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Pediatrics

Child and adult snack food intake in response to manipulated pre-packaged snack item quantity/variety and snack box size: a population-based randomized trial

International Journal of Obesity volume 43, pages 1891–1902 (2019)Cite this article

Subjects

Abstract

Objectives

Snacks contribute to overconsumption of energy-dense foods and thence obesity. Previous studies in this area are limited by self-reported data and small samples. In a large population-based cohort of parent–child dyads, we investigated how modification of pre-packaged snack food, i.e. (a) item quantity and variety, and (b) dishware (boxed container) size affected intake.

Methods

Design: Randomized trial nested within the cross-sectional Child Health CheckPoint of the Longitudinal Study of Australian Children, clustered by day of visit. Sample: 1299 11–12 year olds, 1274 parents. Exposure: 2 × 2 manipulation of snack box container size and item quantity/variety: (1) small box, few items, (2) large box, few items, (3) small box, more items, (4) large box, more items. Procedure: Participants received a snack box during a 15 min break within their 3.5 h visit; any snacks remaining were weighed. Outcomes: Consumed quantity (grams) and energy intake (kilojoules). Analyses: Unadjusted linear regression.

Results

Children who were offered a greater quantity and variety of snack items consumed considerably more energy and a slightly higher food mass (main effect for energy intake: 349 kJ, 95% CI 282–416, standardized mean difference (effect size) 0.66; main effect for mass: 10 g, 95% CI 3–17, effect size 0.17). In contrast, manipulating box size had little effect on child consumption, and neither box size nor quantity/variety of items consistently affected adults’ consumption.

Conclusion

In children, reducing the number and variety of snack food items available may be a more fruitful intervention than focusing on container or dishware size. Effects observed among adults were small, although we could not exclude social desirability bias in adults aware of observation.

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References

  1. Rouhani MH, Haghighatdoost F, Surkan PJ, Azadbakht L. Associations between dietary energy density and obesity: a systematic review and meta-analysis of observational studies. Nutrition. 2016;32:1037–47.

    Article  Google Scholar 

  2. Pelletier AL, Chang WW, Delzell JE, McCall JW. Patients’ understanding and use of snack food package nutrition labels. J Am Board Fam Med. 2004;17:319–23.

    Article  Google Scholar 

  3. Hollands GJ, Shemilt I, Marteau TM, Jebb SA, Lewis HB, Wei Y, et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database Syst. Rev. 2014. https://doi.org/10.1002/14651858.CD0110.

  4. Zlatevska N, Dubelaar C, Holden SS. Sizing up the effect of portion size on consumption: a meta-analytic review. J Mark. 2014;78:140–54.

    Article  Google Scholar 

  5. Raynor HA, Vadiveloo M. Understanding the relationship between food variety, food intake, and energy balance. Curr Obes Rep. 2018;7:68–75.

    Article  Google Scholar 

  6. McCrory MA, Fuss PJ, McCallum JE, Yao M, Vinken AG, Hays NP, et al. Dietary variety within food groups: association with energy intake and body fatness in men and women. Am J Clin Nutr. 1999;69:440–7.

    Article  CAS  Google Scholar 

  7. McCrory MA, Burke A, Roberts SB. Dietary (sensory) variety and energy balance. Physiol Behav. 2012;107:576–83.

    Article  CAS  Google Scholar 

  8. Pérez-Escamilla R, Obbagy JE, Altman JM, Essery EV, McGrane MM, Wong YP, et al. Dietary energy density and body weight in adults and children: a systematic review. J Acad Nutr Diet. 2012;112:671–84.

    Article  Google Scholar 

  9. Rolls BJ. The relationship between dietary energy density and energy intake. Physiol Behav. 2009;97:609–15.

    Article  CAS  Google Scholar 

  10. Small Plate Movement. Home page. http://www.smallplatemovement.org/. Accessed 21 June 2017.

  11. United States Department of Agriculture. Choose MyPlate. http://www.choosemyplate.gov/weight-management-calories/weight-management/betterchoices/decrease-portions.html. Accessed 21 June 2017.

  12. Queensland Government of Australia. How understanding portion sizes can help you meet your healthy eating goals 2018. https://www.health.qld.gov.au/__data/assets/pdf_file/0030/148818/wtmgt-portions.pdf. Accessed 20 January 2019.

  13. South Australian Government of Australia. Portion sizes 2019. https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/healthy+living/healthy+eating/healthy+eating+tips/portion+sizes. Accessed 20 January 2019.

  14. Robinson E, Nolan S, Tudur-Smith C, Boyland EJ, Harrold JA, Hardman CA, et al. Will smaller plates lead to smaller waists? A systematic review and meta-analysis of the effect that experimental manipulation of dishware size has on energy consumption. Obes Rev. 2014;15:812–21.

    Article  CAS  Google Scholar 

  15. Pratt IS, Croager EJ, Rosenberg M. The mathematical relationship between dishware size and portion size. Appetite. 2012;58:299–302.

    Article  Google Scholar 

  16. Wolfe AWJ. The mind’s eye. Scientific American. New York: WH Freeman; 1986.

    Google Scholar 

  17. Holden SS, Zlatevska N, Dubelaar C. Whether smaller plates reduce consumption depends on who’s serving and who’s looking: a meta-analysis. J Consum Res. 2016;1:134–46.

    Google Scholar 

  18. Bauchner H. Notice of retraction: Wansink B, Cheney MM. Super bowls: serving bowl size and food consumption. JAMA. 2005;293:1727–8. JAMA. 2018;320:1648.

  19. Fayet F, Mortensen A, Baghurst K. Energy distribution patterns in Australia and its relationship to age, gender and body mass index among children and adults. Nutr Diet. 2012;69:102–10.

    Article  Google Scholar 

  20. Rangan A, Randall D, Hector D, Gill T, Webb K. Consumption of ‘extra’ foods by Australian children: types, quantities and contribution to energy and nutrient intakes. Eur J Clin Nutr. 2008;62:356–64.

    Article  CAS  Google Scholar 

  21. Rangan A, Schindeler S, Hector D, Gill T, Webb K. Consumption of ‘extra’ foods by Australian adults: types, quantities and contribution to energy and nutrient intakes. Eur J Clin Nutr. 2009;63:865–71.

    Article  CAS  Google Scholar 

  22. Nielsen SJ, Siega-Riz AM, Popkin BM. Trends in energy intake in US between 1977 and 1996: similar shifts seen across age groups. Obes Res. 2002; 10: 370–8.

  23. Archer E, Blair SN. Implausible data, false memories, and the status quo in dietary assessment. Adv Nutr. 2015;6:229–30.

    Article  Google Scholar 

  24. Archer E, Pavela G, Lavie CJ. The inadmissibility of what we eat in America and NHANES dietary data in nutrition and obesity research and the scientific formulation of national dietary guidelines. Mayo Clin Proc. 2015;90:911–26.

    Article  Google Scholar 

  25. Ioannidis JP. Implausible results in human nutrition research. Br Med J. 2013;347:f6698.

    Article  Google Scholar 

  26. Wake M, Clifford S, York E, Mensah F, Gold L, Burgner D, et al. Introducing growing up in Australia’s Child Health CheckPoint: a physical health and biomarkers module for the Longitudinal Study of Australian Children. Family Matters. 2014;95:15.

  27. Clifford SA, Davies S, Wake M, Child Health Check Point Team. Child Health CheckPoint: Cohort summary and methodology of a physical healthand biospecimen module for the Longitudinal Study of Australian Children. BMJ Open 2019;9(suppl 3):3–22. https://doi.org/10.1136/bmjopen-2017-020261.

  28. Sanson A, Nicholson J, Ungerer J, Zubrick S, Wilson K, Ainley J, et al. Introducing the Longitudinal Study of Australian Children (LSAC Discussion Paper No. 1). Melbourne, Australia: Australian Institute of Family Studies (2002).

  29. Soloff C, Lawrence D, Johnstone R. LSAC Technical Paper No. 1: Sample design. Melbourne, Australia: Australian Institute of Family Studies; 2005.

  30. National Health and Medical Research Council. Eat for Health: Educator Guide Information for nutrition educators. Canberra: National Health and Medical Research Council; 2013.

  31. National Health and Medical Research Council. Nutrient reference values for Australia and New Zealand including recommended dietary intakes: 2005 https://www.nrv.gov.au/dietary-energy. Accessed 20 February 2017.

  32. Vivarini P, Kerr JA, Clifford SA, Grobler AC, Jansen PW, Mensah FK, et al. Food choices: Concordance in Australian children aged 11–12 years and their parents. BMJ Open 2019;9(suppl 3):147–56. https://doi.org/10.1136/bmjopen-2017-020898.

  33. StataCorp. Stata Statistical Software. College Station, TX: StataCorp LP; 2015.

    Google Scholar 

  34. Lumley T, Diehr P, Emerson S, Chen L. The importance of the normality assumption in large public health data sets. Annu Rev Public Health. 2002;23:151–69.

    Article  Google Scholar 

  35. Australian Bureau of Statistics. National health survey: first results, 2014-15. 2015. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001. Accessed 28 May 2016.

  36. National Health and Medical Research Council. Obesity and overweight. 2012. https://www.nhmrc.gov.au/health-topics/obesity-and-overweight. Accessed 28 May 2016.

  37. Fisher JO, Liu Y, Birch LL, Rolls BJ. Effects of portion size and energy density on young children’s intake at a meal. Am J Clin Nutr. 2007;86:174–9.

    Article  CAS  Google Scholar 

  38. Fisher JO, Kral TV. Super-size me: portion size effects on young children’s eating. Physiol Behav. 2008;94:39–47.

    Article  CAS  Google Scholar 

  39. Robinson E, Bevelander KE, Field M, Jones A. Methodological and reporting quality in laboratory studies of human eating behavior. Appetite. 2018;125:486–91.

    Article  Google Scholar 

  40. Kral TVE, Rolls BJ. Energy density and portion size: their independent and combined effects on energy intake. Physiol Behav. 2004;82:131–8.

    Article  CAS  Google Scholar 

  41. Robinson E, Aveyard P, Daley A, Jolly K, Lewis A, Lycett D, et al. Eating attentively: a systematic review and meta-analysis of the effect of food intake memory and awareness on eating. Am J Clin Nutr. 2013;97:728–42.

    Article  CAS  Google Scholar 

  42. Robinson E, Kersbergen I, Brunstrom JM, Field M. I’m watching you. Awareness that food consumption is being monitored is a demand characteristic in eating-behaviour experiments. Appetite. 2014;83:19–25.

    Article  Google Scholar 

  43. Robinson E, Hardman CA, Halford JC, Jones A. Eating under observation: a systematic review and meta-analysis of the effect that heightened awareness of observation has on laboratory measured energy intake. Am J Clin Nutr. 2015;102:324–37.

    Article  CAS  Google Scholar 

  44. Herman CP. The social facilitation of eating. A review. Appetite. 2015;86:61–73.

    Article  Google Scholar 

  45. Hall KD, Butte NF, Swinburn BA, Chow CC. Dynamics of childhood growth and obesity: development and validation of a quantitative mathematical model. Lancet Diabetes Endocrinol. 2013;1:97–105.

    Article  Google Scholar 

  46. Hall KD, Sacks G, Chandramohan D, Chow CC, Wang YC, Gortmaker SL, et al. Quantification of the effect of energy imbalance on bodyweight. Lancet. 2011;378:826–37.

    Article  Google Scholar 

  47. Lycett K, Miller A, Knox A, Dunn S, Kerr JA, Sung V, et al. ‘Nudge’ interventions for improving children’s dietary behaviors in the home: A systematic review. Obes Med. 2017;7:21–33.

    Article  Google Scholar 

  48. Cadario R, Chandon P. Which healthy eating nudges work best? A meta-analysis of field experiments. 2018. INSEAD Working Paper No. 2018/18/MKT. https://doi.org/10.2139/ssrn.3090829.

  49. Small L, Lane H, Vaughan L, Melnyk B, McBurnett D. A systematic review of the evidence: the effects of portion size manipulation with children and portion education/training interventions on dietary intake with adults. Worldviews Evid Based Nurs. 2013;10:69–81.

    Article  Google Scholar 

  50. Small L, Bonds-McClain D, Vaughan L, Melnyk B, Gannon A, Thompson S. A parent-directed portion education intervention for young children: Be Beary Healthy. J Spec Pediatr Nurs. 2012;17:312–20.

    Article  Google Scholar 

  51. Potter C, Ferriday D, Griggs RL, Hamilton-Shield JP, Rogers PJ, Brunstrom JM. Parental beliefs about portion size, not children’s own beliefs, predict child BMI. Pediatr Obes. 2018;13:232–8.

    Article  CAS  Google Scholar 

  52. Osei-Assibey G, Dick S, Macdiarmid J, Semple S, Reilly JJ, Ellaway A, et al. The influence of the food environment on overweight and obesity in young children: a systematic review. BMJ Open. 2012;2:e001538.

    Article  Google Scholar 

  53. Australian Bureau of Statistics. Census of population and housing: Socio-Economic Indexes for Areas (SEIFA). 2011. Catalogue 2033.0.55.001. http://www.abs.gov.au/websitedbs/censushome.nsf/home/seifa2011?opendocument&navpos=260. Accessed 28 May 2016.

  54. Blakemore T, Strazdins L, Gibbings J. Measuring family socioeconomic position. Australian Social Policy. 2009;8:121–68.

    Google Scholar 

  55. Clifford SA, Gillespie AN, Olds T, Grobler AC, Wake M. Body composition: Population epidemiology and concordance in Australian children aged 11-12 years and their parents. BMJ Open 2019;9(suppl 3):95–105. https://doi.org/10.1136/bmjopen-2018-023698.

  56. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z., et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11. 2002;246:1–190.

  57. Vidmar SI, Cole TJ, Pan H. Standardizing anthropometric measures in children and adolescents with functions for Egen: update. Stata Journal. 2013;13:366–78.

    Article  Google Scholar 

  58. Petersen AC, Crockett L, Richards M, Boxer A. A self-report measure of pubertal status: reliability, validity, and initial norms. J Youth Adolesc. 1988;17:117–33.

    Article  CAS  Google Scholar 

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Acknowledgements

The authors thank all families, senior researchers, research assistants, students, and interns who assisted in CheckPoint data collection and management. They also acknowledge all families for their continued participation in Growing Up in Australia, the Longitudinal Study of Australian Children (LSAC). LSAC is conducted in partnership between the Department of Social Services (DSS), the Australian Institute of Family Studies (AIFS), and the Australian Bureau of Statistics (ABS). The findings and views reported in this paper are those of the authors and should not be attributed to DSS, AIFS, or the ABS. REDCap (Research Electronic Data Capture) electronic data capture tools were used in this study. More information about this software can be found at www.project-redcap.org. We thank the LSAC and CheckPoint study participants, staff, and students for their contributions.

Funding

The Child Health CheckPoint has been supported to date by the Australian National Health and Medical Research Council (NHMRC) (1041352, 1109355), The Royal Children’s Hospital Foundation (2014-241), Murdoch Children’s Research Institute, The University of Melbourne, National Heart Foundation of Australia (100660), Financial Markets Foundation for Children (2014-055), and Victorian Deaf Education Institute. The following authors were supported by the NHMRC: MW, Senior Research Fellowship 1046518; FKM, Early Career Fellowship 1037449, Career Development Fellowship 1111160; LG, Early Career Fellowship 1035100. PWJ was supported by the Dutch Diabetes Foundation (2013.81.1664), and MW additionally by Cure Kids New Zealand. Research at the Murdoch Children’s Research Institute is supported by the Victorian Government’s Operational Infrastructure Support Program.

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Authors and Affiliations

  1. Murdoch Children’s Research Institute, Parkville, VIC, Australia

    Jessica A. Kerr, Pauline W. Jansen, Fiona K. Mensah, Kay Gibbons, Tim S. Olds, John B. Carlin, Susan A. Clifford, David Burgner, Lisa Gold & Melissa Wake

  2. Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia

    Jessica A. Kerr, Fiona K. Mensah, John B. Carlin, Susan A. Clifford, David Burgner & Melissa Wake

  3. Department of Psychology, Education and Child Studies, Erasmus University, Rotterdam, Netherlands

    Pauline W. Jansen

  4. Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, Netherlands

    Pauline W. Jansen

  5. Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia

    Tim S. Olds

  6. Department of Paediatrics, Monash University, Clayton, VIC, Australia

    David Burgner

  7. Deakin University, Geelong, VIC, Australia

    Lisa Gold

  8. Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia

    Louise A. Baur

  9. Department of Paediatrics & the Liggins Institute, University of Auckland, Auckland, New Zealand

    Melissa Wake

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  1. Jessica A. Kerr
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Contributions

MW conceived the trial. The trial was designed by JAK, PWJ, FKM, and MW, with guidance by senior hospital dietitian KG. JAK conducted the statistical analysis, in consultation with FKM and JBC. JAK wrote the first draft of this manuscript, which was revised by PWJ, FKM, KG, TSO, JBC, SAC, DB, LG, LAB, and MW. All authors have seen and approved the final version.

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Correspondence to Jessica A. Kerr.

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The authors declare that they have no conflict of interest.

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Trial registration: ISRCTN12538380.

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Kerr, J.A., Jansen, P.W., Mensah, F.K. et al. Child and adult snack food intake in response to manipulated pre-packaged snack item quantity/variety and snack box size: a population-based randomized trial. Int J Obes 43, 1891–1902 (2019). https://doi.org/10.1038/s41366-019-0407-z

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