Large food portions may be facilitating excess energy intake (EI) and adiposity among adults. The present study aimed to assess the extent to which EI and amounts of foods consumed are influenced by the availability of different-sized food portions. A randomised within-subject cross-over, fully residential design was used, where forty-three (twenty-one men and twenty-two women) normal-weight and overweight adults were randomly allocated to two separate 4 d periods where they were presented with either 'standard' or 'large' food portions of the same foods and beverages. The main outcome measures were the amount of food (g) and EI (MJ) consumed throughout each study period. Mean EI over 4 d was significantly higher on the large portion condition compared with the standard condition in the total group (59·1 (SD 6·6) v. 52·2 (SD 14·3) MJ; P¼ 0·020); men and women increased their EI by 17 % (10 (SD 6·5) MJ; P,0·001) and 10 % (4 (SD 6·5) MJ; P¼0·005) respectively when served the large food portions relative to the standard food portions. The increased intakes were sustained over the 4 d in the large portion condition with little evidence of down-regulation of EI and food intake being made by subjects. Increased food portion size resulted in significant and sustained increases in EI in men and women over 4 d under fully residential conditions. The availability and consumption of larger portions of food may be a significant factor contributing to excess EI and adiposity. The burgeoning rates of obesity in genetically stable populations such as in Europe and North America suggest that an increasingly obesogenic environment is the major driving force behind this epidemic (1) . Fostering the delicate balance between energy intake (EI) and energy expenditure to maintain a healthy body weight is now exceedingly difficult for many individuals. In the past few decades several key environmental and cultural factors have converged to increase the probability of over-eating in the face of reduced energy needs.One environmental factor which has become the focus of attention is that of food portion size, which has been increasing steadily over the past two decades in parallel with the rise in overweight and obesity (2,3) . Studies have demonstrated that portions of food sold in supermarkets, fast food establishments and restaurants have steadily increased since the mid 1980s (3,4) , a trend that has been most apparent and best documented in the USA. Consequently, it is hypothesised that increasing portion sizes of food may be undermining normal appetite control and inciting over-eating.One possible reason for over-eating is that consumers tend to eat what they are served (5) , even if it is an inappropriate amount for their energy needs, and consequently may not compensate for this overconsumption at subsequent eating occasions. Indeed, it may be the case that the availability of larger food portions may have a greater impact on food consumption than physiological satiety cues.However, despite pervasive commercial trends towards la...
The paper addresses the question in the title via a survey of experienced healthcare modellers and an extensive literature review. It has two objectives. 1. To compare the characteristics of 'generic' and 'specific' models and their success in hospitals for emergency patients 2. To learn lessons about the design, validation and implementation of models of flows of emergency patients through acute hospitals First the survey and some key papers lead to a proposed 'spectrum of genericity', consisting of four levels. We focus on two of these levels, distinguished from each other by their purpose. Secondly modelling work on the flow of emergency patient flows through and between A&E, Bed Management, Surgery, Intensive Care and Diagnostics is then reviewed. Finally the review is used to provide a much more comprehensive comparison of'generic' and 'specific' models, distinguishing three types of genericity and identifying 24 important features of models and the associated modelling process. Many features are common across model types, but there are also important distinctions, with implications for model development.
This paper considers efforts to improve in-patient flows, a particularly urgent issue in the National Health Service (NHS). The context is described and related to reasons why OR has been making relatively little contribution. The paper argues that large complex models may often be unnecessary and even get in the way of providing clear insight and guidance for problem owners. The importance of understanding the generic working of systems to lead to improvement, and the limitations of simply describing them, is stressed. It is demonstrated that some very simple models can be of significant practical value in understanding and managing complex systems, changing mindsets and driving collection and use of operationally valuable data. Recommendations for more effective engagement with the NHS are offered.
The Department of Health (DH) Accident and Emergency (A&E) simulation model was developed by Operational Research analysts within DH to inform the national policy team of significant barriers to the national target for 98% of all A&E attendances to be completed (discharged, transferred or admitted) within four hours of arrival in England by December 2004. This paper discusses why the model was developed, the structure of the model, and the impact when used to inform national policy development. The model was then used as a consultancy tool to aid struggling hospital trusts to improve their A&E departments. The paper discusses these experiences with particular reference to the challenges of using a 'generic' national model for 'specific' local use.
The Department of Health (DH) Accident and Emergency (A&E) simulation model was developed by Operational Research analysts within DH to inform the national policy team of significant barriers to the national target for 98% of all A&E attendances to be completed (discharged, transferred or admitted) within four hours of arrival in England by December 2004. This paper discusses why the model was developed, the structure of the model, and the impact when used to inform national policy development. The model was then used as a consultancy tool to aid struggling hospital trusts to improve their A&E departments. The paper discusses these experiences with particular reference to the challenges of using a 'generic' national model for 'specific' local use.
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