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Counting Calories For Weight Loss – More of The Same



If there is one article in the 2018 special issue of JAMA on obesity that we could have well done without, it is surely the one by Eve Guth promoting the age-old notion that simply counting calories is a viable and effective means to manage body weight.

As the author suggests:

“It is better for physicians to advise patients to assess and then modify their current eating habits and then reduce their caloric ingestion by counting calories. Counseling patients to do this involves provision of simple handouts detailing the calorie content of common foods, suggested meal plan options, an explanation of a nutrition label, and a list of websites with more detailed information. Patients should be advised that eating about 3500 calories a week in excess of the amount of calories expended results in gaining 1 lb (0.45 kg) of body weight. If a patient reduces caloric ingestion by 500 calories per day for 7 days, she or he would lose about 1 lb of body weight per week, depending on a number of other factors. This is a reasonable and realistic place to start because this approach is easily understood and does not ask a patient to radically change behavior.”

There is so much wrong with this approach, that it is hard to know exactly where to start.

For one, this advise is based on the simplistic assumption that obesity is simply a matter of managing calories to achieve and sustain long-term weight loss.

Not only, do we have ample evidence that these type of approaches rarely result in long-term sustained weight-loss but, more importantly this type of advice comfortably ignores the vast body of scientific literature that tells us that body weight is a tightly regulated physiological variable and that there are a host of complex neuroendocrine responses that will defend our bodies against long-term weight loss – mechanisms that most people (irrespective of whether they have obesity or not) will find it exceedingly hard to overcome with “will-power” alone.

No doubt, caloric “awareness” can be an eye-opener for many patients and there is good evidence that keeping a food journal can positively influence dietary patterns and even reduce “emotional” eating. But the idea that cognitively harnessing “will-power” to count calories (a very “unnatural” behaviour indeed), thereby creating and sustaining a long-term state of caloric deficit is rather optimistic at best.

In fact, legions of people who have been battling obesity all their lives can attest to the fact that encouragement to simply “eat less and move more” (ELMM) as a viable strategy to achieve and sustain significant weight loss is about as effective as reminding people with depression to focus on the brighter side of things and cheer up.

Not to mention the debunked 3500 calorie deficit a week = 1 lb weight loss (week after week after week till a so called  “healthy” weight is achieved) myth, which is simply not how bodies work.

Continuing to propagate this antiquated and simplistic idea of what it takes to manage a complex chronic disease like obesity, is exactly what is holding the field back.

There is no reason to assume why more of the same should produce results that are any different from those in the past.

It is time we recognise that restricting caloric intake by willpower alone (irrespective of the dietary strategy) simply does not change the biology of the underlying physiology that effectively defends our bodies against long-term weight loss.

Reading an article like this in 2018 in a reputable journal that promises to “reimagine” obesity is both disappointing and a stark reminder of just how far we have to go to change widely held beliefs that obesity is simply a matter of calories in and calories out – if only life (and human biology) was that simple!

@DrSharma
Edmonton, AB

9 Comments

  1. What do you think about the Weight Watchers new program? Instead of counting calories, it shows how to take better décisions about what you eat.

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    • The overall philosophy and approach of the new Weight Watcher’s progam is no doubt better than the “number” focussed program of the past.

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  2. Issues regarding obesity have been overly simplistic over the years.More blogs have focused mostly on debunking or refuting claims of effective means of sustained weight loss. However most of them fail to provide ‘what works.’ Until a concrete evidence-based solution is identified, populations will continue to feed on what is reported.

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  3. I am glad to see at least one doctor who understands that obesity is biological. The body fights back.

    Your colleague Yoni Freedhoff published just a couple weeks ago a blog post arguing againt the notion of a biological weight set point. He basically said that weight loss maintenance is all about maintaining good dietary habits. And he is an obesiy expert!

    And now this JAMA piece. Hugh. This is so discouraging.

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  4. I agree that the calory-awareness aspect is important Especially for people who eat out a lot or who eat prepared meals. It helps me make a more informed opinion on what I should be eating. I try to think of calories as investment, in the sense it is this item good enough to be worth 500 calories (for example). The evidence is strong that people overestimate how many calories they expend working out and underestimate their intake so all the apps out there, I have found them useful.

    As far as the metabolic processes involved in weight loss and specifically on the bodiy’s long term protection again wright loss (what a bummer). I admit not having a solid handle on that. I just hope I made my life changes before it’s hopeless.

    I liked your write-up. I’ll come visit again.

    Thanks. My best !

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  5. Could not agree more With you. A ridicule analogy is this. Think of a soccer team struggling at the lower end of the table. A lot of bad luck has been the norm, Injuries are many, and it’s a long time since the last win and the team confidence is record low. Then a “soccer doctor” gets a bright idea. He walks into the dressing room to tell the players and the coach his revelation. It’s so simple boys! Here is what you do: you must score more goals and let in less. It’s all about the balance……

    For obvious reasons it is highly unlikely that such a ridicule soccer doctor exists. But this is incredibly enough this what many people with obesity must put up with.

    Keep up the good work Dr. Sharma!

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  6. Loved your post—especially “encouragement to simply “eat less and move more” (ELMM) as a viable strategy to achieve and sustain significant weight loss is about as effective as reminding people with depression to focus on the brighter side of things and cheer up.”

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    • I like Sharma’s nightmare on ELMM street too. His analogy of the rubber band akin to the body’s heroic and effective means to regain one’s lost weight and in fact then gain more on top of one’s starting weight is equally good. And classic Dr. Sharma.

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  7. Thank you for pointing out the obvious uselessness of Dr. Eve Guth’s message. How obtuse must she be to keep promulgating this hogwash? It’s been refuted by large studies and meta-analyses. If she read, watch a video, or listen to a podcast with Dr. Jeffrey Gerber or Dr. Eric Westman, both family docs who have been helping patients on the order of decades, she might learn something.

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