Tuesday, February 7, 2012

Smaller servings and balanced meals.

In a recent study published in the American Journal of Clinical Nutrition (December 2011) the researchers found that feeding preschoolers smaller portions of the main dish at lunchtime meant that they would eat more fruit and vegetables on the side and fewer total calories. The hypothesis of the study was to see if the portion size of the main food serving (in this case macaroni and cheese) affected the consumption of the healthier side dishes of vegetables (green beans) and fruit (applesauce). The children were presented with varying amounts of macaroni and cheese (from less than ½ cup to 1 ½ cups) as well as plenty of green beans and unsweetened applesauce, plus a whole grain roll and milk. The results indicated that the children ate the main dish first, and if they were full would eat the vegetables and fruit last or not at all.

Jennifer Savage (a nutritional researcher) at Pennsylvania State University in University Park and her colleagues found that the bigger the serving size of the macaroni and cheese; smaller amounts of the healthy side dishes were eaten. The preschoolers finished almost all of their smallest portion of mac and cheese, for an average of about 145 calories. But they still ate the majority of the much bigger portions, and put away 390 calories worth of the main course when they started with the most on their plate. When they were served the smallest amount of mac and cheese, kids ate almost half of their healthy side dishes, including fruits and veggies, compared to only a quarter when they were served the biggest mac and cheese portion.

Eating is always a matter of choices. If you give the child an option for a large portion of an entrée food that they really like, they will eat that more and they'll fill up. They'll reach their satiety point and they'll just stop eating thus reducing the nutritional quality of their meal.

So what does this mean to those of us who have a weight problem and have had or are thinking of having WLS? When we were heavy we could choose anything we wanted and eat as much as we wanted. Balancing our nutrition with good food choices was not always high on our agenda. However when you decide to diet or have WLS the concept of nutritional requirements needs to be one of your foremost areas of concern. After weight loss surgery we often find that our restrictive diets often do not allow the inclusion of the balanced nutrition that our body needs. Since we can only eat “Eight Bites” we often look at the main course as all we are going to eat. With so little available room in our stomachs post-surgery we often eat the things we like to eat and leave the “side dishes” alone. That is sort of like the kids who when given a large amount of the dish they prefer will eat it to satiety and then ignore or minimize the ingestion as well as the nutritional value of vegetables and fruit.

As was seen in the research discussed earlier, the kids ate a lower calorie and a more balanced diet when the “main course” was provided at a lower level along with the fruits and vegetables. One of the biggest concerns in the post-WLS eating world is to get sufficient amounts of protein. But how much do we need? The rule of thumb is about 60-70 grams of protein per day. In that light, 3 ounces of beef, pork and chicken all vary generally between 20 to 30 grams of protein; an egg is about 6 grams of protein. Spinach and other cooked greens are about 10-14 grams per cup .

So there are two issues to deal with. The first is to eat the nominal amount of protein necessary to ensure that we remain in balance during our weight loss and weight maintenance; and the second is to ensure that we do vary our diets with vegetables and fruits to get adequate vitamins and minerals. That is a balancing act. Since we can only eat eight bites or thereabouts per meal, how do we ensure that we get the balance we need between protein and vegetables?

I have found that while the largest component of my meals is protein (meats, eggs, cheese) I do add some vegetables and fruit to the meal just to enhance the dining experience. At a restaurant I might order a steak with a baked potato and spinach au gratin. I will cut about 2-3 ounces of the steak up and then I will alternate bites of meat with the vegetables. Eating slowly helps, but at the end of the meal I will need to ask the waiter to bring a take-home box for the remaining steak, potatoes and spinach. I will have consumed about 25 grams of meat protein. If I had a tablespoon of sour cream on my potato that is another gram or so and then the spinach would provide another 3-4 grams of protein. My dinner resulted in the consumption of about half your daily requirement for protein and was balanced nutritionally. It is important that you do not totally focus on the meat portion of your diet but also to provide yourself with a balanced diet.

If we take the children’s study to heart, we would reduce the entrée portion (even though it is already reduced) and add some vegetables and fruits. We would get better overall nutrition, probably lower total calories, and a more varied diet. That is a good thing. You can keep your portion control in check and have the nutrition you need. Remember its only eight bites.