Impact of Portion Control Tools on Portion Size Awareness, Choice and Intake: Systematic Review and Meta-Analysis

Abstract

Portion control utensils and reduced size tableware amongst other tools, have the potential to guide portion size intake but their effectiveness remains controversial. This review evaluated the breadth and effectiveness of existing portion control tools on learning/awareness of appropriate portion sizes (PS), PS choice, and PS consumption. Additional outcomes were energy intake and weight loss. Published records between 2006–2020 (n = 1241) were identified from PubMed and WoS, and 36 publications comparing the impact of portion control tools on awareness (n = 7 studies), selection/choice (n = 14), intake plus related measures (n = 21) and weight status (n = 9) were analyzed. Non-tableware tools included cooking utensils, educational aids and computerized applications. Tableware included mostly reduced-size and portion control/calibrated crockery/cutlery. Overall, 55% of studies reported a significant impact of using a tool (typically smaller bowl, fork or glass; or calibrated plate). A meta-analysis of 28 articles confirmed an overall effect of tool on food intake (d = –0.22; 95%CI: –0.38, –0.06; 21 comparisons), mostly driven by combinations of reduced-size bowls and spoons decreasing serving sizes (d = –0.48; 95%CI: –0.72, –0.24; 8 comparisons) and consumed amounts/energy (d = –0.22; 95%CI: –0.39, –0.05, 9 comparisons), but not by reduced-size plates (d = –0.03; 95%CI: –0.12, 0.06, 7 comparisons). Portion control tools marginally induced weight loss (d = –0.20; 95%CI: –0.37, –0.03; 9 comparisons), especially driven by calibrated tableware. No impact was detected on PS awareness; however, few studies quantified this outcome. Specific portion control tools may be helpful as potentially effective instruments for inclusion as part of weight loss interventions. Reduced size plates per se may not be as effective as previously suggested.

Multisectoral Strategies Needed to Establish Healthy Portion Size Norms That Disincentivize Hyperpalatable, Energy-Dense Foods and Sugary Beverages in Food Environments Linked to Obesity and Diet-Related Chronic Diseases in the United States

“…Evidence reviews have found limited effectiveness for the following strategies: media campaigns to raise awareness and encourage practicing mindful snacking, intuitive eating, or portion balance communications [25,30]; individual behavioral-change strategies, including visual educational resources to nudge people to reduce eating rate and bite size; providing information on product labels; training for portion-control plates and using smaller cooking, serving, and eating utensils; and business strategies to alter products' sensory properties and portion sizes, to improve product labels, and use resealable packages to discourage overconsumption [30,31].…”

Acceptability, Usability and Weight Loss Outcomes in a Randomized Cross-Over Study of Commercially Available Portion Size Tools in an Overweight South Asian Community

“…The changes in weight were likely due to food-related changes (consuming more salad and vegetables and less energy-dense foods) as a result of participation in the intervention. Furthermore, a recent meta-analysis reports portion control tools marginally induced weight loss especially driven by calibrated tableware [38].…”

The Use of Portion Control Plates to Promote Healthy Eating and Diet-Related Outcomes: A Scoping Review

“…We found comparable results to other previously published reviews. For example, a review conducted by Vargaz-Alvarez and colleagues found portion control tools marginally induced weight loss [84]. However, these tools were inclusive of bowls and cutlery in addition to portion control plates.…”