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Background/Objectives: Controlling food portion sizes can help reduce energy intake, but the effect of different portion-control methods on weight management is not known. In a 1-year randomized trial, we tested whether the efficacy of a behavioral weight-loss program was improved by incorporating either of the two portion-control strategies instead of standard advice about eating less. Subjects/Methods: The Portion-Control Strategies Trial included 186 women with obesity (81%) or overweight (19%). Participants were randomly assigned to one of three equally intensive behavioral programs, consisting of 19 individual sessions over 12 months. The Standard Advice Group was instructed to eat less food while making healthy choices, the Portion Selection Group was instructed to choose portions based on the energy density using tools such as food scales and the Pre-portioned Foods Group was instructed to structure meals around pre-portioned foods such as single-serving main dishes, for which some vouchers were provided. In an intention-to-treat analysis, a mixed-effects model compared weight loss trajectories across 23 measurements; at month 12, weight was measured for 151 participants (81%). Results: The trajectories showed that the Pre-portioned Foods Group initially lost weight at a greater rate than the other two groups ( P =0.021), but subsequently regained weight at a greater rate ( P =0.0005). As a result, weight loss did not differ significantly across groups at month 6 (mean±s.e. 5.2±0.4 kg) or month 12 (4.5±0.5 kg). After 1 year, measured weight loss averaged 6% of baseline weight. The frequency of using portion-control strategies initially differed across groups, then declined over time and converged at months 6 and 12. Conclusions: Incorporating instruction on portion-control strategies within a 1-year behavioral program did not lead to a greater weight loss than standard advice. Using pre-portioned foods enhanced early weight loss, but this was not sustained over time. Long-term maintenance of behavioral strategies to manage portions remains a challenge.

Exposure to large portion sizes is a risk factor for obesity. Specifically designed tableware may modulate how much is eaten and help with portion control. We examined the experience of using a guided crockery set (CS) and a calibrated serving spoon set (SS) by individuals trying to manage their weight. Twenty-nine obese adults who had completed 7–12 weeks of a community weight-loss programme were invited to use both tools for 2 weeks each, in a crossover design, with minimal health professional contact. A paper-based questionnaire was used to collect data on acceptance, perceived changes in portion size, frequency, and type of meal when the tool was used. Scores describing acceptance, ease of use and perceived effectiveness were derived from five-point Likert scales from which binary indicators (high/low) were analysed using logistic regression. Mean acceptance, ease of use and perceived effectiveness were moderate to high (3·7–4·4 points). Tool type did not have an impact on indicators of acceptance, ease of use and perceived effectiveness (P>0·32 for all comparisons); 55 % of participants used the CS on most days v. 21 % for the SS. The CS was used for all meals, whereas the SS was mostly used for evening meals. Self-selected portion sizes increased for vegetables and decreased for chips and potatoes with both tools. Participants rated both tools as equally acceptable, easy to use and with similar perceived effectiveness. Formal trials to evaluate the impact of such tools on weight control are warranted.

To validate digitally displayed photographic portion-size estimation aids (PSEA) against a weighed meal record and compare findings with an atlas of printed photographic PSEA and actual prepared-food PSEA in a low-income country. Participants served themselves water and five prepared foods, which were weighed separately before the meal and again after the meal to measure any leftovers. Participants returned the following day and completed a meal recall. They estimated the quantities of foods consumed three times using the different PSEA in a randomized order. Two urban and two rural communities in southern Malawi. Women (n 300) aged 18-45 years, equally divided by urban/rural residence and years of education (≤4 years and ≥5 years). Responses for digital and printed PSEA were highly correlated (>91 % agreement for all foods, Cohen's κw = 0·78-0·93). Overall, at the individual level, digital and actual-food PSEA had a similar level of agreement with the weighed meal record. At the group level, the proportion of participants who estimated within 20 % of the weighed grams of food consumed ranged by type of food from 30 to 45 % for digital PSEA and 40-56 % for actual-food PSEA. Digital PSEA consistently underestimated grams and nutrients across foods, whereas actual-food PSEA provided a mix of under- and overestimates that balanced each other to produce accurate mean energy and nutrient intake estimates. Results did not differ by urban and rural location or participant education level. Digital PSEA require further testing in low-income settings to improve accuracy of estimations.

To validate a picture book for estimation of food portion sizes using two approaches: (i) 'perception' of food portions by comparison with a series of food photos; and (ii) 'conceptualization and memory', using the same photos to estimate the amount of served food one hour after self-served food portions. Each partner developed a country-specific picture book based on the so-called EPIC-Soft picture book. Representative and common photo series were chosen achieving approximately 25 % of the original picture book (n 23). Three portions from each photo series were randomly selected. The study was performed within the Pilot study in the view of a Pan-European dietary survey - Adolescents, adults and elderly (PILOT-PANEU) project. A sample of adolescents and adults was recruited in five countries: Bulgaria (n 103), Finland (n 34), Germany (n 69), Hungary (n 62) and Portugal (n 77). Among the portions of the corresponding photo series and depending on the type of food, from 18 % (cheese) to 96 % (ratatouille) of participants chose the correct portions. In the perception study, agreement between the portions shown and reported was substantial (intraclass correlation coefficient (ICC)=0·805) and the mean difference was very low. In the memory study, agreement between the served and reported portions was lower than in the perception study (ICC=0·536). Agreement also seemed to decrease as the appearance of food on the plate differed from food in the picture. Overall, the picture series selected can be applied in future intake surveys to quantify foods similar to those depicted in the pictures.

Imaging-based methods of food portion size estimation (FPSE) promise higher accuracies compared to traditional methods. Many FPSE methods require dimensional cues (fiducial markers, finger-references, object-references) in the scene of interest and/or manual human input (wireframes, virtual models). This paper proposes a novel passive, standalone, multispectral, motion-activated, structured light-supplemented, stereo camera for food intake monitoring (FOODCAM) and an associated methodology for FPSE that does not need a dimensional reference given a fixed setup. The proposed device integrated a switchable band (visible/infrared) stereo camera with a structured light emitter. The volume estimation methodology focused on the 3-D reconstruction of food items based on the stereo image pairs captured by the device. The FOODCAM device and the methodology were validated using five food models with complex shapes (banana, brownie, chickpeas, French fries, and popcorn). Results showed that the FOODCAM was able to estimate food portion sizes with an average accuracy of 94.4%, which suggests that the FOODCAM can potentially be used as an instrument in diet and eating behavior studies.

Reducing food portion size could reduce energy intake. However, it is unclear at what point consumers respond to reductions by increasing intake of other foods. We predicted that a change in served portion size would only result in significant additional eating within the same meal if the resulting portion size was no longer visually perceived as ‘normal’. Participants in two crossover experiments (Study 1: n 45; Study 2: n 37; adults, 51 % female) were served different-sized lunchtime portions on three occasions that were perceived by a previous sample of participants as ‘large-normal’, ‘small-normal’ and ‘smaller than normal’, respectively. Participants were able to serve themselves additional helpings of the same food (Study 1) or dessert items (Study 2). In Study 1 there was a small but significant increase in additional intake when participants were served the ‘smaller than normal’ compared with the ‘small-normal’ portion ( m difference = 161 kJ, P = 0·002, d = 0·35), but there was no significant difference between the ‘small-normal’ and ‘large-normal’ conditions ( m difference = 88 kJ, P = 0·08, d = 0·24). A similar pattern was observed in Study 2 ( m difference = 149 kJ, P = 0·06, d = 0·18; m difference = 83 kJ, P = 0·26, d = 0·10). However, smaller portion sizes were each associated with a significant reduction in total meal intake. The findings provide preliminary evidence that reductions that result in portions appearing ‘normal’ in size may limit additional eating, but confirmatory research is needed.

The consumption of larger portion sizes (PS) of food has been implicated in the increased prevalence of childhood obesity. The home is usually the first place children learn about food, however, little is known about how parents determine child PS in the home environment. This narrative review aimed to explore parental beliefs, decisions, strategies and barriers to the provision of appropriate food PS for children in the home environment. Results indicate that parental decisions on child food PS are based on the amounts they serve themselves, personal intuition and knowledge of child appetite. Owing to the habitual nature of food provision, parental decisions on child PS may be taken without conscious thought and/or could be part of a complex decision-making process influenced by several interlinked factors, including parental childhood mealtime experiences, other family members and child weight status. Strategies to determine child-appropriate PS include modelling the desired PS behaviour, use of unit-based food packaging and PS estimation aids, and providing the child with a degree of autonomy to rely on their own appetite cues. A lack of knowledge/awareness of PS guidance is a key barrier identified by parents to the provision of age-appropriate PS, warranting the inclusion of salient child-appropriate PS guidance within national dietary recommendations. Further home-based interventions to improve the provision of appropriate child PS are required, leveraged on parental strategies already in use, as outlined in this review.

Introduction Large meal portions contribute to the rise in Body Mass Index (BMI) leading to higher burden of Non-Communicable Diseases (NCDs), especially among the youths. College students frequently exhibit poor dietary habits; thus, it is important to pay attention to their eating habits in order to lower their risk for NCD. Therefore, we conducted this study with objective to measure the effect of health promotion intervention for small portion size consumption behaviour on body mass index (BMI) among college students in Chandigarh, India. Methods We conducted this quasi-experimental research among college students aged 18–21 years from two colleges with co-education, having same streams considered as intervention and control from 2019 to 2020. Motivating group therapy, individual counselling, classroom training including power point presentations, lectures, and messaging via WhatsApp were implemented to the intervention group. No intervention was applied to the control group. Results Overall, the mean BMI decreased in the both the intervention ( n  = 149) and control groups ( n  = 142) between the baseline and 6 months post intervention follow up period. The difference in difference (DID) of mean using paired t-test analysis showed that the estimated difference between the two groups was statistically significant for BMI (0.21; 95% CI 0.117–0.244; p-value < 0.001) and for waist hip ratio (0.02; 95% CI 0.001–0.005; p-value 007). There was reduction of 8.1% (from 28.9 to 20.8%) in obese, while 2.7% (from 44.3 to 47.0%) increase in participants with normal BMI in intervention. On the contrary there was almost no change in the proportion of obese and overweight participants in control group after 6 months. Conclusion Considering the higher surge of obesity especially among the Indian youths, this study provided significant contribution in the field of public health in view of effective health promotion intervention to reduce BMI levels, by which get hold of the rising trend of this alarming problem. We recommend pragmatic community level large scale randomised control trials with frequent and controlled follow up to generate further evidence.

Background Portion size education tools, aids and interventions can be effective in helping prevent weight gain. However consumers have difficulties in estimating food portion sizes and are confused by inconsistencies in measurement units and terminologies currently used. Visual cues are an important mediator of portion size estimation, but standardized measurement units are required. In the current study, we present a new food volume estimation tool and test the ability of young adults to accurately quantify food volumes. The International Food Unit™ (IFU™) is a 4x4x4 cm cube (64cm 3 ), subdivided into eight 2 cm sub-cubes for estimating smaller food volumes. Compared with currently used measures such as cups and spoons, the IFU™ standardizes estimation of food volumes with metric measures. The IFU™ design is based on binary dimensional increments and the cubic shape facilitates portion size education and training, memory and recall, and computer processing which is binary in nature. Methods The performance of the IFU™ was tested in a randomized between-subject experiment ( n  = 128 adults, 66 men) that estimated volumes of 17 foods using four methods; the IFU™ cube, a deformable modelling clay cube, a household measuring cup or no aid (weight estimation). Estimation errors were compared between groups using Kruskall-Wallis tests and post-hoc comparisons. Results Estimation errors differed significantly between groups (H(3) = 28.48, p  < .001). The volume estimations were most accurate in the group using the IFU™ cube (Mdn = 18.9%, IQR = 50.2) and least accurate using the measuring cup (Mdn = 87.7%, IQR = 56.1). The modelling clay cube led to a median error of 44.8% (IQR = 41.9). Compared with the measuring cup, the estimation errors using the IFU™ were significantly smaller for 12 food portions and similar for 5 food portions. Weight estimation was associated with a median error of 23.5% (IQR = 79.8). Conclusions The IFU™ improves volume estimation accuracy compared to other methods. The cubic shape was perceived as favourable, with subdivision and multiplication facilitating volume estimation. Further studies should investigate whether the IFU™ can facilitate portion size training and whether portion size education using the IFU™ is effective and sustainable without the aid. A 3-dimensional IFU™ could serve as a reference object for estimating food volume.

Background Smaller portions may help to reduce energy intake. However, there may be a limit to the magnitude of the portion size reduction that can be made before consumers respond by increasing intake of other food immediately or at later meals. We tested the theoretical prediction that reductions to portion size would result in a significant reduction to daily energy intake when the resulting portion was visually perceived as ‘normal’ in size, but that a reduction resulting in a ‘smaller than normal’ portion size would cause immediate or later additional eating. Methods Over three 5-day periods, daily energy intake was measured in a controlled laboratory study using a randomized crossover design ( N  = 30). The served portion size of the main meal component of lunch and dinner was manipulated in three conditions: ‘large-normal’ (747 kcal), ‘small-normal’ (543 kcal), and ‘smaller than normal’ (339 kcal). Perceived ‘normality’ of portion sizes was determined by two pilot studies. Ad libitum daily energy intake from all meals and snacks was measured. Results Daily energy intake in the ‘large-normal’ condition was 2543 kcals. Daily energy intake was significantly lower in the ‘small-normal’ portion size condition ( mean difference − 95 kcal/d, 95% CI [− 184, − 6], p =  .04); and was also significantly lower in the ‘smaller than normal’ than the ‘small-normal’ condition ( mean difference − 210 kcal/d, 95% CI [− 309, − 111], p  < .001). Contrary to predictions, there was no evidence that the degree of additional food consumption observed was greater when portions were reduced past the point of appearing normal in size. Conclusions Reductions to the portion size of main-meal foods resulted in significant decreases in daily energy intake. Additional food consumption did not offset this effect, even when portions were reduced to the point that they were no longer perceived as being normal in size. Trial registration Prospectively registered protocol and analysis plan: https://osf.io/natws/ ; retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT03811210 .