Putting Weight Loss on Your Plate

My mother used to say, "Clean your plate before you have dessert." She grew up during the Depression, and uneaten food seemed immoral.

Unfortunately, members of the clean plate club frequently do not belong to the lean weight club.

Unless the plate you eat from can help you lose weight.

A new study has evaluated the use of a plate and bowl designed to help overweight and obese patients lose weight.

In this study, published in the most recent issue of the journal Archives of Internal Medicine, Dr. Sue Pedersen and colleagues from the University of Calgary have become the first to test a "portion-control" plate and bowl as a tool for the treatment for obesity among patients with diabetes.

And though the approach seems simple, it just might work. Patients in the study not only lost weight, but many of them were able to cut down on their diabetes medications.

A Big Fat Problem

Overweight-ness and obesity have become major public health problems in the United States, with a nearly threefold increase between 1960 and 2000 in the percentage of American adults who are obese. Currently, one third of American adults are overweight, a problem that is particularly common among minorities, studies indicate. Figures worldwide are also increasing dramatically.

Obesity and overweightness are defined in terms of "body mass index" (BMI), which is a ratio of one's weight to one's height. A BMI of more than 25 defines overweight, while a BMI of more than 30 defines obesity.

As an example, a person who is 5 feet 9 inches tall and weights 169 pounds (BMI=25) to 202 pounds (BMI=29.9) is considered overweight. Weight over 202 pounds for this same individual constitutes obesity.

As noted by the Centers of Disease Control and Prevention, a study in 2003 estimated that the combined costs of overweightness and obesity accounted for 9.1 percent of total U.S. medical expenditures in 1998 -- $92.6 billion in 2002 dollars.

On the individual level, obesity is related to a number of diseases including hypertension, high cholesterol, type 2 diabetes, heart disease, stroke, gallbladder disease, arthritis, sleep apnea and other breathing problems.

There is also good evidence that obesity is related to cancer, particularly cancers of the breast, colon, uterus, kidney and esophagus.

Experts believe a number of factors have contributed to this increase, such as more sedentary lifestyles and an increase in availability of highly palatable, highly caloric foods. Genetics also plays a role.

Increases in food portion sizes at home and in restaurants has also dramatically fueled the obesity epidemic. "Supersize me" has come to mean more than just upgrading your fast-food order from a medium to a large order of fries, as increased food intake induces supersized weight.

The Principle of Portion Control

Despite the fact that portion sizes greatly impact weight gain, there has been very little research on methods to help control how much food individuals eat at each meal.

The amount of food served on a plate directly relates to how much a person eats at each meal, regardless of hunger or feelings or fullness. Therefore, diabetes educators and dietitians have focused much of their efforts on teaching patients how to measure what they eat.

They focus on controlling the out-of-control portion sizes.

Intuitively, of course, it makes sense that portion-size reduction influences weight loss. Despite this notion, no one has tested an actual tool to help patients determine at each meal what are reasonable portions of each of the major food groups: carbohydrates, protein, fats, fruits and vegetables.

Among 130 diabetic patients, Pedersen and colleagues used a commercially available, calibrated portion control plate and cereal bowl called the Diet Plate with markings indicating how much of each food group should be served. Randomly dividing the patients into two groups, one using the plate and the other group receiving only nutritional counseling, these researchers found that the portion control plate actually worked.

Patients using the plate and bowl for six months lost an average of about five pounds, compared to the control group that lost less than half a pound. Weight loss was greatest among the patients who used insulin (seven pounds) compared to those who did not use insulin.

The number of individuals who lost more than 5 percent of their body weight was also higher in the group using the plate -- significant because 5 percent weight loss has been shown to improve a number of weight-related health conditions.

And it was not only weight that changed. Individuals using these dishes reduced their blood pressure, cholesterol and the amount of medication they needed to control their blood sugar.

The authors concluded that "the portion control tool studied in this trial was effective in inducing weight loss in obese persons with type 2 DM [diabetes mellitus] comparable to that seen in investigations of weight loss pharmacotherapy [medication]."

They added that this tool is simple to use, inexpensive, and holds promise for both diabetic and nondiabetic individuals who need to lose weight.

Not Just Food, but Lifestyle

While food intake in excess of caloric expenditure (e.g., exercise) is the final pathway leading to obesity and overweightness, genetics and environment also come into play.

In addition to portion control, strategies to control weight include modifying activity at home, school, work and in the community. For example, reducing time spent watching television and scheduling regular exercise routines into the day can improve the health of the whole household.

Schools can promote weight reduction among children by ensuring school food programs meet nutrition standards and are lower in fat. Quality daily physical activity in the form of physical education can also help.

Work sites can offer exercise areas, and workers can take the stairs instead of the elevator when feasible.

Public policy and community changes can also help by banning things such as trans fat, and increasing opportunities for community fitness in the form of recreational sports leagues as well as local parks, walking paths and bike routes.

The Centers for Disease Control and Prevention has resources available to help reduce your weight and become more physically active.

So, this is one area where you might take issue with your mother. Do not feel compelled to clean your plate -- or, buy a plate that will help you know how much of a plate you should clean.

Dr. John Spangler is a professor of family medicine at Wake Forest University School of Medicine.