The Effect of Portion Size Interventions on Energy Intake and Risk of Obesity in School-Aged Children: A Systematic Review and Meta-Analysis
Abstract
Objectives: An increase in food portion size offered to children over recent decades has been suggested to contribute to the rise in childhood obesity. This review investigated the effect of interventions that manipulated portion size on energy intake and risk of obesity in school-aged children. Methods: A systematic search was performed using MEDLINE, Embase, and Cochrane Library databases (from inception to 2025). Included studies were original articles in English, involving children aged 5–17 years, that focused on portion size interventions using an experimental or controlled study design, with energy intake, body weight, or body mass index (BMI) as the study outcome. The risk of bias was evaluated using the Quality Criteria Checklist (QCC). Results: From 514 articles identified, 10 met the inclusion criteria, including a total of 1765 participants. Larger portion sizes increased food intake (grams) and/or energy intake (kcal) in eight studies but did not affect energy intake in one study. Another study focusing on fruit and vegetable portions found inconsistent results. The meta-analysis found that larger portion sizes were associated with higher energy intake compared to the reference portion (mean difference = 86.0 kcal/meal, 95% CI [62.2, 109.9], p < 0.00001). Conclusions: Offering children larger portions increases energy intake. However, this finding was limited by being based mainly on studies which manipulated portion size at a single meal, in a laboratory…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,765 participants or records.
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