Out of Proportion Portions. Tiffany Jessee, DO. ACOFP 55th Annual Convention & Scientific Seminars

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1 Out of Proportion Portions Tiffany Jessee, DO 8 ACOFP 55th Annual Convention & Scientific Seminars

2 ACOFP FULL DISCLOSURE FOR CME ACTIVITIES Please check where applicable and sign below. Provide additional pages as necessary. Name of CME Activity: ACOFP 55tn Annual convention ana Scientific Seminars Dates and Location of CME Activity: March 22-25, JW Marriott :U ffq.-::ia., ;Je.sse,e, 1 a D,J F.//c:,o5. Name of Faculty/Moderator: L DISCLOSURE OF FINANCIAL RELATIONSHIPS WITHIN 12 MONTHS OF DATE OF THIS FORM A Neither f nor any member of my immediate family has a financial relationship or interest with any proprietary entity producing health care goods or services. B. I have, or an immediate family member has, a financial relationship or interest with a proprietary entity producing health care goods or services. Please check the relationship(s) that applies. Research Grants Stock/Bond Holdings (excluding mutual funds) Speakers' Bureaus,. Employment Ownership Partnership Consultant for Fee Others, please list Please indicate the name{s) of the organization(s) with which you have a financial relationship or interest. and the specific clinical area(s) that correspond to the relationship(s). If more than four relationships, please list on separate piece of paper: Organization With Which Relationship Exists Clinical Area Involved '"If you checked.. Speakers' Bureaus" in item B, please continue: Did you participate in company-provided speaker training related to your proposed Topic? Did you travel to participate in this training? Did the company provide you with slides of the presentation in which you were trained as a speaker? Did the company pay the travelnodging/other expenses? o id you rece"ive an honorarium or consulting Tee for partidpafing in this tralriing? Have you received any other type of compensation from the company? Please specify: When serving as faculty for ACOFP, wm you use slides provided by a proprietary entity for your presentation and/or lecture handout materials? Will your Topic1 involve information or data obtained from commercial speaker training? / DISCLOSURE OF UNLABELED/INVESTIGATIONAL USES OF PRODUCTS _V AA. The content of my material(s)lpreseatation(s) in tllis CME activity will not include discussion of unapproved or investigational uses of products or devices. B. The content of my material(s)/presentation in this CME activity will include discussion of unapproved or investigational uses of products or devices as indicated below: Yes: Yes: Yes: Yes., Yes: Yes: Yes; No: No: No: No_:_ No: No: l:!.!!,; l:!.!!,; I have read the ACOFP policy on full disclosure. If I have indicated a financial relationship or interest, I understand that this information will be reviewed to determine whether a conflict of interest may exist, and I may be asked to provide additional informatlon.1 understand that fatiure or refusal to cfrsclose, false Orsclosure, orlnabifrtyto resolve conflicts wm requ1re the ACOFP to identify a replacement, Signature: 0) Date: Tiffany Jessee, DO r, I /2../JIZ_ Please this form to joank@acofp.org or fax to NO LATER THAN JANUARY 19, 2018

Bariatric Center at Largo Medical Center Portion Size vs.

3 Out of Proportion Portions Tiffany Jessee, D.O., F.A.C.O.S. Fellowship Trained Bariatric Surgeon Director of Bariatric Surgery Florida Bariatric Center at Largo Medical Center Portion Size vs. Serving Size Portion size Serving size amount of a single food item served in a single eating occasion standardized unit of measure of foods 1

4 Portion Distortion Portion sizes of many foods have increased significantly Larger portions are now offered all around us, including in restaurants vending machines packaged foods in grocery stores 2

5 Help Patients to Understand Portions Patients need to become Portion Tellers Use everyday objects for instruction Portion Equivalents for Grains 1 cup of cereal 1 pancake 1 slice of bread 3

6 Portion Equivalents for Fruit/Vegetables 1 cup of salad/greens 1 medium fruit ¼ cup of raisins 1 baked potato Portion Equivalents for Dairy and Fats ½ cup of ice cream 1 ½ oz. of cheese 1 tsp. of margarine 4

7 Portion Equivalents for Meat/Protein 3 oz. meat, fish & poultry 1 Tbsp. peanut butter 3 oz. baked fish 5

8 WEIGHT MANAGEMENT Basic rule Does Portion Size ALWAYS Matter? Portion size doesn t matter if: eat only an appropriate portion (rather than the whole amount served) OR eat fewer calories in subsequent meals 6

9 Do Patients: Typically understand appropriate serving size? Eat only the appropriate serving size, no matter the portion offered? Adjust what they eat later in the day after consuming large portion sizes? 7

10 Factors that may override physiologic satiety cues Large portions Easy access Sensory attractiveness of food Alcohol consumption Pasta Study Design: 180 adults Varying sizes of pasta dishes on different days Price of entrée never changed Results: Increased intake with larger portion Rolls et al Obesity 8

11 Submarine Sandwich Study Design: 75 university students 4 sizes of submarine sandwiches Results: Larger portion meant larger intake Similar ratings of fullness Rolls et al Journal of the American Dietetic Association Bad Popcorn in Big Buckets Study Design: 158 moviegoers Random popcorn snack: small, large, fresh, stale Results: Consumption of large fresh and large stale comparable Wansink, 2005 J Nutr Educ Behav. 9

12 Bottomless Soup Bowl Study Design: 54 subjects 2 normal bowls, 2 bottomless bowls Results: Bottomless bowl participants ate more Satiety ratings similar Wansink, 2005 Obesity Preschool Portion Study Design: 30 preschool aged children 2 series of lunches Age appropriate portion Double portion Results: Larger portion meant larger consumption Larger bites with larger portion Fisher, 2003 American Journal of Clinical Nutrition 10

13 Studies confirm: Participants eat more when confronted with more Even if it tastes BAD!! Phenomena not age specific 11

14 Keep it Simple Pre bag portions Slow down Put fork down Share entrée Snacks that make you work Take a lap Drink H2O before a meal Avoid food/plate contrast 12

15 Do My Eyes Deceive Me? The Delboeuf illusion Portion Control When Eating In Set out salad plates The Smaller Plate Study by Professor Brian Wansink, founder of the Cornell Food and Brand Lab 13

16 Portion Control When Eating In Portion Control When Eating In Avoid second servings 14

17 Portion Control When Eating In Portion Control When Eating In Store leftovers in single serve containers 15

18 Portion Control When Eating Out Portion usually enough food for two or three. But you don't have to eat it all. Order a half portion or appetizer Have waiter box ½ before serving Split a dish with a friend 2016 Weight Loss Market Value.. $66.3 billion MarketData Enterprises,

19 Some need more structure. Diets employing portion control: South Beach Weight Watchers Atkins Jenny Craig Body for Life Nutrisystem Slimfast And Some Need Even Further Structure.. Surgical weight loss: Built In portion control Prolonged satiety Reduced hunger sensation Very often covered by Insurance Smaller portions 17

Most Common Bariatric Procedures Vertical Sleeve Gastrectomy

many, it s human nature to eat more when presented with more

not about dieting, it s about Lifestyle Changes Portion control

20 Most Common Bariatric Procedures Vertical Sleeve Gastrectomy Gastric Bypass LAP-BAND Conclusion Obesity is an epidemic For many, it s human nature to eat more when presented with more Education on portion control needs to start early in life It s not about dieting, it s about Lifestyle Changes Portion control is effective, multimodal approach of teaching and reinforcement may be necessary 18

21 QUESTIONS?

Food Portions. Patient Education Section 9 Page 1 Diabetes Care Center. For carbohydrate counting

Food Portions. Patient Education Section 9 Page 1 Diabetes Care Center. For carbohydrate counting Patient Education Section 9 Page 1 For carbohydrate counting This handout answers the following questions: What s the difference between a portion and a serving? How do I know how big my portions are?