A few years ago, during a pit stop at Denny’s on a road trip, I ordered the now-discontinued spaghetti and meatballs. When the plate arrived, I thought I couldn’t possibly finish the huge platter, but then I managed to because it was right in front of me – even though I knew exactly what was going on.
As an assistant professor of health policy, I study the state of nutrition and how we can promote healthier choices. What isn’t helping us make healthier choices is the super-large portion sizes sold in restaurants. In the U.S., portion sizes for convenience foods and fast foods have grown as much as five-fold since the introduction of some of these products, and the ubiquity of larger portions has increased over the past 50 years.
As my experience at Denny’s shows, people eat and drink what is put in front of them, even if it is more than they intended or want. In one study, those who were given 50% larger portions ate an average of 400 more calories per day. That’s more calories than are in two Krispy Kreme doughnuts. We know that more calories over time means weight gain. While excessive weight gain is a complicated problem with myriad causes, reducing portion sizes is one harm reduction tool we have to address the problem.
My team and I conducted a study to show that there is a simple and inexpensive solution to this problem: restaurants should start offering their entrees in two sizes. Fast-food restaurants already offer customers a choice of multiple sizes; full-service restaurants are starting to do the same. Places like Olive Garden offer lunch versions of their classics, and the Cheesecake Factory offers “SkinnyLicious” options. But many people feel uncomfortable ordering from a stigmatizing “SkinnyLicious” menu. But there are other options: In one study, my team and I showed participants a menu that offered entrees in two sizes. We called the smaller option “standard” and the larger “large.” For the control group, we did not label the smaller size. Those who saw the “standard” label were more likely to choose the smaller size.
Offering two sizes is a win for restaurant customers, public health, and even the restaurant industry. Americans are eating out more often today than ever before, so ordering the smaller entree means restaurant customers won’t succumb to the temptation to overeat consistently. If enough people eat fewer calories and less saturated fat and sodium, the result will be a positive public health impact. In turn, the restaurant industry can benefit from a strategy currently used by major beverage and snack brands. Instead of getting more people to buy one soda, they offer more sizes of that soda to suit different occasions and consumer types. This tactic, for example, has resulted in increased sales for the Coca-Cola Company, which introduced the 7.5 oz mini-can nationwide in 2010.
As a health researcher, I would prefer if people would give up sugary drinks altogether. But that’s not realistic. This method makes it easier to drink in moderation. A 200ml can of soda usually means drinking 200ml of soda. Similarly, a 695-calorie Cajun shrimp and chicken pasta at TGI Fridays would mean consuming 695 calories or less, instead of the current 1,390.
Our habits regarding large portion sizes have developed gradually over time. It will take some time before we get back to a level where a 1,000-calorie appetizer produces the shock it should.
One challenge is that consumers see the larger portion size as a way to save money: Why buy the 230-calorie fries for $4 when you can get twice the amount for just $2 more? But menu boards don’t convey the costs of excessive weight gain. There are the physical costs, which include increased risk of heart disease and type 2 diabetes. And there are the financial costs: Being overweight doubles personal health costs annually, and at a societal level, costs over $260 billion in health care costs. And then there are the personal costs: It’s difficult to lose weight once you’ve gained it, and the impact on mental health. But in our study and others, we found that people choose a smaller portion even if it costs a little more per ounce.
The great thing about focusing on portion sizes is that it’s not about abstinence, but about harm reduction. You don’t have to give up fettuccine Alfredo or spicy jambalaya entirely. When restaurants offer these 1,000-plus calorie dishes in a smaller portion, diners can still eat what they want without risking their health. In doing so, restaurants may find a welcome paradox: By giving customers the option to eat less, more people may come to the table.
Sophia Hua is an assistant professor of health policy at the University of Pennsylvania. For more than a decade, she has researched ways we can change the diet so that the healthier choice is also the easier one.
