Many patients are told to lose weight and watch the fat in their diet to help with heart health and reduce risk factors, but few are successful in this endeavor. Why? For one thing, many have no idea where to begin when attempting weight loss. They don't know a healthy fat from a trans fat and they have heard so much conflicting nutrition information they have lost faith in nutrition science. However, with some guidance, they can learn some key strategies to help them get started on their risk reduction journey and clarify many of the misconceptions. One of the key strategies in weight control is to become aware of portion sizes.
Our patients are accustomed to larger portions and “super-sizing” in restaurants and at home. For example, a recommended serving of pasta or starch (rice, hot cereal) is 1/2 cup or 1 ounce, yet it is not uncommon to be served 3 1/2 cups of pasta at a restaurant. According to the United States Department of Agriculture's MyPyramid, the average person should be consuming about 6 ounces daily from the starch group. So when we go to our favorite Italian restaurant, we are getting more than our daily allotment of starch in just one dish, and that isn't even counting the bread that comes with the entree! Patients are further distressed when they learn that a serving of juice is only 4 ounces (most of us don't even have 4 ounce glasses at home), a serving of meat should be about 3 ounces (not 8–12 ounces as normally served at a restaurant), and one cup (8 ounces) of milk is what they should be having instead of the venti (20 ounce) mocha at Starbucks.
Some simple strategies to get portions under control can be implemented to aid patients in their weight goals. First, measuring portions at home will help patients see exactly what they are eating. Many patients have been shocked to find that their “1 cup” of cereal is actually 2 cups. By measuring portions, they can see where adjustments can be made and this will also help them to eyeball portions when they are eating out or at a friend's house. They needn't measure foods all the time, just a few days of detective work will let them know what their bowls, cups, plates, and serving utensils hold.
Another key opportunity to reduce portions is to use smaller plates, cups, and bowls. Small portions on an 8 inch plate give the illusion that we will be satisfied with the meal. Small portions on the more common 12 inch plate lead one to feel deprived. In addition, the larger the plate, the more likely our patients are to fill it. While they are filling their plate, a good suggestion is to fill half of it with vegetables. There has been ample research on the benefits of low energy density foods in aiding with reducing overall calorie intake and increasing satiation. For those who like to “super-size,” vegetables will fit the bill.
Some research has suggested that people also tend to eat more from larger packages, which are all too common these days with the increase in warehouse-type stores. To help offset this tendency, patients are encouraged to divide the foods in the larger package into multiple individual sized portions and keep those on hand. No more mindless eating out of the bag or box.
In case your patients cannot remember what a serving size is supposed to be, or they don't always carry their food scale or measuring cups everywhere they go, they just need to reference their hand or common items to be reminded. A 3 ounce serving of meat is considered to be the size of a deck of cards, or the palm of one's hand. Three ounces of fish may look like a checkbook. The size of a woman's fist is about one cup of grain or cut up fruit or vegetables. Half of a baseball is about 1/2 cup of cooked grain, rice, or pasta. An ounce of cheese is about the size of a thumb, 4 dice put together, or a one inch square. One teaspoon of margarine or spread is about the size of one die.
If portions are a problem because of frequent restaurant eating, patients have several options. They can consider splitting dishes with companions, thereby saving money and calories. They could also take half (or more) of their meal home. In that case, it is best to ask for the doggie bag when the meal arrives, so that the extra half can be packed away and not tempting when the meal is over. Ordering senior or child-sized portions at restaurants, if available, will reduce intake as well as just ordering from the appetizer menu.
When patients increase their awareness of portion sizes, it gives them the ability to make adjustments in their intake to help with weight loss. The tips included in this article can lead to adequate calorie savings to promote a healthful weight loss of one to two pounds a week. However, with the advent of television programs such as The Biggest Loser, this may not be as rapid a weight loss as patients are seeing on television. This is an excellent opportunity to share realistic weight loss expectations with patients. There are many factors contributing to weight gain, and adjusting portions is a proven way of creating a calorie deficit. A referral to a registered dietitian can give patients additional help in reaching their health goals.
- •www.eatright.org: Evidence Analysis Library
- •Wansink B, Mindless Eating: Why We Eat More Than We Think. New York, NY: Bantam; 2006.
- •Rolls BJ, Barnett RA. The Volumetrics Weight-Control Plan: Feel Full on Fewer Calories. New York, NY: Harper Paperbacks; 2000.