Progress 08/01/08 to 07/31/11

Outputs
OUTPUTS: The main outputs over the course of this grant (2008-2011) involved research, including four experiments evaluating children's self-served portions, and extension, involving the development of interactive educational materials for caregivers of young children focusing on healthy portion sizes. Research outputs: Experiment #1 evaluated the effects of food unit size on children's self-selected portion sizes and intake at a dinner meal. Four experimental conditions were utilized that differed in the number and size of pizza units available at a dinner meal: 2 pieces each weighing 112.5 g, 4 pieces each weighing 56.25 g, 6 pieces each weighing 37.5 g, and 8 pieces each weighing 28.125 g. Complete data were obtained from 41 ethnically diverse 4-6 year-old children of whom approximately half were male (N=21). Experiment #2 evaluated the effect of dishware size (i.e. plate and bowl size) on 1st grad children's self-served portion sizes and intake at school lunch meals. Participants were 42 primarily African American first graders who were observed weekly at school lunch meals. A within subjects design was used where children served themselves using an entree and two side dishes using reference or large dishware (~100% surface area/volume increase); condition order was counter balanced across classrooms. Experiments #3 (n=16) and #4 (n=47) were similarly designed within-subjects experiments compared preschoolers children's intakes at lunch meals where entrees were either plated or self-served. Individual differences in children's self-selected portion sizes based on child weight and children's responsive to large food portions were also evaluated. Extension outputs: In the last phase of this integrated project, we used the findings of our basic research studies to develop state-of-the art Internet-based nutrition education materials for caregivers of young children to promote healthy portion sizes. These materials will be disseminated through Families, Food, and Fitness section of eXtension (www.extension.org) and the Pennsylvania State University's Better Kid Care Program which provides professional development courses for childcare providers through a number of PA state agencies and programs including the PA Department of Public Welfare, and the Keystone STARS accreditation program for early childhood education. Interactive materials, including YouTube videos, photo guides of healthy child portions, classroom lessons, and an interactive game for preschoolers were developed to convey the state of the art science and tips on promoting healthy child portion sizes, encouraging children to listen to their hunger and fullness cues, and teaching children to serve themselves healthy portions. PARTICIPANTS: This project was a collaborative endeavor between Dr. Jennifer Orlet Fisher at Temple University and Dr. Leann L. Birch at the Pennsylvania State University. The research at Temple University was directed by Dr. Jennifer Fisher and the day-to-day operations were coordinated by Kevin Mathias who has a M.S. in Food Science as well as Katherine Disantis, who holds a Ph.D. in Public Health. Elizabeth Hanna, B.S. was a Research Associate and responsible for recruitment and interacted with families during data collection as well as data entry. Yasmeen Bruton, B.S. participated in recruitment efforts and interacted with families during data collection. Undergraduate student workers with backgrounds in Public Health, Neuroscience included Gal Bordo, and Margaret Tait. The research at the Pennsylvania State University was directed by Dr. Leann Birch and the day-to-day operations were coordinated by Dr. Jennifer Savage. Mastaneh Sharafi was a M.S. level student in Nutrition who wrote her thesis using the data from this project. Stephaine Anzman-Frasca was a Ph.D. level student in Human Development and Family Studies who worked on data collection, analyses, and manuscript preparation. Better Kid Care, run through the Pennsylvania State University, partnered with the project to develop and disseminate the nutrition education materials. The eXtension.org Families, Food, and Fitness Community of Practice, lead by a multi-institution team including Drs. Jane Clary, Kathleen Morgan, Carolyn Dunn, partnered with the project to facilitate the development and dissemination of the nutrition education materials through eXtension. The Pennsylvania Department of Education also partnered with the project, via Ms. Cheryl Oberholser, a public health consultant, to develop an on-line based NAP SACC professional development module for the Keystone Kids program based on the aforementioned materials. TARGET AUDIENCES: The scientific community was the main target audience for the research efforts and included students, research staff, collaborating institutions, and individuals in the fields of Nutrition and Obesity who attended scientific sessions at which the data were presented. The participating research teams were composed of primarily female undergraduate and graduate students as well as project staff and faculty. Professional audiences in childcare and nutrition as well as parents of young children were the target audiences of the extension activities. Distance education materials from this project are being available to a broad range of providers in Pennsylvania who complete distance education as part of the state accreditation process for early childhood education as well as parents and nutrition educators who use eXtension as a nutrition resource. PROJECT MODIFICATIONS: Experiment #1 on food unit size was originally designed to focus on food unit and plate size. However, we opted to focus solely on food unit size in order to employ a stronger design. The effects of plate size on self-served portion size are being considered in a separate additional experiment that is being conducted at Temple University as part of this project. Experiment #2 was not part of the original aims; this experiment was a supplementary study conducted to extend knowledge of the capacity of size-related cues in children's eating environments to influence their children's self-served portions. The aims of experiments #3 and #4 were modified to evaluate the role of children's self-served portion sizes on intakes and to evaluate individual differences in children's responses. The internet-based extension materials described in the original proposal were greatly enhanced by moving away from purely informational content (e.g. FAQs) to interactive content (i.e. videos, games, photo guides). The dissemination plans were also enhanced to reach a broader target audience that includes childcare providers, nutrition professionals, and parents.

Impacts
The major outcomes of the research activities are changes in fundamental scientific knowledge of children's self-served portion sizes. Results of Experiment 1 showed that children served themselves significantly less pizza (p<0.05) in the smaller unit size conditions. In conclusion, the findings of this research support the hypothesis that children increasing unit size produced a modest increase (~8%) in children's self-selected portion sizes. Results of Experiment 2 showed main effects of dishware size on children's self-served portions for all foods (p<0.05). Children who served themselves more with larger dishware showed greater increases in total energy consumed at lunch (p<0.05). These findings indicate that using larger dishware causes children to serve themselves larger portions which, in turn, led to greater energy intakes at meals. Results of Experiments #3 and #4 showed that children's entree and energy intakes did not differ between the self-served and plated conditions; however larger self-served entree portions were associated with greater entree intakes. In both experiments, children with diminished satiation responses tended to serve themselves larger portion sizes. These findings indicate that although allowing children to self-select entree portion size, on average, did not influence relative to plated meals, greater self-served portion sizes and intakes were seen among heavier children and those susceptible to portion size. The major outcome of extension activities are increases in knowledge in promoting healthy portion sizes in young children in PA among childcare providers and nationally among parents and nutrition educators. Internet based extension materials were designed to reach a broad range of providers in Pennsylvania who complete distance education as part of the state accreditation process for early childhood education as well as parents and nutrition educators who use eXtension as nutrition resource.

Publications

• Fisher, J.O., Birch, L.L., Grusak, M.A., Hughes, S.O. (2008). How much is enough: effects of portion and serving spoon size on the amount of children's self-served entree portion and intake. Obesity, 16, S91.
• Fisher, J.O., Kral, T.V.E. (2008). Super-size me: Portion size effects on young children's eating. Physiology and Behavior, 94, 39-47.
• Sharafi, M., Fisher, J.O., Manini, M., Edmonson, J., Birch, L.L. (2008). Dose response effects of entree portion size on children's energy intake. Obesity, 16,S56-57.
• Fisher, J.O., Birch, L.L., Grusak, M.A., Hughes, S.O. (2009). Maternal feeding styles and children's self-selected portion sizes and intake at a meal. Abstract presented at the International Society of Behavioral Nutrition and Physical Activity Annual Meeting, Lisbon, Portugal, June 2009.
• Bruton, Y., Hanna, E.L., DiSantis, K.I., Birch, L.L, Serrano, E., Fisher, J.O. (2010). In the eye of the beholder--effects of eating implement and portion size on young children's intake. Abstract presented at the Food and Nutrition program of the 138th APHA Annual Meeting, Denver, CO, November 6-10, 2010.
• Anzman-Frasca, S., Savage, J.S., Marini, M.E., Fisher, J.O., Birch, L.L. (2011). Repeated exposure and associative conditioning promote preschool children's liking of vegetables. (Under review).
• DiSantis, K.I., Birch, L., Bruton, Y., Hanna, E.L., Serrano, E., Fisher J.O. (2011). Do large plates cause children to serve larger portions and to eat more Abstract presented at the Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine, Washington, DC, April 2011.
• DiSantis, K.I., Birch, L.L., Davey, A., Serrano, E., Zhang, J., Bruton, Y., Fisher, J.O. (2011). Child-sized plates and bowls attenuate self-served school lunch portions and subsequent energy intake in young children. (In preparation).
• Fisher, J.O., Birch, L.L., Zhang, J., Hughes, S.O., Grusak, M.A. (2011). Size-related facets of children's eating environments influence children's self-served entree portions at dinner meals. (In preparation).
• Haisfield, L., Fisher, J. O., Savage, J. S., Marini, M.S., & Birch, L. L. (2011). Influence of family style meals on young children's self-selected portions and intake. Obesity, 11, S66.
• Mathias, K.C., Birch, L.L., Fisher, J.O. (2010). Effect of entree unit size on children's self- served portions. Obesity, 18, S108.
• Savage, J.S., Fisher, J.O., Marini, M., Birch, L.L. (2011). Serving smaller age-appropriate entree portions to children aged 3-5 years increases fruit and vegetables intake and reduces energy density and energy intake at lunch. (Under review).
• Savage, J. S., Haisfield, L., Fisher, J. O., Marini, M.S., & Birch, L. L. (2011). Do children eat less at meals when allowed to serve themselves (In preparation).

Progress 08/01/08 to 07/31/09

Outputs
OUTPUTS: The main outputs during this reporting period were the conduct of two experiments on children's self-served portions. Previous research in adults shows that the size of food units influences consumption where adults select and eat a greater weight of food as unit increases. Experiment #1 involved the effects of food unit size on children's self-selected portion sizes and intake at a dinner meal. Four experimental conditions were utilized that differed in the number and size of pizza units available at a dinner meal. A total portion of 225 g was available in the following unit number/size: 2 pieces (9 x 11.5 cm) each weighing 112.5 g, 4 pieces (6.4 x 8.2 cm) each weighing 56.25 g, 6 pieces (5.2 x 6.7 cm) each weighing 37.5 g, and 8 pieces (4.5 x 5.8 cm) each weighing 28.125 g. Convenience sampling was used to recruit 43, 4-6 year-old children and a primary caregiver who were living in urban Philadelphia. Complete data were obtained from 41 children (26 Black, 9 Hispanic, 2 white, 4 other) of whom approximately half were male (N=21). More than half of the children were 5 years of age (N=24), with the remainder roughly split between 4 and 6 years of age. Approximately half (49%) of parents reported a high school or less education, and 11 of 41 reported participation in food stamps. While large portions are thought to be obesity promoting, some studies have not observed portion size effects on food intake and few studies have shown any association with weight status. How children's selection and intake of food portions is associated with weight is unclear. Experiment #2 evaluated the effects of weight status on children's self-served portion size and intake across a range of six entree portion sizes (100 g, 160 g, 220 g, 280 g, 340g, 400 g). This experiment was a follow-up to a previous experiment in which heavier children were observed to eat greater entree portions when served to them and when allowed to self-serve the entree. Participants were 66 children aged 3- to 6 years attending daycare and kindergarten programs in Central Pennsylvania. Of those 66 children, the data from 17 children were excluded from analyses because they failed to meet predetermined inclusion criteria including liking the entree. Data analyses were conducted on 49 children (20 boys, 29 girls); 13 children (26.5%) had a BMI percentile > 85 and were identified as overweight. Parents tended to be highly educated, currently employed, and married. Most of the families (60%) reported combined family incomes of > $80,000. PARTICIPANTS: This project is a collaborative endeavor between Dr. Jennifer Orlet Fisher at Temple University and Dr. Leann L. Birch at the Pennsylvania State University. The research at Temple University was directed by Dr. Jennifer Fisher and the day-to-day operations were coordinated by Kevin Mathias who has a M.S. in Food Science. Elizabeth Hanna, B.S. was a Research Associate and responsible for recruitment and interacted with families during data collection as well as data entry. Yasmeen Bruton, B.S. participated in recruitment efforts and interacted with families during data collection. Dr. Katherine Disantis primarily assisted data collection. Undergraduate student workers with backgrounds in Public Health, Neuroscience included Gal Bordo, and Margaret Tait. The research at the Pennsylvania State University was directed by Dr. Leann Birch and the day-to-day operations were coordinated by Dr. Jennifer Savage. Mastaneh Sharafi was a M.S. level student in Nutrition who wrote her thesis using the data from this project. TARGET AUDIENCES: To date, the scientific community has been the target audience of the efforts of this research and includes students, research staff, collaborating institutions, and individuals in the fields of Nutrition and Obesity who attended scientific sessions at which the data have been presented. The research teams have been composed of primarily female students and staff. The extension aim of this grant will be designed to reach professional nutrition educators and clinicians as well as the audiences they reach. Materials will be designed to be accessible to economically disadvantaged families. PROJECT MODIFICATIONS: Experiment #1 on food unit size was originally designed to focus on food unit and plate size. However, we opted to focus solely on food unit size in order to employ a stronger design. The effects of plate size on self-served portion size are being considered in a separate additional experiment that is being conducted at Temple University as part of this project. Experiment #2 was not part of the original aims; this aim was included to address emerging questions about the arbitrary definition of large portion size employed in previous studies. The range of six portions utilized covered the spectrum of portions consumed by children of the study age and allowed a greater amount of information to be collected on each individual. This design allowed a better estimation of the influence of weight status on children's intake and self-selected portions.

Impacts
The outcomes of the two experiments resulted in a change in basic knowledge of influences on children's self-served portions and intake. Data analyses of Experiment 1 are ongoing. Analyses will focus on the effects of food unit size on the number of units selected and the total amount of food selected. Analyses will also evaluate effects of food unit size on food and energy intakes as well as eating microstructure, particularly the number and size of bites taken. In experiment #2, children's entree intake (range 145-184 g) and total energy at lunch increased with increasing portion size (p < 0.0001), but these effects did not vary by child weight status. Children's mean self-served entree portion was 265 g (+/- 104 g). There was a trend for overweight children to serve themselves more entree (315 g) than non-overweight children (246 g) (p = 0.06). Children's entree intake at the self-selected lunch (M = 180 g, SD = 90) did not differ significantly from the condition when they were served the 400 g portion (M = 191 g, SD = 97). The difference in entree consumed (g) between the self-served and served condition was not significantly different for overweight compared to non-overweight children. However, the amount of entree children served themselves was positively associated with the amount of entree consumed during the self-served condition (r = 0.66, p < 0.0001), as well as the total lunch consumed (g) (r=0.37, p<0.05) and energy of total lunch consumed (kcal) (r=0.57, p<0.0001). Furthermore, overweight children had higher total lunch energy intake (522 kcal) in this condition than non-overweight children (395 kcal) (p < 0.05).

Publications

• Fisher, J.O., Birch, L.L., Grusak, M.A., Hughes, S.O. (2008). How much is enough: effects of portion and serving spoon size on the amount of children's self-served entree portion and intake. Obesity, 15, A203.
• Sharafi, M., Fisher, J.O., Manini, M., Edmonson, J., Birch, L. (2008). Dose response effects of entree portion size on children's energy intake. Obesity, 15, S56-57.
• Fisher, J.O., Birch, L.L., Grusak, M.A., Hughes, S.O. (2009). Maternal feeding styles and children's self-selected portion sizes and intake at a meal. Abstract presented at the International Society of Behavioral Nutrition and Physical Activity Annual Meeting, Lisbon, Portugal, June 2009.