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Marion Nestle and The Importance of Portion

The Atlantic checked in recently with Marion Nestle, professor of Nutrition, Food Studies, and Public Health at New York University, and the author of Food PoliticsSafe FoodWhat to Eat, and Pet Food Politics.

The Atlantic: What is the importance of size in our portions? What is the best way to judge portions when going out to dinner?

Marion Nestle: Easy. Large portions make you eat more. If I could teach just one thing about nutrition, it would be this: Larger portions have more calories. Funny? Portion size is anything but obvious. Research repeatedly confirms that larger food servings not only provide more calories but also have two other effects. They encourage people to eat more and to underestimate how much they are eating.

A few years ago, I asked Lisa Young, who teaches our department's introductory nutrition course, to ask her students to guess the number of calories in an eight-ounce Coke and a 64-ounce Double Gulp -- yes, such things exist. She did not expect beginning students to know the exact numbers, but did expect them to do the math. To her surprise, the average multiplier turned out to be three, not eight. How come? Students said that 800 calories in a drink was impossible. No, it is not, as menu labels now reveal.

How to deal with the portion size problem? Use small plates and cups in the dining hall. When eating out, order appetizers, not entrees. Order the small size, or share large portions with friends.

The system is stacked against you and it's up to you to figure out how to cope with it. Small sizes, for example, usually cost relatively more.

For a long time, I've wanted restaurant owners to give a price break for smaller portions. No luck. They say this would put them out of business. We need to make it easier for people to choose smaller portions, which means changes in public policy.


New Hospital Cuisine: Dishes Made to Order


Pnina Peled, executive chef at Memorial Sloan-Kettering Cancer Center, recently faced an unusual culinary challenge: A teenage cancer patient wanted pizza, but chemotherapy treatments had dulled the girl's taste buds and she could only taste lemon.

"This kid liked Italian food, and we couldn't think of a lemon-flavored pizza because we kept thinking of tomato sauce," says Ms. Peled. After some trial and error, the chef created a pizza with a lemon Alfredo sauce for the young patient. "We made it for her three or four times in a month because she kept requesting it," Ms. Peled says.

Getting patients in a cancer hospital to eat is a challenge. "They can't swallow or they can't taste it or they're nauseous," Ms. Peled says. "The adults force themselves, because they know they need the nutrition. But the children don't understand why food doesn't taste like it used to, or why they can't taste anything."

Most hospitals have been updating their food offerings to include more vegetarian and healthier fare. But some major institutions are going further, hiring trained chefs to revamp menu selections and expanding kitchen hours to cater to a variety of medical needs. Diabetic, gastric-bypass, cardiac, cancer and other types of patients all have different cravings and nutritional requirements, these hospitals say.

Chefs are experimenting with Nutella milkshakes, made from the sweet hazelnut spread, for patients needing extra calories. Cancer patients may dine on chicken with a side dish of Flamin' Hot Cheetos to tingle chemo-numbed tongues.

Rex Healthcare in Raleigh, N.C., maintains a small herb garden outside the cafeteria where patients can watch the chefs cut mint and tarragon for the day's dishes. Jim McGrody, Rex's director of culinary and food services, says each disease has its own issues: Cancer patients can't have fresh herbs and raw vegetables because of bacterial concerns, renal patients have to watch potassium (so, no bananas) and cardiac patients eat a low-fat diet.

"Gastric bypass patients are really a challenge because they have to eat very low-fat, low-sugar diets with high protein," says Mr. McGrody, a Culinary Institute of America graduate. "This summer I tried an outdoor menu, with some cedar-plank-grilled salmon. You have to show them that they can get flavor without the fat using citrus juices or roasted garlic."

What's on the Menu

Examples of how Rex Healthcare in Raleigh, N.C., overhauled its menu in 2009.

Old menu: Eggs, bacon, French toast, one pancake option

New menu: Grilled portabella mushrooms topped with scrambled eggs, feta cheese and spinach. Four types of pancakes: blueberry, whole grain, buttermilk and banana nut. Grilled peaches with a splash of balsamic.

Old menu: Fried or baked fish.

New menu: Lime and ginger glazed salmon. Tilapia en papillote (tilapia filets with snipped green beans, lemon, capers, fresh oregano and white wine wrapped in paper and baked).

Source: Jim McGrody, Rex Healthcare

It takes more work to provide specialized meals. And some healthier ingredients, like fish, can be more expensive. But hospital officials say the cost, which is incorporated into the daily room charge, works out about the same as traditional hospital fare.

"Although we reinvented the menu, the trade off is that we saw a significant reduction in food waste," says Veronica McLymont, director of food and nutrition services at Memorial Sloan-Kettering, in New York. "Patients now order what they want to eat, when they are ready to eat," she says.

Extra care in preparing meals also can give a boost to a hospital's reputation. A 2009 study published in the journal Nutrition & Dietetics found that the more personalized the food service, the more satisfied the patients.

Patients say it makes a difference. Carl William Cousins, 54 years old, had a triple bypass at Rex Hospital last summer. During his six-day stay, he remembers the grilled chicken and turkey sandwiches and well-spiced vegetables.

"Most of the time when you think heart healthy, you just think bland," says Mr. Cousins, a retiree in Raleigh. "I really looked forward to getting something to eat."

Rex Healthcare has two recipes for grilled chicken. "One is marinated in oil with onions, pickles, herbs and spices," Mr. McGrody says. The other, for the heart-healthy menu, "has no oil but is more of a rub of fresh herbs and spices," he says.

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Occupy the Food System: 300,000 Organic Farmers Sue Monsanto in Federal Court


Little did Willie Nelson know when he recorded “Crazy” years ago just how crazy it would become for our cherished family farmers in America.   Nelson, President of Farm Aid, has recently called for the national Occupy movement to declare an “Occupy  the Food System” action.

Nelson states, “Corporate control of our food system has led to the loss of millions of family farmers, destruction of our soil…”

Hundreds of citizens, (even including NYC chefs in their white chef hats) joined Occupy the Food System groups, ie Food Democracy Now, gathered outside the Federal Courts in Manhattan on  January 31st, to support organic family farmers in their landmark lawsuit against Big Agribusiness giant Monsanto. (Organic Seed Growers & Trade Association v. Monsanto) Oral arguments were heard that day concerning the lawsuit by 83 plaintiffs representing over 300,000 organic farmers, organic seed growers, and organic seed businesses.

The lawsuit addresses the bizarre and shocking issue of Monsanto harassing and threatening organic farmers with lawsuits of “patent infringement” if any organic farmer ends up with any trace amount of GM seeds on their organic farmland.

Read more


Let Us Eat Cake (for Breakfast)

These researchers should win a humanitarian award.  A group of Israeli researchers published an ingenious study in the international journal Steroids (as in hormones that regulate eating behavior) that found eating dessert after a big breakfast caused major weight loss. Over the 32 week study, obese participants who ate a large (600 calorie) protein-and-carbohydrate-rich breakfast that included dessert of cake, cookies or chocolate lost significantly more weight--a whopping 40 pounds on average-- than their counterparts eating a typical calorie-restricted, low-carbohydrate breakfast. Both groups were asked to eat the same total calories throughout the day (1400 for women and 1600 for men.)

After the 16th week, in the second half of the study, the low-calorie breakfast group regained an average 22 pounds per person while the high-calorie breakfast-dessert eaters lost an additional 15 pounds each on average. 

In this study persistence paid off, which is often not the case for dieters who typically hit a wall and find themselves gaining back weight despite Herculean efforts. In the first 16 weeks both groups of dieters (heavy vs moderate breakfast) lost the same amount of weight (about 33 pounds), but after the 16th week, in the second half of the study, the low-calorie breakfast group regained an average 22 pounds per person while the high-calorie breakfast-dessert eaters lost an additional 15 pounds each on average. The results will come as no surprise to legions of failed dieters who know how tough it is to be virtuous all the time.

Falling Off the Wagon, graphically: The high calorie breakfast dessert eaters, labeled HCPb, lost significantly more weight in the second half of the study than the low calorie eaters (LCbs.) "Attempting to avoid sweets entirely can create a psychological addiction to these same foods in the long-term," says lead researcher, Daniela Jakubowicz of Tel Aviv University's Wolfson Medical Center. The researchers established a biological basis for falling off the wagon. A major finding was the difference in levels of ghrelin (the hormone that increases feelings of hunger.) For the breakfast-dessert eating group, ghrelin levels fell by 45.3%, but for those who ate a restricted breakfast ghrelin only fell by 29.5%.  The more precipitous drop in ghrelin left the happy breakfast-cake eaters feeling more satisfied and less hungry for the rest of the day.

In the study, those who ate the lighter breakfast with no sweets eventually cheated later in the day. But, says Jakubowicz, "The group that consumed a bigger breakfast, including dessert, experienced few if any cravings for these foods later in the day." In this case, starting the day with a reward increased willpower.


Study Finds Similarities Between Food, Drug Addiction

 By William Weir for the Hartford Courant

A new study from the Yale Rudd Center for Food Policy & Obesity suggests that a chocolate milkshake and a line of cocaine might not be so different.

The study, published Monday in the Archives of General Psychiatry, found that addictions to food and drugs result in similar activity in the brain.

"This past year we got interested in the idea of food addiction and the neural process," said lead researcher Ashley Gearhardt, a clinical psychology doctoral student at Yale University. "We just wanted to get down and deep into whether people really experience food addiction."

The study included 48 women with an average age of 21 who ranged from lean to obese. They took a test developed at the Rudd Center to measure food addiction, based on an established test for measuring drug addiction. The test includes statements such as, "I find that when I start eating certain foods, I end up eating much more than I had planned," and respondents rate how closely the statements match their own experiences.

With functional magnetic resonant imaging (fMRI), a brain imaging procedure, the researchers examined brain activity when the subjects were shown, and then drank, a chocolate milkshake. The results were compared with the subjects' brain's response to the anticipation and consumption of a tasteless solution.

What they found was that the brains of subjects who scored higher on the food addiction scale exhibited neural activity similar to that seen in drug addicts, with greater activity in brain regions responsible for cravings and less activity in the regions that curb urges. The researchers also found that the brain activity indicative of addiction was found in both lean and obese subjects who scored high in the test for food addiction.

Gearhardt says the findings suggest that certain triggers, such as advertisements for food, have not just a psychological, but a physiological, effect on certain people.

"We found that the high food addiction group showed low inhibition: They have less control in their consumption, and that's something we've seen also in addicts," she said.

That's especially significant, she said, when so many processed foods trigger strong reward responses in our brains.

Our response to high-sugar, high-fat foods once helped us survive as a species, she said, "but today, foods are so much more rewarding than anything our brains have evolved to handle." Although there are very few natural foods that are high in both fat and sugar, she said, many processed foods offer both. She compared these foods to strong drugs like cocaine.


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