Chapter 3
Portion Size Matters
Portion Distortion: Have You Encountered It?
Have you ever found yourself thinking, “I can’t believe I ate the whole thing!”? It’s no secret that portion sizes in the U.S. have inflated over the years. Consider twenty years ago . . .
1. A bagel was 3 inches in diameter and 140 calories; now the average bagel is 6 inches in diameter and 350 calories.
An average man of 5'10" weighing about 155 pounds would have to play basketball for 30 minutes to burn off the extra 210 calories!
2. A standard serving of french fries was 2.4 ounces and 210 calories; now it’s nearly double that, at about 5 ounces and 410 calories.
That same average man of 5'10" weighing about 155 pounds would have to do 75 minutes of light yard work to burn off those 410 calories!
Consumers’ perception of appropriate portion sizes has become distorted over time, with larger portions now viewed as the normal appropriate amount to eat on a single occasion. Food portions are larger than they were 20 years ago at almost every food venue, from markets to vending machines to restaurants.
Super-sizing your order or going to an “all you can eat” buffet may seem like a bargain for your wallet, but is it really a bargain if your blood glucose is too high 2 hours later? Diving into a bowl of macaroni and cheese or pasta may bring you comfort in the moment, but are tight clothes or high blood glucose comfortable later on? Slicing off a large piece of cake or pie may seem sweet at the time, but is the high blood glucose and sluggishness that hits a few hours later so sweet?
Why the Concern about Portion Size?
Portion sizes are a big concern because larger portions mean more calories, more carbohydrate, and thus a greater impact on blood glucose levels and weight. Weight management is a concern for many people with type 2 diabetes. According to the American Diabetes Association’s “Nutrition Therapy Recommendations for the Management of Adults with Diabetes,” more than 3 out of 4 adults with diabetes are at least “overweight” (BMI 25–29.9) In fact, nearly half of all those with diabetes actually fall into the obese category (BMI ≥30). Because extra body fat is linked to insulin resistance, and thus blood glucose control challenges, weight loss has long been a recommended strategy for overweight or obese adults with diabetes. Prevention of weight gain is equally important.
Build Awareness of Portion Sizes
Nutrition Information
A growing positive trend is the increasing availability of nutrition information—from the label on food packages to calorie content and other nutrition information at the point of purchase—with the intent to raise consumer awareness and allow you make to informed decisions. Do compare the portion you actually eat to the serving size associated with the nutrition information. If you eat double the serving size noted, then double the calorie, carbohydrate, and other nutrient counts too.
Has seeing the calorie count posted on menus and food packages changed your food and beverage decisions?
Dish and Glass Size
Just as portion sizes have increased, so have the sizes of dishes and glasses. People used to drink juice from 4-ounce juice glasses. Now 10- to 16-ounce glasses and 25-ounce tumblers are typical. No longer is eating on 9-inch plates the norm. Now plates are 11–12 inches or larger. Because a “normal”-size portion looks small in a large glass or on a large plate, people tend to over-serve when using larger glasses and plates. Research confirms that people eat and drink more when they’re served larger portions.
Package Size
“Individual serving” packages may not always be healthy single-serving portions. In some instances the serving in those packages may be much more than you actually need. Studies show that the bigger the package you pour from, the more you will eat—20 to 30% more for most foods.
Are a Few Extra Pounds a Concern for You?
Whether you desire to drop a few pounds or proactively prevent weight gain, reducing calories while maintaining a healthful eating pattern is the bottom line. And as reviewed in Chapter 1, you’re not locked into any one “ideal diet” to accomplish that goal; a variety of eating patterns can achieve calorie and glucose control. Many studies have shown the Mediterranean style of eating leads to the greatest weight loss; however, you may also achieve weight-management success via a low-fat or low-carbohydrate eating pattern, through a vegetarian or vegan eating pattern, or through the DASH (Dietary Approaches to Stop Hypertension) eating style. Total calorie intake, and thus portion sizes, are an important consideration no matter which eating pattern you go with.
Size Up Your Portions—Do You Eat More Than You Think?
As famous actor, director, writer, and producer Orson Welles once quipped: “My doctor told me to stop having intimate dinners for four. Unless there are three other people.” The key message here is to take a look at your portions and size them up. What you may currently think of as a “regular” portion size may not, in fact, be the “best for you” portion size. Are your portions too large, too small, or just right?
Practical Methods and Tools to Size Up Portions
Many people think they eat less than they actually do. In fact, studies show that people tend to underestimate the calories in large meals—the larger the meal, the more the calorie estimation is off. As for carbohydrate control, becoming familiar with serving sizes can help you pinpoint how much you actually eat and whether you are meeting or exceeding your meal and snack carbohydrate goals.
How much does your cereal bowl hold? Is it 1 cup? Or is it actually closer to 2 or 3 cups?
Going one step further, keep track of the actual portion sizes of what you eat (see the following three approaches to determining portion sizes). You may choose to track your food, beverages, and portions through a written log, a mobile app, online, or on the computer—whatever method works for you. And even if you can’t track it every day, any information is better than none. We bet you’ll make some enlightening discoveries.
There are three approaches that you can use to determine portion sizes.
Approach #1: Measuring Tools
The most accurate way to monitor portion sizes is to measure your food or beverage with measuring cups, measuring spoons, or a food scale. Be sure to use liquid measuring cups for liquids and dry measuring cups for non-liquids—there is a difference. Most people are surprised to see how their actual portion sizes measure up against what they “thought” they were eating.
Try this at home . . .
• Over the next couple of weeks, try to measure your food portions as often as possible. The more you actually weigh and measure food, the better you will get at eyeballing portion sizes. You’ll soon become familiar with what 1/2 cup of beans looks like on your plate, what 8 ounces of milk looks like in a glass, and what 1 cup of high-fiber breakfast cereal looks like in a bowl.
• Once a month, do a spot check to make sure you’re still visualizing your portion sizes correctly.
Approach #2: Hand Estimations
Although measuring cups and spoons certainly have their place, they aren’t always convenient or even realistic to use on many eating occasions. (Who wants to take measuring cups to a friend’s house for dinner? Or to the deli at lunch?) In those scenarios, rely on your own hand to estimate portion sizes and carbohydrate counts using the “Handy Guidelines for Portion Estimation” below.
Handy Guidelines for Portion Estimation*
*These are approximations and may vary slightly, depending on the size of your hand.
If you use the handy guidelines when you visit a steakhouse, you may find that the steak you ordered is about 10 ounces (two man-sized palms) and that the side of potatoes is about 1 cup (a small adult fist).
Should you order spaghetti in a restaurant, you can quickly determine the portion size on the plate. Typically the plate arrives with at least 2 cups of cooked spaghetti (that’s 2 small adult fists’ worth). Knowing that 1/3 cup cooked spaghetti has 15 grams of carbohydrate (or 1 carbohydrate choice), you’ll realize that a 2-cup plate of spaghetti contains a whopping 90 grams of carbohydrate (or 6 carbohydrate choices)! No wonder many people notice their blood glucose is above target after eating spaghetti—the portion size is just too large.
When you go to a dinner party, using your hand as a guide, you can select a 3-ounce piece of grilled chicken breast (size of the a woman’s palm), a teaspoon of margarine (1 thumb tip) for your roll, and 2 tablespoons (2 thumbs) of dressing for your salad.
Approach #3: Visualize the Right Portion Size
Another method to help you become familiar with portion sizes is to compare them with everyday household items. Some of our favorite comparisons are on the next page; you may come up with others that work for you.
Once you gain familiarity with standard portion sizes, you can easily compare them to the amount you eat and then calculate how many grams of carbohydrate are in your portions. You will quickly become confident and competent at experience-based estimation of portions and their associated carbohydrate content.
Become an Illusionist: Smaller Dishes Equal “Larger” Portions
Make visual tricks work for you by using smaller dishes to make portions appear larger, and thus trick your mind into believing you’re getting larger portions than you are. Here are some examples of how to trick your mind using plate and glass sizes:
• Plate size: 1 cup of black beans and rice on an 8-inch plate appears to be a nice size serving. However, 1 cup on a 12-inch plate looks like a little appetizer. The illusion of the “larger” portion on the 8-inch plate will likely leave you feeling more satisfied.
• Glass size: With glasses, think slender. A tall, slender 8-ounce glass makes your beverage portion appear larger than it would in a short, wide 8-ounce glass. If you don’t fill your glass all the way, studies show you’ll tend to pour 30% more into a wide glass than you would into a slender one.
Preportion to Head Off Portion Distortion
Another strategy to manage portion sizes, and control the temptation to overeat, is to incorporate preportioned foods whenever possible. Whether you choose to purchase items preportioned, or portion them out yourself into zip-top bags or individual containers at home is up to you. Have a favorite combination of snack mix ingredients? Portion out “right-for-you,” carbohydrate-controlled portions that are ready to grab and go. Preportioned foods means no thinking required when hunger hits.
Here are a few examples of preportioned foods you may enjoy:
• fresh apple, orange, pear, plum
• instant oatmeal packets
• 100-calorie snack packs (such as 100-calorie packs of almonds)
• individual greek yogurt cups
• Laughing Cow or Babybel Light individual light snack cheeses
• individual snack packs of hummus, baby carrots, or apple slices
• healthy, natural frozen meals
Make Swaps to Save Calories Where You Can: Small Calorie Savings Add Up
Granted, trimming portions automatically trims calories. But small switches in the types of foods you eat and beverages you drink can save calories yet still satisfy your appetite and taste buds.
If you are trying to cut a few calories in order to trim a few pounds, saving just 300 calories a day means 2100 fewer calories to worry about at the week’s end. And saving 500 calories a day means 3500 calories less at week’s end. No doubt that’s a step in the right direction!
In the end, almost any food can fit in your diabetes meal plan in moderation. Moderation is the mantra—the key is how much of a food you eat and how often you eat it.
Embrace Mindful Eating
Mindful eating means slowing down, being aware and mindful of what and how much you eat, and really tasting and savoring the food. Most people find that the first two to three bites bring the most pleasure. After that, what they eat is just “noise” and they don’t really enjoy or need any more.
Two- to Three-Bite Taste Test
Try the two- to three-bite taste test yourself! Read on to see how it works . . .
A patient we’ve worked with in the past loved cheesecake. Prior to developing diabetes she’d eat an entire giant slice when she dined at her favorite restaurant. Once diabetes entered her life, she still wanted to try to work in cheesecake on occasion, and realized that portion control was important. We had her try the two- to three-bite taste test. She reported back that she discovered she really savored the first three bites of her cheesecake, but after that the pleasure decreased. Based on her discovery, she decided to eat just three bites of cheesecake at the meal, count and incorporate the carbohydrate accordingly, and take the rest home to spread out the pleasure (and carbohydrate) by enjoying two to three bites at several more meals.
For additional guidance and support when it comes managing your portions, stay in frequent contact with your diabetes health-care team, particularly your registered dietitan/registered dietitian nutritionist. That frequent contact, ongoing education, counseling, and support is important for consistent and sustained weight loss.
Next Steps
Pull out your measuring cups, measuring spoons, and food scale, and let the fun begin!
• Measure 1 cup of cold cereal. Pour it into a bowl and notice how it fills the bowl.
• Weigh a potato that is the size you usually eat.
• Measure 1/3 cup of cooked rice or pasta. Place it on your plate, and compare that with how much pasta or rice you usually eat.
• Measure 8 ounces of milk in a liquid measuring cup. Pour it into a drinking glass, and note how much it fills the glass.
• Measure 4 ounces of juice in a liquid measuring cup. Pour it into a glass, and note how much it fills the glass.
• Weigh an apple, orange, or banana that is the size you usually eat.
• Measure 1/2 cup of green beans or another vegetable. Place them on your plate, and compare that with how much your typical vegetable portion fills the plate.
• Measure 1 tablespoon of salad dressing. Drizzle it over lettuce, and notice how that compares with the amount of dressing you usually put on salads.
• Measure out 2 tablespoons of nuts and then 1/4 cup of nuts. Note how those amounts compare to the portion you usually eat.
What Do I Eat for Dinner?
For 45–60 Grams of Carbohydrate*
3 ounces grilled shrimp
Recipe: Mediterranean Quinoa Salad (1 cup)
1 cup steamed asparagus topped with a light drizzle of olive oil and a squeeze of fresh lemon
1 1/2 cups diced watermelon
For 60–75 Grams of Carbohydrate*
3 ounces grilled shrimp
Recipe: Mediterranean Quinoa Salad (1 cup)
1 cup steamed asparagus topped with a light drizzle of olive oil and a squeeze of fresh lemon
1/2 (6-inch) whole-wheat pita bread
1 1/2 cups diced watermelon
*For most women, 45–60 grams of carbohydrate at a meal is a good starting point; for most men, 60–75 grams of carbohydrate per meal is appropriate. Check with your diabetes health-care team to find the amount of carbohydrate that’s right for you.
Swift, Simple Tips
• As an alternative to grilling shrimp, buy fully cooked shrimp and stir into the Mediterranean Quinoa Salad.
• Buy steam-in-the-bag asparagus cuts.
Mediterranean Quinoa Salad
Serves: 5 / Serving size: 1 cup
Preparation time: 30 minutes / Cooking time: 15 minutes
Ingredients for Salad
1 cup uncooked quinoa
2 cups low-sodium chicken broth
1 cup cherry tomatoes, halved
1 cup diced cucumber
1/2 cup canned chickpeas, drained and rinsed
1/2 cup kalamata olives, chopped
1/2 cup reduced-fat feta cheese
1 tablespoon chopped fresh mint
2 tablespoons chopped fresh parsley
Ingredients for Dressing
1 tablespoon olive oil
Juice of 1 lemon
1 clove garlic, minced or grated
1. Rinse uncooked quinoa thoroughly in a fine strainer under cold running water until water runs clear. Combine quinoa and chicken broth in a small saucepan and bring to a boil. Cover and lower to a simmer. Cook for about 15 minutes, or until all liquid is absorbed and quinoa is fluffy.
2. Transfer quinoa to a mixing bowl. Add cherry tomatoes, cucumber, chickpeas, kalamata olives, feta cheese, fresh mint, and fresh parsley.
3. In a separate small bowl, whisk together olive oil, lemon juice, and garlic. Pour over quinoa mixture and toss to combine.
4. Serve warm or refrigerate and serve chilled.
Choices/Exchanges
2 Starch, 1 Lean Protein, 1 1/2 Fat
Calories 270
Calories from Fat 110
Total Fat 12.0g
Saturated Fat 2.2g
Trans Fat 0.0g
Cholesterol 10mg
Sodium 450mg
Potassium 455mg
Total Carbohydrate 32g
Dietary Fiber 5g
Sugars 5g
Protein 11g
Phosphorus 255mg
Food for Thought
• Portion sizes matter. Portion sizes are a big concern no matter which eating pattern you embrace, because larger portions mean more calories, more carbohydrate, and thus a greater impact on blood glucose levels and weight.
• Build awareness of portion sizes. Check out available nutrition information. Familiarize yourself with the sizes of your dishes and glasses.
• Use tools of the trade. Use measuring tools, hand estimates, and comparisons of food portions to common household items to determine portion sizes and associated carbohydrate content.
• Use smaller dishes so portions appear larger.
• Use preportioned foods when possible.
• View it before you chew it. Put everything you eat in a dish or bowl so you can see exactly how much you’re eating and make adjustments as necessary to achieve your carbohydrate targets.
• Make swaps where you can to save calories.
• Embrace mindful eating and remember the two- to three-bite taste test.