Portion Distortion: How much your child eats can be as important as what he eats

Written by Josh Eberhard, DO 

One of my favorite comedians is Brian Regan. One of his skits involves talking about serving sizes. He says he was trying to watch what he was eating by reading food labels. He looked at a serving size for Fig Newtons, and it said two cookies.

“Two cookies,” says Regan. “Who the heck only eats two cookies?! I eat Fig Newtons by the sleeve!”

He later talks about the serving size of ice cream.

“The serving size of ice cream is half a cup. What is that? My serving size of ice cream is when you hear the spoon hit the bottom of the container!”

It is a funny skit, but unfortunately a lot of us can relate all too well. We can easily find where it says how many calories are in a serving, but we usually skip the serving size.

Sometimes it’s because we assume what we’re getting is one serving. I’ve seen a 20-ounce bottle of soda boast 120 calories per serving, but on the back it says 2 servings per bottle. Who shares a 20- ounce bottle of soda with someone else?

But I think a bigger reason is because it’s hard to picture in our mind what an actual serving is. This is for two reasons: One, it’s hard to imagine “28 grams” of chips or “5 oz” of broccoli. Is a “cup” of juice a measuring cup or a drinking cup? Second, portion sizes given to us have gotten so large that if we saw the actual recommended serving size, we would laugh just like Brian Regan did. We’re used to big portions!

Portion sizes have grown, along with our waistlines

In 1985, the average bagel was 3 inches in diameter. Today, bagels are about 6 inches in diameter. It’s basically double the size, but still just one bagel! A large soda from a fast food restaurant usually has about 32 ounces. But it’s just one “cup,” so we naturally think that the whole thing is “just for me.” But if I were supposed to share my 20 oz bottle with one person, how many people could I share my large with?

Hamburgers are also bigger now than in 1985. And when you go out to eat, most restaurants fill your plate with food. But if you were to go to a restaurant and get the recommended serving size portions, you would probably feel ripped off and ask for your money back!

Most of us think that a serving size is how much it takes to fill us up.

Obviously I’m talking about “portion distortion” because of the obesity epidemic that our country is currently facing. As of 2012, approximately 17% of children aged 2 to 19 years were obese. Adult obesity rates are worse, over 25%.

How to know if your child is overweight or obese

In children, obesity is defined using a growth curve and percentiles. If a child is in the 85^th to 95^th percentile, they are considered overweight. Any child above the 95^th percentile is considered obese. When I show parents where their child is on the growth curve, I show them how much their child should weigh based on their age (this should be close to the 50^th percentile).

However, I often reverse the data, showing them how old their child could be based on their weight. In other words, if I were seeing a 5-year-old who weighed 55 pounds, he would be above the 95^th percentile, making him obese. But when looking at the growth curve where 55 pounds is at the 50^th percentile, this occurs at 8 years old, meaning the average 8-year-old should weigh 55 pounds. This child is 3 years heavier than he should be.

What causes a child to become overweight and what can we do about it?

There are many factors contributing to obesity, including eating unhealthy food, lack of physical activity, and genetic factors. There are many consequences of obesity, most significant is the risk for diabetes and other health issues as an adult.

Many parents are aware of the problems, recognize when their child is heavy, and try to implement changes. But I’ve had lots of parents come back to the office and say they’ve eliminated soda, they’re eating healthy, and they’ve increased the child’s physical activity, but are still struggling to lose (or even just maintain) weight. Sometimes an aspect that they are missing is the portion size of the “healthy” food the child is consuming. Even though it is better for them, it still might be too much.

So what are you as the parent to do? Meticulously add each calorie? Take a scale with you wherever you go to measure out the portion size? Never eat out again? These strategies might work, but usually aren’t sustainable. There is a simpler way to start that I suggest to my parents.

Write it down

First, I encourage them to keep a food diary for the child for just three days, including one weekend day. During this time just observe and be as accurate and detailed as possible. Write it down in the moment. Be a little obsessive- it’s only for 3 days! Don’t make any modifications, just be honest. Sometimes you will pick up that the child is actually having more unhealthy snacks or beverages than you originally thought. Often, you will realize how much the child really does consume. A food diary is a great way to find where changes can be made.

Address the portion size

Next, if portion control is an issue, there are simple ways to reduce sizes that might be easier than measuring everything out. For example, have the child eat with a smaller plate. A big plate with an appropriate amount of food will look like you aren’t getting enough, so a smaller plate will tell the mind it’s enough.

Also, compare the portion your child is receiving to the portion you are having. Your 10-year-old shouldn’t be eating as much as you! If you eat out, order one meal for two people or ask for a “to go” box as soon as your food gets there and put half of it away before you even start eating. This will also help save you money!

Remember that you aren’t eating to get full, you’re eating to satisfy your hunger.

Portion control isn’t the secret to maintaining a healthy weight; a healthy lifestyle includes eating healthy food and incorporating physical activity. But being mindful of the amount of food is an important part of the equation.