Not Just Science: Nutrition & Politics

Now that food–along with religion and politics–has joined the list of things you don’t talk about with friends, I thought I’d do my post-Election day best to offend everyone equally by highlighting just how political food and nutrition is these days.

I like to try to pass myself off as generally apolitical (on principle, I refuse to vote straight-ticket anything—but it could be I’m just a control freak who likes filling in all the bubbles myself). If forced to confess, underneath it all I’m a bleeding-heart liberal who wants to save trees and whales and who tends to blame the world’s ills on old white dudes (even—or especially –the one I’m married to).

But there’s another subtlety (and don’t tell my bleeding-heart liberal friends or they won’t invite me to anymore parties): I’d vote for ANYONE who was serious about fixing our food-health system, but—politically-speaking—who is going to do that?

Restructure subsidies, agricultural insurance, and agricultural financing to support small farmers rather than giant agribusiness? Who would do this? Democrats like feeding the excess corn, wheat, and soy commodities to the hungry people in America who are getting fatter and sicker by the minute as a result (It’s healthy!). Republicans like the big businesses that control those commodities. Everyone says they care for small farmers but no one does anything about it.

Federal nutrition program foods: plenty of soybean oil, corn syrup, gluten, and sugar, with a little arsenic thrown in for good measure

Modify food safety regulations to take into account size and type of operation? Democrats are all about protecting the public and regulating industry, but they are also all about “protecting” the public from the raw milk that those stupid Americans are stupid enough to drink. Republicans are more likely to support the dairy industry–the folks with the vested interest in outlawing raw milk–but also more likely to say the government shouldn’t be telling stupid Americans what they should and shouldn’t drink.

Somebody needs to tell Michelle that “moving more” makes kids hungry more; nothing wrong with that, but they’re not gonna “eat less” as a result.

End the one-size-fits all dietary recommendations? Thank you Michelle Obama for giving renewed vigor to the physiology-defying “eat less, move more” concept. Thank you, giant mom-and-pop-squashing Walmart, for playing right along.

You don’t like Obamacare? You do like Obamacare? You’re both right. Health reform is a joke until we focus on preventive measures that begin with feeding everyone adequate essential nutrition, not preventing chronic disease with foods that don’t prevent chronic disease.

Republicans believe that obesity is a personal responsibility; food and lifestyle choices by the public should not be interfered with by the government. Except when it comes to whether or not the public can know what is actually in the food they choose, in which case, the right to free speech when it comes to putting “health” claims on cereal boxes becomes the right to abstain from speech when it comes to putting GMO information there.

Democrats believe that it is up to the government to intervene in the market when personal choices become a public concern. So Democrats are out to make the “healthy choice” (a phrase that is an embarrassment to true meaning of both words) the easy choice for those poor stupid fat people out there who are too lazy and gluttonous to take care of their own health, never mind that the Democrat’s idea of “healthy” and “choice”  is limited to the USDA/HHS definition of both.

Republicans support the soda industry’s desire not to be taxed. Democrats are hoping butter and meat will be taxed next.

Thank goodness for the Libertarians—who are hard at work legalizing pot so the nation can now get the collective munchies. Watch for the Democrats to insist on restricted access to McDonald’s for those with medical marijuana prescriptions, while the Republicans fight for Monsanto’s right to patent all cannabis seeds grown anywhere ever by anyone. That backyard plot of weed will only be legal for about ten minutes before the Democrats start regulating the fun out of it and the Republicans hand everyone’s right to get stupid over to ConAgra.

Meanwhile, the rich get richer, the poor get fatter and sicker, and we all—rich and poor and middle-class alike—waste precious time, money, and attention on nutrition recommendations that support ideology and industry and do little for our nation’s very real health crisis. Politicians like Nixon and Clinton have undermined the nation’s ability to believe that any politicians can be trusted;  advice from the USDA/HHS, Ornish, and Atkins have done the same for nutrition. It’s a wonder we don’t all turn on, give in, and pig out.

Just Asking the Question

 

 

So wouldn’t it be cool if we could ask folks on the street what they think caused the obesity crisis, and then show them this and ask them again?

Now back to your regularly scheduled blob.

Data from:  Centers for Disease Control and Prevention (CDC).  National Center for Health Statistics, Division of National Health and Nutrition Examination Surveys.  Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1976–1980 Through 2007–2008. 

The Mobius Strip of Policy Change


I love working with individuals, but it takes policy-level change to really make an impact on public health. Policy, however, is a double-edged sword. Decades-long cascades of unintended consequences can arise from well-intentioned policy. The Dietary Guidelines started out in 1980 as an unmandated humble little 40-page booklet offering nutrition guidance to the public, while freely admitting that “we don’t know enough about nutrition to identify an “ideal” diet for each individual” and that “in those chronic conditions where diet may be important . . . the roles of specific nutrients have not been defined.”

Since then, I’m still not sure how, the Dietary Guidelines have become the center of all information and decision-making surrounding food and nutrition in America—in policy, healthcare, industry, media, and science (where researchers should know better than to use a policy document as the basis for scientific research). And—for better or worse—Americans have actually shifted their eating habits to fall in line with Guidelines recommendations (see: Americans don’t follow the Guidelines—or do they?)


The Guidelines were created to prevent chronic disease.  They have changed very little in 30 years, while rates of obesity, diabetes, and other chronic disease have rapidly increased (see: Public Health Nutrition’s Epic Fail). Currently, there is no “policy lever” for changing the way the Guidelines are created or administered. The Guidelines have no system of checks and balances, no outcome evaluation process, and no way to counter the influence of entrenched special interests (including both the food and science industries).

Right now, it seems that no amount of public outcry, accumulation of scientific evidence otherwise, or increase in diseases the Guidelines were meant to prevent can shift them from their current staked position that a high-carbohydrate, high-fiber, low-fat, low-cholesterol, low-saturated fat, low-sodium diet is right for all Americans. Under the USDA/HHS “calories in, calories out” paradigm, it’s Americans that need to change (“eat less and move more”), not nutrition policy. Policy changes are urged only to “make the healthy choice the easy choice”  for fat stupid Americans (especially low-income ones) who apparently otherwise don’t care and can’t think.

I would expect such policy reform to have, as Jon Stewart put it, “the draconian government overreach we all love with the probable lack of results we expect.”

So what kind of policy reform should we be working towards? One of the Big Questions I ponder is whether we need to replace the current USDA/HHS Dietary Guidelines with “better” ones, or find a different way to create nutrition policy, or just ditch all government-sanctioned nutritional recommendations altogether. (Other Big Questions: What’s for dinner? and How can I further embarrass my children?)

I don’t fundamentally oppose or support government-funded nutrition programs. If they were administered differently, I might like them a lot more. If we are going to use government funds to feed people, we will need some way of guiding that process. Right now, our federally-funded nutrition programs have a tendency to serve as outlets for cheap industrialized food, and I’m afraid that our nutrition guidance has not only allowed, but encouraged that role. On the other hand, scrapping that guidance altogether may leave government programs that are struggling for funds vulnerable to choosing food from the lowest bidder, which would only serve to reinforce the current situation.

I also have problems with replacing one-size-fits-all Guidelines with different one-size-fits-all Guidelines because that process denies the very real variability in nutritional needs and preferences of individuals and diverse sub-populations. Worse yet, it teaches people that answers about nutrition come from packages and experts rather than the body’s response to food.

As a transition, or middle ground, I currently favor the idea of locally-determined nutritional policies and programs. Sounds good, right? Nutrition programs could be tailored to meet the needs of the community they serve.

But this is where the confluence of things needed to make this type of policy shift happen turns into a Dilbert cartoon. Everything that needs to happen requires something else to happen first until it all loops back on itself like a Mobius strip.


Let’s take school lunches.  

Ideally, the type of school lunches served should be determined by the members of the community eating them, i.e. the kids, parents, teachers, etc.  This allows for appropriate community-level health, ethnic, cultural, regional, seasonal, and economic adjustments and prevent fiascos like the Los Angeles lunchroom garbage cans filled with “healthy” lunches (like “brown rice cutlets”).

Ideally, a trained professional at the local level, for instance an RD, would be able to guide this process, balancing the nutritional needs of that specific community with other social and cultural factors, creating an affordable menu, and modifying the program based on outcomes.  But this would mean that the RD would have to have training across the spectrum of nutrition science, rather just following USDA/HHS policy statements which are based on research done on white (frequently male) adults circa 1970-1980 and which may not be applicable to other populations.

This in turn would require the nutrition curriculum for health professionals to not be skewed by entrenched interests in academics, politics, and industry (and would probably require almost a complete re-thinking of 30 years of nutrition epidemiology).

This would require the USDA/HHS and other institutions to support–through funding, publication, and use—nutrition research that may possibly undermine or even contradict 30 years of previous nutritional guidance. This research would not only provide a knowledge base for health professionals, but would provide an unbiased source of information for consumers which would help to create informed stakeholders in the nutrition-food system.

At the same time, industry, producers, and growers would have to work with the community to make foods available that meet the demands of the local program at a reasonable cost.  And right now—due to agricultural practices and USDA policies—foods that are widely and cheaply available to federal nutrition programs are the ones that the USDA/HHS Guidelines have determined are “healthy” even though this definition of “healthy” seems to be based, at least in part, on whether or not those foods are widely and cheaply available for federal nutrition programs.

See what I mean?  I have a hard time figuring out where we need to insert the monkey-wrench that will stop the endless cogs from turning out the same policies, practices, and programs that have been radically unsuccessful for the past 30 years.

Which won’t, of course, stop me from trying.

As I’ve been working with Healthy Nation Coalition and tossing ideas around with people who are also working on this issue, I’ve found some that I believe are fundamental to fixing our food-health system. These concepts originated with people much smarter than me, but I am hoping that in my academic work and in our non-profit work at Healthy Nation Coalition, I will have the opportunity to be a part of developing them further:

1) N of 1 Nutrition – a movement towards more individualized nutrition, although the “1” can also be a family, community, or other subpopulation

2) Nutritional Literacy – a movement to foster an understanding of the cultural forces that shape our nutritional beliefs and our relationships to food and food communities

3) Open Nutrition – a movement to raise awareness regarding the laws, policies, institutions, and other social, economic and cultural forces that may impact access to nutrition information and development of sustainable systems that produce foods that support health

It takes about 30 years for any given scientific paradigm to shift. It is time. But how will we do it differently? I think these concepts are the “next steps” that will help us steer the next 30 years of nutrition in a direction that may help us avoid another cascade of unintended consequences down the road. More on each soon.


Why Calories Count—Fo’Shizzle

Calories are the Radical Terrorist Plot of food. We don’t really know what they are, where they are, or how to successfully avoid them, but they affect all aspects of our lives: how much we eat, how often we exercise, whether or not we feel good about ourselves (our notions of “good” and “bad” behavior frequently revolve around how many calories we’ve avoided/consumed/burned/sat on). Like the Radical Terrorist Plot thing, sometimes it means our lives can get a little weird.

We do know one thing about calories though. According to Marion Nestle,
. . . many people in the world are consuming more calories than they need and becoming overweight and obese.” Simply put, we’re fat because we eat TOO MANY CALORIES—whatever that means.


So—exactly why do calories count?


Luckily, Nutrition Expert Marion Nestle has now written a whole big book to help us understand the mysteries of calories. She very thoughtfully posted an interview of herself being interviewed about the book on her website so we could all see what she thought about her own book. But she’s such a smart person, being a Nutrition Expert and all, I was concerned that some folks would have trouble figuring out exactly what she was saying. I hope this helps clarify things.

Calories count because they are easy to understand.

According to Marion Nestle, “Calories are a convenient way to say a great deal about food, nutrition, and health.” This is true. For instance, calories can tell you a great deal about how many calories are in your food, without having to take into account anything about nutrition or health.

Marion Nestle explains that the idea behind calories is abstract but simple: “They are a measure of the energy in food and in the body . . .” This is also true. In addition, calories are a way to measure the guilt quotient (lotsa calories) and marketability (teensyweensy amounts of calories) of food, making calories an exceptionally useful concept to both food manufacturers and those working on developing an unhealthy relationship to food.

Calories—as well as guilt and marketability—in food can be determined directly by using a bomb calorimeter, which measures the exact calorie content of food by igniting and burning a dried portion of it. In case you’re wondering, this is EXACTLY how your body measures calories too!

Marion Nestle explains that “Calories measure energy to keep bodies warm, power essential body functions, move muscles, or get stored as fat.” I would add that I don’t really know what calories do either, but if you use calories to keep your body warm, I guess my hot flashes make me “da bomb (calorimeter).” [I so crack myself up]. Hey, but then wouldn’t menopause turn us all into skinny bitches instead of fat ones?

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Calories count because calories are very confusing.

Marion Nestle explains that the reasons we haven’t been able to grasp the whole calories in-calories out thing is that “Even talking about calories is difficult. For starters, calorie counts are given in no less than five different units — calories, Calories, kilocalories, Joules, and kilojoules (along with their abbreviations cal, Cal, kcal, J, and kJ).” These concepts are so confusing to regular folks that only Nutrition Experts like Marion Nestle and Michael Pollan actually KNOW how many calories people should really be eating; the rest of the country is just guessing.

And when Americans “self report” on how many calories they eat? Well, let’s just say they are “underreporting,” shall we?

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Calories count because we don’t count them.

Government-Approved Nutrition Experts—not unlike Marion Nestle—MUST make a Big Statement about the Plight of Fat Americans, oh, about every year or so (it’s in their job description). When Slender Motivated Upper-class Gainfully-employed (code name: SMUG) Americans who read the New York Times need to know why we just can’t seem to get those fat stupid Americans to stop being so fat and stupid, they can call on Nutrition Experts–not unlike Marion Nestle–who KNOW the problem is that Americans eat too many calories—whatever that means. By keeping the focus on calories in-calories out, Nutrition Experts and food writers know that they can count on Americans to continue not counting calories, just as they have not counted them for hundreds of thousands of years, thus guaranteeing job security and future book contracts all around.

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Calories count because we do count them.

According to Nutrition Expert Marion Nestle, “The U.S. diet industry is worth about $60 billion a year.” Clearly, Americans are willing to shell out for just about anything if they think it will help them figure out why they can’t lose weight when they are doing everything they’ve been told to do for the past 30 years, including eating less fat, eating more carbohydrates, and exercising.

As long as Nutrition Experts can keep Americans counting calories, the food industry, the diet industry, the exercise industry, and the Nutrition Expert industry can keep counting the Benjamins. No calories in a Benjamin—it’s all fiber, baby.


A high fiber Benjamin

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Calories count because we can’t count them.

According to Nutrition Expert Marion Nestle, you can’t see, taste, or smell calories. This means calories are like Santa Claus and the Easter Bunny. You would have no way of knowing they even exist if there weren’t a giant academic-scientific-industrial-media complex devoted to the worship of calories and keeping them alive in our hearts and minds!


Spoiler alert: This is not the real Easter Bunny.  Like calories, the real Easter Bunny is invisible.

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Calories count because we can count them.

Fortunately, there’s an easy way to keep track of your calories even though you can’t see, taste, or smell them.

Marion Nestle says that the best way to measure calories is to step on a scale. So, lessee. I stepped on the scale and I weigh 160 pounds. If I’m 55% water (hooray, no calories there!), and 4% minerals (wait, does calcium have calories?), and then 13% protein (4 calories), 24% fat (9 calories) and 4% carbohydrate (4 calories), well then, hmm multiply by and convert and carry the one and—got it!—I’m exactly 194766.884 I’m exactly 206112.371 calories.

That means if I decrease my calorie intake by 500 calories a day (this where all that helpful calorie information on the side of the box of low-fat, high-fiber, individually calorie-control portion food comes in handy) and increase my activity by 500 calories a day (which I understand I can do simply through insanity, which—according to my children—should not be much of a stretch), that means that on November 10, 2012, sometime around noon, I will disappear altogether because all my calories will be gone. See how easy that is.


Counting calories is easy with a few simple tools.

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Calories count because we should count them.

Because counting calories is sooooo easy, anybody should be able to succeed at maintaining energy balance. There are lots of ways to demonstrate to the world that YOU have the intelligence, willpower, stamina, time, money, and Fine Upstanding Moral Character to keep your calorie balance in check.

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Calories count because counting calories is the only way to keep track of how many calories are in your food.

As with most other important things in life, if you can’t count it, it doesn’t count.

According to Marion Nestle, calories are derived from food. This is true of course, but only if you actually eat it. If you do decide to eat food, it’s really important to know how many calories are in your food.

This is why accurate calorie counts on everything we eat are so important! Turns out that your 500-calorie Leen Quizeen entrée may really contain—brace yourself—540 calories! With such inaccuracies in the calorie labeling of food, it’s no wonder Americans are fat.

According to Marion Nestle, this gross inaccuracy of calorie counts means that, “it works better to eat smaller portions than to try to count calories in food.” Lucky for us, food manufacturers make handy little portion-controlled packages of healthy whole grain food for us. And thoughtful Exercise Experts have given us calorie counts for every activity you can think of!


Healthy BAKED (not FRIED) whole grain portion-controlled fish-shaped food-like substance.

For example: An hour of coal mining equals 5 bags of 100-calorie whole grain goldfish, but since those food companies probably snuck in some extra calories in just to mess with us, if you’re coal mining for an hour, you should probably only eat 4 bags.

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Calories count because they are the only thing in your food worth counting.

Marion Nestle says, “Although diets with varying proportions of fat, carbohydrate, and protein may be easier for you to stick to or be more satiating, the bottom line is that if you want to reduce your body weight, you still need to consume fewer calories.” In other words, whether or not you feel full or satisfied has nothing to do with whether or not you’ll consume fewer calories. The reason we consume too many calories is because portion sizes are bigger, soda is cheaper, TV shows are more interesting, and couches are more comfortable than ever before. Plus the intelligence, moral fiber, character, and willpower of the American people are in serious decline.

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What can we do about the “calorie” problem?

According to Marion Nestle, “many groups have a stake in how calories are marketed, perceived, labeled, and promoted”—with the obvious exception of Nutrition Experts writing books about calories. They have NO dog in this fight.

Food manufacturers want Americans to eat a lot of calories, which totally explains why they sneak extra calories into our food for free without telling us.

This is why efforts to do something about obesity must focus on eating less of the foods that don’t come from food manufacturers—like eggs and meat—and focus on eating more foods that come in boxes and bags and cans that have a CALORIE count on them! Of course, Americans should also consume less soda, fast food, snacks, and other highly profitable items. That is, unless these are highly profitable items that Nutrition Experts really like! And really, it would go a long way towards solving our childhood obesity problem if we could only get calorie counts on beer for goodness sake! Darn that alcohol industry.


Thanks to lobbying efforts of the alcohol industry, there is no CALORIE label on this beer!

As Marion Nestle says, “On the societal level, we need measures to make it easier for people to eat less.” We need to work to change the food environment to one that makes it easier to eat healthfully, because—just between you and me—most Americans are just not willing to take charge of their own health.

Things YOU can do to “make the healthy choice the easy choice” for all those poor stupid fat people:

  • Support labeling laws—those poor stupid fat folks need accurate calorie counts on their movie popcorn, darn it!
  • Insist on more Government Approved Information about Nutrition (code name: GAIN)—because it’s been such smashing success so far!
  • Support controls on food advertising to children. The current childhood obesity crisis clearly demonstrates that parents can’t be trusted with complicated decisions like how to feed their children. This is where Nutrition Experts–not unlike Marion Nestle–can advise the FDA, the FCC, NASA, and NASCAR about the nutritional differences  (i.e. calorie counts) between a whole grain bagel (OK!)* and a frosted donut (Oh no you don’t!)** so parents won’t have to worry their pretty little heads about it anymore.
  • Support agricultural policies that encourage consumption of fruits and vegetables (but not eggs and pork chops) from local food systems.  Everyone knows that 90 calories of kale and kohlrabi are less fattening–and even more importantly, many times more virtuous–than the 90 calories in an egg.
  • Help create environments that encourage physical activity, like cities without public transportation. Those fat people standing in line for a bus would burn a lot more calories if they were WALKING to work!

SMUG Americans must remember: those stupid fat people are not just fat and stupid. In the face of our “obesogenic” environment, they are helpless. You need to be the change you want to see—especially in the seat next to you on an airplane.

That right, SMUG Americans, only YOU can prevent fat people.

*330 calories

**270 calories

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Big Fat Liars

Since 1980, Americans have gotten progressively more lazy and gluttonous. As if this were not bad enough, apparently about 2/3 of the population—the fat 2/3 of the population—have also become unrepentant liars. Although we have no way to explain this precipitous decline in the moral fiber of Americans, we know it must be happening because Americans seem to be getting fatter and fatter even though many of these fat Americans report that they are not eating more calories than their normal-weight, honest, hard-working counterparts.

It seems that when we gave the USDA and HHS the responsibility for determining what food was healthy for each of as individuals, Government Approved Nutrition Experts also developed a magical ability (in Nutrition, we love magic!) to tell the difference between what was Truly True and what was a Big Fat Lie. Here’s a response I got to a food record assignment during an introductory Nutrition course:

Question: What are your barriers to meeting the MyPyramid recommendations? (In other words, what might prevent you from consuming the recommended amount of each food group?)
My answer (after describing the low-carb diet that I used to lose weight and improve my migraines):I have a history of glucose intolerance and overweight/obesity.  Past a certain point of consumption, carbohydrates make me gain weight, raise my blood     pressure, reduce my energy levels, give me migraines, make my blood sugar wonky, and leave me hungry and cranky.  I stick to fiber-rich, nutrient-dense, non-starchy vegetables for my carbohydrates, although I do eat fruit when it is in season locally.
Instructor’s response (I am not making this up):  It is actually the total calories that make you gain weight, not the carbohydrates.  The high fat intake would be more detrimental than the whole grains and fiber rich vegetables.  Refined carbohydrates would cause the symptoms you describe but using whole grains and high fiber fruits and vegetables should not do so.  You need carbohydrate for your brain to function.  It does not function on fat and protein calories.  In fact eating a low carbohydrate diet such as you describe would make you tired, give you migraines, make you hungry and cranky.

Silly me! Of course the Nutrition Expert knows what REALLY caused my weight gain and migraines. Obviously the lack of carbohydrate to my brain prevented me from realizing her innate superiority at understanding and interpreting my own personal experiences. Either that or I’m just a Big Fat Liar.

Let me introduce you to another Nutrition Expert with the magical ability to tell Truth from Fat People Fiction–Michael Pollan:

Consider: When the study began, the average participant weighed in at 170 pounds and claimed to be eating 1,800 calories a day. It would take an unusual metabolism to maintain that weight on so little food. And it would take an even freakier metabolism to drop only one or two pounds after getting down to a diet of 1,400 to 1,500 calories a day — as the women on the “low-fat” regimen claimed to have done. Sorry, ladies, but I just don’t buy it. (Pollan M. Unhappy Meals)

The women in the Women’s Health Initiative (to which Pollan refers) are: Female. Post-menopausal. Overweight. From my experience at the Duke Lifestyle Medicine Clinic (director, Dr. Eric Westman), just about any woman who met those three criteria exhibited this sort of “freaky metabolism.” Not only is it possible for a woman in that hormonal situation to maintain her weight on 1800 kcals/day, it may be absolutely impossible for her to lose weight on 1400-1500 kcals/day—if she’s eating foods that enhance fat storage and prevent fat utilization (carbs, I’m lookin’ at you). In fact, not only did I see many other women like this in clinic, I stopped losing weight myself (at 185 pounds) eating 1200-1500 calories a day—and I wasn’t even postmenopausal. But then, at that point, I wasn’t a Nutrition Expert either. Not like Michael Pollan.

I always wonder why Mr. Investigative Journalist/Nutrition Expert Pollan didn’t go out find a few real live overweight, post-menopausal women and ask them what their personal experiences were with weight loss instead of simply discounting the experiences—and calling into question the humanity and integrity—of the “ladies” in the study. Oh wait, if the ladies he interviews are overweight, they’d all just LIE to him!

Anyway, why ask a real person, when you have Science on your side? Here’s a nutrition textbook explaination just how it is that we KNOW fat people lie:

Another approach to check for underreporting is to compare reported usual energy intake with resting energy expenditure calculated using various equations . . . If a subject’s reported usual energy intake is <1.2 times his or her calculated REE, underreporting of energy, and therefore nutrient, intake is highly likely. (Lee & Nieman, 2007).

In other words, if fat people don’t eat as much as we think they should be eating according to calculations that are known to be notoriously inaccurate, they must be “underreporting” (this is a complicated Scientific Term that means “lying about”) how much they eat. In my current Obesity class at UNC, Dr. Andrew Swick has confirmed—through evaluations done in a metabolic chamber—that some overweight/obese women have energy requirements as low as 1200-1300 calories (hmm, “freaky metabolism” maybe?),  requirements that would be far below “calculated requirements” referred to above. Dr. Swick pointed out to us that some fat people don’t, in fact, eat that much food.

But we should never let reality stand in the way of Government Approved Nutrition Information (code name: GAIN). Our good buddies at the USDA and HHS prepared this helpful chart for the 2010 Dietary Guidelines Advisory Committee Report to show how many calories Americans are consuming compared to the recommended ranges:

The vertical lines are recommended calorie ranges; the pink triangles are the average calorie intake in each group. Caloric intake appears to be within the recommended range for all age levels; adult women in general seem to be consuming at the very low end of their caloric range, about as many calories as a preschool male. That’s right, women over the age of 50 eat, on average, about as much food as 2-5 year old boys.

This must be more of that “freaky metabolism” thing to which Mr. Pollan refers. Or—wait—maybe they are all just LYING (the old ladies, not the little boys): the 2010 Dietary Guidelines for Americans go on to say, “While these estimates do not appear to be excessive, the numbers are difficult to interpret because survey respondents, especially individuals who are overweight or obese, often underreport dietary intake.” And we know what “underreport” means, right?

According the USDA and HHS, Americans aren’t fat because they are told to eat foods they don’t need to eat, Americans are fat because they eat too much–and then lie about it.

So, let me sum this up for the folks at home:

Fat people say that they don’t eat more calories than their normal weight (and apparently morally superior) counterparts.  But we know they are lying because Nutrition Experts—like Michael Pollan—KNOW how much fat people eat should be eating (i.e. A LOT of food—otherwise, golly, they wouldn’t be so darn fat).  ).  He KNOWS this because he’s a Nutrition Expert and because we have scientists who have calculations that tell us how much fat people are supposed to eat (i.e. A LOT) so when fat people say they don’t each as much as scientists think they eat (i.e. A LOT), well then, the only possible explanation for that is that the fat people are LYING!  And if that’s not enough evidence for you (and really, it should be), you can absolutely believe that that fat people LIE about how much they eat because the Government says they do.

And the government never lies.

References:

Lee RD and Nieman DC. Nutritional Assessment, 4th ed. Boston: McGraw Hill, 2007.

Pollan M. Unhappy Meals. The New York Times Magazine, January 28, 2007

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010. June 15, 2010.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm Accessed January 31, 2010.

How to Choose Foods Wisely?

I don’t have the answer; I’m just askin’ the question.

I’m not much for food rules. I’m not much for rules in general (ask my mother). Still, I feel an obligation to provide some guidance that counterbalances the Government-Approved Information on Nutrition (code name: “GAIN”) that screams at us from every shelf in the supermarket.

There are a lot of “how to” guides on choosing foods wisely, from Michael Pollan’s 7 rules to the How to Find Real Food at the Supermarket from Darya Pino to a grass-fed, organic approach from Healthy Eating Politics to a more academic approach from Carlos Monteiro (scroll down to his discussion on meat and bread).

I like all of these.  At the same time, I want something I could give to patients and clients that will help them make reasonable choices—yes, even if they are buying food at a gas station. Most importantly, I want to make this something everyone can do regardless of income level. We have to acknowledge that, at least for now, many “cleanly produced” foods (grassfed beef, farmers’ market eggs, organically-raised produce, etc.) are WAY more expensive than their grocery store counterparts.  Still, I think I would recommend grocery store pork chops over organic “convenience” foods like this

even though all 25 ingredients are “organic”!! even the tofu!

Here’s my initial stab at a “choose wisely” approach. However, I think my own brain capacity is quite limited (especially when I’m trying to wrap it around biostatistics). I’d love some feedback and suggestions for improvement from the community of folks who are doing their best to “choose wisely” on a daily basis. This is not geared toward any particular “dietary approach,” although—as it happens—reducing processing tends to reduce unnecessary carbohydrates. Hmmm. How truly convenient.