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Challenges and opportunities for better nutrition science (bmj.com)
55 points by barney54 15 days ago | hide | past | favorite | 123 comments

The title does not mean that they think calories have no impact on nutrition. They state their stance more clearly midway through the paper:

"We need urgently to overturn calorie counting as the mainstay of nutritional advice and prevention of obesity. There is growing consensus that it lacks value as a practical tool in weight management. It is impossible to measure intake accurately, and too many variables influence calorie expenditure to make calorie counting useful. New research in humans suggests our bodies and metabolic rates can behave differently when given identical calories in different contexts."

This seems accurate to me. What we're doing isn't working great, and it seems unlikely that if we had less emphasis on calorie counting that the obesity epidemic would be much worse. So let's try something else, and see if it works better!

Having calories on food packages helps though, even if it is reductionist, because it's a good surrogate for foods high in energy, low in nutrients, the kind of food that's designed to be overeaten.

For whole food, I agree that calories don't matter because we can trust our satiety signals. For junk food designed to be overeaten, I find that information quite useful.

Note that I do track my calories periodically.

In spite of popular claims it isn't that hard, technically speaking and it doesn't have to be super accurate.

The problem with calorie counting is one of mentality. Because you end up thinking about how many calories you have left, it ends up draining you emotionally and you can suffer binging episodes due to it. The brain is unpredictable and we can't necessarily control ourselves which is why we can get fat in the first place.

I think everyone should try to measure their calories for educational purposes. If you do, the best app is Cronometer, by far.

But to lose weight you need first of all long term compliance, so you need a strategy that can work long term. Counting calories doesn't work long term if you're too emotional and you can't help to treat those numbers as anything else than just data. Counting calories definitely doesn't work for me.

>For whole food, I agree that calories don't matter because we can trust our satiety signals. For junk food designed to be overeaten, I find that information quite useful.

One of the things I -really- appreciate with the newer labeling is that it shows both the calories per serving as well as total calories in the package. Giving both numbers helps people understand how much a binge really costs them.

Speaking of which, since you mentioned satiety signals...

Last night I wound up craving doritos like Stewie griffin eating pancakes. But some mindfulness helped me reach instead for some carrots, which quite frankly were a better crunch, and honestly I felt better after eating them.

Seconding Cronometer as a good tool; it’s the best I’ve found, supports data export, and isn’t full of “social” features that obscure the key feature: easy and accurate calorie tracking. In particular it’s database is more accurate than the crowd sourced ones like MyFitnessPal.

It's accurate indeed, it has useful info on vitamins and minerals. Some people use it for that and not for calorie counting.

It also makes estimating home cooked meals doable because everything comes measured in grams. You just insert your recipe. Estimating home cooked meals in other apps like Myfitnesspal is super frustrating.

I agree with you that it works “well enough”, but with one major thing that needs to be addressed:

Gaming the calorie count through chemicals.

Not only can they cause increased appetites, fat retention, and metabolic disfunction, but they can introduce other health problems as well, far more than the results of even an extra 1000 calories.

Not sure about fat retention, I don't think there's any evidence for that.

But I agree with the claim that companies are trying to game the numbers now and the products might not be healthy.

Back in the day you had companies advertising low fat products as healthier, however humans have an innate desire for foods high in calories or salt, so they had to compensate with sugar or salt.

Nowadays you have companies advertising low calories or low sugar products via use of artificial sweeteners. At least one artificial sweetener that I know of is carcinogenic. Sweeteners can also have a laxative effect since the whole point is that they aren't absorned. I have IBS-D symptoms and for me that's not good.

These days, even if I have a preference for less sugar, whenever I feel the need for sweets, I'd rather have the sugar.

Too late to edit, but the title at the time I wrote this comment was "We need to overturn calorie counting as nutritional advice". It has since been changed to "Challenges and opportunities for better nutrition science", the title of the linked paper.

I think there are two factors that go into maintaining good weight.

1. Calories

2. Metabolic rate

The interesting thing is that some things you eat will increase your metabolic rate, and others will decrease it. And those effects will change depending on the context.

Blindly under-eating calories runs a high risk of gradually decreasing your metabolic rate. That is bad for your weight in the long run, but, more importantly, bad for every other thing your body does. A high metabolic rate means your body is able to organize things and move them to where they need to be so as to not get bogged down with junk and to slow down the vicious feedback loop of bodily disorder that is aging (as far as we can tell)

Probably the best indicator of when you have undergone a metabolism-shifting intervention is when your general sense of "well-being" changes. It's hard to pin down because the signals are likely very varied. When you eat standard commercial fried chicken, you feel pretty sluggish soon afterwards (most common food complaint I've noticed among friends). You may even get a head ache, and in some cases stomach distress. If you pay attention, you may notice that you feel a little more depressed, less creative, maybe emotionally numb. These are all signs of a slowed down metabolism.

If you eat a tablespoon of sugar, you may feel a rush of well being. You may feel tingles on your tongue, a lightness in your head, feelings of playfulness, sociability. Those are all signs of a speeding up metabolism. You may also feel cloyingness on your tongue, maybe even slight nausea. Those are feelings of a slowing down metabolism. The same food can have different effects on your body based on the context. For sugar specifically, you can speed up your metabolism if you do not have other nutritional limiting factors. If you are deficient in minerals, vitamins, protein, etc. your body will not be able to speed up metabolism appropriately. It would be akin to drastically speeding up an assembly line conveyor belt (effect of the sugar as a fuel) without having enough people manning the belt, having borders of the appropriate size to help avoid messes, having enough of some other upstream component, etc. The end result is a bigger mess than before.

The other important factor to consider is the effect of environment on your metabolism. This may be more important than food for some I think.

Nutrition science is unlikely to come to a consensus, but you can help yourself by focusing on anything you can feel. Identify the feelings you like. Take the actions that appear to lead to those feelings. Realize that the same action can and will provide different feelings because of how context dependent everything is. Pursue "well-being" in the most granular fashion that makes sense to you at the moment.

Probably, the most important change you can make to your mental model regarding nutrition, if it's not something you already do, is to realize that nothing is ever off-limits. You need to determine what will work for you in real time. Blanket indefinite approval or rejection of any food almost certainly ensures that you won't reach your potential.

Dieting is calorie counting in some way or the other. Eg: Weight watchers uses a point system. It’s trying to get calories consumed below calories needed.

> Dieting is calorie counting in some way or the other.

Atkins, and many similar low-carb diets, are not.

> It’s trying to get calories consumed below calories needed.

Even if you restrict “dieting” to “dieting for weight loss”, where that sentence is true, it's still not always some form of calorie counting. The goal of achieving a particular calorie balance is not always met through counting calories, even in rough proxy form.

Dieting for weight loss can have lots of strategies.

Atkins and other low-card diets appear to try to use the increase in energy expenditure (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568065, Figure 2, they do a meta analysis but conclude "the effect sizes are so small as to be physiologically meaningless" so I'm not sure if the effect is real) due to the absence of carbs, and then just hope the person doesn't manage to increase the calorie consumption by a similar amount by eating too much---so it might still be called calorie counting, implicitly. I think you're defining calorie counting as specifically when the person following the diet counts the calories explicitly themselves.

You need to get your calories below your BMR in order to lose weight. Even on Atkins or any low carb diet, if you're consuming 3000 calories a day, you will not lose weight. Simple calorie counting could be deciding not eat a 36oz steak for dinner because of the high calories or skipping the 3rd piece of bacon for breakfast.

"The top 10 companies control over 70% of what we eat and drink and have annual sales larger than the gross domestic product of many countries ... systemic change is needed first and this is likely to require governmental action.”

But when the government acts, it acts according to the influence of the companies that its regulatory agencies have been captured by, particular those same top 10 companies that control most of what we eat and drink. This is not a new development. When U.S. nutritional recommendations emerged in the early 1970s they were already being written by these same companies and their predecessors. From my perspective they were already dead wrong, and those recommendations have wrought enormous damage in chronic disease and lives cut short. There is no realistic prospect that this is about to change.

I've been watching as one of my favorite nutrition authors, Nina Teicholz, has been tilting at these windmills via the Nutrition Coalition. They have struggled mightily to present the dissenting science to the people who control these recommendations, and have met with roughly the same success as Don Quixote. Watching them lose their innocence is like watching a slow motion train crash and not being able to do a thing about it.

My preference is to get the government out of the nutrition science business, but that's about as unlikely. Barring that the best approach is to either ignore them or count them as just one more opinion, and to do the research and N=1 experimentation for yourself.

> My preference is to get the government out of the nutrition science business, but that's about as unlikely.

It’s critically important that the government is in the nutrition science business and it does nutrition science correctly. Think about all of the ways the government is implicitly taking a stance on nutrition. The farm bill, school lunches, checkoff programs, government cheese, prison meals, snap, and many more.

The problem is one of incentive alignment. For example, the FDA is responsible for both the agricultural industry and the health of the population, which currently are at odds as the agricultural industry producing a lot of junk food.

Democratic systems can work by increasing the transparency of the government and by increasing the education of the voting population.

"Democratic systems can work by increasing the transparency of the government and by increasing the education of the voting population." Most of the big problems facing the humanity can be addressed using transparency of government combined with better education for all. To that list I would add, decreasing the role corporate money plays into influencing government and universities. For this to happen we need to rethink Economics (https://www.ted.com/talks/kate_raworth_a_healthy_economy_sho...).

Could not agree more.Just need to find an easy way that makes people realise they are the ones ultimately deciding what they put on their plates. Although I do not minimise the difficulty for some people to put their food habits on the top of their list.

I'd say for a lot of people, their food budget decides what is on their plate.

Look at this list of the cheapest food:


Even sticking to that list there's an enormous difference between eggs and beans versus brownies and pancakes. And rural poor can grow the eggs in the backyard for chicken feed, and often do. Only the most desperate can't make consequential decisions about what's on the plate.

Sort of a tangent, but I legitimately thought at the start of lockdown that people would lose weight on average because they couldn't go out to eat anymore. It turns out I just completely underestimated how much people eat out, and how quickly they would all switch to just getting take out.

I have friends that would always talk about how we spend way more than them at the grocery store each week. Obviously, they'd tell me, it's because we didn't shop at Aldi. Nope. Turns out it's because we cook and eat at home.

I don't remember where I heard it (maybe Michael Pollen?), but the advice I try to follow is: Eat whatever you want, just make it yourself.

> the advice I try to follow is: Eat whatever you want, just make it yourself.

This is categorically bad advice. Anyone that has an obese friend that’s into baking knows why. It’s very easy to make incredibly unhealthy and calorie-dense food at home.

I understand the sentiment but there is nothing about the process of making your own food that makes you a more healthy person. It all depends on the ingredients and the amount.

It’s obviously better to eat healthy takeout every day than it is to cook home made french fries for dinner.

I think it comes from the idea that you'll have more knowledge about what you are eating.

There's some truth to that, but cooking for yourself still hides a lot. And it might end up just being a false sense of health.

It's also what stage you are at. Most people can't make soda at home, so eliminating that alone might be a big help for some.

> Most people can't make soda at home

Sure, but most people also already know that soda is unhealthy for you, so they can stop buying it and drink water with their food instead. It doesn't require a framework of "home cook everything" to make these small, incremental changes: in fact I'd argue that these changes are easier than what's essentially just a diet by another name.

> This is categorically bad advice.

Then perhaps a simpler version: Don't be dumb.

If your advice needs to be prefaced with "obviously, don't take this advice literally", then it's not great advice.

Not a hill I'm wanting to die on. You win.

Yep. Dry pasta, white rice, pancakes, and hot dogs are all very easy to make and very calorie dense, especially when served as folks typically do: with buns, syrups, sugary sauces, etc

That's because _patisserie_ is really a combination of processed ingredients (fruit is mostly decoration). Should my obese friend grind wheat into flour, turn milk into butter, juice sugar canes into sugar, he'd surely bake less and expend more calories doing it.

It's not just intake but also how many calories we're burning. I've had dozens of days where I've barely moved more than shuffling around my home. Those days were rare or non- existent pre-lockdown.

As for eating out, I find it to be one of the great joys of life and civilization and wouldn't give it up for anything.

> Eat whatever you want, just make it yourself.

I'm astonished by how few people prepare their own meals. You're playing the diet game on hard mode if you're limiting yourself to cafe/restaurant food (not to mention the cost!). Conversely, it's actually pretty difficult to eat poorly if you cook everything yourself.

Eliminating sugar, refined wheat and ensuring every meal is at least 50% vegetables by volume would go a long way to reducing the number of people in the "obese" category. In that respect, I'd agree that calorie counting is at best unnecessary, at worst counterproductive.

But even with such an incredibly low bar to clear, I'm not sure it will make a difference to obesity rates. I'm highly skeptical that the upwards trend has anything to do with confusion, cost, lack of information or anything like that. People just aren't willing to give up the constant dopamine hit from fried and sugary foods.

Pollen has another good quip: Eat food, not too much, mostly plants.


> Eat whatever you want, just make it yourself.

That works only until you learn how to cook food that you really like. You can end up reproducing fattening food or even make it more fattening pretty easily.

The other major factors in people gaining weight during lockdown are: 1. Additional Stress/Anxiety 2. Fridge proximity

Lack of physical movement that was on the background all the time. Before I had to walk for bus, take bus, walk from bus to work. Walk for lunch and back from lunch. Walk to nearby office to chat.

Walk to kitchen or wc in work is further away.

You dont even realize how much you are moving around until it stops.

And alcohol consumption.

Can you explain? Is it a metabolic thing, or is it related to the carb content of beer/wine?

Alchohol consumption per capita is way up.

I couldn’t disagree more, having used it for myself, and having coached hundreds doing it as a personal trainer.

An individual who employs reasonable practices well can thrive using this modality.

EDIT: IIFYM is “act, measure, adjust” using calorie counting and body weight / size measurements. I understand that there are triggers for some individuals in that statement. Doesn’t really change what needs to be done if body weight / size goals need to be addressed. And yes, there may be other manners of going about this, but those will mostly work around directly engaging in the anchors of IIFYM.

> New research in humans suggests our bodies and metabolic rates can behave differently when given identical calories in different contexts.

I wonder what the "a calorie is a calorie" zealots would say about this?

Proponents of alt-truth theories misunderstand the claim ;-)

Yes, we can talk about the thermic effect of food, about how absorption of food differs depending on quality of food, stress, gut health, etc, but on average the effect was measured and is ... negligible.

There’s also another misunderstanding ... just because calories are what matters in weight loss or weight gain, it does not follow that counting calories is the best strategy for achieving your goals. It’s a logical fallacy basically, used by alt-truth proponents as evidence that the theory is unsound.

For all practical purposes however a calorie is a calorie.

Yeah, I find the "calories in equals calories out" argument stupid not because it's wrong (it's basically the first law of thermodynamics), but because it's relatively useless, and because its proponents usually use it to imply stuff that isn't true.

For example, "calories in" and "calories out" are not independent variables. A reduction of calories in will normally result in the body lowering metabolic rate, resulting in a reduction of calories out.

Similarly, humans aren't robots. Any "solution" that basically tells people to ignore their hunger, one of the body's most basic physiological responses, is not a viable society-wide solution.

> Any “solution” that basically tells people to ignore their hunger [...] is not a viable society-wide solution.

This is a really good point, IMO, because part of the problem is our food itself, with unnaturally and unnecessary high amounts of processed carbohydrates. That kind of food causes hunger to increase.

> A reduction of calories will normally result in the body lowering metabolic rate

This is totally true, but is so commonly stated as somehow proving that calories shouldn’t be counted. Sure, the body adapts, sure calories aren’t perfect or absolutely constant, but if you need to lose weight, what is the alternative? You have to eat less, so slightly lower metabolic rate may be a natural part of the process. BTW, how much lower is my metabolic rate if I reduce my caloric intake by 10%? How much lower can my metabolic rate go? If you’re going to point at metabolic variability, those questions need to be answered. The answer can’t be to ignore calories and not eat less, right? That would be far less effective than counting calories imperfectly. So what other action should someone take?

The reduction in metabolic rate is also negligible ;-) We are talking about ~200 kcal and for many people not even that.

And yes there are exceptions. Hypothyroidism for example can yield a bigger reduction, but no more than 300-400 kcal. This is why people suffering from hypothyroidism should get treatment first.

Maintain an average 500 kcal deficit (from the baseline calculated for your sex, age, height and current weight) and you will lose weight. Conversely if you don't lose weight fact of the matter is you still eat too much.

And yes, counting calories might not be the best strategy for that 500 kcal daily deficit, but if what you're doing doesn't work, then you know why and can take measures.

> Any "solution" that basically tells people to ignore their hunger, one of the body's most basic physiological responses, is not a viable society-wide solution.

But people have lost track of what hunger is!

They tell you they're hungry but really they're bored / depressed / just used to eating constantly even when not actually hungry.

They need to ignore being bored, which they think of as 'hunger' so you need to tell them to ignore their 'hunger' for them to understand.

> But people have lost track of what hunger is!

This is exactly right, and also why I highly encourage people to experiment with fasting (for at least 24 hours) to reset your baseline for what real hunger actually feels like.

What we normally associate with "hunger" is actually a hormonal response from the body's release of ghrelin. It's not real hunger. You're not going to die if you don't eat. Moreover, we also experience "boredom" hunger, which isn't even a hormonal response, it's simply a mental addiction to the feeling of something tasty in your mouth.

It's absurd that we've conditioned society to believe that stuffing our faces with food upwards of three times a day is "normal". It's not. That's why obesity rates are through the roof and CVD is the number one killer.

That being said, I'm doubtful that telling the average person this will have any effect on their eating habits. So OP may be right that it's no solution to tell people to "ignore that feeling you think is hunger". You can lead a horse, but you can't make it drink.

I'm not sure that's necessarily true. It seems very plausible that there's a cultural component, where societies with healthier weights are more willing to ignore mild hunger.

I'll chime in from that group, it provides an upper bound value to work with.

Since nutritional science deals with a lot of macroscopic behaviors that are just stupidly complex and often individually specific with lots of variance, it at least gives you some ballpark bounds to work with, assuming of course businesses are able to give accurate caloric estimates (which they often don't--even more difficult if you're eating at a local restaurant).

The issue is the other side of the envelop: energy expenditure. It's quite difficult for any one person to estimate and your body will often compensate in ways you aren't quite aware of to save those precious energy calories. All you can really do is play with your caloric intake since you have some control and combine it with some information from certain exercises (use lower estimates for exercise caloric expenditures--round down every opportunity to also give reasonable upper bounds on expenditures).

So all in all, a calorie is a calorie but it just provides a starting point for you to work with in your own personal diet. You'll start observing other obvious macroscopic behaviors like "empty" vs "filling" calories that I find are, at least for me, significantly more valuable for weight management. They not only provide an upper bound for energy consumption relation, they provide a ground truth to tie back to my own body: how full or hungry I am after I consume said energy, how groggy I feel, etc. This ultimately, for me, leads to valuable dietary changes that give effective guidelines to proven end results.

When I gained weight during college, this was the trick that, for me, has lead to the most valuable lifelong weight management. YMMV.

It always seemed obvious to me that there has to be some caloric value left in poop, and that it probably varied from person to person.

I read a book about pigs a few years back, and it said there are certain breeds of pig that are easier to fatten up than others. It sounded like main factor was how long their intestines were. The longer the intestines, the more time to extract energy from the food. Thought that was interesting.

Also, the amount of calories that are not for some reason not picked up through the intestine, and instead consumed by bacteria in the large intestine. And probably much more. I think this is a field of knowledge where the holes, certainly so for a layperson, are huge.

Fructose malabsorption is a concrete example of this, although I'm sure there are many others.

"A calorie is a calorie" guy here. I'm also a "food affects metabolic rate" guy, they're not in opposition (that said, . The problem is that people are latching to the idea that such-and-such diet allows you to eat however much you want, and you'll lose weight[1]. To which the answer is, that's not how things work, you still need to have a negative caloric balance to lose weight: "a calorie is a calorie".

Most of the effect of these diets (intermittent fasting, low/no-carb, etc) is due to spontaneous reduction of intake; I haven't seen credible reports of large effects due to metabolic rate change. Granted, I've stopped looking some years ago.

Worrying about "some calories increase metabolism" is majoring in the minors. "Some calories make me less hungry (therefore I eat less)", "some calories make me feel more energetic (therefore I move more)", "some calories come with more micronutrients", "some calories don't come along with poisonous crap" is what most of us should be worrying about.

[1] I know this sounds like a strawman, but this is the actual claim being made.

> The problem is that people are latching to the idea that such-and-such diet allows you to eat however much you want, and you'll lose weight.

This argument is often used not to say you can literally eat an arbitrarily large amount of food and still lose weight but to say if you eat this diet you’ll most likely lose weight without having to feel hungry.

It is often used to say that, in fact I allude to the same. It's also often used to claim that you can literally eat an arbitrarily large amount of <specific food> and still lose weight. I've seen it, I've argued "no what's really happening is that your appetite is what's changed", I've mostly given up arguing nutrition with random internet strangers.

Of course bodies and metabolic rates behave differently in different contexts. That’s not a new discovery, it has been known for a long time. The new research is just confirming what was known, and uncovering some of the specific mechanisms.

How much differently? What contexts? What is the distribution of different metabolic behaviors? What is the range of different rates? Those questions are far more important than whether, if you actually want to understand how calories behave.

The reasoning behind the phrase “a calorie is a calorie” is to summarize the primary metric one should watch when trying to lose weight. It doesn’t say that all calories are the same. You might have already noticed that the words are a tautology. A calorie literally is a calorie, it’s not saying that all calories are the same for all people in all contexts.

An important question to ask here is what action should someone take, armed with the knowledge that metabolic rates have some variability? Does that mean you should not use calories? Do we have a better metric? I’m not aware of one, so believing that variability means you shouldn’t use calories as a metric would be the wrong conclusion, IMO. Calories have always been imperfect estimates, but we have no better estimate. Eating & drinking is the only way we add mass to our bodies, so calories merely attempt to quantify that mass. Knowing that metabolic rates have variability means only that someone who believes their rate to be very different from the average should work to calibrate their measurements. That takes effort and is difficult to do on top of an already difficult activity of monitoring and/or restricting calories, so I wouldn’t recommend trying to calibrate calorie measurements to someone who’s struggling to track calories. The estimates we have aren’t that bad, and they will work for the average person.

“no models are correct, some are useful”

for most people that want to deal with any number of health issues focusing on reducing calories is usually a good thing to do. But human health is very complicated, so just about every recommendation should come with asterisks

If they read the article - probably nothing. At a really basic level, running a caloric deficit is a still a viable method of losing weight.

The article goes on to talk about how at a societal level we tend to fixate on calories only, and then outlines several problems with that. Namely that all calories are not created equal, because health is more than just body weight.

I control my weight. (I also am a co-owner of a gym, so I can't afford to be obese or overweight. It would hurt my credibility.)

"A calorie is a calorie" is a great way to control your weight. Really!

I like to go through "cutting" and "bulking" stages. I go from the bottom of the weight range for my height (around 145 for 5'10") to the top (170 for 5"10). And when it's time to cut, I reduce 3,200 Kcal/week from my diet and I lose a pound a week. It works _exactly_ every time. It doesn't matter what calories I cut. The math just works.

Now, sure, you can optimize this a bit. SUgar/carb calories are bad because they tend not to keep you from feeling hungry again and fat/protein calories are better because you feel full. But that's just an optimization.

Every person will lose weight at a calorie deficit. Every single one. Period.

I run IIFYM rather than pure calorie counting for lifting, but my response is that if you're running a pure calorie counting diet then it doesn't matter honestly. You should be weighing yourself and seeing if your current calorie levels are resulting in weight loss given your eating pattern. If they are not, lower your daily intake. People tend to eat the same general things on a regular basis so if food X has more impact than food Y and you are eating X regularly then you might need to eat fewer calories on average to deal with that.

Calorie counting is obviously a very coarse way to do weight management, but it's coarseness is it's strength in this context.

I'm not a zealot so I'm actually interested in knowing whether this is true, but I noticed that they provide no references for that statement, does anyone know of one?

Those folks tend not to be very interested in the actual problems of nutrition and obesity. In my experience, they are much more about sitting in moral judgement of people who have other-than-ideal bodyweight and fitness.

> I wonder what the "a calorie is a calorie" zealots would say about this?

I don't think any serious person ever meant this literally. You're misrepresenting them by saying this.

There are a lot of calories in coal but I can't digest it so they aren't the same as the calories in sugar. That's obvious, nobody serious is disputing that.

What everyone I know means when they say this is that if you're eating a massive cheese burger or a huge bag of nuts or a kilo of jerky then don't try to kid yourself that for some elaborate reason (I've worked hard today, they're healthy, I deserve a treat, I walked 100m today, I took the stairs instead of the elevator) that the calories in it don't matter. The calories in it are still calories. That's what they mean.

In practice, for me, in my experience, limiting my calorie intake is the only way to control weight to where I want to be. And that means not kidding yourself that a cheese burger doesn't matter for whatever crazy reason.

> I don't think any serious person ever meant this literally. You're misrepresenting them by saying this.

I believe sibling comments do pretty much say that.

> In practice, for me, in my experience, limiting my calorie intake is the only way to control weight to where I want to be.

Aren't you doing that by choosing what you eat and not eat, mostly? E.g. "I'm not going eat some carrots instead of that bag of chips while watching TV" instead of "I'm going to only eat 80% of that bag of chips"?

> You're misrepresenting them by saying this.

I don't think I am. Maybe there are two groups of thought on this though.

Calorie counting functions properly for controlling weight. The physics and chemistry of it is sound. And the empirical proof is the many thousands of professionals who use it successfully: models who need to be a certain shape; football players who need to be heavy so they don't get lifted off their feet by their competitors; or dancers who need to be light so that they can get lifted off their feet by their partners.

I say that up-front because there are a bunch of people out there who think that the basic science of calorie counting is wrong; that there are other hidden factors that keep some people thin and make other people fat.

BUT, what is true--and which this article highlights--is that calorie counting is super hard to do. As a system, it's hard "operate". You can't make mistakes, like forget to enter a meal or a snack, or forget to properly record activity. And it's kind of miserable to live that way. That's probably one reason it's mostly professionals who really do it well.

In software terms, calorie counting has terrible UX. And our food system has bad defaults. The cheapest, most heavily-advertised food is often high in calories per volume.

And of course calorie-counting does nothing for your nutrient intake, which is arguably more important to think about now because foods across the board (i.e. even organic kale) seem to have falling nutrient content.

I've only ever been slightly overweight but once wanted to lose 8kg to feel a little less chubby. All those highly complex miracle diets just overwhelmed me, I didn't want to limit my range of different food items and I didn't want to set schedules. Counting calories was by far the easiest solution. And it worked!

You don't even have to carry a little notebook with you, entering exact numbers to the single digits and making charts. All you have to do is read the labels on footstuff from the supermarket and look up estimates for common dishes. Keep a rough number (+/- 100 calories) of today's calories consumed in the back of your head and try to stay beneath 2/3 of your body's base level and you're golden. It's so easy and often doesn't even feel like a sacrifice since it's usually just leaving out that stupid chocolate bar (reading those labels is half the exercise, it's a constant reminder that all the cliches about fast food and soft drinks making you fat are true).

Now there's a lot of healthy things you can do to your diet that have nothing to do with losing weight and there's further optimizations that go beyond calorie counting. But if loosing weight is your singular goal, calorie counting is still the easiest way to do it. It might be inaccurate but you don't really need accuracy to remind yourself that this food fills you up 3 times as fast as that other food.

Well the other, easier way to do it is have a diet program that you strictly follow each day. That way the calorie counting has been already done, usually by a professional. That way you just have to eat what your list says.

I have found it impossible to count the calories I eat (and consume) each day but following a program is much easier!

You are simply wrong.

Calorie counting is impossible to do right and meaningful. All that experience you mention is simply a chance and has a tone of confouding variables.

Your internals are not fixed like a machine, parts of the system can be shut down (such as reproductive system) and parts of it can demand more energy at specific times (like immune system) and parts of it can appear (like cancer). There are also other factors like hyperinsulinemia which is more like logistics problem (some parts of body get bunch of energy while others are starving). With this kind of dynamic, relying on calorie counting is simply usless as all people are on various states on this system.

Sure, when you bring calories down to 0 you will certainly di of wasting but that has 0 practical value.

Calorie counting is well supported by the studies in which people stay in metabolic wards and are fed a controlled calorie-counted diet. This is close enough to regular life experience to be meaningful, and would disprove your assertion that it's simply chance. You, on the other hand, bring up a lot of fairly extreme situations (immune system fighting an infection, cancer, shutting down the reproductive system), which simply do not happen nearly often enough to be relevant here. So the comment you're replying to is not "simply wrong".

It is not close enough to real life. The controlled calorie counted diet given to you by doctor is also designed to contain all iron you need, all vitamins of all kinds you need, fiber and so on. It is not random person food minus whatever that person finds easy or reasonable to kick out.

The people in metabolic wards are also not expected to be performing in work simultaneously, they are not expected to perform family duties or handle stressful situations reasonably. That also makes it massive difference against normal life where needs like this contribute to peoples failure to keep perfect diet.

watwuf already said it nice, that is anything but real life. Not counted in is that there is also very serious selection criteria (so, not random people).

On the other hand what you call extreme situation is nothing like that - most people have some type of chronic problem.

The most improtant aspect is certainly longevity of treatment - callorie restriction can not be followed - it can for some time, but soon enough (months or years) you will sucumb. Its simply not a normal way to have a life. It must be sustainable life practice, not something you apply from time to time.

Out of curiosity, what is your proposed alternative?

If you’re saying that calorie counting is not 100% accurate, that’s absolutely true, you’re right. It always has been more like 80%-90% accurate for average normal people. So what would it mean to count calories “right”?

It’s a given that there are some people in more extreme situations to which the rules of thumb do not apply, but what should an average normal healthy person do to control weight, if not count calories? (By average normal, I mean someone who’s near the middle of the bell curve in terms of physiology and metabolism.)

It's still far from this to "calorie counting is useless". There's very specific health issues you should probably clear with your doctor and there's inaccuracies. But how far off can calorie counting be for simply losing weight? 10%? 20%? It still serves as a good estimate.

Its temporary fix. That makes it not useless. Its not what people generally want tho - they generally don't want to game body building stats or look nice on beach in 2 weeks but not be fat all the time, and for that, its useless.

A bigger problem with calorie counting even if you get past the mechanical difficulties of keeping track of everything is that it doesn't do anything to adjust what your body "thinks" your needs are.

If you are overweight but your body thinks that you are underweight cutting calories to lower your weight can be seen by your body as the onset of starvation and it can make adjustments to prioritize short term staying alive over long term health.

Even if you are careful to not lower your calories so much as trigger that and do eventually get down to your target weight, as long as your body still thinks it is underweight its going to be trying to get gain it back. Any day you eat a little extra or your activity level is off a little your body is going to try to snatch onto that to put on some weight and hold on to at as it tries to claw back to what it thinks is your proper weight.

A couple months ago there was very good episode of Nova on PBS about fat [1] that covers this (and much more--it's well worth watching). Unfortunately I don't think it is freely available at the moment. (The pattern with much PBS stuff is that after it is broadcast it is available for free streaming on the web and in their apps for a few weeks, then it becomes available only to people who donate at least $60/year to their local PBS stations. Looking at past seasons, some stuff is only for donors and some can be streamed free. I'm not sure what is going on there--whether a given one occasionally flips between donors-only and free, so there are just some that stay free and some that stay donor-only).

[1] https://www.pbssocal.org/programs/nova/truth-about-fat-previ...

Calorie counting alone will have you simply not have enough of nutritients you need in the long term. You will feel bad and sick and passive, you wont be able to focus, you will be sickly and depressive or angry, because you lack stuff your body needs. When you break it, it feels good. You start to be active and have better mood. Because your body is suddenly getting stuff it needs.

I am speaking from personal experience here.

> models who need to be a certain shape

The way models ate and lived in the past was not healthy tho. There were periods where the expectation basically amounted to "eating disorder".

> dancers [...] football players who need to be heavy so they don't get lifted off their feet by their competitors

There is way more that goes to sport food. They dont focus on calories. They focus specifically on protein at specific times and what not.

The thin vs large sport physics is absolutely not about calories only. It is a lot about what kind of sport you do, whether endurance or cardio or strength.

What I said:

> Calorie counting functions properly for controlling weight.

That's an intentionally limited statement of what it works for. I agree with you on nutrients.

> There is way more that goes to sport food. They dont focus on calories. They focus specifically on protein at specific times and what not.

When they have specific weight targets, they do count calories. I posted some examples lower in this thread.

> Calorie counting functions properly for controlling weight.

This is however completely useless goal if you dont add those other requirements like "while staying reasonably healthy and functional".

> When they have specific weight targets, they do count calories. I posted some examples lower in this thread.

The people who are trying to gain weight for sport really don't focus on calories. They focus on total amount of protein. They dont want sugar nearly as much and would not replace one with another.

Very much agreed. I’ve once tried to count calories for about a month out of curiosity. Having Fitbit and tracking all my (amateur) cycling with a powermeter, I could record calorie output consistently. But if you want to eat out regularly, it becomes extremely difficult to estimate the intake right IMO.

> models who need to be a certain shape; football players who need to be heavy so they don't get lifted off their feet by their competitors; or dancers who need to be light so that they can get lifted off their feet by their partners.

I have never seen or heard about a professional diet based on calorie counting.

Every single diet is based on a prescription of nutrient types and quantities, when it's not a detailed prescription of food types and quantities. And the diets that end-up working are all revised several times after controlling by patient's health.

>prescription of nutrient types and quantities

How is that not essentially calorie counting? If a diet says at 8:00am eat 10g Fat, 30g protein 30g carbs that's still a way of saying eat 330 calories

If the diet says at 8:00am eat 330 calories, can you determine how much fat, protein and carbs you must eat?

Do you notice now how they are not equivalent?

There is physics supporting calorie in, calorie out. However, there is also pharmacokinetics to consider...if your calories are a sugary solution like juice, Coke, beer, etc, they will be absorbed into the bloodstream much more quickly, spiking blood sugar and leading to rapid storage in fat cells.

Contrast that with the same calories from a lean chicken breast, it's going to be hours until that's fully digested and absorbed, meanwhile it's much more filling and prevents more calories from being eaten. Also because its protein and not sugar, your body metabolizes it differently and it is not going to be stored as efficiently.

There is a lot of interesting points in this article--not just about demoting the calorie as nutritional advice--such as the lack of funding for basic nutritional studies and the role of large food companies.

I skimmed the contents, but I don't get any alternative to the standard calories counting.

It's the only way to quantify the intake without revolutionising the food industry packaging, or am I missing something?

Weight watchers will allow you to scan a barcode of some food and it will tell you how many “points” it is, and someone in weight watchers has a limited number of “points” they can consume in a day.

This is an example of an existing solution to quantifying intake without adjusting packaging.

If you're just calorie counting, you can certainly have success, but it's not a bad idea to maintain some idea of where you stand in terms of your consumption of fat, carbs, and protein.

If you calorie count and generally try to stay around 33/33/33 in terms of percentage of macronutrient consumption by the end of the day, it's hard to go of course.

It's a course set of rules, but sometimes keeping it simple as opposed to precise (since the pursuit of precision involves complicated and likely to be overturned theories) makes it easier to embark on that journey to begin with. I can't tell you how many people I know who say that want to lose a few pounds but reject calorie counting because they heard that's not the right way to do it. They rarely find an alternative so they never get started.

Im saying that as someone who has gained and lost significant weight to achieve goals (lifting, running, maintenance) at various times.

PS: If you do decide to diet, regardless of what you do - cut out alcohol consumption if that's currently a thing for you, and you'll be amazed at how effortlessly weight comes off, even if you don't really make many changes to other parts of your diet.

I believe it's more urgent to get rid of "serving" as measurement.I recently tried to build up a dash diet shopping list and was sent on a wild hunt for what is a serving exactly (turns out a serving is different depending on the food and measured in different cups and other imperial units).

Most dash diet books (or others) I read spend 200 pages out of 250 explaining basic useless nutrition factoids then get on a "sample week menus" that aren't practical at all if all you want to know is "how much pounds of this and that should I eat per day or per week ?".

I should open a blog about how to get that (easy recipes, easy shopping list), would be a nice journey.

It’s a little annoying, but you can do the math with a spreadsheet and a scale. Also many online resources has nutritional information for an item per 100g, and adjusting measurements of weight to other measurements of weight is much easier than adjusting measurements of volume to measurements of weight.

I guess the holy grail is to get to the point where you can take some lab tests (genetic?) and a doctor can tell you: "eat this kind of diet, avoid these kinds of foods, and you'll be healthy".

Obviously it would take a lot to get there, but having a few high quality studies that can give a lot of people at least some advice (without tons of qualifiers and weasel words) would be a huge help.

This might cost ~50B, but that seems worth it.

This is kind of funny, but we're already there! Take 0 tests, eat a balanced diet with plenty of vegetables, don't eat too much, avoid processed meats and junk food and the rest of it, exercise, and you'll be healthy, you've heard it yourself already too. How many people do you know who'd actually do it if a doctor said something like that to them? You kinda manage to both under- and over-estimate the current abilities of food science at the same time, and if people don't already do the things that we pretty well know for sure, an extra $50B won't really change any of that, that's a people problem.

What you said is probably 80% of the way. I would also be interested in more research about individual responses to food. There's some evidence blood glucose levels vary considerably between individuals consuming the same food: https://www.cell.com/fulltext/S0092-8674(15)01481-6. That would help me choose my staples (what's best for me, brow rice or yam?) and how much junk to include (what if I don't have that much of a blood sugar spike after eating ice cream?).

If people took a high-tech test and were told that that advice was personalized, imagine how much better compliance would be though.

So like a very expensive placebo?

Not quite.

Right now there's a lot of confusion. Is gluten a problem for me, or dairy, or fat, or sugar, or alcohol, or caffiene? It's easy to get overwhelmed.

If you eliminate everything that might be bad for you, there's not a lot left. There's a lot of value in specificity because it's actionable.

I suppose I just fundamentally don't agree with you about the confusion existing in the first place. Here's my understanding. All of those things are fine, in moderation, unless you have a specific medical condition against something. Except for alcohol: that's just bad for you in proportion to the amount you drink. And that's already with existing research, as far as I know, I might not like it but I don't get overwhelmed.

I thought we already knew that caloric contents are context dependent? Or are we living in some strange dietary multiverse?

Weight gain, weight loss, muscle gain, muscle loss, are operations almost independent from each other. There’s a lot of huckstering out there that burning fat and gaining muscle are somehow interlinked or “oppose” eachother such that while you do one, you automatically undo the other. But this is just as ridiculous as the constant lack of good information on nutrition.

A few days ago we had that article on how Vegan diet tends to have people eating garbage. This is again because eating healthy and avoiding eating X have nothing to do with one another, but in the marketing of things we equate veganism with uber healthy eating.

At any rate, we need a comprehensive explanation of how the body works at all stages, and how does nutrition and exercise impact the body at each of these stages. Once you enter ketosis for example, rules change. Something to consider.

Food for thought.

Maybe I'm misunderstanding this, but I honestly couldn't disagree more with the overall premise with regards to losing weight. Yes, nutrition is certainly vastly more complicated than the single data point calories provide, but the vast majority of people (myself included) will never, ever be able to ascertain that knowledge much less be able to interpret them in a way useful for their own health benefit.

For me, calorie counting was a revelation. I'd tried eating less and exercising more without much success, and then I read a simple explanation of calorie counting and realized the whole thing could be simplified into a simple math problem. If I just kept track of my inputs (food) and roughly knew my outputs I could control my weight. Once I focused on that I lost ~45lbs in a year.

The obese and overweight will see these headlines and keep eating 6,000 kcal/day thinking "See! It doesn't matter."

Anecdotal, but a few overweight people I've known have been terrible at estimating how much they eat.

Usually they'd skip over/forget very hefty 'snacks', or think a portion is a portion, while scooping up a small family's serving onto their plate.

The really sad thing is when they don't have a coping mechanism for sadness except for eating, which leads to them being sad over body image issues. It's a terribly vicious cycle.

> Anecdotal, but a few overweight people I've known have been terrible at estimating how much they eat.

That's pretty much the thrust of the article. Calorie counting works in theory, but evidently the average person finds it too hard to follow (either miscalculating, overestimating, forgetting to track or just giving up).

Less p-hacking would be a start.

I’ve lost weight multiple times using calorie counting. It’s literally the only thing that works for me.

A theory I've heard is that any kind of diet is useful for losing weight, because it forces you to think more carefully about what you're eating.

But ditto, I've lost 50lbs twice in my life and both times were basically just via calorie counting.

Likewise, in my adventures in power lifting and body building, I gained ~25-40 lbs on several occasions. The only way to do this reliably for me was to count calories.

Once you establish your basic metabolic rate, it simply works. Yes, it is a pain in the ass. Yes, it's a lot of effort and discipline.. but the results are predictable and reliable.


I eat 5000 calories worth of sawdust a day and can't gain weight.

Insoluble fiber is not included in calorie counts on nutritional labels.

As I understand it, what's actually subtracted from the calorie counts on nutritional labels is a very rough estimate of the number of calories that aren't actually available because they're stuff like insoluble fiber, based mostly on the type of food. So it's not necessarily that accurate.

What a lame strawman.

First off, that's not even food that would be digestible by a human. Secondly, reasonable people don't say all calories are equal, but that estimating TDEE + calories eaten is the best calculation to make for many people, in terms of accuracy vs effort required.

> that's not even food that would be digestible by a human

Well that's the point.

Obviously not all calories are equal. Nobody ever meant that literally. There are calories in diamonds, but you aren't likely to be able to digest them are you?

There are no calories in diamonds and I dont understand why you assume there are some.

The old method of calorie counting involved burning food and measuring temperature. You wont burn diamonds by same methods they used.

The one one involves counting carbs, protein and what not inside and then adding assumed calories from that. Again, diamonds return 0.

> There are no calories in diamonds

I'm afraid you're mistaken!

> I dont understand why you assume there are some

That's fine I'll explain for you. What happens when you burn a diamond? It releases energy exothermically. We can measure that energy in joules, or equivalently in calories, but it means exactly the same thing.

Diamonds contain calories.

That would be old way of determining calories which is not used anymore. Also, the method of burning food in that specific test wont burn diamonds.

That doesn't mean they aren't in there, just that you don't get them out using your experiment.

Which... is the whole point. Not all calories are equally accessible to digestion. That's the point in the first place. Of course a calorie is not just a calorie for the purposes of digestion. We know that, because we can't digest, for example, diamonds.

So, how do you address the other calorie counting method, the one that is actually used?

That doesn’t mean they don’t contain energy!

But..... that's the point..... if you measure in different ways you get different energy released and so different calories measured.

> There are calories in diamonds

Not in this context. A nutrition label for a 50 pound diamond would indicate zero calories.

But again... that's the point. Everyone already knew 'a calorie is a calorie' was not literally true - for example diamonds which you agree about.

People who say “a calorie is a calorie” clearly mean “calories from fats, carbs, and protein are interchangeable”, not “you can survive on a diet of diamonds”.

This seems so condescending. Maybe it wasn't their intent.

"But obtaining a mere $2m-$4m (£1.6m-£3m; €1.8m-€3.6m) for a nutrition study is a lifetime aspiration for most nutrition scientists".

If it's an accurate portrayal of their struggle compared to other scientists, then I don't see how it could be considered condescending. It seems sympathetic to me.

Why does that seem condescending?

CDCs entire "preventing global disease" division is $450M in funding.... For example.

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