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Context: Reward-based eating is a trait that increases risk for eating in the absence of hunger (EAH) and obesity. Eating behaviors such as switching more frequently between different foods may increase intake during EAH by delaying the onset of sensory-specific satiation (SSS); however, this question has not been empirically tested., Objectives: 1) Test whether switching between foods mediates the relationship between reward-based eating and EAH intake. 2) Test whether switching between foods during EAH moderates the relationship between reward-based eating and weight status., Methods: Data were analyzed from a study assessing decision-making in children (n = 63 children; 9.4 ± 1.4 years, 77.0 ± 22.4 BMI%tile). Reward-based eating was quantified using the Children's Eating Behaviour Questionnaire. EAH was assessed as the amount of palatable food consumed following ad libitum consumption of a standard meal. Videos of eating behavior were coded for eating time, number of different foods consumed, and food switches. Ordinary least squares regressions were conducted to test hypotheses., Results: Switching was positively associated with EAH intake for both kcal (p < 0.01) and grams (p < 0.01) such that each additional switch was associated with an increased intake of 17.0 kcal or 3.5 gs. Switching mediated the relationship between reward-based eating and EAH (p < 0.01) such that more frequent switching fully accounted for the positive association between reward-based eating and EAH (ps < 0.01). While reward-based eating was also positively associated with weight status (p < 0.01), this association was moderated by food switching (p < 0.01) such that the relationship was stronger for children who switch more frequently (p < 0.01)., Conclusions: Frequent switching between foods was positively associated with EAH intake and mediated the relationship between reward-based eating and EAH. Moreover, reward-based eating was more strongly related to weight status in children who switched more frequently. Thus, food switching may contribute to overconsumption and be an important behavioral indicator of increased obesity risk in children. Studies across multiple meals and contexts will help determine if switching is a reliable behavioral phenotype., Competing Interests: Declarations of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Following a 1-year randomized controlled trial that tested how weight loss was influenced by different targeted strategies for managing food portions, we evaluated whether the effect of portion size on intake in a controlled setting was attenuated in trained participants compared to untrained controls. Subjects were 3 groups of women: 39 participants with overweight and obesity from the Portion-Control Strategies Trial, 34 controls with overweight and obesity, and 29 controls with normal weight. In a crossover design, on 4 different occasions subjects were served a meal consisting of 7 foods that differed in energy density (ED). Across the meals, all foods were varied in portion size (100%, 125%, 150%, or 175% of baseline). The results showed that serving larger portions increased the weight and energy of food consumed at the meal (P < .0001), and this effect did not differ across groups. Increasing portions by 75% increased food intake by a mean (±SEM) of 111 ± 10 g (27%) and increased energy intake by 126 ± 14 kcal (25%). Across all meals, however, trained participants had lower energy intake (506 ± 15 vs. 601 ± 12 kcal, P = .006) and lower meal ED (1.09 ± 0.02 vs. 1.27 ± 0.02 kcal/g; P = .003) than controls, whose intake did not differ by weight status. The lower energy intake of trained participants was attributable to consuming meals with a greater proportion of lower-ED foods than controls. These results further demonstrate the robust nature of the portion size effect and reinforce that reducing meal ED is an effective way to moderate energy intake in the presence of large portions., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: Recent public health messages have advised consumers to lower dietary energy density (ED) for weight management, but it is not known whether the proportion of the diet from low-ED foods is related to weight status. In a nationally representative sample of US adults, we evaluated whether the proportions of dietary energy intake contributed by low- and high-ED foods are associated with body mass index (BMI) and waist circumference (WC)., Methods: Data were from a cross-sectional sample of 9551 adults ≥18 years in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). ED (kcal/g) was calculated for each food item reported during a 24-h dietary recall; individual foods were divided into five ED categories: very low ED (<0.6 kcal/g), low ED (0.6-1.5 kcal/g), medium ED (1.51-2.25 kcal/g), high ED (2.26-4.0 kcal/g), and very high ED (>4.0 kcal/g). The percentages of total energy and the food weight from each category were evaluated by BMI and WC after controlling for total energy intake and other covariates., Results: Men classified as lean (BMI < 25 kg/m 2 ) reported consuming a greater proportion of total energy from very low- and low-ED foods (7.2 % very low and 23.3 % low ), compared to men considered obese ((BMI > 30 kg/m 2 ); 5.2 % very low and 20.1 low  %; p-trends <0.001 very low , 0.002 low ). Similarly, women classified as lean reported intakes of very low-ED foods of 7.8 % (vs. 6.4 % for women with obesity) of total energy and low-ED foods of 24.7 % (vs. 21.5 % for women with obesity) of total energy (p-trends 0.007 very low , 0.004 low ). Men and women with obesity reported greater proportions of energy from high-ED foods (45.9 % men with obesity vs. 42.4 % lean men , 44.2 % women with obesity vs. 39.9 % lean women ) with significant statistical trends (men = 0.008, women = 0.0005). Similar patterns were observed for intakes of proportions of very low-, low-, and high-ED foods and WC., Conclusion: Higher proportions of energy intake and food weight contributed by very low- and low-ED foods are associated with lower BMI (and WC).

Several dietary patterns, both macronutrient and food based, can lead to weight loss. A key strategy for weight management that can be applied across dietary patterns is to reduce energy density. Clinical trials show that reducing energy density is effective for weight loss and weight loss maintenance. A variety of practical strategies and tools can help facilitate successful weight management by reducing energy density, providing portion control, and improving diet quality. The flexibility of energy density gives patients options to tailor and personalize their dietary pattern to reduce energy intake for sustainable weight loss., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: During a one-year weight loss trial, we compared the Three-Factor Eating Questionnaire (TFEQ), a valid 51-item measure of restraint, disinhibition, and hunger subscales, with the newer 16-item Weight-Related Eating Questionnaire (WREQ) measuring routine and compensatory restraint and external and emotional eating., Methods: Both questionnaires were administered to women with overweight or obesity (n = 186, mean ± SD, age 50 ± 10.6 y, BMI 34 ± 4.2 kg/m 2 ) at five time points. Completion rates were 100% at baseline and Month 1, 94% at Month 3, 83% at Month 6, and 76% at Month 12. Confirmatory factor analysis was conducted on baseline WREQ data and correlations were calculated between TFEQ and WREQ subscales. Multilevel models evaluated the relationship between each subscale and weight change over time., Results: Factor analysis revealed a WREQ structure consistent with previous research, and corresponding subscales on the TFEQ and WREQ were correlated. Lower baseline TFEQ restraint predicted greater weight loss. Across five administrations, TFEQ and WREQ restraint scores were positively related to weight loss (p < 0.01) and TFEQ disinhibition and WREQ external and emotional eating scores were negatively related (p < 0.001). Thus, with one baseline administration, only TFEQ restraint was significantly related to weight change, but multiple administrations showed relationships between all TFEQ and WREQ subscales and weight change., Conclusions: The WREQ offers a shorter alternative to the TFEQ when repeatedly assessing eating behaviors related to weight change., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: Binge eating disorder (BED) is strongly associated with obesity and related medical and psychiatric morbidities. Cognitive behavioral therapy (CBT) has consistently been shown to reduce binge eating frequency and improve psychological functioning, as well as to produce abstinence rates of roughly 50%. This study examined the relationship between binge abstinence and dietary and psychological outcomes after CBT for BED., Methods: Fifty adult patients with BED received 6-month treatments using a combination of CBT and dietary counseling. Trained interviewers conducted two 24-hour dietary recall interviews on randomly selected days at baseline and at 6 months., Results: Participants had significant reductions in energy, macronutrient, and sugar intake and an increase in fruit intake. They reported significant reductions in BMI and binge eating frequency (from mean = 14.24 to mean = 1.90 binge eating episodes during the previous 28 days), as well as improvements in psychological functioning. Those who became binge abstinent reported eating roughly 400 fewer calories per day and experienced greater improvements in psychological functioning than those who did not., Conclusions: Findings from this study suggest that individuals who achieve complete cessation from binge eating have significantly improved dietary and psychological outcomes that could potentially improve weight status, compared with those who continue to binge eat post-treatment., Competing Interests: The authors declared no conflict of interest., (© 2016 The Obesity Society.)

Purpose: Given the current prevalence of obesity, it is important to identify dietary factors that may aid in disease prevention. The objective of the present study was to evaluate the association between consumption of an energy-dense diet and established markers factors for chronic disease, including body weight and measures of body fatness., Methods: Data from a nationally representative sample of 9,551 adults ≥18 years who participated in the 2005-2008 National Health and Nutrition Examination Survey were analyzed. The association between dietary energy density (ED, energy per weight of food, kcal/g) and markers for obesity [including body mass index (BMI) and waist circumference (WC)], insulin insensitivity [including fasting glucose, insulin and homeostasis assessment model for insulin resistance (HOMA-IR)], and markers for inflammation was examined., Results: Dietary ED was positively associated with obesity in both men and women in multivariate models. Overall, obese adults had a significantly higher dietary ED than lean adults (p < 0.0001). Current smokers had significantly higher ED than non-smokers (2.00 vs. 1.75, p < 0.01), and it was determined that smoking status modified the relationship between ED and weight status in women (p interaction 0.03). In both sexes, there was a positive linear relationship between BMI and ED (p trend 0.01 and 0.0002, respectively); a linear trend between WC and ED was also observed in women (p trend <0.001) after adjusting for relevant cofactors. In women, ED was positively associated with HOMA-IR and fasting insulin; though, this relationship was not observed in men. No significant associations between ED and C-reactive protein were observed in either sex., Conclusion: These findings support recent obesity and disease prevention recommendations to consume a diet low in ED.

Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.

Objectives: The National Institutes of Health, led by the National Heart, Lung, and Blood Institute, organized a working group of experts to discuss the problem of weight regain after weight loss. A number of experts in integrative physiology and behavioral psychology were convened with the goal of merging their perspectives regarding the barriers to scientific progress and the development of novel ways to improve long-term outcomes in obesity therapeutics. The specific objectives of this working group were to: (1) identify the challenges that make maintaining a reduced weight so difficult; (2) review strategies that have been used to improve success in previous studies; and (3) recommend novel solutions that could be examined in future studies of long-term weight control., Results: Specific barriers to successful weight loss maintenance include poor adherence to behavioral regimens and physiological adaptations that promote weight regain. A better understanding of how these behavioral and physiological barriers are related, how they vary between individuals, and how they can be overcome will lead to the development of novel strategies with improved outcomes., Conclusions: Greater collaboration and cross-talk between physiological and behavioral researchers is needed to advance the science and develop better strategies for weight loss maintenance., (© 2014 The Obesity Society.)

Reducing dietary energy density (ED) promotes weight loss; however, underlying mechanisms are not well understood. The purpose of this study was to determine if low-ED diets facilitate weight loss through actions on ghrelin and peptide YY (PYY), independent of influences of psychosocial measures. Seventy-one obese women (BMI 30-40 kg/m(2)) ages 22-60 years received counseling to reduce ED. Fasting blood samples were analyzed for total ghrelin and total PYY by radioimmunoassay at months 0, 3, 6, and 12. Restraint, disinhibition, and hunger were assessed by the Eating Inventory. Body weight (-7.8 ± 0.5 kg), BMI (-2.9 ± 0.2 kg/m(2)), body fat (-3.0 ± 0.3%), and ED (-0.47 ± 0.05 kcal/g or -1.97 ± 0.21 kJ/g) decreased from months 0 to 6 (p<0.05) after which no change occurred from months 6 to 12. Ghrelin increased in a curvilinear fashion (month 0: 973 ± 39, month 3: 1024 ± 37, month 6: 1109 ± 44, and month 12: 1063 ± 45 pg/ml, p<0.001) and PYY increased linearly (month 0: 74.2 ± 3.1, month 3: 76.4 ± 3.2, month 6: 77.2 ± 3.0, month 12: 82.8 ± 3.2 pg/ml, p<0.001). ED, body weight, and hunger predicted ghrelin, with ED being the strongest predictor (ghrelin = 2674.8+291.6 × ED-19.2 × BW-15 × H; p<0.05). There was a trend toward a significant association between ED and PYY (PYY = 115.0-43.1 × ED; p = 0.05). Reductions in ED may promote weight loss and weight loss maintenance by opposing increases in ghrelin and promoting increases in PYY., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information., Methods: Using Internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions. We also examined facts that are well supported by evidence, with an emphasis on those that have practical implications for public health, policy, or clinical recommendations., Results: We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations., Conclusions: False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press. (Funded by the National Institutes of Health.).

Pre-portioned entrées are commonly consumed to help control portion size and limit energy intake. The influence of entrée characteristics on energy intake, however, has not been well studied. We determined how the effects of energy content and energy density (ED, kcal/g) of pre-portioned entrées combine to influence daily energy intake. In a crossover design, 68 non-dieting adults (28 men and 40 women) were provided with breakfast, lunch, and dinner on 1 day a week for 4 weeks. Each meal included a compulsory, manipulated pre-portioned entrée followed by a variety of unmanipulated discretionary foods that were consumed ad libitum. Across conditions, the entrées were varied in both energy content and ED between a standard level (100%) and a reduced level (64%). Results showed that in men, decreases in the energy content and ED of pre-portioned entrées acted independently and added together to reduce daily energy intake (both P < 0.01). Simultaneously decreasing the energy content and ED reduced total energy intake in men by 16% (445 ± 47 kcal/day; P < 0.0001). In women, the entrée factors also had independent effects on energy intake at breakfast and lunch, but at dinner and for the entire day the effects depended on the interaction of the two factors (P < 0.01). Simultaneously decreasing the energy content and ED reduced daily energy intake in women by 14% (289 ± 35 kcal/day; P < 0.0001). Both the energy content and ED of pre-portioned entrées affect daily energy intake and could influence the effectiveness of such foods for weight management.

The present study examined a dietary approach - lowering energy density - for producing weight loss in obese patients with binge eating disorder (BED) who also received cognitive-behavioral therapy (CBT) to address binge eating. Fifty consecutive participants were randomly assigned to either a six-month individual treatment of CBT plus a low-energy-density diet (CBT+ED) or CBT plus General Nutrition counseling not related to weight loss (CBT+GN). Assessments occurred at six- and twelve-months. Eighty-six percent of participants completed treatment, and of these, 30% achieved at least a 5% weight loss with rates of binge remission ranging from 55% to 75%. The two treatments did not differ significantly in weight loss or binge remission outcomes. Significant improvements were found for key dietary and metabolic outcomes, with CBT+ED producing significantly better dietary outcomes on energy density, and fruit and vegetable consumption, than CBT+GN. Reductions in energy density and weight loss were significantly associated providing evidence for the specificity of the treatment effect. These favorable outcomes, and that CBT+ED was significantly better at reducing energy density and increasing fruit and vegetable consumption compared to CBT+GN, suggest that low-energy-density dietary counseling has promise as an effective method for enhancing CBT for obese individuals with BED., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Strategies need to be developed to reduce preschool children's energy intake., Objective: To test the effect of reducing the energy density of an entrée on children's ad libitum energy intake., Subjects: Subjects were 2- to 5-year-old children (37 boys and 40 girls) in a university day-care facility., Intervention: In this within-subjects crossover study, children were served a test lunch once per week for 6 weeks. Two versions of a macaroni and cheese entrée were formulated to differ in energy density while maintaining similar palatability. Each version was served to children three times. The higher-energy-density entrée had 2.0 kcal/g and the other entrée was 30% lower in energy density. Lunch, consumed ad libitum, also included broccoli, applesauce, and milk., Main Outcome Measures: Food intake and energy intake were measured., Statistical Analyses: A mixed linear model tested effect of energy density of the entrée on food intake and energy intake. Results are reported as mean+/-standard error., Results: Decreasing the energy density of the entrée by 30% significantly (P<0.0001) reduced children's energy intake from the entrée by 25% (72.3+/-8.3 kcal) and total lunch energy intake by 18% (71.8+/-7.9 kcal). Children consumed significantly more of the lower-energy-density entrée (10.1+/-4.2 g; P<0.05). Children's sex-specific body mass index-for-age percentiles did not affect the relationship between energy density of the entrée and children's intakes., Conclusions: Decreasing the energy density of a lunch entrée resulted in a reduction in children's energy intake from the entrée and from the total meal. Reducing the energy density of foods may be an effective strategy to moderate children's energy intake.

Background: Portion size influences children's energy intakes at meals, but effects on daily intake are unknown., Objective: Effects of large portions on daily energy intake were tested in 5-y-old Hispanic and African American children from low-income families. Maternal food intake data were collected to evaluate familial susceptibility to portion size., Design: A within-subjects experimental design with reference and large portion sizes was used in a study of 59 low-income Hispanic and African American preschool-aged children and their mothers. The portion size of 3 entrées (lunch, dinner, and breakfast) and an afternoon snack served during a 24-h period were of a reference size in one condition and doubled in the other condition. Portion sizes of other foods and beverages did not vary across conditions. Weighed food intake, anthropometric measures, and self-reported data were obtained., Results: Doubling the portion size of several entrées and a snack served during a 24-h period increased energy intake from those foods by 23% (180 kcal) among children (P < 0.0001) and by 21% (270 kcal) among mothers (P < 0.0001). Child and maternal energy intakes from other foods for which portion size was not altered did not differ across conditions. Consequently, total energy intakes in the large-portion condition were 12% (P < 0.001) and 6% (P < 0.01) higher in children and mothers, respectively, than in the reference condition. Child and maternal intakes of the portion-manipulated foods were not correlated., Conclusions: Large portions may contribute to obesigenic dietary environments by promoting excess daily intakes among Hispanic and African American children.

This study establishes the reliability and validity of the Fat Preference Questionnaire, a self-administered instrument to assess preference for dietary fat. Respondents select the food which tastes better and is eaten more frequently from 19 sets of food. Each set is comprised of related foods differing in fat content. The questionnaire was administered to women in laboratory-based (n=63), cross-sectional (n=150), and weight-loss (n=71) studies. The percentage of food sets in which high-fat foods were reported to "taste better" (TASTE score) and to be "eaten more often" (FREQ score) was determined. A measure of dietary fat restriction (DIFF) was created by subtracting TASTE from FREQ. Food intake was assessed by direct measure, 24-h recall, or food diary. Additionally, participants completed a standard survey assessing dietary restraint. Test-retest correlations were high (r=0.75-0.94). TASTE and FREQ scores were positively correlated with total fat intake (r=0.22-0.63). DIFF scores positively correlated with dietary restraint (r=0.39-0.52). Participants in the weight-loss trial experienced declines in fat consumption, TASTE and FREQ scores, and BMI values, and an increase in DIFF scores. Weight loss correlated with declines in FREQ (r=0.36) scores and increases in DIFF scores (r=-0.35). These data suggest that preference for dietary fat declines when following a reduced-fat diet and an increase in restraint for intake of dietary fat is important for weight loss. The Fat Preference Questionnaire is a stable, easily-administered instrument that can be used in research and clinical settings.

Background: Consuming foods low in energy density (kcal/g) decreases energy intake over several days, but the effectiveness of this strategy for weight loss has not been tested., Objective: The effects on weight loss of 2 strategies for reducing the energy density of the diet were compared over 1 y., Design: Obese women (n = 97) were randomly assigned to groups counseled either to reduce their fat intake (RF group) or to reduce their fat intake and increase their intake of water-rich foods, particularly fruit and vegetables (RF+FV group). No goals for energy or fat intake were assigned; the subjects were instructed to eat ad libitum amounts of food while following the principles of their diet., Results: After 1 y, study completers (n = 71) in both groups had significant decreases in body weight (P < 0.0001). Subjects in the RF+FV group, however, had a significantly different pattern of weight loss (P = 0.002) than did subjects in the RF group. After 1 y, the RF+FV group lost 7.9 +/- 0.9 kg and the RF group lost 6.4 +/- 0.9 kg. Analysis of all randomly assigned subjects also showed a different pattern of weight loss between groups (P = 0.021). Diet records indicated that both groups had similar reductions in fat intake. The RF+FV group, however, had a lower dietary energy density than did the RF group (P = 0.019) as the result of consuming a greater weight of food (P = 0.025), especially fruit and vegetables (P = 0.037). The RF+FV group also reported less hunger (P = 0.003)., Conclusion: Reducing dietary energy density, particularly by combining increased fruit and vegetable intakes with decreased fat intake, is an effective strategy for managing body weight while controlling hunger.

Background: Dietary energy density (ED) reductions are associated with energy intake (EI) reductions. Little is known about influences on body weight (BW)., Objectives: We examined the effects of behavioral interventions on ED values and explored how 6-mo ED changes relate to BW., Design: Prehypertensive and hypertensive persons were randomly assigned to 1 of 3 groups: the established group received an 18-session intervention implementing well-established hypertension recommendations (eg, weight loss, sodium reduction, and physical activity), the established+Dietary Approaches to Stop Hypertension (DASH) group received an 18-session intervention also implementing the DASH diet, and the advice group received 1 session on these topics. Two 24-h dietary recalls were collected (n=658)., Results: Each group had significant declines in EI, ED, and BW. The established and established+DASH groups had the greatest EI and BW reductions. The established+DASH group had the greatest ED reduction and the greatest increase in the weight of food consumed. When groups were combined and analyzed by ED change tertiles, participants in the highest tertile (ie, largest ED reduction) lost more weight (5.9 kg) than did those in the middle (4.0 kg) or lowest (2.4 kg) tertile. Participants in the highest and middle tertiles increased the weight of food they consumed (300 and 80 g/d, respectively) but decreased their EI (500 and 250 kcal/d). Conversely, those in the lowest tertile decreased the weight of food consumed (100 g/d), with little change in EI. The highest and middle tertiles had favorable changes in fruit, vegetable, vitamin, and mineral intakes., Conclusion: Both large and modest ED reductions were associated with weight loss and improved diet quality.

Objective: We tested the effect on energy intake of increasing the portion size of all foods and beverages served over 2 consecutive days., Design: The study used a randomized crossover design., Subjects/setting: Subjects were 32 adults from a university community., Intervention: For 2 consecutive days in each of 3 weeks, subjects ate their main meals in a controlled setting and were given snacks for consumption between meals. We used the same two daily menus each week, but varied the portion sizes of all foods and beverages served in a given week (either 100%, 150%, or 200% of baseline amounts)., Main Outcome Measures: Energy intake and ratings of hunger and satiety were measured., Statistical Analyses Performed: A linear mixed model with repeated measures was used., Results: There was a significant effect of portion size on energy intake in both men and women (P<0.0001). Increasing portions by 50% increased daily energy intake by 16% (women: 335 kcal/day; men: 504 kcal/day), and increasing portions by 100% increased intake by 26% (women: 530 kcal/day; men: 812 kcal/day). Energy intake did not differ between the 2 days of each week. Daily ratings of fullness were lowest in the 100% portion condition (P=0.0004), but did not differ significantly in the 150% and 200% conditions., Conclusions: Increasing the portion size of all foods resulted in a significant increase in energy intake that was sustained over 2 days. These data support suggestions that large portions are associated with excess energy intake that could contribute to increased body weight.

Background: When the portion size and energy density (in kcal/g) of a food are varied simultaneously in a single meal, each influences energy intake independently., Objective: We aimed to determine how the effects of portion size and energy density combine to influence energy intake and satiety over multiple meals for 2 d., Design: In a crossover design, 24 young women were provided with meals and snacks for 2 consecutive days per week for 4 wk; all foods were consumed ad libitum. Across the 4 sessions, the subjects were served the same 2 daily menus, but all foods were varied in portion size and energy density between a standard level (100%) and a reduced level (75%)., Results: Reducing the portion size and energy density of all foods led to significant and independent decreases in energy intake over 2 d (P < 0.0001). A 25% decrease in portion size led to a 10% decrease in energy intake (231 kcal/d), and a 25% decrease in energy density led to a 24% decrease in energy intake (575 kcal/d). The effects on energy intake were additive and were sustained from meal to meal. Despite the large variation in energy intake, there were no significant differences in the ratings of hunger and fullness across conditions over the 2 d., Conclusions: Reductions in portion size and energy density independently decreased ad libitum energy intake in women when commonly consumed foods were served over 2 d. Reductions in both portion size and energy density can help to moderate energy intake without increased hunger.

The increase in the prevalence of obesity has coincided with an increase in portion sizes of foods both inside and outside the home, suggesting that larger portions may play a role in the obesity epidemic. Although it will be difficult to establish a causal relationship between increasing portion size and obesity, data indicate that portion size does influence energy intake. Several well-controlled, laboratory-based studies have shown that providing older children and adults with larger food portions can lead to significant increases in energy intake. This effect has been demonstrated for snacks and a variety of single meals and shown to persist over a 2-d period. Despite increases in intake, individuals presented with large portions generally do not report or respond to increased levels of fullness, suggesting that hunger and satiety signals are ignored or overridden. One strategy to address the effect of portion size is decreasing the energy density (kilojoules per gram; kilocalories per gram) of foods. Several studies have demonstrated that eating low-energy-dense foods (such as fruits, vegetables, and soups) maintains satiety while reducing energy intake. In a clinical trial, advising individuals to eat portions of low-energy-dense foods was a more successful weight loss strategy than fat reduction coupled with restriction of portion sizes. Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while restricting energy intake for weight management.

Objective: The energy density (kilocalories per gram) of foods influences short-term energy intake. This 1-year clinical trial tested the effect on weight loss of a diet incorporating one or two servings per day of foods equal in energy but differing in energy density., Research Methods and Procedures: Dietitians instructed 200 overweight and obese women and men to follow an exchange-based energy-restricted diet. Additionally, subjects were randomized to consume daily either one or two servings of low energy-dense soup, two servings of high energy-dense snack foods, or no special food (comparison group)., Results: All four groups showed significant weight loss at 6 months that was well maintained at 12 months. The magnitude of weight loss, however, differed by group (p=0.006). At 1 year, weight loss in the comparison (8.1+/-1.1 kg) and two-soup (7.2+/-0.9 kg) groups was significantly greater than that in the two-snack group (4.8+/-0.7 kg); weight loss in the one-soup group (6.1+/-1.1 kg) did not differ significantly from other groups. Weight loss was significantly correlated with the decrease in dietary energy density from baseline at 1 and 2 months (p=0.0001) but not at 6 and 12 months., Discussion: On an energy-restricted diet, consuming two servings of low energy-dense soup daily led to 50% greater weight loss than consuming the same amount of energy as high energy-dense snack food. Regularly consuming foods that are low in energy density can be an effective strategy for weight management.

A growing body of laboratory-based, clinical, and epidemiological data suggests that low-energy-dense diets are associated with better diet quality, lower energy intakes, and body weight. Dietary energy density can be lowered by adding water-rich fruits, vegetables, cooked grains, and soups to the diet, and by reducing the diet's fat content. Low-energy-dense diets can be successfully incorporated into clinical dietetics since they help lower energy intake without reducing food volume and thus help individuals avoid feeling hungry and deprived. There are multiple steps that could be taken by nutrition professionals and food manufacturers to encourage the consumption of low-energy-dense diets. The goal is to develop reduced-calorie eating plans that meet personal food preferences and also provide satisfying food portions. Since using energy density to guide food choices leads to food patterns consistent with dietary guidelines, policy level initiatives should be devised to help ensure that low-energy-dense diets are affordable and accessible to all.

The rise in obesity rates over the past 30 y has been paralleled by increases in the portion size of many foods and the prevalence of eating away from home. Foods of particular concern are those that have a high energy density (kJ/g). Many well-controlled, laboratory-based studies have found that large portions of energy-dense foods can lead to excess energy intakes. This influence of large portions on energy intake has been supported by data collected in naturalistic settings. Further research is needed to explore strategies that can be used to moderate the effects of portion size on food consumption. One promising strategy is to reduce the energy density of foods, while maintaining food weight or volume, so that consumers can eat satisfying portions while reducing their energy intakes. There is a need for effective educational messages that not only emphasize limiting the consumption of foods high in energy density, but also encourage the consumption of those with a low energy density, such as fruits and vegetables. The delivery of consistent messages will require more cooperation among the food and restaurant industries, policy makers, and scientists. Effective strategies will also require consumers to understand and accept the importance of eating reasonable portions for better health.

Clinical evidence shows that combining advice to increase fruit and vegetable consumption with caloric restriction is an effective strategy for weight management. The purpose of this review is to evaluate epidemiologic evidence to determine whether it supports an association between fruit and/or vegetable consumption and body weight. Few studies have been designed to specifically address this issue, and those that are available vary in methodology and offer inconsistent results. We make recommendations on how to strengthen future studies so that the influence of fruit and vegetable consumption on body weight in free-living individuals is better understood.

Given the recent surge in obesity, effective dietary strategies for weight management are required. Because fruits and vegetables are high in water and fiber, incorporating them in the diet can reduce energy density, promote satiety, and decrease energy intake. Although few interventions have specifically addressed fruit and vegetable consumption, evidence suggests that coupling advice to increase intake of these foods with advice to decrease energy intake is a particularly effective strategy for weight management. This approach may facilitate weight loss because it emphasizes positive messages rather than negative, restrictive messages.

Background: Large portions of food may contribute to excess energy intake and greater obesity. However, data on the effects of portion size on food intake in adults are limited., Objectives: We examined the effect of portion size on intake during a single meal. We also investigated whether the response to portion size depended on which person, the subject or the experimenter, determined the amount of food on the plate., Design: Fifty-one men and women were served lunch 1 d/wk for 4 wk. Lunch included an entrée of macaroni and cheese consumed ad libitum. At each meal, subjects were presented with 1 of 4 portions of the entrée: 500, 625, 750, or 1000 g. One group of subjects received the portion on a plate, and a second group received it in a serving dish and took the amount they desired on their plates., Results: Portion size significantly influenced energy intake at lunch (P < 0.0001). Subjects consumed 30% more energy (676 kJ) when offered the largest portion than when offered the smallest portion. The response to the variations in portion size was not influenced by who determined the amount of food on the plate or by subject characteristics such as sex, body mass index, or scores for dietary restraint or disinhibition., Conclusions: Larger portions led to greater energy intake regardless of serving method and subject characteristics. Portion size is a modifiable determinant of energy intake that should be addressed in connection with the prevention and treatment of obesity.

Objective: The objective of this study was to determine whether children with healthy weight who vary by familial risk for obesity differ in executive functioning. Methods: Children (age 7–8 years) without obesity (n = 93, 52% male) who differed by familial risk for obesity (based on maternal weight status) completed go/no‐go and stop‐signal tasks to assess inhibitory control and an N‐back task to assess working memory. Dual energy x‐ray absorptiometry measured adiposity. Linear and mixed‐effect models assessed unique effects and relative importance analysis‐quantified relative effects of familial risk and percent body fat. Results: Children at high compared with low familial risk showed worse inhibitory control; however, child adiposity was not associated with inhibitory control. Both high familial risk and greater child adiposity were associated with worse N‐back performance when cognitive demand was high (2‐back), but not low (0‐ and 1‐back). The relative effect of familial risk on executive functioning was 2.7 to 16 times greater than the relative effect of percent body fat. Conclusions: These findings provide initial evidence that deficits in executive functioning may precede the development of obesity in children at high familial risk for this disease. Additional family risk studies are needed to elucidate the pathways through which maternal obesity influences child executive functioning and risk for obesity. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate whether dimensions of sleep quality were associated with homeostatic and hedonic eating behaviors among children with healthy weight (BMI‐for‐age < 90%) but varying maternal weight status. Methods: A total of 77 children (mean [SD], age: 7.4 [0.6] years; BMI z score: −0.10 [0.7]) with healthy weight and high (n = 32) or low (n = 45) familial obesity risk based on maternal weight status were served an ad libitum meal (homeostatic eating) followed by palatable snacks to assess eating in the absence of hunger (EAH; hedonic eating). Habitual sleep quality was quantified from seven nights of wrist actigraphy. Partial correlations, adjusted for child energy needs, pre‐meal hunger, food liking, and socioeconomic status, evaluated associations of sleep with meal intake and EAH. Additionally, sleep‐by‐obesity risk interactions were assessed. Results: Greater sleep fragmentation was associated with higher homeostatic meal energy intake, but only among children at high familial obesity risk (p value for interaction = 0.001; β high risk = 48.6, p = 0.001). Sleep fragmentation was not associated with total EAH but was related to higher and lower intake of carbohydrates (r = 0.33, p = 0.003) and fat (r = −0.33, p = 0.003), respectively. Conclusions: Adverse associations of poor sleep with energy intake may be amplified among children already predisposed to obesity. Furthermore, that fragmented sleep relates to preferential intake of carbohydrates over fat during EAH may suggest alterations in taste preferences with poor sleep. [ABSTRACT FROM AUTHOR]

Recent research suggests that ultraprocessed foods, particularly as defined by the NOVA system, facilitate overconsumption and may contribute to the development of obesity. Questions remain as to what properties of ultraprocessed foods are driving excess intake. Ultraprocessed foods tend to be high in energy density and low in volume, easy to eat rapidly, and highly palatable. Studies indicate that these properties are likely contributors to the overconsumption of ultraprocessed foods, rather than the processing per se. Indeed, processing can be used to modify food properties such as energy density and texture to help reduce overconsumption. For many people, ultraprocessed foods provide accessible and affordable sources of nutrients and energy when unprocessed foods are scarce. Future studies should focus on understanding how processing can be used to create widely available and affordable nutrient-rich foods that can help consumers manage energy intake. [ABSTRACT FROM AUTHOR]

Background Although short-term studies have found that serving larger portions of food increases intake in preschool children, it is unknown whether this portion size effect persists over a longer period or whether energy intake is moderated through self-regulation. Objectives We tested whether the portion size effect is sustained in preschool children across 5 consecutive days, a period thought to be sufficient for regulatory systems to respond to the overconsumption of energy. Methods With the use of a crossover design, over 2 periods we served the same 5 daily menus to 46 children aged 3–5 y in their childcare centers. In 1 period, all foods and milk were served in baseline portions, and in the other period, all portions were increased by 50%. The served items were weighed to determine intake. Results Increasing the portion size of all foods and milk by 50% increased daily consumption: weighed intake increased by a mean ± SEM of 143 ± 21 g/d (16%) and energy intake increased by 167 ± 22 kcal/d (18%; both P  < 0.0001). The trajectories of intake by weight and energy across the 5-day period were linear and the slopes did not differ between portion conditions (both P  > 0.13), indicating that there were sustained increases in intake from larger portions without compensatory changes over time. Children differed in their response to increased portions: those with higher weight status, lower ratings for satiety responsiveness, or higher ratings for food responsiveness had greater increases in intake from larger portions (all P  < 0.03). Conclusions This demonstration that preschool children failed to adjust their intake during prolonged exposure to larger portions challenges the suggestion that their self-regulatory behavior is sufficient to counter perturbations in energy intake. Furthermore, overconsumption from large portions may play a role in the development of overweight and obesity, as the magnitude of the effect was greater in children of higher weight status. This trial was registered at www.clinicaltrials.gov as NCT02963987. [ABSTRACT FROM AUTHOR]

Background: Large portions of food promote intake, but the mechanisms that drive this effect are unclear. Previous neuroimaging studies have identified the brain-reward and decision-making systems that are involved in the response to the energy density (ED) (kilocalories per gram) of foods, but few studies have examined the brain response to the food portion size (PS). Objective: We used functional MRI (fMRI) to determine the brain response to food images that differed in PSs (large and small) and ED (high and low). Design: Block-design fMRI was used to assess the blood oxygen level-dependent (BOLD) response to images in 36 children (7-10 y old; girls: 50%), which was tested after a 2-h fast. Pre-fMRI fullness and liking were rated on visual analog scales. A whole-brain cluster-corrected analysis was used to compare BOLD activation for main effects of the PS, ED, and their interaction. Secondary analyses were used to associate BOLD contrast values with appetitive traits and laboratory intake from meals for which the portions of all foods were increased. Results: Compared with small-PS cues, large-PS cues were associated with decreased activation in the inferior frontal gyrus (P < 0.01). Compared with low-ED cues, high-ED cues were associated with increased activation in multiple regions (e.g., in the caudate, cingulate, and precentral gyrus) and decreased activation in the insula and superior temporal gyrus (P < 0.01 for all). A PS 3 ED interaction was shown in the superior temporal gyrus (P < 0.01). BOLD contrast values for high-ED cues compared with low-ED cues in the insula, declive, and precentral gyrus were negatively related to appetitive traits (P < 0.05). There were no associations between the brain response to the PS and either appetitive traits or intake. Conclusions: Cues regarding food PS may be processed in the lateral prefrontal cortex, which is a region that is implicated in cognitive control, whereas ED activates multiple areas involved in sensory and reward processing. Possible implications include the development of interventions that target decision-making and reward systems differently to moderate overeating. [ABSTRACT FROM AUTHOR]

Abstract: Much of the research in ingestive behavior has focused on the macronutrient composition of foods; however, these studies are incomplete, or could be misleading, if they do not consider the energy density (ED) of the diet under investigation. Lowering the ED (kcal/g) by increasing the volume of preloads without changing macronutrient content can enhance satiety and reduce subsequent energy intake at a meal. Ad libitum intake or satiation has also been shown to be influenced by ED when the proportions of macronutrients are constant. Since people tend to eat a consistent weight of food, when the ED of the available foods is reduced, energy intake is reduced. The effects of ED have been seen in adults of different weight status, sex, and behavioral characteristics, as well as in 3- to 5-year-old children. The mechanisms underlying the response to variations in ED are not yet well understood and data from controlled studies lasting more than several days are limited. However, both population-based studies and long-term clinical trials indicate that the effects of dietary ED can be persistent. Several clinical trials have shown that reducing the ED of the diet by the addition of water-rich foods such as fruits and vegetables was associated with substantial weight loss even when patients were not told to restrict calories. Since lowering dietary energy density could provide effective strategies for the prevention and treatment of obesity, there is a need for more studies of mechanisms underlying the effect and ways to apply these findings. [Copyright &y& Elsevier]

Background: Laboratory-based investigations indicate that the consumption of foods with a low energy density (kcal/g) decreases energy intake. Although low-energy-dense diets are recommended for weight management, relations between energy density, energy intake, and weight status have not been clearly shown in free-living persons. Objectives: A representative US sample was used to determine whether dietary energy density is associated with energy intake, the weight of food consumed, and body weight and to explore the influence of food choices (fruit, vegetable, and fat consumption) on energy density and body weight. Design: A cross-sectional survey of adults (n = 7356) from the 1994-1996 Continuing Survey of Food Intakes by Individuals and two 24-h dietary recalls were used. Results: Men and women with a low-energy-dense diet had lower energy intakes (≈425 and 275 kcal/d less, respectively) than did those with a high-energy-dense diet, even though they consumed more food (≈400 and 300 g/d more, respectively). Normal-weight persons had diets with a lower energy density than did obese persons. Persons with a high fruit and vegetable intake had the lowest energy density values and the lowest obesity prevalence. Conclusions: Adults consuming a low-energy-dense diet are likely to consume more food (by weight) but to have a lower energy intake than do those consuming a higher-energy-dense diet. The energy density of a variety of dietary patterns, including higher-fat diets, can be lowered by adding fruit and vegetables. Our findings support the hypothesis that a relation exists between the consumption of an energy-dense diet and obesity and provide evidence of the importance of fruit and vegetable consumption for weight management. [ABSTRACT FROM AUTHOR]

Background: Increases in both the portion size and energy density of food have both been shown to increase energy intake, but the combined effects of such increases have not been investigated. Objective: The objective was to determine the combined effects of energy density and portion size on energy intake in women. Design: This study used a within-subjects design. Once a week for 6 wk, 39 women were served breakfast, lunch, and dinner ad libitum. The main entrée at lunch was formulated in 2 versions that varied in energy density (5.23 or 7.32 kJ/g), each of which was served in 3 different portion sizes (500, 700, or 900 g). The 2 versions were matched for macronutrient composition and palatability. Breakfast and dinner were standard meals. Results: Increases in portion size and energy density led to independent and additive increases in energy intake (P <0.0001). Subjects consumed 56% more energy (925 kJ) when served the largest portion of the higher energy-dense entrée than when served the smallest portion of the lower energy-dense entrée. Subjects did not compensate for the additional intake by eating less at the subsequent meal. Despite substantial differences in energy intake, no systematic differences in ratings of hunger and fullness across conditions were observed. Conclusions: The energy density and the portion size of a food act independently to affect energy intake. The findings indicate that large portions of foods with a high energy density may facilitate the overconsumption of energy. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine how the portion size of a packaged snack affects energy intake of the snack and of the subsequent meal. On five separate days, 60 subjects (34 women and 26 men) ate an afternoon snack and dinner in individual cubicles. For each snack, subjects were served one of five packages of potato chips (28, 42, 85, 128, or 170 g), which they consumed ad libitum directly from the unlabelled, opaque package. Subjects returned to the lab three hours later for a standard dinner, which was also consumed ad libitum. Results showed that snack intake increased significantly as the package size increased for both males and females (p<0.0001). The combined energy intake from snack and dinner also increased as the package size increased. On average, when served the largest snack package compared to the smallest, subjects consumed an additional 596 kJ (143 kcal) at snack and dinner combined. Results from this study demonstrate that short-term energy intake increases with increasing package size of a snack. These data suggest that the availability of large packages of energy-dense snacks may be one of the environmental influences associated with excess energy intake. [Copyright &y& Elsevier]

The article reports that large portions of energy-dense foods are contributing to the obesity epidemic in the U.S. People eat in units, and larger units or portions mean that they eat more. Some steps that could be taken to address the problem include education and consumer awareness, food labels with portion size and more point-of-purchase nutrition information.

This experiment examined whether food volume and energy content affected satiety in lean and obese women, when visual and oral cues were bypassed by infusing food intragastrically. The effects of volume and energy content were examined separately by using liquid foods that differed in energy density (kcal/g). On 5 separate days, 25 lean and 29 obese women consumed all of their meals in the laboratory. A nasogastric tube was inserted 30 min before lunch on 4 days; on three of these occasions, a liquid preload was infused for 15 min and, on the fourth occasion (control), the preload was diverted covertly. On the remaining day, no tube was inserted. The three preloads varied two-fold in volume and energy content: 200 ml/200 kcal, 400 ml/200 kcal and 400 ml/400 kcal. The results showed that increasing the volume of infused food, but not the energy content, affected satiety in both lean and obese women. There was a mean decrease in energy intake at lunch of 77 kcal (13%) after the 400-ml preload compared with the iso-energetic 200-ml preload (P=.013). Increasing the energy content of infused food, but not the volume, did not affect satiety. Thus, when sensory cues were bypassed, the volume of liquid food infused intragastrically affected subsequent energy intake in both lean and obese women. These results suggest that gastric and postgastric mechanisms are involved in the effects of high-volume, low-energy-dense foods on satiety. [Copyright &y& Elsevier]