Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
, 2015 (9), CD011045

Portion, Package or Tableware Size for Changing Selection and Consumption of Food, Alcohol and Tobacco

Affiliations
Review

Portion, Package or Tableware Size for Changing Selection and Consumption of Food, Alcohol and Tobacco

Gareth J Hollands et al. Cochrane Database Syst Rev.

Abstract

Background: Overeating and harmful alcohol and tobacco use have been linked to the aetiology of various non-communicable diseases, which are among the leading global causes of morbidity and premature mortality. As people are repeatedly exposed to varying sizes and shapes of food, alcohol and tobacco products in environments such as shops, restaurants, bars and homes, this has stimulated public health policy interest in product size and shape as potential targets for intervention.

Objectives: 1) To assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children.2) To assess the extent to which these effects may be modified by study, intervention and participant characteristics.

Search methods: We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, eight other published or grey literature databases, trial registries and key websites up to November 2012, followed by citation searches and contacts with study authors. This original search identified eligible studies published up to July 2013, which are fully incorporated into the review. We conducted an updated search up to 30 January 2015 but further eligible studies are not yet fully incorporated due to their minimal potential to change the conclusions.

Selection criteria: Randomised controlled trials with between-subjects (parallel-group) or within-subjects (cross-over) designs, conducted in laboratory or field settings, in adults or children. Eligible studies compared at least two groups of participants, each exposed to a different size or shape of a portion of a food (including non-alcoholic beverages), alcohol or tobacco product, its package or individual unit size, or of an item of tableware used to consume it, and included a measure of unregulated selection or consumption of food, alcohol or tobacco.

Data collection and analysis: We applied standard Cochrane methods to select eligible studies for inclusion and to collect data and assess risk of bias. We calculated study-level effect sizes as standardised mean differences (SMDs) between comparison groups, measured as quantities selected or consumed. We combined these results using random-effects meta-analysis models to estimate summary effect sizes (SMDs with 95% confidence intervals (CIs)) for each outcome for size and shape comparisons. We rated the overall quality of evidence using the GRADE system. Finally, we used meta-regression analysis to investigate statistical associations between summary effect sizes and variant study, intervention or participant characteristics.

Main results: The current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Ninety-six per cent of included studies (69/72) manipulated food products and 4% (3/72) manipulated cigarettes. No included studies manipulated alcohol products. Forty-nine per cent (35/72) manipulated portion size, 14% (10/72) package size and 21% (15/72) tableware size or shape. More studies investigated effects among adults (76% (55/72)) than children and all studies were conducted in high-income countries - predominantly in the USA (81% (58/72)). Sources of funding were reported for the majority of studies, with no evidence of funding by agencies with possible commercial interests in their results.A meta-analysis of 86 independent comparisons from 58 studies (6603 participants) found a small to moderate effect of portion, package, individual unit or tableware size on consumption of food (SMD 0.38, 95% CI 0.29 to 0.46), providing moderate quality evidence that exposure to larger sizes increased quantities of food consumed among children (SMD 0.21, 95% CI 0.10 to 0.31) and adults (SMD 0.46, 95% CI 0.40 to 0.52). The size of this effect suggests that, if sustained reductions in exposure to larger-sized food portions, packages and tableware could be achieved across the whole diet, this could reduce average daily energy consumed from food by between 144 and 228 kcal (8.5% to 13.5% from a baseline of 1689 kcal) among UK children and adults. A meta-analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (SMD 0.25, 95% CI -0.14 to 0.65).One included study (50 participants) estimated a large effect on consumption of exposure to differently shaped tableware (SMD 1.17, 95% CI 0.57 to 1.78), rated as very low quality evidence that exposure to shorter, wider bottles (versus taller, narrower bottles) increased quantities of water consumed by young adult participants.A meta-analysis of 13 independent comparisons from 10 studies (1164 participants) found a small to moderate effect of portion or tableware size on selection of food (SMD 0.42, 95% CI 0.24 to 0.59), rated as moderate quality evidence that exposure to larger sizes increased the quantities of food people selected for subsequent consumption. This effect was present among adults (SMD 0.55, 95% CI 0.35 to 0.75) but not children (SMD 0.14, 95% CI -0.06 to 0.34).In addition, a meta-analysis of three independent comparisons from three studies (232 participants) found a very large effect of exposure to differently shaped tableware on selection of non-alcoholic beverages (SMD 1.47, 95% CI 0.52 to 2.43), rated as low quality evidence that exposure to shorter, wider (versus taller, narrower) glasses or bottles increased the quantities selected for subsequent consumption among adults (SMD 2.31, 95% CI 1.79 to 2.83) and children (SMD 1.03, 95% CI 0.41 to 1.65).

Authors' conclusions: This review found that people consistently consume more food and drink when offered larger-sized portions, packages or tableware than when offered smaller-sized versions. This suggests that policies and practices that successfully reduce the size, availability and appeal of larger-sized portions, packages, individual units and tableware can contribute to meaningful reductions in the quantities of food (including non-alcoholic beverages) people select and consume in the immediate and short term. However, it is uncertain whether reducing portions at the smaller end of the size range can be as effective in reducing food consumption as reductions at the larger end of the range. We are unable to highlight clear implications for tobacco or alcohol policy due to identified gaps in the current evidence base.

Conflict of interest statement

Gareth Hollands declares no financial or other conflicts of interest.

Ian Shemilt declares no financial or other conflicts of interest.

Theresa Marteau declares no financial or other conflicts of interest.

Susan Jebb is Chair of the Public Health Responsibility Deal Food Network, which develops voluntary agreements with industry to improve health, including reductions in portion size of foods high in fat, saturated fat, sugar and salt. She has also led research projects in which foods have been provided by a range of commercial companies as part of dietary intervention studies funded by public bodies. She was also a co‐author of a published study (completed 2010) funded by the Coca‐Cola Institute for Health & Wellness, which showed no effect on weight loss of a putative functional beverage.

Hannah Lewis declares no financial or other conflicts of interest.

Yinghui Wei declares no financial or other conflicts of interest.

Julian Higgins declares no financial or other conflicts of interest.

David Ogilvie declares no financial or other conflicts of interest.

Figures

Figure 1
Figure 1
Final conceptual model. The 28 constructs included in the provisional conceptual model (Hollands 2014) and retained in this final version are shown in plain type. The 22 constructs added to this final conceptual model based on theory and evidence encountered during the review process are shown in red type. The 2 constructs included in the provisional conceptual model (Hollands 2014) but excluded from this final version are shown in strikethrough plain type. See Table 5 for a full record of the conceptual model development process.
Figure 2
Figure 2
PRISMA study flow diagram.
Figure 3
Figure 3
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all eligible studies (N = 83. 'Risk of bias' assessments completed for 72 eligible studies included in the review. White spaces in the bars of this graph denote the respective proportions of the 72 included studies that did not measure (i) selection or (ii) consumption outcomes. See also Results of the search and Figure 2).
Figure 4
Figure 4
Effect sizes re‐expressed using familiar metrics
Figure 5
Figure 5
Forest plot of the standardised mean difference in unregulated consumption of food or tobacco between participants exposed to larger (intervention) versus smaller (control) sized portions, packages, individual units and/or tableware
Figure 6
Figure 6
Assessing publication bias. Funnel plots including all studies reporting the selection outcome (left) and consumption outcome (right) do not show asymmetry (Egger test P value = 0.20 and P value = 0.18 respectively)
Figure 7
Figure 7
Summary effect sizes (standardised mean differences) in subgroups of studies (consumption outcome)
Figure 8
Figure 8
Bubble plots. Fitted meta‐regression lines showing associations between study‐level effect sizes for consumption and study characteristics (continuous variables) identified as effect modifiers: a) FSA score; b) energy density; c) age.
Figure 9
Figure 9
Forest plot of the standardised mean difference in unregulated selection (without purchase) of food between participants exposed to larger (intervention) versus smaller (control) sized portions, packages and/or tableware
Figure 10
Figure 10
Summary effect sizes (standardised mean differences) in subgroups of studies (selection outcome)
Figure 11
Figure 11
Forest plot of the standardised mean difference in unregulated selection without purchase of fruit juices or water between participants exposed to shorter, wider (intervention) versus taller, narrower (control) empty glasses or plastic bottles

Update of

  • Cochrane Database Syst Rev. doi: 10.1002/14651858.CD011045

Similar articles

See all similar articles

Cited by 81 PubMed Central articles

See all "Cited by" articles

References

References to studies included in this review

    1. Ahn HJ, Han KA, Kwon HR, Min KW. The small rice bowl‐based meal plan was effective at reducing dietary energy intake, body weight, and blood glucose levels in Korean women with type 2 diabetes mellitus. Korean Diabetes Journal 2010;34(6):340‐9. - PMC - PubMed
    1. Argo JJ, White K. When do consumers eat more? The role of appearance self‐esteem and food packaging cues (Study 1). Journal of Marketing 2012;76(2):67‐80.
    1. Argo JJ, White K. When do consumers eat more? The role of appearance self‐esteem and food packaging cues (Study 2). Journal of Marketing 2012;76(2):67‐80.
    1. Argo JJ, White K. When do consumers eat more? The role of appearance self‐esteem and food packaging cues (Study 4). Journal of Marketing 2012;76(2):67‐80.
    1. Argo JJ, White K. When do consumers eat more? The role of appearance self‐esteem and food packaging cues (Study 5). Journal of Marketing 2012;76(2):67‐80.

References to studies excluded from this review

    1. Andrade AM, Greene GW, Melanson KJ. Eating slowly led to decreases in energy intake within meals in healthy women. Journal of the American Dietetic Association 2008;108(7):1186‐91. - PubMed
    1. Ashton H, Stepney R, Thompson JW. Smoking behaviour and nicotine intake in smokers presented with a "two‐thirds" cigarette. Smoking Behaviour ‐ Physiological and Psychological Influences. Edinburgh: Churchill Livingstone, 1978.
    1. Attwood AS, Scott‐Samuel NE, Stothart G, Munafo MR. Glass shape influences consumption rate for alcoholic beverages. PloS One 2012;7(8):e43007. - PMC - PubMed
    1. Balagura S, Harrell LE. Effect of size of food on food‐consumption ‐ some neurophysiological considerations. Journal of Comparative and Physiological Psychology 1974;86(4):658‐63. - PubMed
    1. Bell EA, Roe LS, Rolls BJ. Sensory‐specific satiety is affected more by volume than by energy content of a liquid food. Physiology & Behavior 2003;78:593‐600. - PubMed

References to studies awaiting assessment

    1. Bajaj D. Effect of number of food pieces on food selection and consumption in animals and humans. Dissertation Abstracts International: Section B: The Sciences and Engineering2014; Vol. 74.
    1. Haire C, Raynor HA. Weight status moderates the relationship between package size and food Intake. Journal of the Academy of Nutrition and Dietetics 2014;114:1251‐6. - PubMed
    1. Kral TVE, Remiker AM, Strutz EM, Moore RH. Role of child weight status and the relative reinforcing value of food in children's response to portion size increases. Obesity 2014;22:1716‐22. - PMC - PubMed
    1. Loney T, Lawton K, Allen D, Carter JM. Size matters! Effect of a school canteen portion size intervention on weight loss in obese Emirati adolescents. Obesity Reviews 2010;11(1):239 (T3: PO 54).
    1. Marchiori D, Papies EK. A brief mindfulness intervention reduces unhealthy eating when hungry, but not the portion size effect. Appetite 2014;75:40‐5. - PubMed

Additional references

    1. Anderson LM, Petticrew M, Rehfuess E, Armstrong R, Ueffing E, Baker P, et al. Using logic models to capture complexity in systematic reviews. Research Synthesis Methods 2011;2:33‐42. - PubMed
    1. Anderson LM, Oliver SR, Michie S, Rehfuess E, Noyes J, Shemilt I. Investigating complexity in systematic reviews of interventions by using a spectrum of methods. Journal of Clinical Epidemiology 2013;66:1223‐9. - PubMed
    1. Beasley JM, Ange BA, Anderson CA, Miller ER, Erlinger TP, Holbrook JT, et al. Associations between macronutrient intake and self‐reported appetite and fasting levels of appetite hormones: results from the Optimal Macronutrient Intake Trial to Prevent Heart Disease. American Journal of Epidemiology 2009;169(7):893‐900. - PMC - PubMed
    1. Bell EA, Castellanos VH, Pelkman CL, Thorwart ML, Rolls BJ. Energy density of foods affects energy intake in normal‐weight women. American Journal of Clinical Nutrition 1998;67:412‐20. - PubMed
    1. Birch LL, Johnson SL, Andresen G, Peters JC, Schulte MC. The variability of young children's energy intake. New England Journal of Medicine 1991;324(4):232‐5. - PubMed
Feedback