Downsizing: using environmental prompts to understand healthy portion control and appropriate food servings in children, adolescents and caregivers

英国的国家调查数据显示，一些能量密集的食物（食物超过2.5千卡/克）的份量与超重和肥胖有关。习惯性和频繁地消耗能量密度高的物品有助于高的总能量摄入。特别是一些含糖饮料、咸味小吃、糖果和蛋糕的摄入量与体重增加有关。“部分扭曲”一词现在通常用来反映过去20年来家庭外提供的食物部分的变化。这指的是超大的普通膳食和零食，如汉堡，比萨饼，软饮料，薯片和糖果，以及为适应这些大量食物以实现能量平衡所需的额外体力活动。超大型和改变预先包装的数量是重要的，因为消费者依赖于单位的大小，以指导摄入量。增加的份量以两种方式改变了吃多少-直接通过提供更多，消费者（包括儿童）吃得更多，间接通过将更大的量呈现为“标准”，因此这是消费者期望喝或吃的。因此，第一种碳酸糖甜味饮料的体积通常为8液量盎司（236 ml），但今天的瓶子可用于单份或更多的12液量盎司（~ 375 ml）。这些变化向消费者表明，现在的典型或正常食用量比以前更高。研究证实了“份量效应”，即当提供更多食物时，吃得更多或被认为是适当的一份。例如，大规模调查方法（例如，欧洲食品工业委员会关于欧洲13，000名消费者的报告）和小规模实验室实验证实了份量大小对食物摄入或自我选择服务的显著和可靠的影响。份量效应在成人和儿童身上都有体现。然而，由于儿童和青少年通过沿着对这些食物的饱腹感反应来了解适当的份量，因此可以通过学习来改变适当的份量。学习是关键的心理过程，儿童通过学习了解适合文化的饮食习惯，包括进餐和零食的频率，以及家庭环境中食物的种类和数量。该提案旨在通过测试各种环境策略来挑战份量效应，以“缩小”提供给婴儿并由学龄前儿童和青少年选择的份量。第一项研究将记录提供给24- 36岁婴儿的高能量零食的典型份量，然后在一项试点随机对照试验（RCT）中测试替代或减少这些食物的份量的影响。第二项研究将涉及系统地改变膳食项目的数量在托儿所使用品种和适口性，以抵消部分大小的影响，自我服务的金额在学龄前儿童。第三项研究探讨了使用社交媒体和数字技术来分享社会规范的可行性和可接受性。第四项研究使用直接观察的家庭与婴儿和学龄前儿童，以确定包装解决方案相匹配的家庭需要，以调整部分大小的家庭成员。该项目的最后一部分将提供证据，以建议家庭、儿童保育工作者、医疗保健专业人员、行业和政策制定者等利益相关者可以采用精简战略来支持健康部分控制。基于证据的策略将包括使用智能包装，小容器和视觉提示的方法，以减少HED零食和膳食的摄入量;并鼓励摄入高饮食质量的LED食品，如水果和蔬菜。

National survey data for the UK shows that portion sizes of some energy dense foods (foods more than 2.5kcal/g) are associated with overweight and obesity. Habitual and frequent consumption of items which are high in energy density contributes to a high total energy intake. In particular intakes of some sugar sweetened drinks, savoury snacks, confectionery and cakes are associated with higher body weights. The term "portion distortion" is now commonly used to reflect changes in portions of foods offered outside the home over the last 20 years. This refers to both the supersizing of common meal and snack items such as burgers, pizzas, soft drinks, crisps and sweets and the additional physical activity required to accommodate these large amounts to achieve energy balance. Supersizing and changes to pre-packaged quantities are important since consumers rely on unit size to guide intake. Increased portion sizes alter how much is eaten in two ways - directly by providing more, consumers (including children) eat more and indirectly by presenting larger amounts as "normative", so this is what consumers expect to drink or eat. Thus the first carbonated sugar sweetened beverage volume was typically 8 fluid ounces (236ml) but today bottles are available in 12 fluid ounce (~375ml) for a single serving or greater. These changes suggest to the consumer that the typical or normal serving size is higher now than before. The "portion size effect" where more is eaten or identified as an appropriate serving when more is offered has been confirmed by research. For example large scale survey methods (e.g. the EUFIC report on 13,000 consumers in Europe) and small scale laboratory experiments confirm a significant and reliable effect of portion size on food intake or self selected serving. The portion size effect has been seen in adults and children. However since children and adolescents learn about the appropriate portion size from what it served to them along with satiety responses developed to these foods over time, establishing appropriate portions is modifiable through learning. Learning is the key psychological process by which children understand culturally appropriate food habits, including meal and snack frequency, types and amounts of foods within their home environment. This proposal sets out to challenge the portion size effect by testing a variety of environmental strategies to "downsize" portions offered to infants and selected by pre-schoolers and adolescents. The first study will record typical portion sizes of high energy snacks offered to infants aged 24-36m then test the effect of replacing or reducing portions served of these foods within a pilot randomised control trial (RCT). The second study will involve systematically changing meal item amounts served in nurseries using variety and palatability to offset the portion size effect on self served amounts in pre-schoolers. The third study examines the feasibility and acceptability of using "nudging" to promote smaller portions of snacks in adolescents using social media and digital technologies for sharing social norms of portions. The fourth study uses direct observations in households with infants and pre-schoolers to identify packaging solutions matched to family needs to adjust portion sizes for family members. The final part of the project will provide evidence to recommend ways that stakeholders such as families, childcare workers, healthcare professionals, industry and policymakers can apply downsizing strategies to support healthy portion control. The evidence based strategies will include ways to use smart packaging, small containers and visual cues to reduce intake of HED snacks and meal items; and to encourage intake of LED foods, high in dietary quality such as fruits and vegetables.