From the American Overseas Dietetic Association (AODA)

- an affiliate of the Academy of Nutrition and Dietetics (Academy)
  • Simplifying Portions and Servings in a Developing Country
     
    A continuing challenge in dietetic practice is to move clients from awareness of the need to change eating practices to actually trying the plan.  A large part of counselling has depended on imparting explanations of measuring foods as served according to portion sizes to control and tracking the calorie intake. This is more complex to understand than generally thought.  Clients are not used to measurement or prefer not to do this but tend to eat based on experience and what appears visually adequate. For a society accustomed to deprivation as in developing countries, the demonstrated serving sizes appear extremely small since when persons eat, they try to consume as much as possible in a single sitting. This is compounded by the difficulty in understanding exchanges, when long lists are provided with foods within food groups which is not how persons eat. Many clients in developing countries are semi-literate and even if highly literate they prefer not to read long lists or to think too much about eating and preplanning exchanges so advice is ignored.
     
    The mistakes made are many and the possible solutions are based on the following observations:
    1. Measuring cups and spoons are not used in serving cooked food, but a regular household enamel or plastic mug (about 2 cups) may be used instead for say rice thereby resulting in 2-4 times the expected amount.  Persons however understand weight as purchased so it would be more practical to state servings as amounts of food to buy and raw amounts to cook.
    2. Many persons do not prepare their own food but eat whatever is served on the plate.  The ‘cooks’ who control the eating are the ones who need to understand how much to cook so that the amounts served will be more appropriate for those who are eating.
    3. In using processed foods, the serving amounts on the labels are very variable and usually different from serving amounts demonstrated in counselling so interpreting calories is very confusing. If however, the serving sizes were determined to give a similar number of calories, this would become easier to interpret and apply.
    4. Totaling the number of servings is also challenging because of the differences between food groups. Most persons tend to cross food groups even though the calorie counts differ.  For instance, if vegetables are disliked, the client would merely take the assigned 2 or 3 servings from another food group such as fruits or starchy vegetables even though the calories would then double or triple. Standardizing by a set amount of calories across all the food groups would solve this problem.
    5. Referring to foods as fattening or non-fattening is largely based on perception since the importance of quantity and counting calories may not be well appreciated. Again, if all food groups were standardized for the same calorie count, then it would be easier to convey calorie differences by amounts and not perceptions.
    The Unit counting system
     
    This system was developed for use with clients in Jamaica and is based on standardizing against 100 calories for the following reasons.
    1. It simplifies all food quantities to amounts of a single standard equivalent of 100 calories. All persons can count in 100s, and 50s, being familiar to the monetary values.  One hundred calories is 1 unit, 200 calories are 2 units, 50 calories count as ½ and so on.
    2. Many food labels express servings in the raw, uncooked quantities including rice, flour, nuts and peas and beans which are already using 100 calories as the serving size amount so it would be less confusing if the same standard were applied to household measures.
    3. The quantities based on food groups show greater uniformity when stated as the raw, uncooked amounts so there are less serving sizes to learn.
    Based on the Caribbean food groups, the serving sizes would be as follows:
    1. Staple foods: This group can be regarded as two sub-groups namely:
      1. Cereal Grains – which include all grains used whole or made into flour such as wheat, rice, maize (corn) and their products such as breakfast cereals. Serving size is 1 ounce dry and 3 ounces cooked as porridge (same as the ½ cup measure). Bread slices are now larger than formerly and the standard whole wheat bread equates to 100 calories per slice.
      2. Starchy fruits, roots and tubers otherwise known as ‘provision’ or starchy vegetables. Most give 100 calories from ¼ pound market weight as purchased (AP) that equates to 3 ozs cooked (or 1 standard piece as used in soup or other dishes).
    2. Legumes: Dried peas, beans (pulses) – 1 ounce dry (¼ cup cooked) also gives 100 calories as does ½ ounce of most nuts and seeds.
    3. Foods from Animals: These include all foods of animal source with the main nutrient being protein. Meat and chicken equate to 100 calories for 1½ - 2 ounces raw edible flesh which applies equally to all the bony meats, canned fish and lean meats, about one ounce cheese and low fat milk (when used) equates to 8 ounces or 1 cup.
    4. Vegetables:   All raw vegetables equate to one pound AP for 100 calories, which would replace the variable amounts when expressed as cooked such as dark green leafy such as pakchoi or callaloo (2 cups), yellow e.g. pumpkin (1½ cups), carrot (1 cup) and other non-starchy vegetables (variable amounts). This is explained as the total amount of vegetables to eat daily which equates to the original 3 servings so persons have a better perspective on the quantum required and even if they exchange across food groups (as so often happens), the calorie count remains the same.
    5. Fats & Oils: The main nutrient is fat and includes avocado pear and Jamaican ackee. Fats and oils are 1 tablespoon for a portion equivalent of 100 calories, the same amount used on food labels.  Coconut jelly would be one ounce while ackee and avocado, 2 ounces each.
    1. Fruits: The popular fruits such as ripe banana and Julie mango easily equate to 100 calories for 1 medium as opposed to the original ½ ripe banana which most persons found impractical. The other fruits are easily described as being 50 calories and the amount of two fruits that would usually be eaten anyway can be allowed as equivalent to 100 calories.
    Other advantages are:
    1. Sugars and combination foods such as Jamaican patty are easily explained with this system since persons understand how much of other foods they would have to replace/exchange to accommodate the continued use of large amounts of sugar in juice drinks and/or for snacks.
    2. Less time is spent explaining servings and portions with more time available for diet planning so persons get a better understanding of how much to cook for the whole family and how to best share meals for all family members in terms of amounts of food to be eaten based on raw weight to cook rather than already cooked measures.
    3. This approach also simplifies the use in families for persons with diabetes and to facilitate carbohydrate distribution and meal planning.
     
    RNutr. Patricia Thompson M.Sc. DMS, SNS, CMSN Registered Nutritionist (Jamaica), CR-AODA
    Health Promotion Consultant
    Email:  patriciat@cwjamaica.com