato. Have water or nonfat milk with your meal instead of a soft drink. If you want french fries, order the small size. Remember... The amount of calories you eat affects your weight and health. In addition to selecting a healthful variety of foods, look at the size of the portions you eat. Choosing nutritious foods and keeping portion sizes sensible may help you reach and stay at a healthy weight. Additional ReadingU.S. Department of Agriculture Center for Nutrition Policy and Promotion. The Food Guide Pyramid. Home and Garden Bulletin No. 252. October 1996. Phone 1-888-878-3256. www.usda.gov/cnpp/pyrabklt.pdf. U.S. Department of Agriculture Center for Nutrition Policy and Promotion. How Much Are You Eating? Home and Garden Bulletin No. 267-1. March 2002. Phone 1-888-878-3256. www.usda.gov/cnpp/Pubs/Brochures/index.htm. U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition. Guidance on How to Understand and Use the Nutrition Facts Panel on Food Labels. June 2000. www.cfsan.fda.gov/~dms/foodlab.html. Medical Care for Obese Patients Approximately 30 percent of adults in the United States are obese, up from 15 percent 2 decades ago. As prevalence rates continue to rise, most health care providers can expect to encounter obese patients in their practices. This fact sheet offers practical tips for overcoming the challenges unique to providing optimal care to patients who are obese, independent of weight loss treatment. Obesity and Body Mass IndexBody mass index (BMI) closely correlates with body fat and can help predict the development of health problems related to excess weight. BMI is calculated by dividing weight in kilograms by height in meters squared (or weight in pounds by height in inches squared and multiplied by 703), or by using the chart below. The National Institutes of Health (NIH) identifies obesity as a BMI of 30 kg/m2 or greater. Obesity is further broken down to Class I (BMI of 30-34.9 kg/m2), Class II (BMI of 35-39.9 kg/m2), and Class III (BMI of 40 kg/m2 or greater), also called extreme obesity. Challenges in Treating Obese PatientsPatients who are obese may delay seeking medical care. They may also be less likely to receive certain preventive care services, such as Pap smears, breast examinations, and pelvic examinations. Insufficient medical care is probably the result of both patient and physician factors.
Providing Optimal Medical Care to Obese Patients“My doctor talks about nutrition and what to eat for my type, but not about dieting. She encourages exercise, but doesn't push. I have been able to make beneficial changes in my diet under her non-judgmental guidance. She is very respectful... my comfort seems to be a goal for her.” —A patient “My doctor never judges me on my weight, and never talks down to me about it.” —A patient Health care providers can take steps to overcome barriers to ensure optimal medical care of patients who are obese. Optimal care begins with educating staff about treating patients with respect. Having appropriate equipment and supplies on hand further increases patient access to care. Weighing patients privately and only when necessary may help overcome their reluctance to seek out medical services. Offering preventive services in addition to monitoring and treating ongoing medical conditions helps ensure that obese patients receive the same level of care as non-obese patients. Finally, providers should encourage healthy behaviors and self-acceptance even in the absence of weight loss. Using the following checklist can improve patient care in your office. To create a positive office environment, review the checklist with your medical and administrative staff. Create an accessible and comfortable office environment. Provide sturdy, armless chairs and high, firm sofas in waiting rooms. Provide sturdy, wide examination tables that are bolted to the floor to prevent tipping. Provide extra-large examination gowns. Install a split lavatory seat and provide a specimen collector with a handle. Use medical equipment that can accurately assess patients who are obese. Use large adult blood pressure cuffs or thigh cuffs on patients with an upper-arm circumference greater than 34 cm. Have extra-long phlebotomy needles, tourniquets, and large vaginal speculae on hand. Have a weight scale with adequate capacity (greater than 350 pounds) for obese patients. Reduce patient fears about weight. Weigh patients only when medically appropriate. Weigh patients in a private area. Record weight without comments. Ask patients if they wish to discuss their weight or health. Avoid using the term obesity. Your patients may be more comfortable with terms such as ”difficulties with weight“ or ”being overweight.“ Monitor obesity-related medical conditions and risk factors. Conduct tests to assess type 2 diabetes, dyslipidemia, hypertension, sleep apnea, ischemic heart disease, and nonalcoholic steatohepatitis. Consider concerns of the extremely obese patient that may be overlooked such as lower extremity edema, thromboembolic disease, respiratory insufficiency (Pickwickian syndrome), skin compression (ulcers), and fungal infections. Offer preventive care services. Allow adequate time during office visits for preventive care services. Recommend or provide preventive care services that are not impeded by the size of the patient, such as Pap smears, breast examinations, mammography, prostate examinations, and stool testing. Encourage healthy behaviors. Discuss weight loss—as little as 5 to 10 percent of body weight—as a treatment for weight-related medical conditions. Emphasize healthy behaviors to prevent further weight gain, whether or not the patient is able or willing to lose weight. Encourage physical activity to improve cardiovascular health. Seek out professional resources to assist your patients and provide referrals to registered dietitians, certified diabetes educators, exercise physiologists, weight management programs, and support groups, as appropriate. Promote self-acceptance and encourage patients to lead a full and active life. Providing optimal medical care to patients who are obese may be challenging. Changes that foster a supportive and accessible environment for the patient, however, are within reach of most health care providers and can go far to overcome both patient and provider barriers to care. Patient Barriers to Adequate Medical Care and Preventive ServicesSelf-consciousness about weight Fears of disparaging, negative, or inappropriate comments from physicians and medical staff Weight gain or failure to lose weight since last medical appointment Past negative experiences with or disrespectful treatment from physicians and medical staff Health Care Provider Barriers to Adequate Medical Care and Preventive ServicesLack of appropriate medical equipment to accurately assess and treat patients who are obese Lack of training in accommodating the physical and emotional needs of persons who are obese Perception that patients’ obesity is mainly due to lack of willpower Difficulty performing examinations, such as pelvic exams, due to the patient’s size Focus on treating ongoing medical conditions, to the exclusion of preventive care services Patient Referrals and InformationNational Diabetes Information Clearinghouse American Dietetic Association American Association of Diabetes Educators Medical Supplies and EquipmentAmplestuff: Make your world fit you (catalog) ConvaQuip Bariatric Equipment Advocacy OrganizationsAmerican Obesity Association Council on Size and Weight Discrimination National Association to Advance Fat Acceptance
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