Appetite 88 (2015) 11–16

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Appetite
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Research report

Right sizing prevention. Food portion size effects on children’s eating

and weight
Leann L. Birch a, Jennifer S. Savage b,*, Jennifer Orlet Fisher c
a Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
b
Center for Childhood Obesity Research, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
c Center for Obesity Research and Education, Department of Public Health, Temple University, Philadelphia, PA, USA

A R T I C L E I N F O A B S T R A C T

Article history: Experimental findings provide consistent evidence that increasing the portion size of palatable, energy
Received 17 September 2014 dense entrees relative to an age appropriate reference portion increases children’s energy intake of the
Received in revised form 17 November entree and the meal. Most of these studies have been conducted on preschool aged children between 2
2014
and 6 years of age, in childcare or laboratory settings, using repeated measures designs. In these studies,
Accepted 18 November 2014
Available online 20 November 2014
children’s intake is compared across a series of meals, where the size of the entrée portion is varied and
other aspects of the meal, including the portion size of other items on the menu, are held constant. This
paper provides an overview of what we know from this research, what is not known about the effects
Keywords:
Portion size of portion size on children’s intake and weight status, and points to some of the important unanswered
Children questions and gaps in the literature. Lastly, we discuss how individual characteristics may make someone
Individual differences more or less susceptible to large portions of foods and how the palatability of foods may moderate ob-
Policy served associations among portion size, children’s intake, and weight status. Future studies that address
Eating behavior the gaps identified in this paper are needed to inform policy and to develop effective and efficient in-
Dietary intake terventions to prevent childhood obesity.
© 2014 Elsevier Ltd. All rights reserved.

Introduction across age groups (Smiciklas-Wright, Mitchell, Mickle, Cook, &

One approach to designing interventions to prevent childhood
obesity is to identify and investigate modifiable environmental and
behavioral factors associated with obesity. Epidemiological studies
point to a number of secular changes in the eating environment and
eating behavior that have occurred during the same time frame as
increases in the prevalence of childhood obesity (McConahy,
Smiciklas-Wright, Birch, Mitchell, & Picciano, 2002; Piernas & Popkin,
2011). These include increases in portion size, foods consumed away
from home, the frequency of eating, the consumption of sugar sweet-
ened beverages and energy dense foods (Rolls, 2014).
In addition to the evidence that portion sizes have increased over
time (Young & Nestle, 2002) evidence from epidemiological studies
indicates that for infants and young children, portion sizes con-
sumed are positively correlated with children’s relative weight status
(McConahy et al., 2002; Piernas & Popkin, 2011), with heavier chil-
dren consuming larger portions than their learner counterparts.
Epidemiological data showing relations between body size and
portion size consumed have been used to develop guidance about
the range of appropriate portion sizes for children, both within and
* Corresponding author.
E-mail address: jfs195@psu.edu (J. Savage).
Goldman, 2002; USDA Center for Nutrition Policy and Promotion,
2005). This use of the findings reminds us that although there is a
positive correlation between portion size and weight status, these
data do not support the idea that large portions are causally im-
plicated in the development of greater body mass and obesity. In
this case, the positive relation between portion size and weight status
probably reflects “reverse causation”: children with greater body
mass consume large portions because their energy requirements
are greater. For example, a 9 year old boy that is 53 inches and 60
pounds (BMI percentile = 23) who is low active requires approxi-
mately 1755 calories per day, whereas, if that same boy weighed
80 pounds (BMI percentile = 92), he would require approximately
2030 calories per day, an additional 275 calories per day to support
growth and development. One way to address the question of
whether large portions play a causal role in the development of
obesity is to adjust energy intake for differences in body weight;
another is to conduct randomized experiments in which portion size
is varied and effects on intake and weight status are measured.
Evidence for the impact of portion size on children’s dietary intake
and weight status is relevant to current public health nutrition policy,
depicted in “My Plate”, the centerpiece of current public health nu-
trition policy communication. Based on the 2010 Dietary Guidelines,
“My Plate” is intended to promote healthier diets and reduce obesity
risk among children and adults alike, and is based on a simple graphic

http://dx.doi.org/10.1016/j.appet.2014.11.021
0195-6663/© 2014 Elsevier Ltd. All rights reserved.
12 L.L. Birch et al./Appetite 88 (2015) 11–16
Fig. 1. USDA MyPlate Graphic.
showing the relative size of portions on a plate (see Fig. 1). For most
Americans, changing their diets to more closely resemble “My Plate”
requires reducing the size of the energy dense “protein” (entrée)
portion to about a quarter of what’s on the plate, while increasing
portion sizes of other food groups, including fruit, vegetables, and
complex carbohydrates. However, for children there is no evi-
dence that such changes in portion size have the intended effects
on diets and weight status.
This paper provides an overview of what is and is not known
about the effects of portion size on children’s intake and weight
status, and points to some of the important unanswered ques-
tions and gaps in the literature. The evidence for the effects of portion
size on adults’ intake is more complete and well developed than
the research on children; see Rolls (2014) for a review of the liter-
ature on the role of portion size on intake in the context of adult
weight management and a meta-analysis on the effects of portion
size on children’s consumption (Zlatevska, Dubelaar, & Holden, 2014).
The first experimental research on portion size effects on chil-
dren’s intake was published about 15 years ago (Rolls, Engell, & Birch,
2000). Since then a number of experimental studies on the effects
of increasing the portion size of entrees (i.e., the main food item
served at a meal) on children’s intake have been conducted (Fisher
& Kral, 2008; Rolls, 2014; Small, Lane, Vaughan, Melnyk, & McBurnett,
2013). In general, findings revealing that serving children large por-
tions of palatable entrees (mostly macaroni and cheese) can increase
intake of those foods, and that the actual or perceived (see Robin-
son, this volume) amount of food on the plate is a powerful
determinant of intake, whether the portions are served by the child
(DiSantis et al., 2013; Fisher, Birch, Zhang, Grusak, & Hughes, 2013;
Savage, Haisfield, Fisher, Marini, & Birch, 2012b) or by the mother
(Johnson et al., 2014). How increasing the portions size of the main
“entrée” or meal item affects the amounts of other foods con-
sumed in a meal, especially fruits and vegetables is limited.
The evidence for effects of portion size on children’s intake comes
from a relatively small body of research conducted by a few inves-
tigators, using similar designs. This research has typically been
conducted with preschool aged children between 2- and 6 years of
age, in childcare or laboratory settings. Using repeated measures
designs, children’s intake is compared across a series of meals, where
the size of the entrée portion is varied and other aspects of the meal,
including the portion size of other items on the menu, are held con-
stant. Main dishes or entrees served at a meal have been pasta dishes,
usually macaroni and cheese, chosen because they are familiar and
well-liked by most preschool children; in most studies children who
do not like these pasta dishes are typically excluded from partici-
pation. In most cases, control conditions include a standard, age-
appropriate reference portion and this is contrasted with one or more
conditions with substantially larger entrée portion sizes, with other
components of the meal held constant across conditions. Mea-
sures of energy intake are derived from data obtained using pre-
and post-meal weighing approaches. Outcomes include measures
of intake of the entrée, other foods, and total energy at the meal.
Overall, experimental findings provide consistent evidence that
increasing the portion size of palatable, energy dense meal items
or entrees relative to an age appropriate reference portion in-
creases energy intake of the main meal item that was manipulated
(i.e., the entrée) and the meal (Fisher & Kral, 2008). In these ex-
perimental studies, primary outcomes are energy intake measured
within a single meal, and so no evidence for effects on more distal
health outcomes is obtained. In the only study to look at the cu-
mulative effects of large portions on daily energy intake, Fisher and
colleagues (Fisher & Kral, 2008) reported that doubling the size of
entrée portions and a snack increased children’s energy intake from
these foods by 23% and this increased children’s total daily energy
intake by 12%. A related finding is that portion size is a very strong
predictor of children’s intake, and this is the case whether the food
portion is pre-plated and served to the child (Fisher, Arreola, Birch,
& Rolls, 2007a; Fisher, Liu, Birch, & Rolls, 2007b; Looney & Raynor,
2011; Ramsay, Safaii, Croschere, Branen, & Wiest, 2013; Smith,
Conroy, Wen, Rui, & Humphries, 2013), or when children are allowed
to self-serve their portion “family style” from a large serving dish
(Orlet Fisher, Rolls, & Birch, 2003; Savage et al., 2012b). This un-
derscores the importance of generating an evidence base to address
the question, “What size portion is the ‘right size’?”
The singular focus of the existing literature on effects of pro-
viding large entrée portions is both a strength and a weakness. There
is consistent evidence that large portions can cause increases in
energy intake, which implicates portion size as a contributing factor
in secular increases in energy intake and the childhood obesity ep-
idemic. However, given the relatively narrow scope of the existing
findings, several key issues remain to be addressed. The first relates
to the evidence for “My Plate” guidance.
Does serving smaller entrée portions and increasing the
portion size of other foods (fruits, vegetables, complex
carbohydrates) on the plate lead to reductions in entrée intake
and increases intake of fruits and vegetables?
The bulk of the existing literature doesn’t address whether “My
Plate” recommendations to reduce entrée portion and increase fruit
and vegetable portions are likely to have the desired effects on chang-
ing patterns of intake at a meal. However, results of a few studies
(Kral, Kabay, Roe, & Rolls, 2010; Savage, Fisher, Marini, & Birch, 2012a;
Spill, Birch, Roe, & Rolls, 2010, 2011) are relevant. While none of
these have included decreasing entrée size and increasing fruit and
vegetable portions within the same design, several have investi-
gated the effects of increasing portion size of vegetables, either as
a first course or at the meal (Mathias et al., 2012; Spill et al., 2010,
2011), and one has looked at the impact of serving smaller entrée
portion on intake of the entrée and of fruits and vegetable served
at the meal (Savage et al., 2012a). Vegetables were served alone,
as a first course, and results indicated that serving larger portions
of vegetables as a first course, either as a vegetable soup (Spill et al.,
2011) or raw carrots (Spill et al., 2010) increased vegetable intake
at the meal compared to when smaller portions were served. In ad-
dition, vegetable intake increased significantly with increases in the
 L.L. Birch et al./Appetite 88 (2015) 11–16
portion size of vegetables served in the first course. Doubling the
portion size of vegetables increased vegetable intake by nearly 50%,
but plate waste was substantial, especially in the large portion con-
ditions, which could be a barrier to implementation (Spill et al.,
2010). In two other studies, fruit and vegetable portions were varied
at a meal (Kral et al., 2010; Mathias et al., 2012). In both studies,
conditions included reference portions or portions were doubled.
Relative to reference, when portions were doubled, fruit intake in-
creased more than vegetable intake.
In an experiment (Savage et al., 2012a), we expanded the range
of entrée portions served preschool children to include those that
were both smaller (25–50%th percentile) and larger (95th percen-
tile) than the average reference portions based on the children’s age,
with entrée portions varying from 100 to 400 grams. Fixed por-
tions of a fruit and vegetable (i.e., green beans and unsweetened
applesauce) and milk were served with the entree. Results re-
vealed effects on fruit and vegetable intake: across the range of entree
portions, serving smaller, age appropriate portions of a palatable
entrée significantly increased children’s intake of the fruit and veg-
etable, thereby decreasing the energy density and increasing dietary
variety and quality of the meal consumed (Savage et al., 2012a) (see
Fig. 2). These findings provide some evidence that “My Plate” changes
could have positive effects on children’s intake at a single meal;
longer term studies are required to assess the impact on chil-
dren’s diet quality and weight status.
How do children’s food likes and dislikes, prior experiences
with food and eating rules/routines, and food palatability
moderate the impact of large portions on intake? What about
the palatability of other foods available?
Although children’s food preferences are primary determi-
nants of what and how much food is consumed (Birch, 1999) the
effects of preferences and palatability have not been systematical-
ly studied in portion size experiments. Compared to increasing
portion size of vegetables, increasing portion size of fruit pro-
duced greater increases in intake in studies that manipulated both
the size of fruit and vegetable portions (Kral et al., 2010; Mathias
et al., 2012). Mathias et al. (2012) reported that portion size effects
for vegetables were limited to children who liked the vegetables that
were served. While additional research is needed, findings suggest
that liking or palatability may play a role in determining whether
300
Entree
Amount Consumed (g)
Other Foods
200
100
0 themselves “family style” has been widely adopted in childcare set-
0
0
10
22
28
34
16
40
Entree Portion Served (g)
Fig. 2. The main effects of portion on entrée and other food intake (g) across the
100 to 400 g portions (Savage et al., 2012a). Fixed portions of “other foods” include
unsweetened applesauce, green beans, and wheat roll. There was a significant pos-
itive linear effect of portion size on entrée intake across the 100 to 400 g (p < 0.0001)
and 220 to 400 g (p < 0.0001) portions. There was a significant negative linear effect
of portion size on other food intake across the 100 to 400 g (p < 0.0001) and 220 to
400 g (p < 0.01) portions. Data were analyzed using within subjects Linear Mixed
Model.
13
increasing portion size increases children’s intake. If children don’t
like the food, they’re not likely to increase their intake as the portion
of foods offered increases. Given the apparent link between liking
and portion size effects, the exclusion of children who don’t like the
foods served in these studies has biased the findings, resulting in
an overestimation of portion size effects. Future studies should
include measures of liking and explore how liking moderates effects
of large portions and impacts plate waste. Specifically, there is ev-
idence that with increasing portion size, plate waste appears to be
relatively greater for foods that children don’t like (e.g., veg-
etables). Lastly, before translating this research to policy, it is
important to consider effect sizes of manipulating portions of dif-
ferent combinations of foods on intake as they translate to calories
and USDA servings, counterbalanced by plate waste.
What individual differences moderate the effects of portion
size? In our obesigenic environment, why are some children
more susceptible to large portions and others less susceptible
(i.e., positive deviance)?
To date, individual differences have not been a focus of re-
search on the effects of portion size on children’s intake. Variability
in children’s response to portion size has been limited by exclud-
ing those children who do not like the foods served in experimental
meals. Although a few studies have addressed individual differ-
ences in children’s susceptibility to large portions, research protocols
that have focused on individual differences in other children’s eating
behavior can inform the design of future portion size studies. For
example, research on caloric compensation (Johnson, 2000; Johnson
& Taylor-Holloway, 2006) and eating in the absence of hunger (Birch,
Fisher, & Davison, 2003; Fisher & Birch, 2002; French, Epstein, Jeffery,
Blundell, & Wardle, 2012) has shown genetically based individual
differences among children in regulation, reactivity, and respon-
siveness to food that manifest in differences in children’s food intake
and weight status (Anzman, Rollins, & Birch, 2010; Anzman-Frasca,
Stifter, & Birch, 2012; Faith, Carnell, & Kral, 2013; Llewellyn,
Trzaskowski, Plomin, & Wardle, 2014a; Llewellyn, Trzaskowski, van
Jaarsveld, Plomin, & Wardle, 2014b; van Jaarsveld, Boniface,
Llewellyn, & Wardle, 2014). In addition, there is limited informa-
tion regarding demographic differences in response to portion size.
Although demographic characteristics of children and parents such
as age, race, ethnicity, income, food insecurity and weight status are
usually reported, these studies have not been designed or powered
to look at main effects or moderation by these factors.
The potential importance of individual differences is under-
scored by the positive associations between portion size and relative
body weight (McConahy et al., 2002) and the fact that portion size
effects appear to be moderated by differences in children’s food pref-
erences for foods offered (Kral et al., 2010; Spill et al., 2010, 2011).
Information on individual differences should increase our ability to
predict who is likely to increase intake and overeat when offered
large portions; several of the other papers in this supplement address
these issues (see other papers in this supplement). One hypothe-
sis is that children would eat less when allowed to serve themselves
in comparison to serving pre-plated meals. Allowing children to serve
tings with the rationale that it allows children to begin to make food
and portion size choices in a supervised setting and promotes the
development of motor and social skills (Ramsay, Holyoke, Branen,
& Fletcher, 2012). However, research on how allowing children to
serve themselves affects energy intake at meals has been limited.
In one study addressing this issue, based on the conventional
wisdom, we hypothesized that children would eat less at self-
served than at pre-plated meals, but intake did not differ across these
two conditions (Savage et al., 2012b). In this research, children par-
ticipated in both pre-plated and self-serve conditions. In the
14 L.L. Birch et al./Appetite 88 (2015) 11–16
self-serve condition, children were served a series of pre-plated meals
in which the main meal item or entrée varied from 100 to 400 g.
In the self-serve condition, children were allowed to serve them-
selves the main meal item or entrée. Menus across all conditions
were the same, and portions remained fixed for the side and bev-
erage items.
Results indicated that individual differences in the size of chil-
dren’s self-served portions predicted entree and total lunch intake
(Savage et al., 2012b). Further, these individual differences in chil-
dren’s self-served intake were predicted by an index of portion size
susceptibility, which was the slope of the relation between plated
entrée portion size and energy intake calculated for each child, based
on data from the plated meals in which entrée portion increased
in size from 100 to 400 grams. These individual slope scores were
also positively related to a measure of food responsiveness and neg-
atively related to satiety responsiveness (Llewellyn et al., 2014b; van
Jaarsveld et al., 2014), using the Child Eating Behavior Question-
naire (CEBQ) (Carnell & Wardle, 2007) which is based on maternal
reports. The constructs of food and satiety responsiveness are trait-
like dimensions of appetite that have shown evidence of heritability
in early development and are thought to be intermediate pheno-
types related to growth rate and weight status and associated with
genetic variation in candidate genes for obesity. Finally, the slopes
for susceptibility to increasing portion sizes were also positively
related to child weight status in this small sample. A majority of
obese children were in the upper quartile of susceptibility and the
majority of normal weight children were in the lowest suscepti-
bility quartile. However, Kral, Remiker, Strutz, and Moore (2014)
failed to note such relationships.
In addition to the above, research reported elsewhere in this
special supplement (Kral & Hetherington, 2015) as well as a review
(Anzman-Frasca et al., 2012) have pointed to potential individual
differences among children that can predict susceptibility to over-
eating, and are probably related to individual differences in response
to large portions of palatable foods. Such approaches may also iden-
tify “positive deviance”, children who are resistant to such effects.
In a review, Anzman-Frasca et al. (2012) reported that several di-
mensions of temperament, including negativity, inhibitory control,
and reactivity/approach are related to differences in eating behav-
ior and weight status. Although these have not focused on
susceptibility to portion size as a potential behavioral phenotype,
these findings point to the need for research that assesses how mea-
sures of individual differences in children’s self-regulation and
reactivity, including temperament and the reward value of food,
predict or moderate portion size susceptibility, food selection, and
eating frequency, as well as measures of growth and weight status.
Parent feeding practices and individual differences in response
to portion size?
Parenting styles and practices, long a target of interventions de-
signed to affect a range of child outcomes, have been implicated as
causal factors in children’s overeating and excessive weight gain
(Birch & Fisher, 1998; Costanzo & Woody, 1985) and play a role in
shaping individual differences in children’s responses to portion size.
For example, parental encouragement to “clean up your plate”
focuses the child on portion size as the determinant of intake, and
has different effects on intake than encouragement to “stop when
you feel full” (Birch, McPheee, Shoba, Steinberg, & Krehbiel, 1987).
However, bidirectional influence characterizes parent–child rela-
tions and there is also evidence for reverse causality: parenting
practices are also a response to the child’s characteristics, includ-
ing the child’s eating behavior and weight status. For example,
thinner children described as “picky eaters” are more likely to be
pressured to eat, while restrictive feeding practices are more likely
to be used with children who are overweight and are lower on
inhibitory control and more reactive to food cues (Ventura & Birch,
2008). The evidence on causal pathways is limited but findings from
a randomized controlled trial designed to prevent excessive weight
gain in infants revealed that parenting moderated relations between
temperamental reactivity self-regulation (i.e., infant negativity) and
weight status during infancy (Anzman-Frasca et al., 2012). Other
findings also indicate that the effects of individual differences among
children in self-regulation and reactivity on children’s weight status
are moderated by mothers’ feeding practices (Anzman & Birch, 2009).
Together, these findings suggest that research on how parental
feeding practices interact with child characteristics to affect the de-
velopment of children’s understanding of appropriate portion size
and susceptibility to portion size could yield new insight regard-
ing early interventions to prevent obesity (Leung et al., 2014). In
addition, research suggests that individual differences in the rein-
forcing value of food early in life may increase the risk of obesity.
We developed and validated a behavioral measure of individual dif-
ferences in the reward value of food that can be used in children
as young as 3 y (Rollins, Loken, Savage, & Birch, 2014). In this study,
children who worked harder (i.e., greater number of total re-
sponses and faster response rate) consumed more calories in the
snack session with heavier children responding at a faster rate. This
measure provides a tool that could be used to assess the extent to
which differences in the reinforcing value of food affect young chil-
dren’s responsiveness to large portions.
How generalizable are the findings of studies of portion size in
children to: snacking, to older children and adolescents, and
children from demographic groups at high risk for obesity?
The evidence to date is limited to studies of preschool chil-
dren, at mealtime in childcare settings or laboratories; whether the
effects of portion size can be generalized to home settings and to
older children is unknown. Further, the effect of prior experience
with food and the rules and routines taught in childcare settings
on portion size effects remains unclear. Although larger portions
predict greater intake among young children and adults, whether
the magnitude of portion size effects differs across age groups is
unknown. Given the dramatic developmental changes that occur
between early childhood and adolescence, it seems inappropriate
and unwise to generalize findings obtained with preschoolers to older
children and adolescents. The relative salience of factors influenc-
ing the behavioral controls of food intake may also change with
development during childhood and adolescence: autonomy in-
creases, along with concerns about weight and body image, the
importance of peer influence and opportunities to make their own
food choices (Savage, Fisher, & Birch, 2007). Research with chil-
dren and adolescents on eating in the absence of hunger has revealed
that consumption of palatable snack food increases with age, even
when children have reported they are not hungry (Francis, Ventura,
Marini, & Birch, 2007). These data suggest the possibility of devel-
opmental increases in responsiveness to food cues or in subjective
norms about eating over time. During this period, there are also shifts
in exposure to media and marketing designed to impact consum-
er decisions. Together, these changes could make older children
particularly vulnerable to large portions.
There is evidence for the effects of portion and package sizes of
snack intake among adults but research on portion size effects on
children’s snack intake is scant (Looney & Raynor, 2011), despite
the important contribution snacking make to children’s energy and
nutrient intakes. Given that effects of portion size are greater
when foods are liked, and that many foods consumed as snacks are
designed to be highly palatable foods, we would hypothesize that
the effects of portion size might be relatively large, especially
if snacks involve a single food. There are no data on whether
the effects of portion size on children’s snack or meal intake differ
 L.L. Birch et al./Appetite 88 (2015) 11–16
by demographic factors, including age, race, ethnicity, family edu-
cation and income, participation in government funded programs
that provide nutrition education and food to low-income families
such as the United States federally funded Special Supplemental Nu-
trition Program for Women, Infants, and Children (WIC) program
or Supplemental Nutritional Assistance Program (SNAP), and food
insecurity. Most research has included convenient, homogeneous
samples; thus, the impact of portion size on dimensions of health
disparity, namely obesity risk, is unclear. Finally, the context where
eating occurs, whether at home during family meals, while watch-
ing TV, in childcare, in quick serve restaurants, or other away from
home settings, may be an important moderator of the impact of large
portions, but their effects are currently unknown.
What do we know about the impact of persistent changes in
portion size, imposed beyond a single meal for days, weeks, or
months have on children’s food and energy intake and on
health outcomes, including children’s diet quality, growth and
weight status?
There is currently no literature that addresses this question; re-
search on this topic is warranted, especially given that “My Plate”
makes assumptions about the impact of such changes on dietary
intake and health. There are methodological barriers to conduct-
ing such studies outside the laboratory, especially challenges of
monitoring fidelity and compliance with both portion size and intake.
Advances in technology could soon make conducting this work
outside the laboratory (Martin et al., 2012, 2014) more feasible and
affordable, with the availability of remote food photography ap-
proach using smart phone applications. Innovative methods would
allow the design of research studies that could begin to address the
impact of chronic changes in portion size on important long-term
outcomes, including weight status and indices of diet quality.
What and how are children learning about portion size? How
do we promote both knowledge and eating behavior
consistent with consuming portions that support healthy diets
and growth? What is a “right sized” portion?
These questions have not been addressed but need attention.
There is no systematic research on this topic but a variety of factors
are likely to be involved, including media, marketing, observa-
tional learning of parents and others’ eating behavior, parents’ feeding
practices, and post-ingestive feedback following the consumption
of various portion sizes.
What factors determine the portion sizes served to children by
parents and other caregivers?
The experimental evidence for the effects of portion size on chil-
dren’s intake has been obtained in childcare or laboratory settings,
where young children eat many of their meals. Expanding the con-
texts where research on the effects of portion size is conducted to
include the home and away from home settings is essential to in-
creasing the generalizability and ecological validity of findings. This
research would also help us in developing an understanding of what
factors determine the portion sizes served to children.
There are a range of factors that likely affect portion sizes served
to children, but few of these have been systematically studied (mar-
keting, setting of defaults, social norms about portion size defaults:
parent’s experience as children, their own portion sizes). Early learn-
ing and experience influences the child’s developing food preferences
and eating behavior (Birch, Savage, & Ventura, 2007), but how early
learning and experience affect children’s responsiveness to portion
size is unknown. Parents play a key role in shaping the early feeding
environments that provide the context for learning about food and
15
eating, but research on portion size, conducted mostly in child care
settings hasn’t focused on the role parents and the family play in
learning about portion size. Children learn by observing others, es-
pecially parents and other family members; parents’ own eating,
the availability of marketing in the home, and parents’ rules and
routines about eating all have the potential to shape responsive-
ness to portion size. For example, parents’ feeding practices differ
in the degree of external control imposed on the child, and persis-
tent differences in the use of external control in feeding should affect
children’s responsiveness. One untested hypothesis is that feeding
practices focused on having the child finish a portion of food on the
plate would likely increase the child’s focus on portion size as a key
determinant of intake, while feeding practices that focus the child
on use of internal feedback cues of hunger and fullness as the rel-
evant cues could serve to reduce the salience of portion size as a
determinant of intake.
Summary and conclusions
Current evidence indicates that providing large portions of pal-
atable, energy dense foods increases children’s intake; however, no
study to date, has examined the long-term, sustainable effects of
portion size on children’s energy intake, energy density, dietary
variety, weight status, or health over time. Longer-term studies that
examine how individual susceptibility and characteristics of the food
(e.g., palatability, exposure, etc.) influence portion size effects on
eating behavior over time are needed to develop effective and ef-
ficient interventions to promote healthy growth and development,
and ultimately to inform public policy.
References
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