Influencing and modifying children's energy intake: the role of portion size and energy density

Abstract

Childhood obesity is of concern worldwide. The portion size (PS) and energy density (ED) of food are two major determinants of children's energy intake (EI). Trends towards increasing PS are most apparent and best documented in the USA, where PS of numerous food products have increased in the marketplace over the past three decades, particularly high-energy dense foods. Analyses of population-level dietary surveys have confirmed this trend in children for both in-and out-of-home eating, and a plethora of observational evidence positively associates PS, ED and adiposity in children. A limited number of intervention studies provide clear evidence that children, even as young as 2 years, respond acutely to increasing PS, with some studies also demonstrating the additive effects of increased ED in promoting excessive EI. However, most of the evidence is based on children aged 3-6 years and there is a paucity of data in older children and adolescents. It is unclear whether decreasing PS can have the opposite effect on children's EI but recent acute studies have demonstrated that the incorporation of lower energy dense foods, such as fruit and vegetables, into children's meals down-regulates EI. Although a direct causal link between PS and obesity remains to be established, the regular consumption of larger PS of energy dense foods do favour obesity-promoting eating behaviours in children. Further research is required to establish the most feasible and effective interventions and policies to counteract the deleterious impact of PS and ED on children's EI.

A comparison of snack serving sizes to USDA guidelines in healthy weight and overweight minority preschool children enrolled in Head Start

“…Lower socioeconomic status neighborhoods are at a higher risk of obesity [44, 45]. Overall our findings are consistent with previous studies, which also could not establish a relationship in preschool children between portion size, healthfulness, and obesity, although researchers report this behavior presents itself as obesity promoting [6, 46]. …”

Association Between Age and Obesity Over Time

“…29,54 Societal changes that promote inactivity and food consumption contribute to childhood obesity. [55][56][57][58] Varying cultural norms 22 in feeding practices 59 are also associated with children's weight, although this relationship can be confounded by education and economics. 22,25 And obesity can "spread" through social networks.…”

Implementation of a School Nurse-led Intervention for Children With Severe Obesity in New York City Schools

“…Factors outside the school setting such as advertising of unhealthy foods (Andreyeva, Kelly, & Harris, 2011), poor neighborhood walkability (Vandegrift & Yoked, 2004), fast food restaurant access (Newman, Howlett, & Burton, 2014), perceived or actual healthy food access (Rundle et al, 2009; Zenk, Mentz, Schulz, Johnson-Lawrence, & Gaines, 2016), and large portion sizes (Pourshahidi, Kerr, McCaffrey, & Livingstone, 2014) impact health, nutrition, physical activity and body weight. Such factors only intensify physiological, hormonal, and metabolic resistance to weight loss (Farias, Cuevas, & Rodriguez, 2011; Müller, Bosy-Westphal, & Heymsfield, 2010).…”