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Perceptions of tableware size in households of children and adolescents with obesity

  • Isabelle Mack
  • Helene Sauer
  • Katja Weimer
  • Dirk Dammann
  • Stephan Zipfel
  • Paul Enck
  • Martin Teufel
Original Article

Abstract

Purpose

Portion size influences energy intake and is an important factor when developing weight management strategies. The effect of tableware on food intake is less clear, especially in children. To date, the relationship between the body weight of individuals and the tableware used in their households has not been investigated. The aim of this study was to analyze the sizes of tableware in households of children and adolescents with obesity (OBE) in comparison to participants with normal-weight matched for age and gender (NW).

Methods

60 OBE (32 female, 26 male) and 27 NW (12 female, 15 male) aged between 9 and 17 years participated in a structured interview on the tableware used at home. Responses were standardized based on the selection of different sizes of tableware and everyday objects presented to the children.

Results

In households of NW, larger plates and bowls were used during meals and desserts compared to OBE. OBE drank out of larger bottles. Shapes and sizes of drinkware, the number of children drinking out of bottles and the cutlery used during dessert did not differ between the groups.

Conclusions

Drinking out of large bottles may be an unfavourable habit of OBE if they contain sugar-rich liquids. The use of smaller plates and bowls of OBE may result in multiple helpings being consumed and so contribute to an overall increased portion size.

Level of evidence

Level V, Descriptive study.

Keywords

Children Obesity Portion size Cutlery Tableware Bottle 

Background

Obesity and its associated diseases are a key worldwide health problem. The underlying cause of obesity is an imbalance between energy intake and energy expenditure in favour of the former [1]. Portion size appears to be an important factor when developing weight management strategies, as a recent Cochrane review found that children and adults ate or drank more when offered larger-sized portions, packages or tableware (utensils such as plates, glasses, knives, forks, etc., that are used for serving and eating food at a table) in comparison to smaller-sized versions [2]. Moreover, adults, but not children, selected more food when larger-sized portions, packages or tableware were offered [2]. When looking in detail at the original literature and the above-mentioned review, it becomes apparent that most of the studies conducted in children analyzed the influence of portion size, with few considering the influence of tableware size [3, 4, 5, 6, 7]. Additionally, pressure to eat from parents may have been a confounding factor in these studies since, at least for pre-school children, it was shown that those children that were told to clean their plates by their mothers requested more cereal than other children [8]. Thus, it is difficult to draw conclusions about the role of tableware in children’s food intake.

Recently, Wansink et al. analyzed 52 depictions of the last supper to compare the sizes of the food and plates [9]. They found that not only portion size but also plate sizes increased over the millennium. Large sizes of tableware and food packaging may lead to subconscious overeating [10]. Wansink et al. also reported that adults in social situations serve themselves more ice-cream when larger bowls were used and even more when they were given a large serving spoon [11]. When crisps were offered at a party in bowls, more crisps were consumed when offered in 4000 cc bowls compared to 2000 cc bowls [12]. Rolls et al. conducted three cross-over experiments with 45 adult participants and reported that using smaller plates did not reduce food intake at lunch when compared to larger plates under these laboratory conditions [13]. Similar results were obtained by two other investigators from different groups for obese and normal-weight women [14, 15]. For elementary school children it has been shown that they serve themselves more when using large plates and large bowls at a buffet than when using small bowls and plates [3]. Moreover, the children requested more cereal from the adults serving them when large bowls were used [4]. Interestingly, van Ittersum and Wansink reported that introvert children aged 6–12 years are not affected by bowl size when serving themselves, in contrast to extrovert children who serve themselves more if large bowls are offered [5]. Although several studies, therefore, show that using large sizes of tableware lead to subconscious overeating due to the consumption of increased portion sizes, other studies contradict these findings.

The shape and size of drinkware may also influence the volume consumed [6, 16, 17] and energy intake (if the drinks contain calories). Raghubir and Krishna [16] investigated the effect of elongated glasses on consumption volume in adults and found that with pre-poured drinks, elongated glasses were not only perceived to contain more liquid prior to consumption, but also that greater volumes were consumed from these glasses [16]. Wansink and van Ittersum demonstrated in children and adults that they increased the intake of juice when using a short, wide glass compared to a tall, narrow glass, with subjects having the perception that the opposite behaviour was true [6]. They concluded that in a self-serving context, the elongation of glasses negatively influences consumption.

With regard to body weight management, the question arises as to whether or not a relationship exists between the body weight of individuals and the tableware used in their households.

The aim of this study was to analyze in households of children and adolescents with obesity (OBE) the sizes and shapes of tableware used at diverse meal occasions in comparison to participants with normal-weight matched for age and gender (NW). We tested the hypotheses that in households of the OBE-group (i) larger sizes of plates and bowls are used; (ii) for dessert, soup-spoons and forks instead of teaspoons and pastry-forks are used, respectively; (iii) larger sizes of drinking glasses are used; (iv) the proportion of participants drinking directly from the bottle is higher; and (vi) larger bottle sizes are used by those participants drinking directly from the bottle, when compared to the NW-group. We validated the perception sizes using non-food household items.

Methods

Study design and participants

The study protocol was approved by the Ethics Committee of the medical faculty for the University Tübingen, Germany. This study is registered at the German Clinical Trials Register (DRKS) with the clinical trial number DRKS00005122. The study presented here was conducted as part of the DROMLIN-study PreDictor Research in Obesity during Medical care—weight Loss in children and adolescents during an INpatient rehabilitation [18].

Children and parents were informed about the study purpose and provided written consent prior to inclusion. In short, 60 overweight and obese children (OBE) with a BMI over the 90th percentile for their age and sex specific norms [19], with an age between 9 and 17 years (47% male) and an indication for hospitalization for weight loss intervention at the Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany were included. The program comprised physical activity, cognitive behavioral therapy and a balanced diet. A detailed description of the setting is reported elsewhere [18]. Exclusion criteria were severe psychological comorbidities, linguistic or intellectual limitations, type-1 diabetes, malignant tumors, systemic disorders, or severe cardiovascular diseases. Additionally, 27 healthy normal-weight children (NW) matched for age and gender with a BMI between the 10th and 90th BMI percentile [19] and aged between 11 and 14 years (56% male) from the catchments area of the University Hospital Tübingen, Germany were interviewed.

We initially planned pairwise sex and age-based matching of NW to our total sample of OBE by recruiting children from local schools but did not receive permission to do so. Therefore, we recruited from the children of hospital employees, resulting in a smaller control sample with a narrower age range (11–14 years). To account for this we performed additional post-hoc analyses where we compared only the subset of OBE aged 11–14 years (n = 46) to NW (n = 27).

Procedure

We interviewed OBE and NW in a standardized manner about the tableware used at home for different occasions (Table 1a). Tableware and real-size utensils were used to help the children with their decisions (Table 1a, b). The characteristics of the tableware are presented in Table 1b. An example of the standardized procedures used is as follows: to gain insights into the plates used for a warm meal we presented the children three different sizes of plates (small, 20 cm; medium, 23–24 cm and large, 25.5–28 cm) and asked them to indicate which size they regularly use at home for a warm meal. The child would then point with the finger towards the chosen plate and any additional comments were documented. For further details please refer to Table 1.

Table 1

Questions about the tableware used at home and characteristics of the presented tableware

Plates and bowls

Presented tableware

A: Questions about the tableware used at home

 Which sizes of plates are used for a warm meal?

Plates: small, medium, large

 Which sizes of plates are used for diverse meal occasions (breakfast, snacks)?

Plates: saucer, small, medium, large

 Which sizes of bowls are used for diverse meal occasions (breakfast, snacks)?

Bowls: large, medium, small, very small

 Which sizes of plates are used for dessert?

Plates: saucer, small, medium, large

 Which sizes of bowls are used for dessert?

Bowls: large, medium, small, very small

Cutlery

 Which kind of forks are used for dessert?

Cutlery: fork, pastry fork

 Which kind of spoons are used for dessert?

Cutlery: soup spoon, table spoon

Drinkware

 Which sizes of drinkware (glasses) are used?

Glasses: low + wide, high + wide, medium low + narrow, high + narrow

 Do you regularly drink directly from the bottle?

None

 If yes, what is the bottle size?

Bottles in l: 1.5, 1.0, 0.75, 0.5, 0.33

 

Diameter (widest point)

Height

Volume

B: Characteristics of the presented tableware

 Plates

  Large

25.5–28 cm

  

  Medium

23–24 cm

  

  Small

20 cm

  

  Very small (saucer)

14–15 cm

  

 Bowls

  Large

15 cm

7 cm

 

  Medium

14 cm

6 cm

 

  Small

13 cm

5 cm

 

  Very small

12 cm

4 cm

 

Drinkware (glasses)

  Low and wide

7.5 cm

9 cm

0.18–0.22 ml

  High and wide

8 cm

13.5 cm

0.35 ml

  Medium

6 cm

14 cm

0.25 ml

  Low and narrow

5.5 cm

13 cm

0.2 ml

  High and narrow

5.5–6 cm

15.5–18 cm

0.35–0.375 ml

Bottles

  1.5 l bottle

  

1.5 l

  1 l bottle

  

1 l

  0.75 l bottle

  

0.75 l

  0.5 l bottle

  

0.5 l

  0.33 l bottle

  

0.33 l

 Cutlery

  Fork, pastry fork

  Table spoon, soup spoon

Each child’s cognitive ability to discriminate between physical dimensions was tested in the DROMLIN-study by successively presenting everyday objects of different size: a mobile phone (9 cm), a book (24 cm), and a bottle (34 cm). After each presentation the object was removed and the child was asked to estimate its length on a caliper. Ratios were calculated by dividing the subjective lengths by the actual lengths of the objects.

Eating behaviour was assessed by the validated Eating Behaviour and Weight Problems Inventory for Children (EWI-C), consisting of 60 items and 10 subscales [20]. In this study, the subscale “pressures to eat from parents”, consisting of five items, is reported. The Cronbach`s α of the scale, a measure for internal consistency, is 0.7. Percentile ranks for the values of the subscale “pressures to eat from parents” were retrieved by sex and age specific norm tables. Values between the 16th and 84th percentile can be considered normal. The other subscales are not reported here since they are not relevant for this study.

Statistics

The sample size was calculated for the DROMLIN-study [18] which aims at identifying predictors which play a role in successful weight loss and weight loss maintenance in children and adolescents. However, the sample size of n = 87 allowed us to test for medium effect sizes of \(\Phi\) = 0.35 (2 × 2 χ2-test, α = 0.05, Power = 0.8) in this study as calculated with G-Power [21].

The data were analyzed using SPSS version 19. Normally distributed data are presented as mean ± standard deviation. Non-normally distributed data are presented as median [interquartile range]. Frequencies are given as sample size (n) and percentages (%). Differences between OBE and NW were calculated using unpaired t tests (age, weight, height, BMI, BMI-SDS), χ2 test (sex, meal plate size, dessert plate size, drinking out of bottle, glass sizes) or Fisher`s exact test (diverse occasions plate size, cutlery sizes) or Mann–Whitney-U-test if data were non-normally distributed or non-metric (EWI-C, bottle size, ratios of everyday objects). Fisher`s exact test was applied when the χ2 test was inappropriate because the frequencies in the cross-tables were less than 5 in a cell in > 20% of the cells. A p value < 0.05 was considered statistically significant (everyday objects, EWI-C). To control for multiple testing regarding the tableware analyses, the p values were false discovery rate (FDR) [22] adjusted. FDR-values of < 0.05 and were considered statistically significant.

Results

Sixty OBE and 27 NW matched for age and gender were interviewed about the tableware used in their households. The characteristics of the study population are given in Table 2. The data are presented by topic: (a) estimates of presented everyday objects, (b) plate and bowl sizes, (c) cutlery used for dessert, (d) drinking glasses and drinking directly from the bottle, (e) pressure from parents to eat and, (f) additional post-hoc analyses. Detailed descriptive and test statistics for (a), (b), (c) and (d) are presented in Fig. 1 and Table 3, respectively.

Table 2

Characteristics of the study population

 

Obese

Normal-weight

p value

n

60

27

(χ2 test)

Sex

(32 ♀ 28 ♂)

(12 ♀ 15 ♂)

0.443

 

(Mean ± SD)

(Mean ± SD)

(T test)

Age (years)

13 ± 1.9

12.5 ± 0.9

0.093

Weight (kg)

84 ± 20.5

45.4 ± 8.2

< 0.001

Height (cm)

163.1 ± 10.5

158.1 ± 9.4

0.037

BMI (kg/m2)

31.2 ± 5.2

18.1 ± 1.6

< 0.001

BMI-SDS

2.51 ± 0.57

− 0.19 ± 0.55

< 0.001

Fig. 1

Cognitive ability to discriminate between physical dimensions of everyday objects. ac Ratios were calculated by dividing the subjective lengths through the objective lengths of the objects. d The mean ratio for all objects was calculated. ad The data are presented as box-whiskers, showing the median and the interquartile range in the boxes. No differences were observed between the groups. Statistics: ratio mobile phone (U = 697.0, p = 0.23); ratio book (U = 781.5, p = 0.79); ratio bottle (U = 795.0, p = 0.89); ratio of all everyday objects (U = 774.0, p = 0.74). OBE = obese children, NW = normal-weight children

Table 3

Tableware sizes in households of children with obesity (OBE) and normal weight (NW)

 

OBE

NW

Test value

FDR

Phi

A. Plate and bowl sizes

 Warm meal–plate-size

  Medium

   n

45

15

χ2 = 5.594

0.036

0.26

   %

80.4%

55.6%

   

  Large

   n

11

12

   

   %

19.6%

44.4%

   

 Diverse meal occasions–plate-size

  Small

   n

52

22

Fisher`s exact test (has no test value)

0.589

 

  %

86.7%

81.5%

   

  Medium

   n

8

5

   

   %

13.3%

18.5%

   

 Dessert–plate size

  Small and very small

   n

52

15

χ2 = 14.109

< 0.001

0.41

   %

91.2%

55.6%

   

  Medium

   n

5

12

   

   %

8.8%

40.7%

   

 Diverse meal occasions–bowl size

  Small

   n

9

2

χ2 = 18.795

< 0.001

0.47

   %

15.5%

7.4%

   

  Medium

   n

41

9

   

   %

70.7%

33.3%

   

  Large

   n

8

16

   

   %

13.8%

59.3%

   

 Dessert–bowl size

  Small

   n

29

10

χ2 = 14.836

0.03

0.42

   %

50.0%

37.0%

   

  Medium

   n

25

6

   

   %

43.1%

22.2%

   

  Large

   n

4

11

   

   %

6.9%

40.7%

   

B. Cutlery for dessert

 Dessert–spoon size

  Teaspoon

   n

52

26

Fisher`s exact test (has no test value)

0.533

 

   %

88.1%

96.3%

   

  Soup spoon

   n

7

1

   

   %

11.9%

3.7%

   

 Dessert–fork size

  Pastry fork

   n

46

26

Fisher`s exact test (has no test value)

0.052

0.24

   %

76.7%

96.3%

   

  Fork

   n

14

1

   

   %

23.3%

3.7%

   

C. Drinking glasses and drinking directly from the bottle

 Drinkware–glass size

  Low wide or narrow

   n

25

14

χ2 = 0.801

0.670

 

   %

41.7%

33.3%

   

  Medium

   n

10

4

   

   %

16.7%

14.8%

   

  High wide or narrow

   n

25

9

   

   %

41.7%

51.9%

   

 Drinking directly from the bottle

  No

   n

12

8

χ2 = 0.975

0.459

 

   %

20.0%

29.6%

   

  Yes

   n

48

19

   

   %

80.0%

70.4%

   

 Bottle-drinker–bottle size in litres

  Median [interquartile range]

 

1.0 [0.5–1.5]

0.5 [0.5–1.0]

U = 262

0.013

 

Estimates of presented everyday objects

As a validation step, each child’s cognitive ability to discriminate between size dimensions of three everyday objects was tested. The results are presented in Fig. 1. No statistical differences were observed for any of the objects and for the mean ratio for all objects between OBE and NW, respectively.

Plate and bowl sizes

When asked for the plate and bowl sizes used at home for a variety of meal occasions (Table 3a), NW reported the use of larger plates for main meals and desserts in their households when compared to OBE. No differences were found for the size of plates used at diverse meal occasions (breakfast and snacks). NW also reported the use of larger bowls at home at diverse meal occasions and desserts (Table 3a).

Cutlery used for dessert

Assessment of the children’s habits of using cutlery during dessert, most children reported the use of pastry forks and teaspoons (Table 3b). However, 14 of 60 OBE reported using normal forks versus 1 of 27 NW. This finding only showed a trend towards statistical significance after the p values were adjusted for multiple testing (p = 0.031, FDR = 0.052). Although 7 of 59 OBE versus 1 of 27 NW reported using soup spoons instead of teaspoons, this finding was not statistically significant.

Drinking glasses and drinking directly from the bottle

When asked about the drinking glasses used in the children’s households and their habits of drinking directly from the bottle (Table 3c), no differences between the groups were found for the drinking glasses. There was also no difference between the groups in the ratio of those children and adolescents drinking and those not drinking directly from the bottle. Interestingly, OBE drinking directly from bottles reported drinking out of larger bottles when compared to NW.

Pressure from parents to eat

Pressure from parents to eat was analyzed as a possible confounding factor in the debate of tableware size and overeating. The values for the subscale “pressures to eat from parents” were normal in both groups, with median percentile ranks of 54 [36–73] in OBE and 63 [36–87] in NW, respectively. No differences between OBE and NW were observed (U = 646.5, p = 0.133).

Additional post-hoc analyses

From 24 h food-recall analyses it is known that children of 10 years and older can give reliable information about the food intake [23], To assess for possible age effects due to immaturity, we performed post-hoc analyses by excluding the four youngest children aged between 9 and 10 years but gained similar results when compared to the complete analysis (data not shown). Additionally, we performed post-hoc analysis excluding the OBE children < 10 and > 14 years of age (the age range not represented by NW). The results were comparable with those of the complete analysis except that no significant difference or trend was observed for the use of a fork or pastry fork during dessert between OBE and NW (data not shown).

Discussion

In this novel study, we interviewed children and adolescents with obesity and normal-weight about the tableware used at home for a variety of meal occasions. Our report provides new insights into the relationship between perceived tableware size and subconscious overeating in relation to body weight in real life situations.

We found (i) that NW reported more often than OBE that large bowl- and plate sizes were used for a variety of meal occasions, (ii) no difference for the groups regarding cutlery preference for dessert; although there was a trend for preferred use of a fork versus a pastry-fork in OBE versus NW, (iii) no differences between the groups regarding drinking glass sizes and shapes, (iv) no differences between the groups regarding the proportion of participants drinking directly from the bottle and, (vi) that OBE versus NW drank out of larger bottles in the “bottle-drinker” group.

Hypothesis i

We initially tested the hypothesis that in homes of OBE, larger sizes of plates and bowls are used when compared to NW, with the inference that this may lead to overeating due to increased portion sizes and thus increased body weight. However, the opposite was observed for bowls and plates at a variety of meal occasions. In this context, it is not clear whether or not there were differences of plate/bowl sizes available at home or if it was simply the preference to use certain plate/bowl sizes at meals. We suggest that using small tableware could be problematic if this leads to several second helpings in a family setting [24]. This in turn could lead to losing a clear overview of what has already been eaten and could result in increased portion sizes and energy intake, especially if particularly energy dense foods are the main component of a meal.

This hypothesis is supported by a study of Wansink and Payne [25], demonstrating that in a buffet setting, students ate more chicken wings if the leftovers were removed in comparison to students where the leftovers remained on the table. Libotte et al. reported that large plate size was associated with healthier eating in adults, as participants using large plates served themselves more vegetables without affecting the total energy content of the meal [26]. At least for the meals, it is imaginable that parents of NW subconsciously prefer using larger plates and bowls to have enough space for vegetables. It is possible that the findings of Libotte et al. [26] apply to older children and adolescents but this has not been tested in prospective studies.

In adults, one group showed that the amount of popcorn eaten while watching television in a laboratory setting was similar in participants with a small bowl versus a large bowl, although there was a tendency to eat more in the small bowl [27]. Three other independent groups found that under laboratory conditions, plate size did not influence energy intake [13, 14, 15]. Furthermore, Rolls et al. reported that participants using small plates made more trips to the buffet then those having larger plates, thus compensating for the fact that less food could be placed at one time on small plates. In fact, the amount of food eaten was remarkably consistent from meal to meal [13]. Other studies have found that when serving the same amounts of food on different occasions, the weight of food types consumed was remarkably consistent, indicating that people learn how much volume they need to ingest of particular foods to perceive satiety [28, 29]. Nevertheless, food-related cues in the environment can influence this tendency towards eating consistent weights of food, in particular, when large portion sizes are offered [30].

The relationships between bowl and portion size have been investigated in naturalistic situations. For bowls, Wansink et al. reported that more ice-cream and crisps were eaten in large bowls versus smaller bowls [11, 12]. DiSantis et al. found that elementary school children increased their energy intake if they served themselves on adult-sized plates and bowls but no separation between bowls and plates was made [3]. Wansink et al. reported for children that they consumed and wasted more cereal using large bowls [4]. The data by von Ittersum and Wansink show the complexity of this issue by finding that elementary school children serve themselves more cereal in large bowls compared to small bowls if they are extroverts, whereas introverts were unaffected by the size of the bowls. Moreover, when the children were asked by adults how much they wanted to eat, all children requested less cereal when given the small versus the large bowl [5].

As personal, social and environmental factors [5, 7, 31, 32, 33] influence portion size and energy intake, this may explain why under laboratory conditions no influence of plate size on portion size was observed, whereas an influence of bowl size on portion size in naturalistic settings was found. Overall, there is a lack of data in this field of research especially for children (> 6 years of age) and adolescents. For this group, there are also no studies which analyze the impact of tableware on portion size over several days.

Hypothesis ii

Our second hypothesis tested whether in homes of children with obesity, soup-spoons and forks instead of teaspoons and pastry-forks are used for dessert. Although we observed a trend that OBE reported the use of normal forks instead of pastry forks more often in comparison to NW in the whole sample, this was not the case in our post-hoc analysis where children < 11 and > 14 were excluded (which may be due to the decreased sample size). Interestingly, self-served portions increase if large serving spoons are used by children [7] and adults [11, 34]. Only one study investigated whether portion size and energy intake is also influenced by the sizes and shapes of cutlery and found that adults ate more when equipped with smaller forks in comparison to larger forks in a restaurant setting [35]. Although it is possible that eating speed might be influenced by cutlery size [36, 37], the role of cutlery size on food intake in children and adolescents has yet to be fully elucidated.

Hypotheses iii, iv and v

Since the shape and size of drinkware may also influence the volume consumed [6, 16, 17], the intake of sugar-sweetened drinks and juices can substantially contribute to energy intake [38, 39] and children with obesity also need increased gastric volumes to feel full [40], our third hypothesis tested whether increased sizes of drinking glasses are used in homes of the OBE versus the NW. This hypothesis was rejected along with our fourth hypothesis, which tested whether the number of participants drinking directly from the bottle was increased in OBE versus NW. However, our final hypothesis that larger bottle sizes are used by OBE versus NW, in those participants drinking directly from the bottle, was confirmed. Whereas Wansink and van Ittersum demonstrated in children and adults that in a self-serving situation the intake of juice was increased when short and wide glasses compared to tall and narrow glasses were used [6], no studies have been conducted which analyze the influence of liquid intake and bottle size.

Our study found that the drinking glassware in households and the habit of drinking directly from bottles per se are not related to increased body weight in our sample. Nevertheless, drinking directly from large bottles may increase energy intake if they contain sugar-sweetened drinks or juices and could contribute to an increased BMI-SDS. On the other hand, drinking from large bottles containing no or low calorie drinks, preferably water, this could also offer a chance to increase the water intake. The influence of the bottle size on liquid intake remains to be tested.

As a potential confounding factor, we assessed the pressure to eat from parents as it is a considerable confounding factor in the debate over tableware size and overeating [8, 41]. In our study, this factor did not appear to play an important role, neither in OBE nor NW in the chosen age range. It may be a more important consideration in (underweight) pre-school children [8, 42] when parents may have greater anxiety regarding appropriate weight gain in their child. In children aged 13–15 years, pressure to eat from parents was an issue for girls but not boys. It is suggested that parents might encourage girls to eat more, with the girls themselves restricting their food intake [43].

Among the limitations of our findings we are unable to exclude that OBE only perceive that their bowls and plates at home are smaller. However, the probability of this is low given that we demonstrated that the cognitive ability of children to estimate the sizes of everyday objects did not differ between OBE and NW. We also do not consider social desirability to have been an issue in this interview. Although some of our OBE may have received instructions ahead of their inpatient stay about appropriate portion sizes for specific foods, information on the relationship between tableware and portion size are not part of dietary training. Moreover, as OBE reported drinking out of larger bottles, had social desirability been an issue (children thinking that large plates, glasses, bottles, etc. are the undesired response), we would have expected to find a systematic misreporting across all tableware items. Additionally, we did not assess whether the children serve themselves at mealtime, or whether the food is served directly on plates/bowls at the table, or whether the children are allowed to take multiple servings or not; these factors may have had a bearing on results.

Conclusions

Taken as a whole, this study provides novel and interesting insights into the tableware used in the homes of children and adolescents with obesity and normal-weight. Large plate and bowl sizes, but not drinking glass shapes, were associated with lower body weight of children. Moreover, eating desserts with a fork instead of a pastry fork and drinking directly from large bottles (containing sugar-rich liquid) may be unfavourable habits of the obese group with regard to body weight management.

Notes

Acknowledgements

This study was funded by Grants from the Else Kröner-Fresenius-Stiftung, Bad Homburg, Germany (2011_A135) and the “Minigraduiertenprogramm” of the Center for Nutritional Medicine (ZEM), Tübingen-Hohenheim, Germany. IM receives a grant by the Ministry of Science Baden-Württemberg and the European Social Fund.

Author contributions

IM was responsible for conception, funding, design and preparation of the study, data analysis, data interpretation and drafted the paper. HS was responsible for conception and design of the study and acquired data. DD and SZ were responsible for conception and design of the study. PE was responsible for conception, design and funding of the study. KW and MT were involved in data interpretation. All co-authors revised the manuscript. We thank all staff of the Fachkliniken Wangen i. A. for their support in carrying out the study and all colleagues at the University Hospital Tübingen who helped us with planning, implementation and realization. We thank Mr. Riyad Peeraully for reviewing the manuscript as a native English speaker.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Mack et al, the children and their parents provided informed consent prior to the children’s participation.

References

  1. 1.
    Kahn SE, Hull RL, Utzschneider KM (2006) Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature 444(7121):840–846.  https://doi.org/10.1038/nature05482 CrossRefPubMedGoogle Scholar
  2. 2.
    Hollands GJ, Shemilt I, Marteau TM, Jebb SA, Lewis HB, Wei Y, Higgins JP, Ogilvie D (2015) Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database Syst Rev 9:CD011045.  https://doi.org/10.1002/14651858.CD011045 Google Scholar
  3. 3.
    DiSantis KI, Birch LL, Davey A, Serrano EL, Zhang J, Bruton Y, Fisher JO (2013) Plate size and children’s appetite: effects of larger dishware on self-served portions and intake. Pediatrics 131(5):e1451–e1458.  https://doi.org/10.1542/peds.2012-2330 CrossRefPubMedGoogle Scholar
  4. 4.
    Wansink B, van Ittersum K, Payne CR (2014) Larger bowl size increases the amount of cereal children request, consume, and waste. J Pediatr 164(2):323–326.  https://doi.org/10.1016/j.jpeds.2013.09.036 CrossRefPubMedGoogle Scholar
  5. 5.
    van Ittersum K, Wansink B (2013) Extraverted children are more biased by bowl sizes than introverts. PLoS One 8(10):e78224.  https://doi.org/10.1371/journal.pone.0078224 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Wansink B, van Ittersum K (2003) Bottoms up! The Influence of elongation on pouring and consumption volume. J Consum Res 30(3):455–463.  https://doi.org/10.1086/378621 CrossRefGoogle Scholar
  7. 7.
    Fisher JO, Birch LL, Zhang J, Grusak MA, Hughes SO (2013) External influences on children’s self-served portions at meals. Int J Obes (Lond) 37(7):954–960.  https://doi.org/10.1038/ijo.2012.216 CrossRefGoogle Scholar
  8. 8.
    Wansink B, Payne C, Werle C (2008) Consequences of belonging to the “clean plate club”. Arch Pediatr Adolesc Med 162(10):994–995.  https://doi.org/10.1001/archpedi.162.10.994 CrossRefPubMedGoogle Scholar
  9. 9.
    Wansink B, Wansink CS (2010) The largest Last Supper: depictions of food portions and plate size increased over the millennium. Int J Obes (Lond) 34(5):943–944.  https://doi.org/10.1038/ijo.2010.37 CrossRefGoogle Scholar
  10. 10.
    Wansink B (2010) From mindless eating to mindlessly eating better. Physiol Behav 100(5):454–463.  https://doi.org/10.1016/j.physbeh.2010.05.003 CrossRefPubMedGoogle Scholar
  11. 11.
    Wansink B, van Ittersum K, Painter JE (2006) Ice cream illusions bowls, spoons, and self-served portion sizes. Am J Prev Med 31(3):240–243.  https://doi.org/10.1016/j.amepre.2006.04.003 CrossRefPubMedGoogle Scholar
  12. 12.
    Wansink B, Cheney MM (2005) Super Bowls: serving bowl size and food consumption. Jama 293(14):1727–1728.  https://doi.org/10.1001/jama.293.14.1727 CrossRefPubMedGoogle Scholar
  13. 13.
    Rolls BJ, Roe LS, Halverson KH, Meengs JS (2007) Using a smaller plate did not reduce energy intake at meals. Appetite 49(3):652–660.  https://doi.org/10.1016/j.appet.2007.04.005 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Shah M, Schroeder R, Winn W, Adams-Huet B (2011) A pilot study to investigate the effect of plate size on meal energy intake in normal weight and overweight/obese women. J Hum Nutr Diet 24(6):612–615.  https://doi.org/10.1111/j.1365-277X.2011.01210.x CrossRefPubMedGoogle Scholar
  15. 15.
    Yip W, Wiessing KR, Budgett S, Poppitt SD (2013) Using a smaller dining plate does not suppress food intake from a buffet lunch meal in overweight, unrestrained women. Appetite 69:102–107.  https://doi.org/10.1016/j.appet.2013.05.017 CrossRefPubMedGoogle Scholar
  16. 16.
    Raghubir P, Krishna A (1999) Vital dimensions in volume perception: can the eye fool the stomach? J Mark Res 36(3):313–326.  https://doi.org/10.2307/3152079 CrossRefGoogle Scholar
  17. 17.
    Wansink B, van Ittersum K (2005) Shape of glass and amount of alcohol poured: comparative study of effect of practice and concentration. Bmj 331(7531):1512–1514.  https://doi.org/10.1136/bmj.331.7531.1512 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Sauer H, Krumm A, Weimer K, Horing B, Mazurak N, Gulewitsch MD, Hellmond F, Dammann D, Binder W, Linse P, Zipfel S, Ehehalt S, Binder G, Demircioglu A, Muth ER, Enck P, Mack I (2014) PreDictor research in obesity during medical care—weight Loss in children and adolescents during an INpatient rehabilitation: rationale and design of the DROMLIN study. J Eat Disord 2:7.  https://doi.org/10.1186/2050-2974-2-7 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß HC, Hesse V, von Hippel A, Jaeger U, Johnsen D, Korte W, Menner K, Müller G, Müller JM, Niemann-Pilatus A, Remer T, Schaefer F, Wittchen H-U, Zabransky S, Zellner K, Ziegler A, Hebebrand J (2001) Perzentile für den Body Mass Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatschrift Kinderheilkunde 149(8):807–818.  https://doi.org/10.1007/s001120170107 CrossRefGoogle Scholar
  20. 20.
    Diehl JM (1999) Attitude to eating and body weight by 11- to 16-year-old adolescents. Schweiz Med Wochenschr 129(5):162–175PubMedGoogle Scholar
  21. 21.
    Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160.  https://doi.org/10.3758/BRM.41.4.1149 CrossRefPubMedGoogle Scholar
  22. 22.
    Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B (Methodol) 57(1):289–300.  https://doi.org/10.2307/2346101 Google Scholar
  23. 23.
    Biro G, Hulshof KF, Ovesen L, Amorim Cruz JA (2002) Selection of methodology to assess food intake. Eur J Clin Nutr 56(Suppl 2):S25–S32.  https://doi.org/10.1038/sj/ejcn/1601426 CrossRefPubMedGoogle Scholar
  24. 24.
    Elfhag K, Tynelius P, Rasmussen F (2010) Family links of eating behaviour in normal weight and overweight children. Int J Pediatr Obes 5(6):491–500.  https://doi.org/10.3109/17477160903497001 CrossRefPubMedGoogle Scholar
  25. 25.
    Wansink B, Payne CR (2007) Counting bones: environmental cues that decrease food intake. Percept Mot Skills 104(1):273–276.  https://doi.org/10.2466/pms.104.1.273-276 CrossRefPubMedGoogle Scholar
  26. 26.
    Libotte E, Siegrist M, Bucher T (2014) The influence of plate size on meal composition. Lit Rev Exp Appet 82:91–96.  https://doi.org/10.1016/j.appet.2014.07.010 Google Scholar
  27. 27.
    Robinson E, Sheen F, Harrold J, Boyland E, Halford JC, Masic U (2015) Dishware size and snack food intake in a between-subjects laboratory experiment. Public Health Nutr  https://doi.org/10.1017/S1368980015001408 Google Scholar
  28. 28.
    Rolls BJ (2000) The role of energy density in the overconsumption of fat. J Nutr 130(2S Suppl):268S–271SCrossRefPubMedGoogle Scholar
  29. 29.
    Schusdziarra V, Hausmann M, Wittke C, Mittermeier J, Kellner M, Wagenpfeil S, Erdmann J (2010) Contribution of energy density and food quantity to short-term fluctuations of energy intake in normal weight and obese subjects. Eur J Nutr 49(1):37–43.  https://doi.org/10.1007/s00394-009-0046-6 CrossRefPubMedGoogle Scholar
  30. 30.
    Rolls BJ (2014) What is the role of portion control in weight management? Int J Obes (Lond) 38(Suppl 1):S1–S8.  https://doi.org/10.1038/ijo.2014.82 CrossRefGoogle Scholar
  31. 31.
    Throop EM, Skinner AC, Perrin AJ, Steiner MJ, Odulana A, Perrin EM (2014) Pass the popcorn: “obesogenic” behaviors and stigma in children’s movies. Obesity (Silver Spring) 22(7):1694–1700.  https://doi.org/10.1002/oby.20652 CrossRefGoogle Scholar
  32. 32.
    Gaina A, Sekine M, Chandola T, Marmot M, Kagamimori S (2009) Mother employment status and nutritional patterns in Japanese junior high schoolchildren. Int J Obes (Lond) 33(7):753–757.  https://doi.org/10.1038/ijo.2009.103 CrossRefGoogle Scholar
  33. 33.
    Rolls BJ (2010) Plenary Lecture 1: Dietary strategies for the prevention and treatment of obesity. Proc Nutr Soc 69(1):70–79.  https://doi.org/10.1017/S0029665109991674 CrossRefPubMedGoogle Scholar
  34. 34.
    Geier AB, Rozin P, Doros G (2006) Unit bias. A new heuristic that helps explain the effect of portion size on food intake. Psychol Sci 17(6):521–525.  https://doi.org/10.1111/j.1467-9280.2006.01738.x CrossRefPubMedGoogle Scholar
  35. 35.
    Mishra A, Mishra H, Masters TM (2012) The influence of bite size on quantity of food consumed: a field study. J Consum Res 38(5):791–795.  https://doi.org/10.1086/660838 CrossRefGoogle Scholar
  36. 36.
    Robinson E, Almiron-Roig E, Rutters F, de Graaf C, Forde CG, Tudur Smith C, Nolan SJ, Jebb SA (2014) A systematic review and meta-analysis examining the effect of eating rate on energy intake and hunger. Am J Clin Nutr 100(1):123–151.  https://doi.org/10.3945/ajcn.113.081745 CrossRefPubMedGoogle Scholar
  37. 37.
    Ferriday D, Bosworth ML, Lai S, Godinot N, Martin N, Martin AA, Rogers PJ, Brunstrom JM (2015) Effects of eating rate on satiety: a role for episodic memory? Physiol Behav.  https://doi.org/10.1016/j.physbeh.2015.06.038 PubMedPubMedCentralGoogle Scholar
  38. 38.
    Ritze Y, Bardos G, D’Haese JG, Ernst B, Thurnheer M, Schultes B, Bischoff SC (2014) Effect of high sugar intake on glucose transporter and weight regulating hormones in mice and humans. PLoS One 9(7):e101702.  https://doi.org/10.1371/journal.pone.0101702 CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Bray GA, Popkin BM (2014) Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: health be damned! Pour on the sugar. Diabetes Care 37(4):950–956.  https://doi.org/10.2337/dc13-2085 CrossRefPubMedGoogle Scholar
  40. 40.
    Mack I, Sauer H, Weimer K, Dammann D, Zipfel S, Enck P, Teufel M (2014) Obese children and adolescents need increased gastric volumes in order to perceive satiety. Obesity (Silver Spring) 22(10):2123–2125.  https://doi.org/10.1002/oby.20850 CrossRefGoogle Scholar
  41. 41.
    Birch LL, McPheee L, Shoba BC, Steinberg L, Krehbiel R (1987) “Clean up your plate”: effects of child feeding practices on the conditioning of meal size. Learn Motiv 18:301–317.  https://doi.org/10.1016/0023-9690(87)90017-8 CrossRefGoogle Scholar
  42. 42.
    Francis LA, Hofer SM, Birch LL (2001) Predictors of maternal child-feeding style: maternal and child characteristics. Appetite 37(3):231–243.  https://doi.org/10.1006/appe.2001.0427 CrossRefPubMedGoogle Scholar
  43. 43.
    Brown A, Lee M (2011) Maternal control of child feeding during the weaning period: differences between mothers following a baby-led or standard weaning approach. Matern Child Health J 15(8):1265–1271.  https://doi.org/10.1007/s10995-010-0678-4 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Isabelle Mack
    • 1
  • Helene Sauer
    • 1
  • Katja Weimer
    • 1
  • Dirk Dammann
    • 2
  • Stephan Zipfel
    • 1
  • Paul Enck
    • 1
  • Martin Teufel
    • 1
    • 3
  1. 1.Department of Psychosomatic Medicine and Psychotherapy, Medical HospitalUniversity of TübingenTübingenGermany
  2. 2.Fachkliniken Wangen i.A.Children Rehabilitation Hospital for Respiratory Diseases, Allergies and PsychosomaticsWangen i.A.Germany
  3. 3.LVR-Clinic for Psychosomatic Medicine and PsychotherapyUniversity of Duisburg-EssenEssenGermany

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