We tend to eat what's on our plate. Most of us have a hard time stopping at satiety or assessing caloric count; we therefore rely on outside cues and eat the unit offered, believing that that unit is what normal people eat.
So restaurants influence how much we'll eat just by deciding the serving sizes, and those are unpredictable and range from petite to colossal. A study published last year surveyed 245 restaurant chains and found that entrees averaged 674 calories, appetizers 813 calories, sides 260 calories, salads 496 calories, drinks 419 calories, and desserts 429 calories. Combine just two portions and you're way over the Institute of Medicine's recommended 640 per meal, and these calorie counts are averages -- Olive Garden's Chicken Alfredo has 1,540 calories a plate.
A new commentary by Deborah Cohen and Mary Story in the American Journal of Public Health has an interesting suggestion: Let's standardize portion sizes in restaurants.
There are standards for screws, nuts and bolts, argue the authors. Portion sizes are established for packaged foods. Alcohol is standardized: A standard drink contains about 0.6 ounces of ethanol in the U.S. (the U.S. alcohol unit is more generous than the U.K. one), and would therefore amount to a large 12-ounce glass of beer, 5-ounce or half a glass of wine or a tiny 1.5-ounce shot of vodka. This enables people to gauge their alcohol consumption, knowing that it takes about an hour to metabolize each unit of alcohol. Most states outlaw all-you-can-drink sales of alcohol -- you're free to order as many drinks as you wish, but it's illegal to automatically refill your glass.
Yet when it comes to restaurant food serving sizes are all over the place, making it very difficult to practice portion control unless you can consult calorie charts and bring along measuring cups and scales. Palm-of-your-hand tricks for estimating the meat portion hardly work for amorphous foods that take the shape of a deep plate. Portion control relies totally on consumer education, but why not enlist the provider -- who after all has much better access to measuring cups -- for assistance?
Cohen and Story suggest using some combination of the USDA and FDA's portion sizes -- those were developed for the Dietary Guidelines for Americans and for packaged foods -- and coming up with a standard size that would, for example, standardize an entrée without sauce at 3 ounces, and with sauce at 5 ounces. They suggest all prepared foods should be available in single portions, and family size portions, whole fish and cuts of meat would clearly state they contain 3 or 4 portions. This way the default is one serving, and the diner has the choice of ordering as many portions as he wishes, while being better informed about the size of the serving he's ordering.
Would restaurants be willing?
Let me guess: Of course not. Remember the outcry when Mayor Bloomberg suggested capping sugary drinks at 16 ounces per serving? Nobody likes regulations, but Cohen and Story remind us of the response preceding the clean indoor air laws. Restaurants objected fiercely and claimed they'd lose customers and money, yet no such thing happened, and if a few smokers stopped frequenting a bar, people who previously avoided the smoky establishment replaced them. I bet one of the most frequent questions servers get is "how big is your portion" -- this new system might bring in diners that were previously cautious of overeating when dining out.
Will customers like this? Would you?
Follow Ayala Laufer-Cahana, M.D. on Twitter: www.twitter.com/DrAyala