Gerd (see comments above) got me sorted. In my changeFont handler I create a temp font of size 10 then pass it back to the font manager and check the size of the returned font. If it's bigger then CMD+ was pressed, if it was smaller then CMD- was pressed.
- (void)changeFont:(id)sender
{
NSFontManager* fm = sender;
NSFont* fntBefore = [NSFont systemFontOfSize:10];
NSFont* fntAfter = [fm convertFont:fntBefore];
CGFloat delta = fntAfter.pointSize - fntBefore.pointSize;
}