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Research shows that features of food packaging can help to promote healthy food choices. Laboratory-based studies demonstrate that smart design of packaging facilitates portion control. However, the extent to which consumers notice packaging features for portion control is not known. Therefore, this study investigated how individuals interact with food packaging, how they utilise the on-pack serving-size guidelines and how they make portion decisions. To do this, 25 adult participants were recruited to participate in an online semi-structured interview. Data were analysed using thematic analysis until saturation was achieved. Participants reported that they rarely attend to on-pack serving recommendations and indicated some resistance to them. Some structural features (small/single serving, pre-portioned and resealable packaging) were identified as facilitators of portion control. In contrast, the healthiness evaluation of the product from packaging cues was described as a permissive cue to eat more of the product. Participants in this study value their autonomy and control, preferring convenient behavioural choices over recommended portion servings. They also reported future concerns about the effects of their diet on health, but that current context (hunger, convenience) sometimes presented a barrier to healthy eating. Packaging does more than protect its contents, packaging can affect eating decisions to support portion control, and for some, offers permission to overconsume. This study identified ways that participants use packaging to make portion decisions, revealing the role of habits, current context and future health considerations. The interviews revealed the importance of consumer values on food choice in general and portion control in particular. In conclusion, smart food packaging design could use these findings to nudge healthy portion decisions by incorporating consumer values and by recognising consumer needs for habitual, current and future concerns.

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The influence dishware size has on meal energy intake is unclear and no study to date has examined the impact on total daily energy intake. In a pre-registered RCT we investigate the impact of breakfast dishware size on breakfast and post-breakfast energy intake, as well as daily energy intake and hunger/fullness. In a repeated-measures design, 50 females (aged 18-77 years) were randomised to receive smaller or larger breakfast dishware on two separate days. Energy intake was also measured during the rest of the day. The primary outcomes were breakfast and post-breakfast energy intake (kcal). Secondary outcomes were total daily energy intake (kcal), and hunger/fullness (rated from 0 to 100). We examined if results differed by socioeconomic position (SEP). Dishware did not affect energy intake at breakfast (smaller: M = 394.8 kcal; SD = 172.2 larger: M = 394.4 kcal; SD = 164.4; d = 0.003, p = 0.98), and there was no statistically significant evidence that dishware size affected energy intake after breakfast, though post-breakfast energy intake was somewhat higher after using larger breakfast dishware (smaller: M = 1974.6 kcal; SD = 475.2; larger: M = 2077.5 kcal; SD = 525.9; d = -0.27, p = 0.06). Total daily energy intake, hunger and fullness ratings did not significantly differ between dishware conditions. There was no evidence that SEP moderated the effect of dishware size on energy intake. Smaller vs. larger breakfast dishware size had no significant effect on breakfast or post-breakfast energy intake, hunger, fullness, or daily energy intake. Previous studies may have overestimated the promise of dishware size as an intervention for reducing energy intake. Alternative interventions targeting the food environment should now be prioritised.

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BACKGROUND: Reducing portion sizes of commercially available foods could be an effective public health strategy to reduce population energy intake, but recent research suggests that the effect portion size has on energy intake may differ based on socioeconomic position (SEP). OBJECTIVE: We tested whether the effect of reducing food portion sizes on daily energy intake differed based on SEP. METHODS: Participants were served either smaller or larger portions of food at lunch and evening meals (N = 50; Study 1) and breakfast, lunch and evening meals (N = 46; Study 2) in the laboratory on two separate days, in repeated-measures designs. The primary outcome was total daily energy intake (kcal). Participant recruitment was stratified by primary indicators of SEP; highest educational qualification (Study 1) and subjective social status (Study 2), and randomisation to the order portion sizes were served was stratified by SEP. Secondary indicators of SEP in both studies included household income, self-reported childhood financial hardship and a measure accounting for total years in education. RESULTS: In both studies, smaller (vs larger) meal portions led to a reduction in daily energy intake (ps < .02). Smaller portions resulted in a reduction of 235 kcal per day (95% CI: 134, 336) in Study 1 and 143 kcal per day (95% CI: 24, 263) in Study 2. There was no evidence in either study that effects of portion size on energy intake differed by SEP. Results were consistent when examining effects on portion-manipulated meal (as opposed to daily) energy intake. CONCLUSIONS: Reducing meal portion sizes could be an effective way to reduce overall daily energy intake and contrary to other suggestions it may be a socioeconomically equitable approach to improving diet. TRIAL REGISTRATION: These trials were registered at www. CLINICALTRIALS: gov as NCT05173376 and NCT05399836.

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Portion control tableware has been described as a potentially effective approach for weight management, however the mechanisms by which these tools work remain unknown. We explored the processes by which a portion control (calibrated) plate with visual stimuli for starch, protein and vegetable amounts modulates food intake, satiety and meal eating behaviour. Sixty-five women (34 with overweight/obesity) participated in a counterbalanced cross-over trial in the laboratory, where they self-served and ate a hot meal including rice, meatballs and vegetables, once with a calibrated plate and once with a conventional (control) plate. A sub-sample of 31 women provided blood samples to measure the cephalic phase response to the meal. Effects of plate type were tested through linear mixed-effect models. Meal portion sizes (mean ± SD) were smaller for the calibrated compared with the control plate (served: 296 ± 69 vs 317 ± 78 g; consumed: 287 ± 71 vs 309 ± 79 g respectively), especially consumed rice (69 ± 24 vs 88 ± 30 g) (p < 0.05 for all comparisons). The calibrated plate significantly reduced bite size (3.4 ± 1.0 vs 3.7 ± 1.0 g; p < 0.01) in all women and eating rate (32.9 ± 9.5 vs 33.7 ± 9.2 g/min; p < 0.05), in lean women. Despite this, some women compensated for the reduced intake over the 8 h following the meal. Pancreatic polypeptide and ghrelin levels increased post-prandially with the calibrated plate but changes were not robust. Plate type had no influence on insulin, glucose levels, or memory for portion size. Meal size was reduced by a portion control plate with visual stimuli for appropriate amounts of starch, protein and vegetables, potentially because of the reduced self-served portion size and the resulting reduced bite size. Sustained effects may require the continued use of the plate for long-term impact.

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CONTEXT: Portion size norm is described as the perception of how much of a given food people choose to eat. Reducing the portion size norm of foods that are high in saturated fat, added sugar, and added salt toward smaller sizes might be a potential strategy to promote appropriate portion size selections. However, an overview of existing portion size norms for discretionary foods has yet to be established. OBJECTIVE: The aim of this systematic review was to examine the portion size norm of discretionary foods and assess the methodologies used to investigate the norm. DATA SOURCES: The literature search was conducted in 6 databases following the PRISMA guidelines (from inception to January 2022). DATA EXTRACTION: Forty studies were eligible and grouped into 3 categories by portion size norm measures: normal (n = 26), appropriate (n = 8), and preferred portion sizes (n = 3). Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. DATA ANALYSIS: A wide range of portion sizes were considered normal for each food type, with means/medians varying from 2- to 4-fold among studies. Studies differed considerably in design, with variables including the setting, food type, food presentation, the manner in which portion-size-related questions were formulated, and the range and number of displayed serving size options. The quality of reviewed studies was mixed (25 studies had low or moderate risk of bias, 15 had high risk of bias), and the method of assessing portion size was not validated in 15 of 33 quantitative studies. CONCLUSION: The assessment of portion size in future studies should be conducted using tools that are validated for the population of interest so that more definitive conclusions can be drawn regarding portion size norms for discretionary foods. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42021249911.

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Excess caloric intake increases the risk of weight gain, and diet-related chronic diseases. Restaurants play an integral role in the portions of food people consume. Standardization of portion sizes in restaurants can help customers recognize appropriate portions. Through customer interviews, we aimed to assess and understand the feasibility, perceptions, and acceptability of standardized portions in restaurants. Kaiser Permanente partnered with three restaurants in Southern California to create alternative menu options of meals that would not exceed 700 calories. Kaiser Permanente members who lived within a 5-mile radius of the restaurants were informed through email about the study. Customers (N=33), who dined at one of the restaurants participated in a one-on-one semi-structured interview. Interviews were recorded, typed, transcribed verbatim, and analyzed using thematic analysis. Four themes emerged from the analysis: 1) Customers perceive standard portions as a better choice and the benefits outweigh regular portions; 2) Individual and restaurant-related factors may influence portion preferences; 3) Restaurant portions are perceived to be in excess of what customers need; and 4) Portion standardization is an evolving area for restaurants. Our findings suggest positive perceptions and acceptance of standardized portions among restaurant customers. Customer awareness and restaurant standardization procedures can improve customers' dining experience.

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BACKGROUND: International prenatal care guidelines set a standard for clinicians to discuss gestational weight gain with their patients along with the complications associated with prepregnancy obesity and excessive gestational weight gain. Clinicians often lack evidence-based eating, nutrition, and activity strategies to share with patients. METHODS: This systematic review aimed to find eating patterns and behaviors that could be used safely during pregnancy to limit excessive gestational weight gain. PubMed, MEDLINE, and Web of Science were searched for research or systematic reviews performed in the United States or Canada and published in English from 2013 to 2023. Keyword search terms included weight, manage, behavior, strategy, strategies, gestational weight gain, and nutrition. Excluded research used pediatric or adolescent populations, restrictive diets, such as no carbohydrate or no fat diets, fasting, bariatric surgery, weight loss medications, private industry or profit-earning programs using food brands, or specific diet programs. RESULTS: A total of 844 abstracts were retrieved, with 103 full-text studies reviewed. Behaviors had to be useful for maintaining a healthy gestational weight gain and had to be safe for use during pregnancy. Behaviors useful during pregnancy included meal planning, home meal preparation, portion control, using diets such as the Mediterranean diet, the low-glycemic index diet, and the Dietary Approaches to Stop Hypertension diet (DASH), regular physical activity, sleeping 6-7 h a night, mindful eating, intuitive eating, and regular seif-weighing. CONCLUSION: The evidence-based strategies outlined in this review are safe for use during pregnancy and can assist patients in avoiding excessive gestational weight gain while maintaining the nutrition needed for healthy fetal growth.

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Evidence demonstrates that food packaging attracts consumers to purchase and has the potential to nudge consumers towards healthy choices, including reducing portion size. However, food purchasing decisions are often automatic and packaging features may go unnoticed. Therefore, it is important to understand what consumers identify as most salient about packaging: what they notice and why, and which elements might nudge consumers towards healthy options and smaller portions of high-energy-density foods. This study explored consumer perception of food packaging, investigated specific features associated with portion control and elicited design ideas to improve packaging for healthy eating and downsizing. A qualitative approach was adopted applying a participant-driven photo-elicitation (PDPE) task with in-depth interviews. Participants were 25 adults living in the UK (aged 20-32 years; 17 females, 8 males, x ¯ BMI = 23 kg/m2 ). Participants took photographs of 10 food packages according to salience (n = 5) and portion control (n = 5). These were uploaded to a secure site and then discussed at the interview, which was transcribed and analysed. The salience of packaging was described in terms of trust building, stimulating appetite and relating to self-identity, whereas for portion control, themes included structural reminders, healthy prompts and portion awareness. Packaging can be designed to make health value or serving size more salient by prompting portion control and increasing the attractiveness of packaging. While food purchase decisions happen with little deliberation, when probed, consumers provide useful insights for packaging design to assist portion control.

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Evidence confirms that parents know that they should limit non-core foods for their children since these tend to be high in energy density (HED), fat, salt and sugar. However, it is unclear how knowledge of portion size limits, such as the 100 kcal guide from Public Health England are applied in practice. To observe in real-time children's home food environment related to portion control and to explore with parents their reported portion size strategies, a mixed methods study was designed. Families with children aged 1-5 years were recruited (n = 21) to a three-part study: (1) to complete questionnaires and interviews on household food intake and portion control; (2) to report daily food intake for 4 days (n = 13) for one parent and their child(ren); (3) to observe home-based food provisioning via videorecording during dinner, breakfast and snack time (n = 6). Although the problem of large portion sizes of HED foods was recognised by mothers, strategies to downsize portions were not necessarily applied at home, as revealed in home observations and diaries. A mismatch between what was observed at home, what was reported in food diaries and what was said in interviews became apparent for some families. Mothers reported the need for greater support and guidance to downsize HED foods since they relied on pre-packaging as a guide to intake. Education and engagement were identified as important parameters for downsizing by mothers. One strategy which could be explored and applied by manufacturers is packaging design to faciliate the 100 kcal guidance using physical and engaging ways to assist parents in downsizing HED foods for their children. To facilitate effective government communication, innovative packaging design can be used to convey clear guidance and to tailor portion size messages for children. Packaging design, alongside government recommendations, can support parents' goals to achieve healthy eating and can reinforce guidance for portion norms through innovation involving learning, playful engagement, and interaction.

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South Asian women living in the UK are particularly at high risk of obesity-related complications, such as type 2 diabetes and cardiovascular disease. Exposure to large portion sizes is a risk factor for obesity. Specifically designed tableware helps individuals to manage weight by controlling food portion sizes. Thirty-one (n = 31) overweight or obese South Asian adult women participated in a randomised cross-over trial aimed to assess the efficacy, acceptance, and weight change of two guided/calibrated commercially available portion control tools (Utensil set and Crockery Set) used in free-living conditions. Data on acceptance, perceived changes in portion size, frequency, and meal type was collected using paper questionnaires and 3-day diet diaries. Scores describing acceptance, ease of use, and perceived effectiveness were derived from five-point Likert scales from which binary indicators (high/low) were analysed for significance using multivariate variance analysis for repeated measurements. A reduction in BMI was observed at each point of measurement (p = 0.007). For overall tool use, the crockery set scored higher in all areas of acceptance, ease of use, and perceived efficacy for all comparisons. Self-selected portion sizes increased for salads and decreased for cooking oil and breakfast cereals with both tools. Further research to scale up and evaluate similar weight management interventions for this group is warranted.

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To fully understand the causes and mechanisms involved in overeating and obesity, measures of both cognitive and physiological determinants of eating behavior need to be integrated. Effectively synchronizing behavioral measures such as meal micro-structure (e.g., eating speed), cognitive processing of sensory stimuli, and metabolic parameters, can be complex. However, this step is central to understanding the impact of food interventions on body weight. In this paper, we provide an overview of the existing gaps in eating behavior research and describe the development and validation of a new methodological platform to address some of these issues. As part of a controlled trial, 76 men and women self-served and consumed food from a buffet, using a portion-control plate with visual stimuli for appropriate amounts of main food groups, or a conventional plate, on two different days, in a random order. In both sessions participants completed behavioral and cognitive tests using a novel methodological platform that measured gaze movement (as a proxy for visual attention), eating rate and bite size, memory for portion sizes, subjective appetite and portion-size perceptions. In a sub-sample of women, hormonal secretion in response to the meal was also measured. The novel platform showed a significant improvement in meal micro-structure measures from published data (13 vs. 33% failure rate) and high comparability between an automated gaze mapping protocol vs. manual coding for eye-tracking studies involving an eating test (ICC between methods 0.85; 90% CI 0.74, 0.92). This trial was registered at Clinical Trials.gov with Identifier NCT03610776.

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The role of portion control plates in achieving healthy diets is unclear. The aim of this scoping review was to systematically map findings from peer reviewed and grey literature to provide evidence for the use of portion control plates to promote healthy eating and nutrition-related knowledge in children and adults. A secondary aim was to review the design characteristics of portion control plates. The search was conducted in four databases, including Medline, CINAHL, Embase, and PsycInfo, and grey literature sources following the PRISMA scoping review guidelines. A total of 22 articles comprising 23 intervention studies and 8 from grey literature were included. It was found that the various two-dimensional and three-dimensional portion control plates examined were effective tools for better portion size selection in healthy children and adults. Most portion control plates dedicated half the plate to vegetables, a quarter to protein, and a quarter to carbohydrates. The use of portion control plates in nutrition interventions appears to promote weight loss among those with overweight and obesity and/or type 2 diabetes. However, portion control plates were mostly used as part of multicomponent interventions and the effectiveness of the portion control plate as a stand-alone educational resource or portion control tool alone was uncertain. Further interventional research is indicated to investigate portion plates as tools to improve dietary behaviours and food consumption at the population level.

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The current study evaluated the effectiveness of a treatment package including a behavior contract, brief portion selection training, and a food diary, to manage portion control in an adolescent female with autism. The behavior contract specified a reinforcement contingency for meeting a weekly goal that described how many servings the participant may consume but should not exceed during meals consisting of target foods. Results of the study demonstrated that the treatment package was successful in managing the number of portions the participant consumed across treatment and generalization sessions. • The flexible nature of the intervention may lead to greater treatment adherence • The intervention was rated with high social acceptability. • The intervention is generalizable to other naturalistic contexts. • The intervention may promote independence through teaching self-management skills.

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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.

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Chronic, excess energy intake contributes to overweight and obesity. Solutions are needed to guide consumers towards portion control, especially for high energy density (HED), palatable foods. Food packaging, a key element of the eating environment, offers a potential solution. To investigate whether packaging design influences measured food intake, a systematic search was undertaken in four electronic databases (Ovid Medline; Ovid PsycInfo; Ovid Embase and Web of Science) across the previous decade. This process yielded 1671 discrete papers, of which 23 articles containing 40 relevant studies were retrieved. Most (n = 36) of the manipulated packaging features influenced consumption quantity with the largest effect sizes observed for packaging which guided consumers either by on-pack cues or structural features. For example, images on the front of the pack, packaging size, as well as partitioning and resealability all helped to reduce food intake. However, individual differences and attentional focus mediate packaging effects. Overall, packaging features can help to limit intake of HED foods and increase intake of nutrient-dense foods (e.g., carrots). Future studies on packaging for portion control (downsizing) might benefit from long term, randomised control trials to test effects outside of the laboratory context and applied to everyday consumer usage.

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BACKGROUND: The purpose of this systematic review and meta-analysis was to assess whether the available research to date supports the use of portion-controlled plate (PCP) and leads to reductions in body weight and improvements in other anthropometric and biochemical parameters. The systematic review summarizes existing PCPs and their impact on anthropometric and metabolic changes. METHODS: A systematic search was conducted in the following databases: PubMed®, Web of Science®, Scopus®. Data were pooled using random or fixed effects meta-analysis. RESULTS: From 426 potentially relevant articles, 5 publications were included in this review, and 4 of which reported four different PCPs. All five studies reported a positive effect of PCP on obesity and metabolic parameters. PCP significantly reduced body weight (BW) by 2.02 kg (95% CI, -3.03 to -1.01, p < 0.0001), body mass index (BMI) by 0.87 kg m-2 (95% CI, -1.28 to -0.47, p < 0.0001) and waist circumference (WC) by 2.28 cm (95% CI, -4.57 to 0.01, p = 0.05). A non-significant reduction was observed for waist-to-hip ratio (WHR) (-0.01, 95% CI, -0.03 to 0.01, p = 0.35) during the three-month intervention period. PCP significantly decreased both BW (-1.66 kg; 95% CI, -2.69 to -0.62, p = 0.002) and percentage body weight (% BW) (-1.64%; 95% CI, -2.69 to -0.58, p = 0.002) when the intervention was undertaken for a 6-month period. CONCLUSIONS: Overall, results showed that portion control intervention significantly reduced BW, BMI and WC, along with a positive trend for WHR, plus biochemical and blood pressure reduction.

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Healthy eating campaigns can increase awareness of healthful foods and eating patterns and prompt behavior change. Portion control can be a useful strategy in weight management efforts, and new, innovative campaigns can help invigorate messages related to portion control and weight management. This qualitative study presents results of formative testing of portion control and calorie reduction messages and infographics for a proposed campaign. We conducted 17 focus groups with 113 adults ages 18-65 years in 3 US cities. We conducted separate focus groups by weight status (overweight/healthy weight) and gender (male/female) and analyzed coded data and categorized emerging themes. Participants, especially those with healthy weights, gravitated toward specific, and achievable messages to encourage portion control and calorie reduction. Men with overweight and women with healthy weights preferred messages that had a positive, supportive tone. Participants favored messages that addressed overeating and allowed for autonomy. In particular, women and those with healthy weights preferred messages that encouraged calorie budgeting. Many participants, in particular men, provided positive feedback on messages encouraging a "fresh start" on Mondays. Additionally, participants preferred messages that were colorful, informative, realistic, attractive, and relatable. With regard to message dissemination, participants suggested that messages and infographics be positioned in high-traffic areas and men generally suggested places where food decisions are made. Moreover, participants suggested message dissemination through trusted health professionals and credible research organizations. Health organizations planning a portion control or calorie reduction campaign should consider these factors early in the development process to help ensure acceptance and success.

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BACKGROUND: Increasing portion size has been shown to increase energy intake. However, little is known about the effect of reducing portion size on subsequent consumption and the consequent energy intake. OBJECTIVE: The purpose of this study was to examine the effect of decreasing portion size of an entrée on the amount of dessert consumed as a following course. METHODS: A total of 81 participants were instructed to consume a lunch entrée and dessert ad libitum. The participants were given the same entrée and dessert on the same day of the week for four consecutive weeks. However, the entrée was reduced to 90%, 85%, 80%, and 75% of the amount they consumed in the first week of the study. Participants were randomized into four groups and were served the reduced entrée according to a Latin square design. Dessert was consumed ad libitum. In addition, subjects' hunger and satiety levels were assessed before the entrée, after the entrée, and after dessert. RESULTS: Reducing portion size had no effect on the amount of dessert consumed despite the finding that measures of hunger and satiety indicated that participants experienced increased hunger at 80% and 75% portion reductions. CONCLUSIONS: Reduction in the portion size of an entrée by up to 25% did not increase the amount of dessert consumed, despite an increase in perceived hunger at lower portion sizes. Further investigation is needed to study how much further portion size could be reduced with a sustained decrease in energy intake without compensation, as well as to examine potential interventions for portion control that could reduce daily energy intake.

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Large portion sizes increase consumption and eating smaller portions is recommended as a weight control strategy. However, many people report difficulties enacting this advice. This study examined the experience of individuals using two commercially available portion-control tools to try to manage their weight. In a crossover design, 29 adults with obesity (18 women) who had attended a previous weight loss intervention in the community were invited to use two portion-control tool sets over a period of four weeks (two weeks each) and to complete a semi-structured questionnaire about their experience. The tools were a guided crockery set (sector plate, calibrated bowl, and calibrated glass) and a set of calibrated serving spoons (one for starch, one for protein, and one for vegetables). Data were analyzed using thematic framework analysis. A key theme was related to the educational benefits of the tools, such as generating awareness, guidance, and gaining an independent ability to judge appropriate portions. Other key themes were tool usability, acceptability, and feasibility of usage. Barriers identified by participants included unclear markings/instructions and the inconvenience of using the tool when eating away from home. Overall, the tools were perceived to be educationally useful, easy to use, and potentially effective for learning to control portions, which suggested that these instruments could help in weight management interventions alongside other strategies. Elements of the tool design could influence the ability of participants to adhere to using the tool, and hence allow the educational effect to be mediated.

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The SMARTsize intervention embeds an evidence-based portion control intervention in regular dietetic care. This intervention was evaluated to explore (1) which patients participated, (2) the implementation process, and (3) the outcomes of the intervention. The intervention was evaluated with an observational study design including measures at baseline, and three, six, and nine months after the start of the program. Data concerning the process (participation, dose delivered, dose received, satisfaction) and the outcomes (self-efficacy, intention, portion control strategies, and Body Mass Index (BMI) were collected with forms and questionnaires filled out by dietitians and patients. Descriptive analyses, comparison analyses, and cluster analyses were performed. Patients were mainly obese, moderately to highly educated women of Dutch ethnicity. Use of the intervention components varied from 50% to 100% and satisfaction with the SMARTsize intervention was sufficient to good (grades 7.2⁻8.0). Statistically significant (p < 0.001) improvements were observed for self-efficacy (+0.5), portion control strategies (+0.7), and BMI (-2.2 kg/m²), with no significant differences between patients with or without counselling. Three clusters of patients with different levels of success were identified. To conclude, implementing an evidence-based portion control intervention in real-life dietetic practice is feasible and likely to result in weight loss.

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