Perceptions of portion size and energy content: implications for strategies to affect behaviour change

Objective: To assess Australian consumers' perception of portion size of fast-food items and their ability to estimate energy content. Design: Cross-sectional computer-based survey. Setting: Australia. Subjects: Fast-food consumers (168 male, 324 female) were asked to recall the items eaten at the most recent visit to a fast-food restaurant, rate the prospective satiety and estimate the energy content of seven fast-food or 'standard' meals relative to a 9000 kJ Guideline Daily Amount. Nine dietitians also completed the energy estimation task. Results: Ratings of prospective satiety generally aligned with the actual size of the meals and indicated that consumers perceived all meals to provide an adequate amount of food, although this differed by gender. The magnitude of the error in energy estimation by consumers was three to ten times that of the dietitians. In both males and females, the average error in energy estimation for the fast-food meals (females: mean 3911 (SD 1998) kJ; males: mean 3382 (SD 1957) kJ) was significantly (P < 0.001) larger than for the standard meals (females: mean 2607 (SD 1623) kJ; males: mean 2754 (SD 1652) kJ). In women, error in energy estimation for fast-food items predicted actual energy intake from fast-food items (beta = 0.16, P < 0.01). Conclusions: Knowledge of the energy content of standard and fast-food meals in fast-food consumers in Australia is poor. Awareness of dietary energy should be a focus of health promotion if nutrition information, in its current format, is going to alter behaviour.