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'Supersizing' Hits the Dinner Table

Study Traces Rise of Obesity to Larger Portions of Food Served at Home, Too

By Rob Stein
Washington Post Staff Writer
Wednesday, January 22, 2003; Page A02

In addition to the super-size fries and big-gulp drinks served in countless restaurants, Americans are eating bigger and bigger portions at home as well, according to the first study to examine the issue.

Between 1977 and 1996, average portion sizes ballooned for salty snacks, soft drinks, French fries, hamburgers and other mainstays of the much-criticized American diet , according to the study, which is being published today.

The trend toward bigger helpings provides strong new evidence that a driving force behind the nation's obesity epidemic is that people are simply eating more.

"Portion sizes have increased over time, and it's not just outside the home," said Samara Joy Nielsen, who conducted the study with Barry M. Popkin of the University of North Carolina in Chapel Hill. "This is also occurring inside the home, which is not good news."

Although previous studies have documented a trend toward bigger portions in restaurants, packaged foods and even in recipes, the new study is the first to examine how much people actually eat, especially at their own dinner tables.

"Many people have said anecdotally, 'Oh, food portion size has increased over time,' " said Nielsen, whose findings are being published in the Journal of the American Medical Association. "Nobody's actually looked at whether portion size consumed had changed."

The nation is amid an epidemic of excess weight and obesity, which sharply increases the risk for a host of serious health problems, including heart disease, stroke, cancer and diabetes.

While lack of exercise is considered an important factor in the nation's weight problem, the new data underscore the idea that the larger portions people are eating play a major role, too, experts said. The growth in portion sizes has coincided with the rise in the number of people who are overweight or obese.

"You don't need any more explanation for the obesity epidemic. It's exactly what's causing it," said Marion Nestle, a professor and chair of the Department of Nutrition and Food Studies at New York University and author of "Food Politics: How the Food Industry Influences Nutrition and Health." Nestle doesn't reject the idea that a lack of exercise is playing a role in the obesity epidemic, but she thinks increased caloric intake is the most important factor.

The increase in the amounts people eat at home probably was spurred by the larger portions being served in restaurants, said Barbara Rolls, a professor of nutrition at Pennsylvania State University.

"Once people become accustomed to eating bigger proportions, they are going to learn that that's the appropriate amount of food. I'm not surprised it's carrying over to the home," said Rolls, who recently published a study that showed people tend to eat whatever amount is put in front of them.

Once a person has become accustomed to larger portions, it is hard to go back to more modest meals, said Larry Lindner, executive editor of the Tufts University Health and Nutrition Letter.

"The body has a really finely tuned mechanism for knowing when it's hungry and when it's full. But it can be thrown off. You can teach your body that it needs to eat more to feel full," he said.

For the study, Nielsen and Popkin examined data collected from two earlier surveys: the Nationwide Food Consumption Survey in 1977-78 and the Continuing Survey of Food Intakes by Individuals between 1991 and 1996. Together, the samples consist of 63,380 people ages 2 and older.

Between 1977 and 1996, portion sizes increased both inside and outside the homes for all categories except pizza -- an exception the researchers could not explain.

For example, the size of a typical serving of potato chips or other salty snack jumped more than a half ounce -- from 1 ounce to 1.6 ounces, which adds up to an additional 93 calories. Desserts increased from 4.2 ounces to 4.8 ounces -- an additional 55 calories. Soft drink sizes went from 13.1 ounces to 19.9 ounces, adding 49 calories. Hamburgers grew from 5.7 ounces to 7 ounces, for 97 more calories. Mexican food went from 6.3 ounces to 8.0 ounces, which piles up 133 more calories.

"Let's say you take in an extra 10 calories a day. Well, in a year, that's a pound. We're looking at increases of almost 100 calories for some of these foods. Chances are this will lead to weight gain," Nielsen said.

When snow delayed the opening of Muscatine High School in Iowa by two hours earlier this month, the question many students asked as they finally arrived wasn't about altered class schedules, postponed sporting events or even the weather.

"All they wanted to know was, 'When are we going to get our fruit today?' " said Muscatine principal Dennis Heiman.

At a time when nutrition surveys show that three out of four American youths fail to eat the minimum five servings a day of fruit and vegetables recommended by health officials, a U.S. Department of Agriculture (USDA) pilot program is slipping a cornucopia of these foods into the classrooms of nearly 65,000 students in Indiana, Iowa, Ohio, Michigan and New Mexico.

Tacked onto the 2002 Farm Bill by Sen. Tom Harkin (D-Iowa) and others, the $6 million program is testing whether providing healthful snacks -- baby carrots, star fruit, dried plums, fruit smoothies and, yes, even broccoli and cauliflower -- means that students will eat them. It's asking whether serving fruit and vegetables can help foster good eating habits and possibly put a dent in the obesity epidemic. According to the federal Centers for Disease Control and Prevention, the proportion of obese children and teens swelled from 11 percent to 15 percent during the past decade and is closely shadowing the epidemic of overweight and obesity in adults.

"We know that balanced diets and physical activity are essential to children's growth and learning," said Eric M. Bost, USDA's undersecretary for food, nutrition and consumer services. The pilot program, he said, offers an excellent opportunity "for creative approaches and possible solutions."

The USDA program also seems to be giving some schools a new weapon against high-calorie snack foods and sweetened beverages that have become standard vending machine fare in many schools. Since fruit and vegetable snacks were introduced at Muscatine High, sales of candy, snacks and soda have dipped 25 percent, Heiman said. That was enough of a drop to prompt school officials to get rid of a candy machine and to replace a soda machine with one dispensing milk. "Our kids seem to really like the fruit and vegetable snacks," Heiman said. "I see a world of difference."

Nearly 900 public and private schools applied for the pilot program last July when the USDA offered it in four states and on the Zuni Indian reservation in New Mexico, where the problems of overweight and obesity have hit particularly hard. One hundred schools were selected to participate.
No official reports on the program's impact are yet available. In March, the National Cancer Institute's Five-A-Day program plans to convene a conference for participating schools to discuss their experiences with the program.

The value of eating enough fruit and vegetables throughout life has been studied repeatedly. Low intakes of fruit and vegetables are linked with increased risk of heart disease, higher rates of cancer and elevated blood pressure as well as increased body weight and type 2 diabetes.

Yet, study after study points to large segments of the U.S. population that still fall short of the minimum five servings a day recommended by the government. "Only about one in four kids eat five a day," said Lorelei DiSogra, director of the Five-A-Day program. (Adults are encouraged to consume even more, with women urged to aim for seven servings a day and men for nine.)

What's more, studies suggest that the fruit and vegetables consumed by youths often don't include the dark green or deep yellow varieties that have the most phytonutrients, vitamins, minerals and fiber. For example, a 1996 National Cancer Institute study found that french fries made up nearly a quarter of all vegetables consumed by children and adolescents aged 2 to 18.

It's exactly that kind of narrow nutritional range that USDA officials hope will be widened with the pilot program. Schools receive $89 to $152 per student to buy fruit and vegetables snacks for the academic year, with each school making its own purchases. The only caveat is that all food provided in the program must be grown in the United States. (Bananas are exempt from this rule.)
When and how participating schools serve the fruit and vegetables is up to them. That's been both a benefit and a challenge to the schools that have received this bounty.

In Muscatine, a small city where Samuel Langhorne Clemens, aka Mark Twain, once worked at the local newspaper, the high school food service personnel at first struggled to distribute the healthy snacks at 10 a.m. every day. "We have 1,800 students and it was a bit of a logistical nightmare at first," Heiman said. There were also some unexpected complications -- such as where to put those 1,800 apple cores on the days when Granny Smith apples were the snack.

Snack boxes are distributed to classrooms, where students eat the snacks while watching Channel One, which broadcasts news-oriented programs to schools; teachers bring in extra bags for the trash. "We're being creative in how we're dealing with it," Heiman said.

Reaction has been good. The program "has made kids aware of different eating options," Heiman said. "It's been a real eye-opener. Some kids have never had a tangerine before. And it's actually become somewhat of a biology lesson. If the bananas are too green, then we say, 'Let's put them in a paper bag and tomorrow they will be okay.' "

Among the fruit and vegetables that have been served are raisins, grapes, dried cherries, caramelized apples, star fruit, dried banana chips, baby carrots and fat-free ranch dressing, Heiman said. "The least popular was the trail mix, which I thought could have been used for cinders or melting the snow. But my wife is a kindergarten teacher at another school where they have the same grant, and her kids loved it."

Kids being kids, there were a few early instances of an apple careering down the hall or a box of raisins going airborne. "We told them, 'If you don't want the food, you don't have to eat it,' " Heiman said, noting that the few pranks stopped.

April Beason, a 16-year-old junior at Muscatine, gives the program high marks. "It's pretty neat," she said. "I ate vegetables at home, but it's increased the fruits and vegetables that I eat at school because, instead of having junk food and stuff, I eat the snack."

At Summit Country School, a kindergarten through grade 12 private school in Cincinnati, the program has taken a visible bite out of consumption of desserts and french fries. "Everyone seems to be eating healthier," says Melissa Geers, head of the school's food service.

Students are greeted every morning with huge trays of fresh strawberries, pineapple, cantaloupe, kiwis and honeydew melon that are available to munch on until 10 a.m. At 2 p.m., carts of vegetables and dips are in the halls as students change classes.

Geers recently overheard two students debating the culinary delights of cauliflower. "One student said, 'Ew, cauliflower. Yuck, it has no taste,' " Geers recalled. "And the other one said, 'Yeah, but if you put it in the ranch dressing, it's pretty good' "Fresh strawberries are the hands-down favorite in Princeton, Ohio, where students "are begging us for more," says Linda Bass-Wiley, a dietitian for the school district, which has two schools participating in the USDA pilot project. "They also love clementines and blood oranges." About 150 requests a week are coming in from teachers, guidance counselors, coaches and even members of the debate team, who place their orders online with the food service department.

"It's a good experience and a very positive thing that we could really introduce our kids to the notion that fruits and vegetables make a good snack, too," Bass-Wiley said.

Despite the response, school officials interviewed said that limited local and state funds make it unlikely that they will be able to continue providing the snacks once the USDA project ends this year. "If the grant money wasn't available, I don't know that we could do this school-wide," said Margaret Brennan Krueger, principal of Liberty Center Elementary School in Liberty Center, Ohio.

Not surprisingly, parents are also paying close attention to the outcome. "Parents are very, very excited about this," Krueger said. "They hope that it will help them introduce more fruit and vegetables at home."

© 2003 The Washington Post Company

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