It seems apt, in the midst of the festive season – a holiday typified by consumption to excess of all sorts of goods, after all – to put forward a new topic in this series ‘A Culture of Overconsumption’. In this article, I will be considering the concept of ‘portion size’ and the role it plays in determining how much we eat. By ‘portion size’ I mean the amount of food that is placed on the plate in front of us, as we prepare to eat a meal or snack. This volume of food may be determined by us, or a family member, or a restaurant or a food producer (for example, if we were to follow the manufacturer instructions on serving size).

There’s no doubt that typical portion sizes have increased over recent decades. One classic example is that of the fizzy drink that often accompanies a fast food meal. Since the 1950s, the average size of one of these ‘fountain drinks’ has increased by 500%. And it’s not alone. Products like pies, pizzas and bagels have got noticeably bigger just since the 1990s.

Interestingly, one study looked at depictions of the Last Supper across 52 paintings and found that even that meal had grown exponentially in size. Between the year 1000 and the 1700s, the size of the main meal grew by 69%, with the bread also growing by around 20%. Between 1500 and 1900 was a period of particularly rapid rises in the sizes of the portions, and without a religious reason for the change, it must be considered that this probably reflects popular perceptions of the size of meals across time. In addition to meals, the same thing has happened to snacks. Few people can have failed to notice that we are now handed giant buckets of (sugary, fatty) popcorn when we enter cinemas or that ‘share bags’ (does anyone actually share??!) of crisps or sweets have become infinitely more common in recent years. With greater exposure comes less ability to discriminate an appropriate from a non-appropriate portion size. We’re almost trained by our food environment to shift our thinking on consumption norms to the extent that we may be affronted by a restaurant food portion that is appropriate and not lavishly oversized.

These trends, of course, coincide with increases in the frequency with which we eat outside of the home, and therefore the food industry - playing on our perceived needs for ‘value for money’ and indulgence - has considerable power over our total caloric intake. We are a nation of plate cleaners after all. Who wasn’t guilted into finishing everything on their plate as a child by references to those starving in Africa? Therefore, put more food on our plates and we will eat more. It’s a robust phenomenon that has been shown time and again in laboratory settings and in ‘real-world’ environments.

However, there are some subtleties to consider. Even before the food has reached our plate, certain factors can influence how much will end up there. Plate size is one. In studies, if people are given larger dishware with which to serve themselves, they will take more food (and thus, likely eat more). If a larger spoon or other serving utensil is provided, they will scoop more onto their dish. If a greater number of items of food are available, say at a buffet, then more will be eaten overall. If we buy large quantities of food or drink from a supermarket (for example bulk purchasing or taking advantage of a ‘BOGOF’ deal) then, perhaps perversely, we often repurchase the same item sooner than if we had purchased it in smaller portions, because of the stimulating effect of the presence of the large portion in our homes on our intake.

Importantly, such overconsumption is rarely, if ever, compensated for at later eating occasions. Despite our many, varied and intricately clever systems for regulating food intake (hormones emerging from almost every step of the digestion pathway to tell our brain how the meal is going), we’re just not very good at knowing when we’ve had enough and therefore when to stop. Nor are we any good at saying “I overate at lunchtime, therefore I am going to reduce the size of my evening meal to ensure that my caloric consumption for today is not excessive”.

It just doesn’t happen, the previous load of excess calories is swept under the carpet in our minds (but carefully stored as fat by our bodies) and we continue to eat as normal from the next eating occasion onwards. Thus, the ‘portion size effect’ contributes to sustained overconsumption (the very sort that leads to weight gain). This is true regardless of demographic characteristics such as socioeconomic status, age, body mass index and sex. Worryingly, there are signs that children as young as 2 years of age may be susceptible to the intake-enhancing effects of large portion sizes.

Given the above, it’s clear that self-regulation of portion size, particularly as it relates to eating outside of the home and when snacking, is extremely challenging - particularly for those seeking to manage their weight. There may be things we can do about it. Pressure from public health bodies has led to the withdrawal of many of the ‘super-sized’ options available in fast food outlets. But a major cultural and societal shift has taken place in these ‘consumption norms’ over the last 50 or so years, and it would take a lot of work to reverse the trend. Would consumers be amenable to reduced portion sizes? The food industry is of course motivated by the need to make profits, and as there is already considerable distrust between consumers and the industry with regard to their motives for portion sizes, reductions are likely to be poorly tolerated by many.

As we sit down for our Christmas meals this year, few of us will be thinking we should go easy. Eating until we fall asleep in front of the family festive movie is tradition, and there’s no real harm in that as a once a year treat, but as we move beyond Christmas we might all like to take a look at the culture of the food environment around us in a new, critical light. Do we need 50% extra free? Maybe less really is more. Perhaps, as a start, we could try placing greater value on our health than our wallets. That’s one New Year’s resolution that may just make a difference.

Dr. Emma Boyland continues her series with a look at marketing strategies by Big Food to promote overconsumption.

A drum-playing gorilla. An orange tiger saying “grrrreat!”. Even the simplicity of a jingle and “I’m loving it!”. What do all of these things have in common? They’re all television adverts that have entered our homes and our consciences in recent years. They’re also all promotions designed to persuade us to purchase and consume products high in fat or sugar or both. And therein lies the problem. We are eating too much of this stuff, and it is literally killing us. Several large scale prospective studies (the type that watches for outcomes such as disease development during the study period and then relates that outcome to suspected risk factors) have shown that overweight and obese individuals have a much greater risk of death than individuals of a healthy weight.

Another recent study also demonstrated that the current, massive, diet-related disease burden reflects a larger contribution from poor diet than tobacco, alcohol and inactivity combined. So while those other issues (smoking, drinking, and exercise) are clearly very important, we really need to get thinking about what determines why we eat the way we do, the foods we choose and the amount we consume. What can be done to make our choices better, healthier and supportive of a long healthy life? Of course, our diets have a complex set of determinants, crossing socio-economic, demographic, environmental and cultural domains.

This article will focus on one aspect of the current ‘obesogenic’ food environment - that of food marketing. It’s a contentious topic, with the food industry regularly squaring up to the public health community when restrictions are called for. Policy progress has been slow, there are few politicians in the capitalist economies of the west willing to truly take on so-called ‘Big Food’ and perhaps this is not a surprise when one considers that the fast food industry alone generates revenues of over $500 billion per year globally. That’s greater than the economic value of most countries. No wonder the Government’s recent childhood obesity ‘plan’ (downgraded from a strategy) spoke so pointedly about “economic realities” when leaving out proposals for further marketing restrictions and why efforts by four federal agencies in the US to enact better nutrition standards for foods marketed to children were scuttled in 2011 by corporate lobbyists.

Mouth Feel

But coming back to things ‘on the ground’, as I mentioned in the first article of this series, as the number and range of products on the typical supermarket shelf has risen in the last half century, so have efforts from each manufacturer to make their product stand out. Most are highly calorific, intensively processed, and have chemicals added and tweaked to ensure that the product hits the maximum sweet spot for “mouth feel” that makes us keep coming back. It has been suggested that we spend just 6 seconds deliberating over each item before we make a purchase decision, so that product has just those few seconds to convince you. How does it do that? And does marketing really affect us?

Yes it does. Studies have shown that children are able to recognise major food brand logos (such as the infamous golden arches) before they can even talk. I’ll just pause and let that sink in for a moment. Carrying on, by around 3 years of age, children are able to express specific branded product preferences (and in my experience as a parent, they are not shy at doing so!).

There’s not just one outcome of food marketing, it has affects across a broad range of behaviours, from awareness, attitudes, preferences, purchase intent, actual purchasing, and consumption. It doesn’t work in isolation of course, it must always be considered in the wider context of other individual, social and environmental influences on food choice, but it takes all the gall of a highly paid marketing executive to claim that food marketing does not contribute to food choice and, therefore, have a big part to play in obesity.

Experimental psychological research to explore just how marketing affects what we eat has been going on since the late 1970s. As with any field of study, results vary slightly depending on the sample of participants studied, the type of marketing explored, the outcome measure that was used. But time and again, large scale systematic reviews of these types of studies have concluded that food marketing affects food preferences, choices and intake. I recently conducted a meta-analysis (a fancy way of saying all the data from a load of reasonably similar studies was combined and analysed together) that showed the exposure to unhealthy food advertising, whether on the television or on the Internet (i.e. so-called ‘advergames’, games on websites that immerse children in a heavily branded environment), resulted in children eating more calories from subsequently available food than they did following exposure to non-food advertising or no advertising at all.

You all know that our kids are like little sponges. They absorb whatever is around them. But they don’t yet have the ability to question and analyze what they’re told. Instead, they believe just about everything they see and hear, especially if it’s on TV. And when the average child is now spending nearly eight hours a day in front of some kind of screen, many of their opinions and preferences are being shaped by the marketing campaigns you all create.
- Michelle Obama, White House Convention on Food Marketing to children, 2013.

Interestingly, the same effect wasn’t found for adults. But there are a lot fewer studies looking at adults (children don’t understand how marketing works, so are seen as inherently vulnerable to marketing, arguably a form of exploitation of incredulity and lack of cognitive maturity). Also, when they know their eating is being monitored by researchers, adults tend to eat a lot less than they would normally (this too has been demonstrated experimentally). Adults also tend to be better at guessing the true aims of studies, and therefore adjusting their behaviour according to what they believe the researcher wants to find (social desirability bias). So it is probably worth taking these few adult studies with (sorry, terrible food-related pun coming up) a ‘pinch of salt’ for now until a greater body of work has been conducted.

The food marketers really target their efforts at children, anyway. Children have independent spending money - the guilt of the greater proportion of working parents means pocket money is rising at over 20 times the rate of inflation. They have influence over family spending (the bill for the family shop rises by around £5 when a child is taken to the supermarket) and they are adult consumers of the future. Gaining brand loyalty in childhood could result in a lifetime of sales, and that’s the grab the food industry really wants.

Targeting children

So we see children targeted in increasingly imaginative, and frankly, frightening ways. We all know about TV advertising. We all know about billboards, about sports sponsorship and about the ads at the start of a film at the cinema. But are we all aware that food companies are tracking young people online? Every action on social media, for example, every website visited, every device and network used, every geo-location picked up, every personal preference, ‘like’ and social activity is used to build up an online behavioural profile and those data (even when related to child users) are routinely being sold for the purposes of refining personalised advertising, advertising that has the biggest impact on the target demographic. Even the recent Pokemon Go craze has been seized upon as an opportunity to market to young people - McDonalds in Japan teamed up with the makers of the app to ensure that their restaurants were made into key game locations.

The food industry has been named and shamed for their marketing activity before. Their reaction? To continue to market their fatty, sugary, salty foods but alongside a raft of low fat, diet, low-carb, sugar-free ‘healthy’ processed foods! Marketed to the very people made overweight by the former, who are now desperate to lose weight using the latter. So they make even more money from obesity, by generating the ‘diet industry’. Their other response is to espouse the notion of personal responsibility. Any talk of marketing restriction is met with calls of ‘nanny state’ and claims that this would be depriving the consumer of their right to free choice. But true choice is a fallacy when the food environment has such power over what, how, when and how much we eat. This was alluded to by the UN Special Rapporteur on the Right to Food, back in September 2011, when he said:

It is unacceptable that when lives are at stake, we go no further than soft, promotional measures that ultimately rely on consumer choice, without addressing the supply side of the food chain. [...] Food advertising is proven to have a strong impact on children, and must be strictly regulated in order to avoid the development of bad eating habits early in life.

And while we are busy with quotes, I think the best way to wrap up this article in the series is by handing over to the WHO Director General, Margaret Chan and the comments she made in her opening address at the 8th Global Conference on Health Promotion in Finland, June 2013:

Efforts to prevent noncommunicable diseases go against the business interests of powerful economic operators…this is one of the biggest challenges facing health promotion. It is not just Big Tobacco anymore. Public health must also contend with Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics. Few governments prioritize health over big business. I am deeply concerned by…efforts by industry to shape the public health policies and strategies that affect their products. When industry is involved in policy-making, rest assured that the most effective control measures will be downplayed or left out entirely. This, too, is well documented, and dangerous.