There have been a couple of interesting conversations on the interwebz involving calories lately. I don’t normally pay attention to these things because I am so busy napping being, well, busy, but I am paying attention to these conversations because they are both starring–ME!!!
Let’s face it, the whole “only calories matter, period” vs. “calories, shmalories” debate tends to be an oversimplification on both sides. But, the truth is, only one of these sides has been the primary focus of many decades of unsuccessful public health nutrition intervention. In that regard, the “all you have to do to lose weight is make sure your calories out exceed your calories in” stance deserves to be questioned.
To this end, Adam Kosloff has gathered a useful compendium of calories in-calories out naysayers (including yours truly):
Then, a different Adam, does some naysaying about the naysayers:
While it would be fun to naysay all the naysaying about the naysayers, rather I will just address the part starring ME!!!
In reference to my scientific-y calorie calculations about how long it would take me to “disappear altogether,” Adam the Second had this to say:
“Yes, If she were to drop her calories in by 500 a day and increase her calories out by 500, she would lose a shit load of weight after 6 months.”
Um, no I wouldn’t. I would lose about 30 pounds, then I would begin to regain. Because that’s what happened to me in my real life. Oh wait, but it probably didn’t happen to me in real life because I was a fat person then, and everybody knows that fat people lie about how much they really eat, and because everyone knows that scientific-y calculations are more real than anybody’s actual life.
Adam the Second:
“She just has to remember that metabolism will vary over that time span, so her calories will also have to. This is due to the body naturally requiring less calories [sic] as a smaller vessel, and also the body will lower non exercise energy expenditure (general fidgeting, moving around etc).”
WHAT? My metabolism is going to change over time because I’ve changed my eating patterns? That’s in direct contradiction to the whole “calories in, calories out” premise. There are no differentiated calorie labels that say “This low-fat yogurt contains 250 calories for those of you who haven’t been on a diet for 6 months, BUT it contains 5,680 calories for those of you who have.”
Yes, in more sophisticated venues, calorie calculators for “energy out” change with weight, but the overall premise stays the same and leads to the same conclusion.
So if I weigh 205 pounds, walking at a moderate pace for an hour burns 307 calories. Once I diet & exercise down to 180 pounds, I can burn only 270 pounds doing that same amount of exercise. Which means that now I have to eat EVEN less and move EVEN more to continue to lose weight (regardless of how little I was eating or how much I was moving in order to get to 180 pounds in the first place)? When does the madness stop???
Lucky for you, dear reader, I will now demonstrate, due to the magic of calories, that the whole “eat less, move more” ad infinitum ad nauseum ad starvatium ad exhaustium does stop and in fact–this is the magic part–even reverses itself. All for the low low price of free.
Let’s take this whole calorie calculation/deficit/mumbo jumbo out for a “brisk pace” walk, shall we? One of the reasons I think that some folks are such diehard supporters of calories in-calories out, it that they’ve never actually been a fat person trying to navigate the terrain of the whole calorie-counting experience. So let’s hold hands & try it together.
Let’s say I’m a big fat newbie. Let’s say I’m a 35-year-old, 5’10” OBESE female who weighs 240 pounds (not my current age or weight, but that’s approximately where I started in my own weight loss journey). I already know that I need to “eat less and move more” in order to lose weight, because that’s what my doctor told me. I go to a trusted source, the Mayo Clinic, for guidance (for those of you who want to play along at home, here’s the Mayo Clinic calculator).
First I need to know how many calories I actually require (so I can reduce them). I start off with a estimated energy requirement for my activity level, which I will calculate as “inactive” (“never or rarely include physical activity in your day”), because we all know that the reason that fat people are fat in the first place is because they are lazy slugs.
My calorie needs as calculated by the Mayo Clinic, by way of the Harris Benedict Equation and the Dietary Reference Intakes, are: 1850 calories/day.
The Mayo Clinic says: “Weight loss comes down to burning more calories than you take in. You can do that by reducing extra calories from food and beverages, and increasing calories burned through physical activity.” They don’t provide any details about how to do this, but by consulting with the Academy of Nutrition and Dietetics, I find that “A negative energy balance is the most important factor affecting weight loss amount and rate” and that I can achieve this negative energy balance by decreasing my energy intake by about 500 calories/day or increasing my activity by about 500 calories/day–or doing both. Since “adipose tissue, which is mostly fat, contains about 3500 kcals/pound,” if I create a negative energy balance of 1000 calories/day, I’m 7000 calories down–or 2 pounds worth of fat–over the course of a week.
So here goes. I’m going to subtract 500 calories from my Mayo calculation (close your eyes, it’s a mathy part) in order to figure out that I should be eating: 1350 calories/day.
Okay, let’s say I add 500 calories of activity to my day. Using the handy-dandy chart below (also from the Mayo Clinic), I find have to walk for 1 hour and 45 minutes in order to burn 533 calories.
I am now at a caloric deficit of (at least) 1000 calories/day, which according to the super-duper magical 3500 calories = 1 pound of fat formula (Zoe Harcome explores the rigorous scientifically-proven assumptions behind the formula here) means I lose about 2 pounds a week. Not that this would always happen in real life, but okay, fine. Flash forward 5 months, I’m down 40 pounds. I now weigh 200 pounds. At 200 pounds I am no longer OBESE, I’m just OVERWEIGHT, but I still have more weight to lose. Because my body is naturally going to “require less calories [sic]” because it is a “smaller vessel,” it is time to recalculate my energy needs. To the Mayo Clinic calculator, Boy Wonder!
(What happened in my own real life when I dieted and exercised my way from 215 pounds to about 185 is that, not only did my weight loss stall, but I started to regain lost weight. Or at least, that’s what would have been happening to me if I hadn’t been lying about it to myself and my hunger and exhaustion weren’t complete figments of my feeble imagination, while in reality I stuffed my face with HoHos and laid around on the couch watching The Young and the Restless).
According to the “smaller vessel” theory, I should require fewer calories, but if I fill out the calculator–WTF??– I end up with more?
I weigh 40 pounds less, and I get to eat 200 more calories/day? I don’t get it, but the Mayo Clinic is a trusted source and I’m just a newbie, so on we go. I subtract my 500 calories/day so I can lose weight, now I am eating: 1550 calories/day
Okay, 1550 calories/day is not a lot, but it’s more than 1350 calories/day I was eating before.* I’m not sure why this is, but I’ll take it, because–even though I am a “smaller vessel”–clearly there must be some calorie magic at work. But while I may be able to eat (a little) more, on the other hand, now I have to exercise even more because my ability to burn calories has decreased (see chart below). Now I have to walk for 2 full hours each day in order to get my 500 calories out.
Following the magic 3500 calories calculation that exists in our magical perfect world, we can flash forward another 5 months. I now weigh 160 pounds, my goal weight. I am now no longer OBESE or even OVERWEIGHT, but thankfully, NORMAL.
But, being NORMAL, I am also now an even smaller “smaller vessel,” and because “the body will lower non exercise energy expenditure (general fidgeting, moving around etc),” it’s time to recalculate. This is really scary because if I could only eat 1850 calories/day as an inactive OBESE 240-pounder, will I even be allowed to eat at all now that I weigh 160 pounds? Will I have to exercise half the day away in order to be able to “afford” the calories in a low-fat bran muffin?
Oh, I can hardly stand the–wait! Hmmm. Now hold on just a hot second here.
I can see by the calculator that at 160 pounds, I could be inactive and eat 1800 calories/day.
OH THANK YOU CHEESESAUCE!
Because I’ve been eating 1550 calories a day and walking for 2 hours every day, and I am FREAKIN TIRED AND HUNGRY and sick of spending 14 hours a week walking around and getting nowhere.
According to the magic of “calories in, calories out,” I can now eat (even) MORE and move (a lot) LESS and I will NOT gain weight. No matter what I eat–as long as I consume no more than 1800 calories/day, I can sit on my (now slender) ass all day long and never gain an ounce.
HOORAY for CALORIES!!!!
P.S. If you are by any chance wondering why an OBESE inactive female who weighs 240 pounds is only supposed to be eating 50 calories more a day (a 7.7 calorie/pound allotment) than a NORMAL weight inactive female who weighs 80 pounds less (an 11.3 calorie/pound allotment), that’s because NORMAL weight people are more honest and virtuous than OBESE people and therefore deserve more calories per pound body weight.
P.P.S. Dear Adam the Second should you happen by to read this. Not trying to pick a fight. Just trying to illustrate how the calories in-calories out principle–put to work in a real-life example–may be an overly simplistic (if not downright illogical) approach to weight loss for some folks. Hey, if it works for you & your buddies, great! But it doesn’t work for everyone, and the use of this paradigm as the foundation for public health nutrition practice has changed how we think about eating in ways that I would argue have done more harm than good.
P.P. P.S. For more snarkily outraged, or outrageously snarky, commentary on calories, try these calorie-free nuggets of wiseassedness:
Calories in, calories out, Would You Please Go Now?
*This is where calories in-calories out folks sometimes like to say “But you may have needed more calories. If you cut your calories too much [whatever that means], you’ll crash your metabolism.” I don’t know. They may be right. But that’s not how the calories paradigm works. There are no “metabolism crashing” exceptions on the Mayo Clinic calculator.
Eathropology 
Hi Adele,
I just translated my free book into English language. I hope you like it.
https://novuelvoaengordar.com/libro/
Thanks so much for the link to your book! I look forward to checking it out.
I don’t get what this article is supposed to say other than that the calculator used in the example is erroneous. Is that the idea? Because it sure seems like you use a flawed calculator to somehow “prove” that cico is nonsense. How about using a functioning calculator instead?
http://www.calculator.net/calorie-calculator.html
http://scoobysworkshop.com/calorie-calculator/
http://www.freedieting.com/tools/calorie_calculator.htm
Testing your example with those three, all of them spit out the same logical results, with these taken from the first one (using your numbers):
At 240lbs: You need 2,237 Calories/day to maintain your weight
At 200lbs: You need 2,019 Calories/day to maintain your weight.
At 160lbs: You need 1,801 Calories/day to maintain your weight.
I wasn’t attempting to prove that cico is “nonsense” because I don’t think it is”non” sense. It’s more like “not-so-much” sense. How was I supposed to know the calculator was flawed? Do you really think I tested all the calorie counters all over the interwebz of creation until I found a broken one? No, I did what anyone trying to manage their diet in this day and age of eat-less-move-more would do. I googled calorie counter, I came up with the Mayo clinic’s calculator (a trusted source, yes?) and I set to work. There’s a big difference between what might work in theory, what might work under controlled conditions, and what works as public health practice. As public health practice, cico–aside from whether it works in theory or works under controlled conditions–does not seem to have worked as public health nutrition guidance. The fact that the Mayo clinic’s calculator (MAYO CLINIC) spits out warped calculations is but a small, although to me highly amusing, aspect of this lack of effectiveness.
Small aspect? Your entire article is based on it! Sure, one needs to be blind to not realize your stance on cico, which I guess is why you didn’t do what I would expect most people to do in this situation, which is try out a second calculator in order to confirm or disconfirm whether it was the first calculator that was erroneous or not. I mean, your instincts were correct – what you encountered didn’t make sense to you. So it seems that due to your preconceived notion towards cico, you just went with it, happy to have found new ammunition to battle cico, instead of going with the more logical approach. And it’s not even that the calculator is “a little off”, but it actually does the exact opposite of what it should do. Many calculators use different formulas and arrive at different results (obviously, since any calculator is only ballparking this and narrowing down TDEE is individual work over weeks of meticulous tracking), but going UP in calories when going DOWN in totall mass without accounting for body composition just screams “maybe I should try another calculator just to double-check”. And hey, I just don’t buy that someone this experienced in the matter and this knowledgeable on the topic would just accept this without questioning it, but be able to write a comprehensive article to ridicule it.
I absolutely agree that the real world and “controlled conditions” can differ greatly and having used both a ketogenic/low carb approach with great success to halve bodyfat as well as a meticulous calorie counting approach to cut towards single-digits and maintain weight, I certainly know both sides of the spectrum, which in my opinion makes it all the more important, that information we give out on either side is based on proper information, not some joke article that’s more looking to establish that the Mayo Clinic is a bunch of incompetent people by being as sarcastic as possible.
After all, if this was just a small aspect, re-do the article with a proper calculator. Unless you can’t, which then would raise the question whether it really was just that small of an aspect, or whether it was just what you were looking for.
Hmmm. My point was that the Mayo Clinic is a responsible and trustworthy source–not incompetent. And my stance–assuming you actually read the article–is that I was approaching this effort as a “big fat newbie” not someone who was experienced in these matters.
But really, I think this says it all: “narrowing down TDEE is individual work over weeks of meticulous tracking.” Because this is what I–and most of the rest of America I’m sure–want to do with our lives. Now, thanks to the no-doubt highly accurate and helpful tools that you’ve provided, we can spend every waking moment “meticulously tracking”–not to mention agonizing over–how many calories are going which way. Whew. Thanks.
I’m confused. You fill out the calculator the first time, you’re 240 lbs and inactive (which is likely why you’re 240 lbs) and it tells you that your requirements are 1850 calories a day. You cut 500 calories from this number and add enough activity to burn 500 calories, right?
After 5 months of walking an hour and forty minutes a day at 1350 calories you’re down to 200 pounds and you run through the calculator again. Why are you listing yourself as inactive again? You just got done saying that at your current weight it would take TWO HOURS of walking a day to burn the 500 calories. Two hours of activity a day is NOT being inactive, in fact it fits perfectly into the calculator’s specific definition of “active”. When you fill in the calculator as a 200lbs actve woman It tells you that you need 2450 calories a day, NOT 2050. Drop 500 from that and you’re now taking in 1550 calories a day, which makes sense as you need more fuel now that you’re being more active.
So where are you getting this notion that the smaller vessel theory means that you just keep cutting calories? The smaller vessel theory means that for the same level of activity, a smaller person requires less calories; but if you start out doing nothing, and move into two hours of fitness daily, that’s NOT the same level of activity.
Can you explain where you’re getting your reasoning from? It seems like you’re correct, calories don’t matter, but only if you fail to accurately report your own activity levels which according to this article, you did. Maybe I’m not understanding part of your argument.
“After 5 months of walking an hour and forty minutes a day at 1350 calories you’re down to 200 pounds and you run through the calculator again. Why are you listing yourself as inactive again?” This is a good question. I was quite torn about this during my own weight loss period, way back when. I didn’t include my waffling about this issue in the blog post as it was long enough already.
I’m not the one promoting the “smaller vessel” theory that indicates that if I am a smaller person I need fewer calories. That was some CICO broscientist, who also indicated that (because I was eating less) I would have less spontaneous movement & thus would require fewer calories. Plus, I would now need MORE activity in order to burn the same amount of calories, which the activity charts seem to confirm. So he was saying, since I’ve lost weight (by eating less and moving more), I now need to adjust my calorie intake downward to account for my “smaller vessel,” while you are saying, because I’m moving more (as part of the eating less and moving more package), I now need to adjust my calorie intake upward (which is what would effectively happen if I did as you suggest). So, do I need less “fuel” because I’m now a smaller person, or more “fuel” because I’m more active? Are you saying that if I’d eaten more calories, I would have lost more weight? 🙂
Yeah, I sort of get why you might not be understanding part of my argument. Maybe because it doesn’t make a lot of sense? I’ve nowhere in this post (or elsewhere for that matter) said that “calories don’t matter.” I’m simply trying to demonstrate that we’ve given the public a particular paradigm to work with that can be confusing, contradictory, and–for some–ineffective.
Terrific post Adele. And I’ve enjoyed the comments enormously too.
I’m at my wit’s end with CICO and blame. I’ve been having an on-going discussion with a wonderful friend who is currently coaching me through knee replacement recovery. She’s a naturally thin person. I’m a naturally fat person who’s managed to stay within the societal bounds of “reasonableness” (i.e. “oh, you’re not fat–yeah, well, check out my admittedly stupid BMI) mainly, I would say, by not having spent my whole life yo-yo dieting and having found and implemented the basic tenets of intuitive eating.
OK, so much for background.
My friend’s sister also had a knee replacement last year. She’s doing really well, but she’ll need the other knee done eventually. My friend is always lamenting how, in the final analysis, it’s her sister’s fault. She’s fat. She eats too much. It all comes down to personal responsibility.
There doesn’t seem to be any middle ground between personal responsibility and the fact that, let’s face it, if you’re fat you’ve got to watch every single thing that goes in your mouth and even if you do, if you’re lucky you’ll end up like me (“you’re not fat”, even though I am) and not like my friend’s sister.
I feel I’m rambling, but I just don’t know what to say or think anymore. If you scratch below the surface, even the nice, “enlightened” people will always end up blaming the individual fat person for being fat. It always comes down to CICO for them.
BTW, many years ago, on the advice of my homeopath, I entirely cut out sugar. I religiously read labels and didn’t let any sugar pass my lips for several months. I gained weight and felt angry and frustrated.
As far as paleo goes, I just can’t get past the “good food/bad food” dichotomy. I don’t eat a loaf of bread a day, but if you told me that not a morsel of bread would ever pass my lips again, we’d probably have a murder-suicide on our hands. So I live with being “acceptably fat”.
Thanks so much for sharing. Having seen many sides of this issue (success/failure with CICO; success/failure with low-carb; healthy obese people; unhealthy thin people & all sorts of disordered eating/exercise and exercise/food fanaticism), I keep coming back to this. The first & most important reason that we eat food is because food provides our body with things that it needs from the environment that it can’t make on its own. So any conversation about food must first be a conversation about essential nutrition. Not weight, and certainly not prevention of chronic disease. Then, we have to remember that food is also about culture, family, economics, time use, social relationships, pleasure, nostalgia, politics, religion, you name it. There is little in our lives that food doesn’t intersect with in some way. Disregarding these aspects of food and eating makes no sense when trying to figure out what way of eating is going to work for any given individual.
In that regard, I think the intuitive eating approach makes a lot of sense, although I would place “intuition” after “essential nutrition.” And the reason I say this is because when our bodies seem to “crave” something, we may interpret those signals in a way that matches expectations/preferences from elsewhere besides our biology 🙂 But all that means is feed yourself adequate essential nutrition first & whatever your intuition guides you to after that. Essential nutrition is pretty easy: a decent serving of protein ( maybe a little more if it is plant-based) at every meal, colorful veggies for micronutrients (or a multivitamin if you hate veggies); and essential fatty acids from your preferred source (you don’t need much, but you do need some). That’s it. Then eat whatever else moves you.
Body size is not a marker of health (despite what Walter Willett would say); your own sense of your health is your best marker. If you feel tired, achy, bloated & burbly, hungry, distracted by food, etc.–then you might actually have a food-related health issue. But as far as I’m concerned, body size is not by definition a food-related health issue. Weight loss should be a side-effect (if you can call it that) of a reasonable way of eating, not its goal, because not everyone who eats a nutritionally-adequate diet within some “appropriate” (whatever that means) limits of energy intake will lose weight, even if they otherwise feel great.
As far as I’m concerned, the good food/bad food dichotomy is one of the most insidious effects of the Dietary Guidelines. When I was growing up, we had few “food rules”–sugar will rot your teeth, don’t swim after eating, and don’t fix yourself a snack before dinner–which we routinely violated. The only good food/bad food dichotomy was this: If Kim’s mom’s cooked it, it was “good food.” If my mom cooked it, it was probably “bad food,” especially if it was something she called “New England Boiled Dinner.” (I love my mom. She’s a smart cookie, just a lousy cook.) Food was just food. I’m not sure how to reclaim that idea, or if it is even possible or worthwhile. (I know that there is an “eat the food” movement, but my experience with it is that there are just as many rules about “eating the food” as there are about “not eating the food,” and anybody who doesn’t “eat the food” according to the rules gets collectively diagnosed with an “eating disorder.” Weirdness.) What if we just ate the food that we needed to nourish our bodies, plus the food we feel like eating, minus the food we don’t feel like eating (or the food that gives us gas or heartburn or whatever)–and then just went about our business?
208 seems to be where the magic happens with the Mayo Clinic calculator.
At 209 lbs – 1750 calories, but if you can dehydrate yourself down one more pound,
at 208 lbs – 2050 calories!
This is messed up! And the Mayo numbers seem more like BMR (Basal Metabolic Rate) numbers than regular living, even sedentary. Plus they do not agree with any of the other online calorie calculators I tried with the same body parameters.
I think the Harris-Benedict equation should give you a nice linear graph, and the other online calculators seem to bear this out. I think the Mayo clinic’s calculator is incorrectly coded, doing some improper rounding somewhere leading to the discontinuities.
You may be correct in all of that, but bottom line: “This is messed up.” 🙂
So your response is basically, “I dieted like a moron and I want to be able to eat without consequences.”
” If you are trying (accurately or not) to fulfill the requirements of calories in-calories out, AND YOU CAN’T LOSE WEIGHT, then that approach doesn’t work. ”
No, it means you aren’t doing it right. How can you possibly dismiss accuracy? Studies have shown that people routinely misrecord their intake by about 50%. That isn’t a problem with the measuring, it means you need to learn how to measure accurately. Imagine if this way of thinking were applied to science experiments. “Sorry, the needed measurements are too hard to get right. Science must not work as an approach.”
Metabolic Ward studies going back to the 1930s have show categorically that calories are it.
Hmmm. There’s a lot of judgement in that statement. “I dieted like a moron and I want to be able to eat without consequences.”
I dieted like I was told to, which may truly have been moronic in retrospect given the amount of success CICO has had as a public health intervention. I want to be able to eat without “consequences”? Not sure what that means. I do expect to be able to eat without math, however.
Ah, thanks so much for supplying the magic words: “No, it means you aren’t doing it right.” Usually I have to dig around through MyFitnessPal forums to find this special line, but now I have my very own! This line is very useful when demonstrating that government endorsement of the CICO paradigm has reinforced the position of experts (or random internet trolls) who “doing our knowing for us.” Beautiful. Can’t thank you enough.
“Sorry, the needed measurements are too hard to get right. Science must not work as an approach.” Hmmm. Doesn’t mean science does not work in general. But science doesn’t “work” when we acknowledge that people can’t seem to get their diet reporting done accurately (which you’ve done), but we nevertheless insist on using reports that are considered highly inaccurate to create public health nutrition policy, including the one that says that we need to “eat less and move more” in order to manage weight. We can’t have it both ways.
Some measurements are too difficult to obtain (especially in large-scale studies) to reach conclusion that are consistent and conclusive enough for the creation of public health nutrition policy regarding the prevention of chronic disease. This is a problem that had dogged nutrition epidemiology from the very beginning & has yet to be resolved.
For every diet study (and diet expert) there is an equal and opposite study/expert. I would never discount the ability of a low-calorie diet to cause weight loss. It often does. When calories are reduced, carbohydrate is often reduced as well. Unless these two factors are teased apart in a very well-designed/controlled study, we don’t really have the assurance that “calories are it” now do we?
Interesting you should employ the word Useful
Great post! I love your sarcastic wit. It reminds me of ME! I believe someday soon we will all hear a very loud sucking sound followed by a massive POP. This will be the sound of the “experts” finally removing their heads from their hindquarters. As long as we have people such as yourself to jump up and smack conventional wisdom in the noggin, that is.
On a side note I did notice one small discrepancy in the paragraph just below the “calories burned walking” chart. You seem to have used the word “pounds” in place of the word “calories” in a couple places. Such as “So if I weigh 205 pounds, walking at a moderate pace for an hour burns 307 pounds.” I was able to understand what you meant but you need to correct it so the “experts” can understand it as well. You know how they are.
Keep up the great work!
Thanks! The proofreading fairy has apparently joined the vacuuming fairy in her strike and is refusing to cross the picket line . . .
I was wondering where you had gone; I’m glad to see you’re back posting again. I too am bemused by the “eat less and move more” brigade, especially since I just watched the HBO documentary The Weight Of The Nation, which uses calories in = calories out rationale for a lot of its advice on how to lose weight. And (AFAIC) it committed a true faux pas by having overweight doctors tell me this. While some of the physicians and other talking heads were slim people, others plainly had their own issues with CICO. But “Do as I say, not as I do” has always been a good fallback position for the holier-than-thou, hasn’t it?
Of course, we are up against Marion Nestle, so we don’t have a chance. 🙂 Some time I would dearly love to be able to tell her that I lost 35 pounds of fat AND gained muscle mass at the same time by eating more calories…it just happened that those calories didn’t contain any grains. (And especially…no wheat, which is what started the whole journey. I had to figure that out on my own, no thanks to well-meaning allopaths who totally missed the boat on me for decades.)
I hope you are able to find the time to post more often; I enjoy your articles.
Thanks for the kind words! I’d love to post more often, but my PhD program is kicking my butt most of the time. Trying to do more this summer while I have time, but we’ll see . . .
As for the experts who seem to be failing at CICO, this is a topic that fascinates me. How is it that the most expert among us cannot succeed at this whole “weight management” endeavor & yet the rest of us “just folks” are supposed to do better? Not that I agree with everything Sullum has to say, but he ran into some interesting responses when he questioned why obesity policy expert Kelly Brownell (formerly of Yale, now at Duke) seems to himself be obese. If you haven’t run across the little dust-up between Sullum and Brownell, it’s worth checking out.
I just sat through HBO’s The Weight of the Nation and Brownell was the one who really got to me because he was such an obvious example of “Do as I say, not as I do”. Meanwhile, in the Extras disc there was a feature on the biology of losing weight that was classic CICO and it had both me and my wife tearing at our hair in frustration, especially at the end when they were talking about one of the subjects in their calorie restricted diet trial and they said things like “XXX will have a terrible time when she gets back into the real world – we know that almost nobody keeps weight off and it’s just going to be so hard for her.” Implication: failure. I was thinking “Thanks, guys – you are so supportive”. I wish I could remember the researcher’s name because he’s such a good violator of the “First, do no harm” concept. While a low carb diet doesn’t (apparently, anyway) work for everybody, I would have liked to see her try that as an option. It certainly works for some people, at least if I count as a person.
And as far as the troll who keeps coming here to pee on your lamppost goes, you’re doing exactly the right thing by ignoring her.
Good luck with your PhD (the classic example of delayed reinforcement, if not intermittent reinforcement, LOL) but I hope you are able to post from time to time.
“XXX will have a terrible time when she gets back into the real world – we know that almost nobody keeps weight off and it’s just going to be so hard for her.” This is an excellent example of why I’ve taken weight loss “off the table” as an outcome when I give nutrition guidance. If you make a change your diet so that you can just eat some food, be well-nourished, feel well (energy, satiety, etc.) , and go on about your life and you don’t lose weight, well, you can go on about your life, right? (And if you lose some weight, well, that’s fine too.) But if you change your diet, feel like crap, spend your time doing stuff you don’t want to do (counting food components and calories in/out), and you lose weight–and then regain it as soon as you start having a life again–that’s one step up and two steps back. We have known for some time that dieting is positively associated with weight gain and obesity, and there is evidence that repeated dieting is worse for long-term health than overweight/obesity. The heaviest folks we saw in clinic were the ones with decades of dieting experience, usually since adolescence, but some from childhood. You are so right: “First, do no harm.”
BTW, all of the images of those overweight academics mentioned in the post you linked to have been removed. I think somebody hit a nerve.
I’m sure KB was not pleased. But then, all you have to do is google “Kelly Brownell” images . . .
I’m not sure how helpful it is to point to someone else’s body shape and say “you can’t give advice on obesity because you are obese.” The speaker may, in fact, have some insight into the issue for just this reason. But if that’s the case, that person should be open and honest about his/her fatness and share whatever insights that might be available to him/her as a result. Brownell seems to want to ignore his own fatness–I see his rhetoric as one where he uses the collective obesity of America, which belongs to no one person, as a sort of camouflage for his own body shape–and focus on the responsibility of government and industry in preventing obesity, rather than that of the individual. I get all that, but the CICO model by definition ultimately lays the blame for obesity on the individual, and the “make the healthy choice the easy choice” approach suggests that body size says something about a person’s ability/desire to maintain his/her individual health. So Brownell’s presence in the discussion suggests that he–apparently a really smart and capable guy otherwise–needs help making “healthy choices” that he otherwise can’t or won’t make. If he won’t make the “eat less move more” choices he “should” be making, he’s just asserting the agency that I think most of us feel we should have over our own lives. If he can’t make those choices, maybe he’s not as capable as he seems or maybe he really is “addicted” to food the way one might be addicted to cigarettes. If Brownell is convinced that food “addiction” is a real thing (which it might be), he needs to push to have this addressed this scientifically first and stay away from making sweeping policy proclamations until after addictive mechanisms have been established. This is how the case against Big Tobacco was built. But Brownell has identified a spectrum of foods–“fatty” foods, sugary foods, and “junk” foods–as problematic, with no clear rationale as to why some foods might be taxed and others not. If Brownell thinks “food addiction” is the problem–and he was straightforward about his own body size–at the very least he could suggest policy changes that would help him out personally by taxing the foods that he thinks he’s addicted to–and we could see how that works, right? 🙂
“This is an excellent example of why I’ve taken weight loss “off the table” as an outcome when I give nutrition guidance.”
To be fair, in the case of XXX, she had come to the researcher (whose name I really wish I could remember – I believe the feature said he was one of the ones involved in the discovery of leptin, so this is fairly high level stuff) specifically because of the study he was running on losing weight. I think it would be very hard for any physician to refuse service to someone who is double her own healthy body weight, and she was certainly responding in good faith to the call for subjects. So when someone comes to you specifically wanting help with that (and when the someone is that overweight) I think it would be awfully hard to “take weight off the table”; I mean, at that point weight isn’t *on* the table, it *is* the table. And she did lose something like 40 or 50 pounds on a calorically restricted diet. But the doctor could not look outside of his fixation with calorie-restricted diets to propose anything beyond simply turning the woman loose once the study was over; to me, that’s beyond cold. And to tell her that she was probably not going to have a successful outcome…well, that says a lot about his own confidence in his approach, doesn’t it?
The program does single out sugar, and it mentions starchy carbs, but it seemed to me to go out of its way to stigmatize fat. So some of the ideas have gotten through, but not enough of them. As long as people still think eating fat will make you fat…well, I guess they will get fat.
A study situation and a clinical response are, yes, two different things. But the focus in clinical situations (even with low-carb docs) is frequently weight loss, rather than health. I can’t, in good conscience, counsel for the former if I feel it will hinder, rather than help, the latter. I’m not opposed to weight loss at all. But it must be in the context of a livable life and overall well-being. For me that means prioritizing essential nutrition and daily functionality ahead of numbers on a scale or chart.
Sorry about the flurry of posts, but I did some research and the doctor I was referring to in the feature is Dr. Rudolph Leibel. He himself is not overweight, so his patients probably tell themselves “Hey, it works for him” and then feel awful if it doesn’t work for them…something that he seems to predict in the feature. Once again, the implication is that these people are somehow guilty because they can’t control themselves. Bad dog! Bad dog! But it’s always better to figure out why the dog is misbehaving and then treat the cause than to try to treat the symptom, isn’t it?
Couldn’t agree more.
Along the lines of “do what I say …” I wanted to mention a TV show I saw a while back. I was flipping channels one night and came across “My 600-Pound Life” on Lifetime or some cable channel. This poor woman was like 606 pounds and wanted bypass surgery, but the surgeon wouldn’t perform it unless she was 600 pounds (like 6 pounds would make a difference, but he had his rules).
The surgeon recommended this doctor who works with the morbidly obese. He was very full of himself (and naturally lean). He “guaranteed” she would lose weight on his plan. Hey, he even had a guarantee printed up and hung on his wall in a gold frame. What more proof do you need?
So, he put her on a diet. A couple months later they took her to the hospital again for a weigh-in. The doc was expecting her to be around 550 (loss of around 56 pounds), but she ended up being 667 pound (a gain of 61 pounds in 2 months). He couldn’t believe it, had them recalibrate the scale, but no, she weighed 667.
Turns out she was asking neighbors to bring her food during the day when her daughters were not home. But why didn’t this trigger something for the doctor? How could she have gained so much in 2 months? Surely this isn’t CICO. This woman’s system was severely messed up.
So, back on the diet she went. That’s when a few details of the diet came to light. That doctor had put her on just 700 calories a day! You never saw what her lunch and dinner were, but the breakfast they showed was carb-heavy and consisted of instant oatmeal, skim milk, and orange juice.
She died a few months later.
This has bothered me ever since. Why the drastic diet of 700 calories a day? Anyone who has tried such a low-calorie diet knows it’s doomed to failure, that you’re ravenous all the time. Why not put her on a 2000-calorie diet? Or even 1500 calories, and include some protein and fat? Wean her down slowly, let her lose weight more slowly while still eating enough so that she didn’t feel compelled to have food snuck into her house.
It seems to me this woman died because of the vanity of a quack doctor whose reputation meant more to him than helping this poor woman. He said he would do “anything” to get her to lose weight, but it was for himself, not for her.
What a sad story. Yes, it sounds like vanity and ego on the doctor’s part, but I’m afraid this is much of what keeps RDs and MDs in the mindset of “You’re not doing it right.” And clearly this woman was “cheating” on her doctor’s diet, but who wouldn’t? This is where our thinking about CICO really messes us up. Doing my internship, I worked with a dietitian who told me, in all seriousness, that as people get fatter, they become more manipulative. That’s how they get people to cook or bring them food when they have mobility issues due to their weight. Now, it is a family joke (“Darling, I’ve put on a few pounds, so my Vulcan mind control has really kicked up a notch”) but at the time, I had to go to the bathroom to cry because I was so angry and upset.
I would love for all nutrition professionals to repeat after me:
–If a patient doesn’t lose weight on a prescribed diet, maybe it’s the wrong diet.
–If a patient “cheats” on a prescribed diet, maybe it’s the wrong diet.
–If a patient is hungry and tired on a prescribed diet, maybe it’s the wrong diet.
–If a patient couldn’t happily follow this diet for an indefinite period of time, maybe it’s the wrong diet.
And finally:
–My job is to ensure that a patient is adequately nourished in a way that allows him/her to pursue life activities with energy and a sense of well-being. It is not my job to determine what body size is appropriate for that individual.
Now I understand that the woman that you’re referring to was obese in a way that interfered with her pursuing her life activities. But she’s still a person who deserves not to feel starved. I don’t understand why we think it is appalling for little children to go to bed hungry, but for a fat person, it is perfectly acceptable. There’s a great deal of moral judgement involved in that perspective (“you got yourself fat, now you deserve to starve”? how is that okay?), and yes, it often comes from those “born at the finish line.”
I can’t even begin to tell you how much I LOVE you. You say what I want to say and if I had a audience I would. Your information is humorous and honest. Thank you. Sincerely – the fat lady who “lies” about eating so little and losing nothing, all so she can be called a liar, while eating those gut-busting 800 calories a day.
Thanks so much! One day, all of us lying old fat ladies need to get together and beat the crap out of Michael Pollan with our over-sized handbags. I still resent that he made it okay to call fat old ladies liars. This is from his oft-quoted article, Unhappy Meals:
Yeah, I got one of those freaky metabolisms. How bout you?
Pollan also said that gluten sensitivity is a “social contagion”. ( http://www.stuffed-pepper.com/gluten-sensitivity-is-not-a-social-contagion-here-are-the-facts/ ) As one of those “contagious” people, I really resent that remark.
Ah the gluten thing. Makes me feel like I’m back in middle school with this crap.
In clinic, I was privileged to witness a stunning remission of schizophrenia in a patient after beginning a low-carb (also very low in gluten) diet. So, yeah, does everyone need to be gluten-free? No. Can some folks benefit from it? Well. Yes. Do we have a good way of knowing which person is which? No we don’t, but then we know a lot less about diet-disease relationships in general than we like to let on.
Brilliant and devastating analysis, per usual! Maybe the Mayo Clinic will change its calculator now 🙂
Thanks! But ADAM, calories are MAGIC!!!
broscience simply does not account for the mature female body. i always wonder why fat middle-aged women WANT to take their advice?
Yes. And this is what I would often see on those fitness app forums–somebody with the profile pix of a skinny young little white (always white, don’t ask me why) dude, berating someone with the profile pix of a much older, overweight/obese woman for thinking she’s a “special snowflake” when calorie in-calories out doesn’t seem to be working for her. Bleh.
There are mathematical models online using the calorie approach, they reliably show that an initial deficit of 500 calories a day does not deliver a weight loss of 1 pound a week. Your body turns various functions down or off when it figures you’re short of food, so the calories out declines simply because you’re dieting – without even losing any weight.
But that would contradict some of the calories in-calories out fundamental assertions, namely that 3500 of calories out = 1 pound of body fat off, and that what you eat (or don’t eat) only affects the calorie-in part of the equation, not the calories-out. C’mon. We can’t have heresy like that being tossed about.
Here’s what I said about this in one of those other calorie-yammering posts: “It is crucial to remember that our bodies not really designed to either “gain” or “lose” weight, but to respond to our environment by small shifts– up-regulating and down-regulating—the production of proteins, enzymes, and other biomolecules to meet the pressures of the environment. We are adapted to adapt. Food is one of the primary signals our bodies get about our environment. Food lets the body know what the conditions are like “out there” so that we can make appropriate adjustments “in here.” These adjustments, we know now, can be passed on from one generation to the next, so that our offspring are also prepared for what is “out there.”
If our body thinks that we are running as fast as we can to get away from a flood that has wiped out most of our food supply, it may take it upon itself to adjust accordingly.
Love it.
Thanks 🙂
Whenever I see a new email notification of a post from you, I get a big smile on my face. This post is no exception.
You’ve clearly laid out the problems here. I’d love to hear how the Mayo Clinic would explain away the your examples.
Before I began low-carb eating around 1998, I had a summer in which I ate no more than 1000 calories a day (less than 10% fat) and did strenuous 1-hour step aerobics workouts 4 to 5 times a week. Over the course of about 4 months, I gained 20 pounds. Everyone told me that was impossible, and yet I lived it.
Thanks for yet another great post!!!
Thanks for the kind words! I wrote a paper on fitness/nutrition apps last semester and stories like yours on the app forums would get these awful nasty “Oh, you must be a special snowflake to break the laws of thermodynamics like that” type of reactions, accompanied by demands to “show us the data” of your diet/activity. Not only is this sort of stuff just insulting, it misses the point. If you are trying (accurately or not) to fulfill the requirements of calories in-calories out, AND YOU CAN’T LOSE WEIGHT, then that approach doesn’t work. Period. Never mind that for some of us, a diet of 1200 (or less) low-fat, high carb calories plus a couple hours of aerobics may result–immediately or ultimately–in weight gain even when we are anal-retentively counting those damn calories. Thanks for sharing your story!
I actually made an appointment with my doctor at the time about the weight gain, and even showed him a detailed journal of my eating and workout regimen. He gave it only the slightest glance and said something to the effect of, “Well, we all overeat from time to time. When you do, just up the exercise a bit.” This is a guy who is very tall and very lean, always has been, and is a runner. He’s one of those who (according to Tom Naughton) “was born on the metabolic finish line and thinks he’s won the race.”
LOL. Sounds like my story too. My (very young, very thin) doctor had the same response. To this day, I believe I have secured my place in a blissful hereafter because I was very HUNGRY and did not pulverize him and put him on a sandwich.
I used to weigh my food, calculate the calories and macronutrients, using labels and nutrition data from the USDA. I knew exactly what I was eating, down to the ounce. To the calorie. I counted every single bit of food or drink that went into my mouth, including chewing gum (5 Kcals) and vinegar (0.000000001 Kcals). I recorded my exercise, erring on the conservative side of whether it was “moderate” or “intense.” According to my DETAILED records and the best science could offer, I *should have* been losing 2-3 pounds a week. Actual loss: 0 pounds a week. I did this for YEARS. Years of my life I should have spent on different concerns.
CICO can kiss my ass. To paraphrase Dr. Lazarus* from 1981’s Outland, “I’m FAT, I’m not STUPID.”
*An overlooked gem of a performance. She was brilliant as the cynical, grouchy scientist, playing a role not often given to women.
knewman2013: apparently we go to the same doctor.
This: “Years of my life I should have spent on different concerns.” The worst outcome of the CICO, low-fat paradigm is this. I don’t regret much, but I do regret every hour I wasted doing exactly what you describe. Thanks for the great response!
Ginger, not only must we go to the same doctor, we seem to be living the same life. I’m always using that line from Outlander! “I’m unpleasant. I’m not stupid.” Brilliant!
I neglected to mention that the doctor offered me a referral to see a nutritionist about how to eat to lose weight. Know what she said? Eat the same things every day. For example, she wanted me to eat toast and orange juice for breakfast, a baloney sandwich, an apple, and a glass of skim milk every day for lunch, and chicken breast and a salad (no dressing) for dinner.
He recently made the offer again after I mentioned that I’m again gaining for no reason. I told him I eat 2 eggs, sometimes with sausage or bacon, for breakfast, an avocado or berries as a snack, leftover meat and veggies for lunch, and a protein and veggies for dinner. I don’t eat processed foods and stay away from grains, sugar, and starch. Seriously, what is the nutritionist going to tell me?
Ack! The dreaded chicken breast (skinless? of course) for dinner. Yuhhhhkkk.
What is a nutritionist going tell you? This nutritionist would tell you that if you’re eating in a way that makes you feel healthy and energetic throughout your day & (as Gingerzini pointed out) let’s you do something besides agonize over every bite, you’re doing exactly what you should be doing, weight be damned.