# Restaurant portions destroy your diet: Eating out is killing us!

## Bloomberg's right: We have standard alcohol pours. Only when we standardize restaurant meals can we control obesity

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(Credit: AP/Matt York)
Excerpted from: "A Big Fat Crisis"

Have you ever wondered why bars from New York to Los Angeles serve beer in twelve-ounce servings, wine in five-ounce servings, and liquor in 1.5-ounce shots? It’s because beer, wine, and liquor all contain different concentrations of alcohol, so the standardized serving of each contains 0.6 ounce of pure alcohol. Standardized serving sizes ensure that a drink is a drink is a drink: 0.6 ounce of alcohol, no more, no less, no matter what you choose to imbibe.

Compare that to food, where serving sizes are all over the map. A double cheeseburger at McDonald’s has 440 calories and a medium fries has 380. At Carl’s Jr., a Super Star Cheeseburger has 940 calories and a medium fries has 430. At Denny’s, a cheeseburger and fries is 1,400 calories. And at Chili’s, the burger-and-fries platters range from 1,310 calories for the Oldtimer to 2,290 calories for the burger with ancho chili BBQ. Even with calorie labels on menus, you’d have to be pretty good at math, algebra, and geometry to figure out how to divide up your food in order to eat just 640 calories, the amount that is recommended by the Institute of Medicine for a single meal for the average person trying to maintain a normal weight. The IOM assumes adults eat three meals and one snack to obtain the recommended average of 2,000 calories per day.

Although calorie-labeling on menus was intended to help people make better choices in the same way a speedometer helps people estimate and control their driving speed, it hasn’t been very successful. Without a speedometer, people cannot precisely estimate how fast they are traveling. Their only clue might be based upon how quickly the scenery flies by. Drivers are trained to regularly check the speedometer. Road signs let them know when they can drive at which speeds and when they need to stop. But there are no signposts that define the optimal calories to choose or stop signs that indicate when we have consumed enough. It isn’t patently clear to many people how to respond to the calorie counts on menus.

Every restaurant serves different portion sizes: some are large, some giant, and others gargantuan. This leaves many of us confused and prone to eating far too much. How much easier would it be to control our intake if we knew that a cheeseburger had 400 calories whether we purchased it at McDonald’s, Burger King, or Denny’s? Or that lunch was going to contain just 640 calories, regardless of what we ordered?

Why can’t restaurants be held responsible for designing and serving meals that contain what we need? If people eat too much at one meal, they usually don’t eat less at the next to compensate. Similarly, if we don’t get enough of something at one meal, like fruits and vegetables, we don’t usually make it up by eating more of those foods later. This means that when restaurants serve us too much food with too many calories and too few essential nutrients, they put us at risk for chronic diseases.

Right now, as a society we accept this risk, and we don’t expect restaurants to be responsible for taking care of us. However, this is something we need to seriously reconsider, because it is too difficult for most people to figure out how to compensate for meals with too many calories and too few nutrients that protect us from disease.

Just as policies like standardized serving sizes evolved to support the moderate consumption of alcohol, we need commonsense regulations that will moderate our consumption of food. Alcohol regulation provides an excellent model for food because of the inherent similarities: consuming too much alcohol—just like consuming too much food—leads to chronic disease. In the case of alcohol, it’s cirrhosis of the liver, hypertension, and a variety of cancers. In the case of eating too much of the wrong kinds of food, it’s diabetes, hypertension, heart disease, stroke, and a variety of cancers. (Binge drinking also leads to injury and aggression, but there is no parallel to food in that regard.)

Alcohol control policies have a proven track record of keeping the public safe—or at least safer—from harm. Although they have not eliminated alcohol-related problems or alcoholism, such policies have been highly effective in controlling alcohol’s harms. Over the past three decades, deaths from alcohol-related traffic crashes have declined by 60 percent. Alcoholic liver cirrhosis declined by 48.3 percent between 1970 and 2005. Compare this to the incidence of obesity and diet-related chronic diseases, which have been skyrocketing.

We are beginning to recognize that people are limited in their ability to control how much they eat. We have already recognized that many people have limitations when it comes to behaviors like smoking, drinking, and substance use. Although eating food is not the same as drinking alcohol or taking illegal drugs, the evolution of our understanding of people’s ability to control how much they consume of these substances is quite instructive. It is only because we changed our view of alcohol that our society developed public health responses that have reduced alcohol-related illnesses and deaths.

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As mentioned earlier, restaurants, unlike bars, have no standard serving guidelines, which means there is no common yardstick for us to judge the number of calories we are consuming when we go out to eat. This may be the most important cause of the clear association between eating food prepared away from home and unwanted weight gain.

“Unit bias,” a term coined by scientists Andrew Geier, Paul Rozin, and Gheorghe Doros from the University of Pennsylvania, refers to the idea that people judge how much to eat based on what they are served. If we are served one apple, the entire apple is the unit, and we will typically eat the whole thing. If the unit is a half cup of applesauce or a cup of rice, that is the amount we think is appropriate to consume.

Geier and his colleagues documented that people served themselves more when the unit presented was larger, and less when it was smaller. In their experiments, people ate more M&M’s when a quarter-cup scoop was in the serving bowl than when a tablespoon was; they helped themselves to fewer Philadelphia-style soft pretzels when they were cut in half than when they were displayed whole. Yet people are usually just as satisfied when they are served a smaller amount.

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Having standardized portions will not only establish the appropriate amount to eat, but will also make portions uniform across all food establishments. Standardized portion sizes have already been determined by the USDA and the FDA. The FDA’s system is the basis for the labeling on packaged processed foods. Labeling was mandated by the FDA as part of the 1990 Nutrition Labeling and Education Act. Both the USDA and FDA initially based serving sizes on how much people typically ate in a single meal during 1977–1978—before the obesity epidemic accelerated. However, the FDA adjusted some of its sizes based on food consumption data from 1985–1988, which is why some of its portion sizes are larger than those of the USDA.

When New York City’s Mayor Michael Bloomberg floated the idea of capping the servings of sugar-sweetened beverages to sixteen ounces, a common refrain from his critics was that this type of policy would interfere with a person’s free choice. At the other extreme, some thought the sixteen-ounce cap on soda was ridiculous. People would just order more than one soda, so it would likely have no impact on the obesity epidemic. In fact, the “standardized” portion size of soda is eight ounces, so the regulation, had it been approved, would still have New Yorkers consuming double what people drank thirty years ago.

Moreover, an eight-ounce size is more in line with the 2009 recommendations of the American Heart Association on daily added sugar intake: about six teaspoons is the maximum added sugar recommended for women, the amount in one eight-ounce cup of soda. For men, 150 calories is considered the maximum, or about twelve ounces of soda.

Bloomberg’s proposal to ban serving sizes of soda larger than sixteen ounces was overturned, primarily because it had many loopholes. It applied only to sodas rather than all high-calorie drinks, and it covered only a subset of food outlets, excluding convenience stores like 7-Eleven, which is known for serving the Big Gulp, a thirty-two-ounce serving of soda, and the Super Big Gulp, at forty-four ounces. A comprehensive system of standardized portions would overcome these legal concerns because it would apply to all eating-out establishments and all food products prepared and sold for immediate consumption.

The scientific support for standardized portions is extremely robust: people invariably eat more when they are served more, and they typically do not feel any less satisfied when they are served smaller amounts.

Efforts made to train people to control mindless eating and to pay attention to portion sizes generally fail in the long term. Cornell University professor Brian Wansink, author of “Mindless Eating,” says that even when he challenges his students not to eat too much from big bowls, they nevertheless do. Wansink’s solution to mindless eating is to use small bowls—a different method for ensuring smaller portions.

Because eating is typically an automatic behavior, the quantity that people eat depends on the quantity they are served. Therefore, if all restaurants serve customers food using standardized portions (based on the national Dietary Guidelines for Americans), we could very likely make a real dent in the number of us who gain unwanted pounds.

The primary requirement of a standardized portion system would be that all foods must be available in single portions. But this would not necessarily preclude restaurants from offering the same dishes in larger sizes. Practically speaking, some foods, like a whole fish, cannot easily be divided into a single portion without ruining the presentation. Items that are larger would simply have to be presented with the number of serving units they contain and priced proportionally. For example, many restaurants that offer “family-size portions” would need to state that the serving contains three or four portions, or however many servings it actually has. Given that a single serving of meat is three ounces, a twelve-ounce steak would have to be described as containing four portions.

Standardized portions would serve as a benchmark that would make it much simpler for people to figure out how much to eat. They would also serve as a guide to make adjustments for individual differences. A triathlete might ask for two portions, someone who wanted to lose weight could ask for a half portion, and most people who ordered one portion could be reasonably confident that it would be the right amount.

When foods that are associated with chronic diseases are served in portions that exceed a single serving, there should be a notice that such consumption may increase one’s risk of chronic diseases. True consumer freedom is having relevant and accessible information, with the consequences spelled out loud and clear at the time people make their selections. People would still have the right to order and consume as much as they want.

There is no doubt that most restaurants would vehemently protest, no matter how logical or beneficial the new regulations are. Standardized portion sizes would likely have to be implemented over the objections of the food industry.

Excerpted from: “A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic — and How We Can End it” by Deborah A. Cohen. Excerpted by arrangement with Nation Books. Copyright 2013.

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