Portion Distortion

While making healthy food choices is essential for good health and weight management, the amount we eat is also important.  And due to increasing portion sizes of packaged foods, fast foods and restaurant meals, alongside bigger bowls, plates and glasses, many of us have lost touch of how much we eat.

New research from The George Institute for Global Health has found that portion sizes for some of Australia’s most commonly consumed ‘discretional’ foods (that’s foods that provide little nutritional value) have risen significantly over the past 20 years.  Comparing data from 1995 to 2012, the researchers found that pizza and cake were the worst offenders, with the kilojoule content of a typical portion increasing by 66%! For cake this translates to almost 1000kj more in an average slice, compared to two decades ago.  Typical serves of processed meats, cereal bars, ice-cream and wine also increased in size, ranging from 17 to 39% bigger.

Previous research from the US has shown similar findings, with fast food restaurants the biggest offenders.

Considering that the latest national health survey has found that the average Australian gets one-third of their energy from discretional foods, this is a concern.  It’s not surprising that our waistlines are expanding!

Portions matter

The problem with big portion sizes is that research has shown that if we are served larger portions we will eat them, without feeling any fuller or reducing our subsequent food intake.

For example when subjects in one study were served different size sandwiches, of which they could eat as much as they liked, females consumed 12% more energy and males consumed 23% more energy when they were given a larger sandwich compared to one that was two-third the size. Despite these differences, ratings of hunger and fullness were not significantly different.  It’s not just single meals either.

Another study found that when subjects were given larger portions of all food and drinks for 11 days, they continued to consume the larger amounts with no signs of cutting back.

Similarly, a study in which a group of normal and overweight adults were given either ‘standard’ or ‘large’ portions of the same foods and drinks, the men served the large portions consumed 17% more energy and the women 10% more energy than those given the regular portions and they sustained this higher food intake over the 4 days of the study.

Plate control

 If the amount we serve dictates what we eat, then serving the right portions in the first place is a key part of managing our weight. And one way to do this is to use smaller plates. 

A recent review of the research, combining the results of 56 studies on the effect of smaller plates on food consumption, found that halving our plate size, on average, leads to a 30% reduction in the amount of food we consume, particularly if we are serving ourselves. On the other hand, if we double our plate size, the amount we serve and eat increases around 40%.

Consistent with these findings, a study of 130 overweight people with type 2 diabetes found that compared to those who only received dietary education, those who were also given a commercially available portion control plate and bowl to use, lost significantly more weight and more than twice as many of them were able to reduce their diabetes medication after 6 months.

Another study in Korean women with type 2 diabetes found that providing a small rice bowl led to a greater reduction in energy intake, weight and blood glucose levels compared to women given a larger bowl, although both groups were given the same guidelines for reducing their food intake.

Take control

So what can you do to avoid supersizing your meals?

At Home:

  • serve meals on smaller plates
  • when serving your meal, portion any leftovers straight into containers and pack away for another meal so you’re not tempted to go back for seconds
  • fill at least half your plate with vegies and salads
  • eat slowly
  • buy single serve size foods rather than larger packs, especially for high energy snack foods
  • always serve a single portion of food into a bowl or on a plate and avoid eating directly from the packet
  • sit at the table to eat, not in front of the television or computer – it’s easy to overeat when you are distracted

Eating Out:

  • order entrée sizes and add a side serving of vegetables or salad
  • share desserts or cake with a friend
  • ask for a doggie bag if the meal is too much to eat at the time
  • choose small serving sizes when buying takeaways
  • resist being ‘upsized’ just because it seems like better value
  • remember that fluids count too – make water or mineral water your drink of choice

8 Steps to End Emotional Eating

If you’ve ever eaten when you’re stressed, bored, angry or upset, even if you weren’t actually hungry, you’re not alone.  Most of us have eaten for emotional reasons at some time, and if it only happens occasionally it is unlikely to be a problem.

For some however, emotional eating can become a viscous cycle, where food is used as a way of dealing with negative emotions, and overeating then leads to feelings of guilt and poor self-esteem.

There are many reasons why we eat in response to our emotional state – food can provide pleasure and improve mood, eating can be a distraction from unpleasant or stressful situations, or we may have developed a habit of using food as a reward or way of feeling better.

Unfortunately this only provides a short-term solution and in the long term, emotional eating can result in health and weight problems and can prevent us from learning more productive ways to deal with emotional problems and stress.

If you find yourself regularly eating in response to your emotions, here are some tips to help you overcome this habit:

  1. Learn to recognize true hunger. Many people have lost the ability to distinguish true physical hunger from a desire to eat. Learning to recognise when you are really hungry (and when you are full) is the first step to conquering emotional and other non-hungry eating. If you’ve eaten a meal in the last few hours then you’re probably not hungry – try a glass of water or cup of tea first, then wait 15 minutes to see if you still feel the need to eat.  If you weren’t actually hungry, the craving to eat may have passed in this time.  A good trick is to get into the habit of rating your hunger before you decide to eat. Ask yourself where you are on a scale of 1 to 5, where 1 is ravenous and 5 is full; try to avoid eating if you rate a 4 or 5.
  1. Identify eating triggers. Knowing the situations that trigger your desire to eat when you’re not hungry is an important step in overcoming this habit. The best way to identify your triggers is to keep a food diary.  Write down what you eat, when you eat, how you are feeling and how hungry or full you are at the time. Do this for a week or two, then review your diary to identify any patterns, including particular situations that cause you to overeat, or any ‘danger’ times in your day or week.
  1. Find alternatives. The key to changing unhealthy habits is to replace them with positive alternatives. If eating makes you feel better when you’re upset, then plan some other feel-good activities to do instead – have a bath, read a good book, meet a friend or have a massage – anything that’s enjoyable and relaxing for you.  If, on the other hand, you eat to distract yourself from a boring or stressful situation, try to plan some other activities to keep you busy such as cleaning out your wardrobe, sorting old photographs or meeting a friend for a walk.  Make a list of alternatives and keep it handy so you can easily refer to it at times when you are ready to reach for the biscuits!  If there’s a particular time of the day or week that’s a problem for you, then regularly plan other activities to fill that time.
  1. Remove temptations. It’s all too easy to turn to your ‘comfort’ foods when you’re feeling vulnerable if they’re always within easy reach. Instead aim to keep a range of healthy snacks you enjoy at home and at work, and keep the ‘treats’ as occasional indulgences that you can include in small amounts when you are feeling good and can truly savour and enjoy them.
  1. Eat a balanced diet. Eat a well-balanced diet with regular meals and snacks built around mostly unprocessed wholefoods. This will ensure that your physical hunger is satisfied and your body is getting the energy and nutrients it needs to function at its peak. Avoid missing meals or cutting out whole food groups as this can lead to hunger and cravings, and may trigger overeating.
  1. Exercise regularly. Exercising regularly makes you feel better, both physically and mentally. Exercise is one of the best ways to reduce stress levels and improve depression, and can help to regulate appetite. So next time you’re feeling down and are tempted to reach for the chocolate, grab a friend and head out for a walk or put on your favourite music and slip on your dancing shoes!
  1. Get enough rest and sleep. Feeling tired can cause you to turn to food to improve your energy levels, and can also reduce your resolve to eat well. Research has also shown that lack of sleep can affect hormones that increase appetite, which may in turn contribute to overeating and weight gain.  Aim for 7-8 hours of good quality sleep each night.
  1. Learn to manage stress. If stress is a major trigger for your emotional eating, it’s worthwhile learning different ways to manage your stress. This could be done by building in activities that you find enjoyable and relaxing (such as having a bath or sitting in the sun and reading a magazine), taking up meditation or yoga, or using a guided relaxation program at home.  If these don’t help, you may want to consider getting professional help from a psychologist or counsellor who can assist with strategies to help you to relax and cope with stress.

Finally, if you do give in to emotional eating, don’t beat yourself up about it!  Learn from the experience and work out ways to prevent it happening again.  Then put it behind you and get back to your healthy eating plan.

Preventing Diabetes: The Six Lifestyle Habits that Count

July is National Diabetes Week so this month our focus is on diabetes, Australia’s fastest growing chronic disease, which is estimated to affect 1.7 million Australians.  In fact, 280 of us are diagnosed each day – that’s one every five minutes. And many people with type 2 diabetes remain undiagnosed.

While the statistics paint a gloomy story, there is some good news.  Type 2 diabetes is largely preventable and because in most cases it develops slowly, this presents plenty of opportunity to intervene and reduce your risk.

Type 2 diabetes: what goes wrong?

Diabetes is a condition where there is too much glucose (or sugar) in the bloodstream. When we consume carbohydrate (starchy and sugary foods) our body breaks them down into glucose (the body’s main energy source), which enters the blood stream. Insulin (a hormone produced by the pancreas) is needed for the absorption of glucose by the body’s cells. Diabetes occurs when the body doesn’t produce insulin or when the insulin that is produced doesn’t work effectively.

Type 2 diabetes, which is by far the most common form, affects 85-90% of all people with diabetes. While it’s more often diagnosed in older adults, due to our increasing rates of obesity, we are now frequently seeing young children with type 2.

The development of type 2 diabetes begins with a condition called insulin resistance, where the body’s insulin is unable to work properly. Initially, the body makes extra insulin to overcome this resistance, so blood glucose levels remain normal.  But if nothing is done to reduce the extra workload on the body’s insulin producing (beta) cells, eventually they can’t keep up and blood glucose levels start to rise. Basically, the beta cells can no longer produce enough insulin to overcome the resistance.

As blood glucose levels rise, you progress from insulin resistance to impaired glucose tolerance or impaired fasting glucose, both also known as ‘pre-diabetes’.  This is where blood glucose levels are above normal but not high enough to be diagnosed with diabetes.  At this stage, lifestyle changes, moderate weight loss and possibly the use of medication can significantly reduce the risk or delay the development of diabetes. Without intervention, however, it is likely that blood glucose levels will continue to rise and progress to type 2 diabetes within 5-10 years, or sometimes sooner.

Why prevention matters

Unfortunately research has found that by the time many people are diagnosed with type 2 diabetes they have already lost up to 80% of their beta-cell function. In other words, only 20% of their body’s insulin producing capacity is left.  This means that lifestyle changes may not be effective for long, and diabetes medications might be needed at the time of or soon after diagnosis, with many people progressing to needing insulin to manage their diabetes within a few years. Of particular concern is that many people with type 2 diabetes already have early signs of complications such as eye, kidney and nerve damage, by the time they are diagnosed.

Diabetes complications occur when the blood glucose levels remain elevated for periods of time – these complications include heart disease, kidney disease, eye damage and circulation problems.  If diabetes is diagnosed early and blood glucose levels are kept well managed, with lifestyle changes and the addition of medication when needed, the risk of developing these complications can be significantly reduced.  So early diagnosis, and maintaining blood glucose levels as close as possible to the normal range, as well as managing cholesterol and blood pressure, is the key.

As the symptoms of diabetes (such as thirst, frequent urination, blurred vision and fatigue) don’t usually kick in until the blood glucose levels are quite high, awareness of risk factors is the key to early diagnosis of type 2.  That’s right – the key to preventing diabetes and its complications is not to sit around and wait for it to happen but to get in early and do everything possible to ward it off.  And the best way to do this is with lifestyle changes.

Lifestyle is key – proof is in the research.

While genetics play a part, and we can’t change our genes, type 2 diabetes is also a lifestyle disease that is more common in people who are overweight and inactive. It makes sense, then, that diet and exercise might help to prevent this condition from occurring in the first place.  The good news is that we have proof that this is the case and the benefits are significant.

Several studies have now shown the benefits of lifestyle intervention for preventing diabetes but the best evidence comes from two large studies, one in the USA (called the Diabetes Prevention Program, or DPP) and another in Finland (called the Finnish Diabetes Prevention Study) which both found that people with pre-diabetes who took part in a lifestyle intervention program reduced their risk of developing diabetes by 58%.  This means you can more than halve your risk of developing diabetes just by improving your eating habits, walking regularly and losing a few kilograms.

Of note, the US study found that lifestyle changes were twice as effective as medication in preventing diabetes. Even if you already have diabetes, making these changes will help you to manage your condition, may delay or reduce your need for medication, and can help to reduce the chances of long-term complications.

So if you want to take control of your health, now is the time to take action!

Diabetes prevention in 6 easy steps

Here are the lifestyle changes that matter:

Move more. It’s well established that regular exercise can significantly reduce diabetes risk.  A combined analysis of 10 studies carried out by researchers at the Harvard School of Public Health found that compared to those who were sedentary, people who regularly participated in moderate intensity physical activity had a 31% reduction in risk of type 2 diabetes. And those who walked briskly for at least 2.5 hours each week had a 30% lower chance of developing diabetes than those who did almost no walking. These findings were similar in men and women and were independent of weight. And if you need more motivation to get moving, check out our blog post Motivation to Exercise with some tips to get you started.

Sit Less. It’s not just about regular exercise – even sitting less can help. Australian research has linked television watching and time spent in sedentary activities with a higher risk of raised blood glucose levels.  Other studies have found that breaking up prolonged sitting (even for a minute or two every 20-30 minutes) can improve insulin sensitivity and glucose tolerance. Obviously sitting is bad for our health but even small changes can make a difference!

Adopt a plant-based diet. Eating habits have a vital role to play when it comes to your risk of developing type 2 diabetes.  Limiting total energy intake to manage your weight is important but the types of food you eat also matter.  Diets high in saturated fat, red meat and processed meats have been linked with an increased risk of diabetes while diets high in fibre, wholegrains, legumes, nuts and vegetables are associated with a reduced risk.  This means basing your meals around plant foods (vegetables and salads, legumes, wholegrains and nuts), eating more fish and legumes in place of red meat, choosing only lean cuts of meat and avoiding processed meats.  One large study found that a Mediterranean diet (which is consistent with these recommendations) reduced the risk of diabetes by 52% in those with cardiovascular risk factors. Similarly, a number of studies have found that those who follow a vegetarian or vegan diet are significantly less likely to develop diabetes.  Not sure where to start?  Check out or Pinterest recipe board for some inspiration.

Reduce your waist measurement. Carrying excess weight increases the risk of diabetes, particularly when it’s around the middle.  If your waist measurement is above 80cm for women or 94cm for men, you are at much higher risk of developing diabetes. The good news is that losing just 5-10% of your weight can significantly reduce your risk of developing diabetes.

If you smoke, quit now. We all know that smoking isn’t good for us and can increase the risk of heart disease and cancer, but most people don’t realise that it can also increase your diabetes risk. Studies have shown that smokers are more insulin resistant and have an increased risk of developing type 2 diabetes.  One large study of more than 4000 men found that compared to those who had never smoked, those who smoked up to 20 cigarettes per day had a two-fold increase in risk of developing diabetes while those who smoked 20 cigarettes or more each day had a 2.4-fold increase in risk.

Get a good night’s sleep. Lack of sleep has been shown to worsen insulin resistance and studies have shown that both sleep quality and quantity are related to diabetes risk. A combined analysis of 10 studies found that sleeping less than 5-6 hours/night increases the risk of diabetes by 28% while sleeping more than 8-9 hours increases the risk by almost 50%.  The same study also found that difficulties getting to sleep and difficulties maintaining sleep were associated with a 57% and 84% increase in risk of diabetes, respectively. In those with diabetes, too little or too much sleep is associated with higher blood glucose levels.

Diabetes – are you at risk?

If you answer yes to one or more of the following questions, you are at higher risk of developing diabetes, so it’s important to discuss this with your doctor:

  • I have a family history of type 2 diabetes
  • I have high blood pressure
  • I have high triglycerides and low levels of good (HDL) cholesterol
  • I have heart disease or have had a heart attack
  • I am overweight, particularly around the middle
  • I am over 55
  • I am of Chinese, Indian or Pacific Islander Heritage
  • I am an Aboriginal or Torres Strait Islander
  • I have Polycystic Ovary Syndrome (PCOS)
  • I had diabetes in pregnancy or gave birth to a large baby (over 4.5kgs)
  • I don’t exercise regularly or get much activity in my day

You can also check out your risk online with the AUSDRISK interactive tool – by answering ten questions based around the risk factors above, you will be able to calculate your risk of type 2 diabetes in the next 5 years.

 


 

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