Leveraging Food Technology for Obesity Prevention and Reduction Efforts Workshop Summary (2011) / Chapter Skim
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Workshop Summary
Workshop Summary
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Human eating behavior is inordinately complex, with multiple layers of influence. Eating is impacted not only by the biological responses that occur when the presence of food or even the smell of food triggers physiological 1 For adults, obesity is defined as having a body mass index (BMI)
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Reducing the energy density of foods is by no means the only or best way to leverage food technologies in the effort to reduce and prevent obesity. Other technologies being leveraged for obesity prevention and reduction efforts include ready-to-eat portion-controlled frozen meals, which have been shown to be associated with reduced energy intake and increased short-term weight loss; a variety of fruit- and vegetable-based technologies, based on the association between fruit and vegetable intake and maintenance of a healthy weight (when substituted for more energy dense foods)
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This workshop summary was prepared by the rapporteurs for the Forum's members and is organized into sections as a topic-by-topic description of the presentations and discussions that took place during the workshop. The main topics covered include, in order, the following: trends in overweight and obesity over the past 30 years; the complexity of eating behaviors; lessons learned and best practices; major challenges; and potential for innovation: next steps.
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4 LEVERAGING FOOD TECHNOLOGY 100 90 80 70 Percent of Adults 60 50 Overweight 40 Obese 30 20 10 0 1976-1980 1988-1994 2001-2002 2007-2008 Years FIGURE 1 Prevalence of overweight and obesity in adults aged 20 years or older, 1976–2008. Among U.S.
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5 WORKSHOP SUMMARY 100 6-11 years old 12-19 years old 90 Percent of Adolescents 80 70 60 50 40 30 20 10 0 1971- 1976- 1988- 1999- 2001- 2003- 2005- 2007 1974 1980 1994 2000 2002 2004 2006 2008 Years FIGURE 2 Prevalence of obesity in children (6–11 years) and adolescents (12–19 years)
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For example, speaker Brendan Boyle, partner and chief invention officer at IDEO, suggested that product distribution is as important to consider as product innovation when devising technology-based strategies for obesity intervention, with a major challenge being the distribution of novel food products to lower-income neighborhoods where people would otherwise not have access to such products. Arguably one of the first and most obvious variables to consider when exploring possible causes of the obesity crisis is the amount of energy in food available for human consumption, as measured by calories per capita per day.
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In another presentation, Jennifer Fisher, associate professor and research scientist at Temple University, explored in more detail the growing body of evidence showing that increased portion sizes are associated with increased energy intake. (Summaries of the information presented by Leahy and Fisher are provided later in this report.)
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Average portion sizes have increased since the mid-1970s, with the most dramatic increases for soft drinks and fruit drinks, Figure 3 rev pointing to beverage consumption as a possible target for obesity prevention and reduc tion interventions.
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Total weight loss over the entire 27 months, as a percentage of initial weight, was 5.9 kg for the energy-restricted group and 11.3 kg for the portion-controlled group. Similar results were observed in a four-year study comparing energy restriction and portion control (Flechtner-Mors et al., 2000)
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.10 Although adolescents comprise only a small proportion of the population, these data point to snacking as another potential target for intervention. Food Consumption Outside the Home Foster observed that often when people think about the products that the food industry manufactures they have in mind foods that are 9 According to a recent study by Piernas and colleagues (2010b)
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This section summarizes the workshop presentations and discussions that revolved around those behavioral challenges, with a focus on portion size (and the challenge of moving the public toward eating more healthful portions) ; energy density (and the challenge of providing the public with less energy dense foods that taste as good or better than their counterparts)
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This section begins with a summary of Mattes' reflections on regulation of eating behavior -- what is known and what is not known -- and implications for intervention. Understanding what drives dysfunctional energy balance is critical to developing effective strategies to prevent or reduce overweight and obesity.
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For example, Prentice and Jebb (2004) reported a cyclical pattern in Gambian women, with annual cycles of weight loss and regain; the severity of weight loss depended on the adequacy of the previous year's harvest.
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Moreover, Mattes argued that fixing the magnitude of overconsumption that is driving the increase in overweight and obesity prevalence in the United States will require more than minor interventions. He pointed out the logical error in the often-cited example where a 10-calorie daily increase in energy intake over a five-year period should lead to a weight gain of 2.37 kg (Veerman et al., 2007)
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The remainder of this section explores the behavioral science evidence base from which these and similar claims are drawn. Portion Size, Energy Intake, and Obesity Fisher reviewed evidence on the relationship between portion size, energy intake, and overweight and obesity; identified major challenges to reversing the recent trend in increasing portion size; and suggested potential solutions to "normalizing" portion sizes in a way that promotes more healthful eating.
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. The effect of portion size on energy intake is independent of the effects of energy density on energy intake, in both adults and children, with the effects of portion size exacerbated when the foods are energy dense.
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A handful of cross-sectional studies have evaluated associations between portion sizes consumed and actual weight status (Burger et al., 2007) , but it is unclear whether trends in increasing portion size are contributing to the increasing prevalence of overweight and obesity in the United States.
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Fisher emphasized that these and similar data are associational only, with no clarity around whether there is any causal relationship. Additionally, if there is direct causation, it is unclear which factor is driving the other -- that is, whether larger individuals are drawn to larger portion sizes or larger portions are driving weight gain.
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decrease portion sizes; and (7) use portion-controlled packaging.
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In a survey of 300 chefs, while 76 percent surveyed said that they served "regular" portions, in actual ity 83 percent served portion sizes exceeding the USDA standard (Condrasky et al., 2007)
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. Energy Density, Energy Intake, and Obesity Although portion size clearly has a powerful effect on energy intake, Rolls put forth the argument that energy density has an even greater effect.
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Satiety Studies on the Effect on Energy Intake of Reducing Energy Density One of the first studies conducted on the effect of reduced energy density on energy intake involved simply increasing the water content of foods. Specifically, Rolls and colleagues (1999)
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To gain a better understanding of how reductions in energy density impact energy intake in typical eating situations, Rolls and colleagues (2004b) examined the combined effect of reducing energy density and decreasing portion size by serving a salad preload in three different energy densities (0.33 cal/g, 0.67 cal/g, 1.33 cal/g)
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The researchers found that energy intake was influenced by both energy density and portion size, with the greatest reduction in intake observed when individuals ate the large low-energy-dense salad (300 g, 0.33 cal/g) ; they consumed 12 percent fewer calories at the meal than when they ate no salad (p < 0.001)
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The researchers reported that reducing energy density by 25 percent led to a 24 percent reduction in energy intake; reducing portion size by 25 percent led to a 10 percent decrease in energy intake; and reducing both energy density and portion size by 25 percent led to a 32 percent reduction in energy intake. So energy density and portion size each independently reduced energy intake, with energy density reduction having the greater
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. Based on this evidence, Rolls suggested that strategies to reduce energy intake can use energy density and portion size interventions in combination or separately, depending on the food product.
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Vegetableenhanced entrees did not affect the intake of vegetable side dishes; overall vegetable intake increased 49 percent when adults were served main dishes with the 15 percent reduction in energy density and 80 percent when adults were served main dishes with the 25 percent reduction. Other ways to reduce energy density include increasing volume via aeration, as was done in some of the satiety studies, and decreasing fat content, as was done in some of the satiation studies.
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that the greater weight loss associated with the high-protein Atkins diet, compared to non-high-protein diets, was a result of the greater satiety value of the higher protein content of the Atkins diet. Mattes argued that the only way that the Gardner and colleagues (2007)
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Although it is unclear whether protein really has a greater effect than other macronutrients on energy intake by virtue of its effect on satiety, Mattes explained that protein can impact energy balance in other ways -- for example, through thermogenesis (i.e., protein requires energy for digesting, absorbing, etc.) and via the retention of lean body mass (which leads to increased metabolism and greater caloric expenditure)
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versus ad libitum intake (i.e., people had some choice about how much they were going to ingest) daily weight loss as a function of added fiber was the same for both, even though studies with a fixed fiber load show a 20 g per day weight loss, on average, compared to a 24 g daily weight loss in the ad libitum intake studies.
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Thus, Mourao and colleagues concluded that liquid diets pose a greater risk for positive energy balance (e.g., weight gain) because liquids have a lower satiety value than solid foods.
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Consumer Decision Making and Energy Intake In addition to identifying eating behaviors that serve as good targets for innovative food technology-based obesity prevention and reduction interventions, it is equally important to consider how consumers make decisions about the products that have been altered with those technologies. As speaker David Just, associate professor in applied economics and management and director of graduate studies at Cornell University emphasized, an innovative food technology can be leveraged for obesity prevention and reduction efforts only if (1)
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So, differentiating between new food products that have been improved through
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LESSONS LEARNED AND BEST PRACTICES Workshop participants described several different types of technologies that have been developed and commercialized for the purpose of providing consumers with foods that can be used for weight loss or maintenance. These include reduced energy dense foods with lower fat or sugar content (see previous section for a summary of the workshop dialogue on the relationship between energy density, energy intake, and obesity)
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Reducing Calories by Reducing Fat Although removing or reducing fat content of food products is technologically challenging, it is possible. The challenge is not the actual removal of the fat, rather it is maintaining taste.
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Along with some other changes to the manufacturing process, Frito-Lay had to design an extremely high heat transfer rate oven in order to create a crispy-textured chip. USDA Grain-Based Technologies for Fat Reduction Outside of the food industry, USDA scientists have been involved in developing a range of innovative grain-based technologies for fat reduction, including several types of soluble and insoluble fiber fat replacers and a reduced-fat-uptake rice batter.
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, weight loss (4.5 pounds on average) , and increased satiety (Hallfrisch and Behall, 1997; Hallfrisch et al., 1995; Scholfield et al., 1993)
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Champagne suggested that, like C-Trim, insoluble fiber fat replacers not only reduce fat content, but may also increase satiety by virtue of their high viscosity, in this case absorbing 24 times their weight in water. However, insoluble fiber fat replacers are not as effective as soluble fiber fat replacers in improving glucose tolerance.
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As discussed later in this report, CRADA is one of two mechanisms through which manufacturers can partner with ARS to commercialize new food technologies developed by ARS scientists. Reducing Calories by Reducing Sugar Although removing fat may seem like the most obvious way to reduce the energy density of foods, given that fat contains more calories per gram (9 cal/g)
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She noted that reducing sugar poses enormous formulation challenges because sugar acts as a bulking agent; when sugar is removed, aeration or other tools need to be used to increase volume. Using Portion-Controlled Frozen Meals to Reduce Calorie Intake Reducing the energy density of foods by removing or reducing fats and sugars is by no means the only way to reduce calorie intake.
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Bolles interpreted these results to mean that not only can portion-controlled, frozen, ready-to-eat meals help people lose weight, but they can also help people to change their behavior by increasing awareness of portion size. Additionally, Bolles said, portion-controlled frozen meals are an effective way to reduce energy density.
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. In an effort to reduce the risk of obesity by increasing fruit and vegetable intake, in addition to the fat-reducing technologies described by Champagne (and summarized previously)
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As a way to increase legume intake, Jose Berrios of ARS and collaborators from Washington State University have been using a novel extrusion technology to develop legume-based breakfast cereals and snack food products. Casting Technology and Fruit- and Vegetable-Based Films and Sheets ARS scientists used casting technology to develop films or thin sheets containing 85–90 percent fruits and vegetables, and the service partnered with NewGem Foods (formerly Origami Foods)
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These new technologies include new bioconversion or bioprocessing technologies for adding soluble fibers and increasing nutrient levels; new separation technologies for removing bitter and other undesirable compounds; and new emulsification technologies for improving solubility, stability, and bioavailability of targeted components. MAJOR CHALLENGES All of the technologies described in the previous section -- and the many food products that have been commercialized or are currently being developed using these technologies -- reflect significant progress toward providing consumers with tools to reduce energy intake and help control weight.
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This section summarizes what workshop participants identified as the most difficult and important challenges to developing and commercializing innova tive food technologies aimed at providing consumers with new tools to reduce energy intake and control weight. In addition to taste, workshop participants discussed affordability, reformulation, and price challenges of leveraging innovative technologies to alter existing products, regulatory hurdles to commercializing new or altered food products, and the challenge of consumer trust.
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, 49 percent of participants preferred Healthy Choice Café Steamers over freshly cooked meals, suggesting that the steamers taste as good as freshly prepared meals. As Bolles explained, ConAgra Foods utilizes an innovative steaming technology that results in less moisture loss (2.1 percent compared to 8 percent for traditional frozen meals)
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Affordability As important as taste is, it is not the only factor to consider when developing and commercializing improved food products. As previously summarized, Just explained that not all consumers are willing to pay more for improved products.
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As another example, Flat Earth, a fruit- and vegetable-based snack launched by Frito-Lay in 2008, was discontinued because of low volume of sales. Product Formulation and Ingredient Costs Although many of the technologies described during the workshop were developed for the purpose of commercializing new food products or new types of food products, Midness emphasized that innovative technologies can also be leveraged to reformulate or otherwise improve existing products.
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. Consumer Trust An overarching theme of the workshop discussion was that the food industry has been "demonized" by much of the American public, with modern food processing technologies being widely perceived as unhealthy at
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Reaching consumers who are already philosophically opposed to the very concept of food processing, or food technology, creates a tremendous challenge, adding to the many technological and economic challenges of reducing energy density or otherwise altering foods in order to provide consumers with more healthful foods. POTENTIAL FOR INNOVATION: NEXT STEPS At the end of the workshop, participants engaged in a discussion of strategies for moving forward in an effort to leverage innovative technologies for obesity reduction and prevention efforts.
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He suggested starting small and with a particular focus so that the conversation is actually a conversation. A question was raised about whether there was any sector besides the food industry in a position to make a compelling case that processed foods can make a positive contribution to people's diets.
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Government-Industry Collaboration ARS is just one example of how partnering with government can serve the food industry well with respect to leveraging innovative new technologies in obesity prevention and reduction efforts. The ARS has proven to be a robust resource for innovation over the past several decades (Box 1)
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Recognizing the challenge that this creates for small businesses in particular, in 2007 ARS established a program called the Agricultural Technology Innovation Partnership (ATIP) to manage intermediary agreements with economic development entities that provide the necessary complementary assets.
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The ARS is credited with conceiving and developing countless innovations in food technology over the past half-century and longer, beginning in the 1940s: • D eveloped palatable dehydrated eggs (1943) • C onducted research on the creation of fruit essences, which led to the development of concentrated frozen apple and grape juices (1943)
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. Innovation: There Is No Magic Bullet Clydesdale asked if there is a way to involve the food industry in a dialogue with the public health community and relevant government agencies in an effort to make products that satisfy specific recommendations around obesity prevention and reduction.
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Rolls asked whether it is preferable to make small changes to many foods or large changes to a few foods. Should efforts be broadly focused on reducing energy density or portion size in small increments over time, or would it be more effective to make major changes to a select group of key foods?
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Chor-San Khoo, vice president of global nutrition and health at Campbell Soup Company, framed the question about prioritizing in a slightly different way. She asked what the number one priority should be when developing food products aimed at reducing or preventing obesity, given the large number of demands placed on the food industry by competing public policy interests (i.e., competing health interests, such as heart disease, diabetes, pediatrics, etc.)
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If the primary focus is tooth decay, then it makes sense to lead with sugar messaging, but if the primary focus is obesity, then it makes sense to lead with calories. While there may be some unintended consequences of posting calorie content on the front of a package or in a restaurant, educating people about calories in some form or another seems to be a reasonable starting strategy -- the more people hear about calorie intake and portion size, the more likely it is that appropriate calorie intake will become a social norm, in much the same way that the wearing of seatbelts is today.
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Some participants remarked that while there are situations in which silent changes may be helpful, the use of technologies to improve the food supply, whether done silently or not, does not eliminate the need for public education on healthy eating behavior. Not only could public education, whether through front-of-package labeling or other means, contribute toward changing maladaptive eating behaviors, it also could be used to raise awareness about the health benefits of food technology.
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Bolles said that frozen meals as a portion control strategy are left out of many weight management publications and guidelines from public health organizations including the CDC, the National Institutes of Health (NIH) , and the Department of Health and Human Services.
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, a reality that points to the importance of prevention. Unless the cause of the behavior that leads to obesity is addressed, people who lose weight through structured weight loss programs will eventually regain the extra weight.
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The absence of exercise at school, combined with increased time at home spent in front of the television or computer, is just one example of the type of social pressure existing today that impacts energy balance. The audience member noted that a systematic analysis would help manage expectations around what the food industry can do -- and what it cannot do -- by leveraging technology to change foods or eating behaviors.
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Rolls mentioned research showing that people who diet with prepackaged 100-calorie packs may end up eating more than when eating ad libitum. She wondered whether people who eat the restricted-portion size packs are receiving some type of message, such as "it's a ‘diet food'" that makes them feel so good about eating it that they want to eat more.
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In fact, Continuing Survey of Food Intakes by Individuals (CSFII) data indicate that eating frequency accounts for a greater proportion of variance in energy intake than does portion size, mostly likely because of a compensatory response.
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There are as many studies showing that increased fruit and vegetable intake leads to no change in body weight, or even increased body weight, as there are studies showing that increased fruit and vegetable intake leads to weight loss.14 For example, Allison pointed to a study by Whybrow and colleagues (2006) that showed no significant difference in weight change between individuals who ate more fruits and vegetables over the course of eight weeks compared to individuals who ate a standard diet.
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. Although the food industry does not engage in R&D to the extent that it probably should, Allison commented that it does do "good science." He mentioned past research with trans fatty acids and how the food industry and USDA partnered to fund research that eventually showed the negative health consequences of trans fatty acids (Judd et al., 1994)
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Workshop participants explored four general categories of eating behavioral challenges. First, a growing body of evidence shows a strong association between increased portion size and increased energy intake.
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. However, as with portion size control, Rolls stated that the long-term effect of reduced energy density on weight status is unclear.
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Suggestions from the participants for moving forward included keeping the focus on calories, recognizing that some segments of the population are not reachable through conventional public education and that alternative strategies need to be developed, educating children about portion sizes and other eating behavior norms, and educating educators themselves. Additionally, there was quite a bit of discussion around the potential for fruitful collaborations between industry and government to develop novel
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An audience member remarked that a systematic analysis would help to manage expectations of the role and responsibilities of the private sector. These next steps suggested by workshop participants helped to establish a greater understanding of how food technology can be incorporated into the multifaceted response to the complex interplay of environmental, social, economic, and behavior factors that influence the prevention and reduction of obesity.
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2008. Prospective study of dietary energy density and weight gain in women.
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2007. Chefs' opinions of restaurant portion sizes.
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2007c. Effects of portion size and energy density on young children's intake at a meal.
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1993. Strengthening behavioral interventions for weight loss: A randomized trial of food provision and monetary incentives.
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2008. Association of breakfast energy density with diet quality and body mass index in American adults: National Health and Nutrition Examination Surveys, 1999–2004.
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2007. Dietary energy density is associated with obesity and the metabolic syndrome in U.S.
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2003. Patterns and trends in food portion sizes, 1977–1998.
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2004b. Salad and satiety: Energy density and portion size of a first-course salad affect energy intake at lunch.
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2009. Do calorie-controlled portion sizes of snacks reduce energy intake?
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2007. Portion sizes and obesity: Responses of fast-food companies.
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