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Does Measuring Your Food Add Up?



diet journalMeasuring and monitoring your food intake – a strategy that may involve counting points or calories, weighing and measuring your food and drink, paying attention to food labels or calories on menu boards, obsessing about added fat or sugar, and excluding or limiting certain foods, are the backbone of virtually all weight management strategies.

Indeed, there is enough evidence in the literature to show that most “successful” dieters develop a somewhat obsessive relationship to accounting for every bite they put in their mouths – measuring, counting, adding, journaling, avoiding and restricting become part of their daily routine. For some it becomes so automatic a behaviour, that they are no longer even conscious of doing it (nor do many stop to realise just how “abnormal” such a behaviour actual is).

If this helps them better manage their weight – good for them. As a strategy for the population – or in other words when measured in terms of “effectiveness” – such an approach is bound to fail. This is because most people are simply not going to live their lives that way (and who can blame them?).

That said, it turns out that calorie counting (in whatever form) may indeed be the only behavioural weight management strategy that actually works (albeit with rather modest results).

This is apparent from a new meta-analysis by J. Hartmann-Boyce and colleagues from a UK-based Behavioural Weight Management Review Group, published in Obesity Reviews.

The rather painstaking systematic review, meta-analysis and meta-regression included 37 randomized controlled trials of multicomponent behavioural weight management programmes in over 16,000 overweight and obese adults.

While the overall effect of these interventions at 12 months was a rather meagre 2.8 Kg weight loss, the authors went to great lengths to try to dissect out what worked and what did not.

Thus, for e.g. there was no evidence that supervised physical activity, frequency of contact (rather surprisingly), or in-person contact were related to overall effectiveness.

In fact, the meta-regression analysis found only three factors that had a somewhat greater impact:

1) Calorie-counting (-3.3 Kg)

2) Contact with a dietitian (-1.5 Kg)

3) Behaviour change techniques that compare one participant’s behaviour to others (-2.9 Kg)

Thus, the authors conclude that programs involving some form of calorie-counting and contact with a dietitian may be the most effective. I would add to the list interventions that include group settings where participants can compare notes.

But with all of this said, the real message is  just how modest the outcomes of behavioural approaches to obesity actually are – in fact the finding from this analysis fly in the face of what most people (health professionals included) are convinced is possible based on anecdotes (“success stories”) and from what  commercial and non-commercials programs  so often claim (with virtually no published or otherwise publicly accessible data to support these claims).

Indeed, if I were to tell my patients that they need to start counting calories so that they can lose an additional 5 lbs, most would probably be walking out of my office never to return.

Thus, if anything, this analyses should conclusively lay to rest the notion that for most people, clinically meaningful weight loss can be achieved (and maintained) through behavioural interventions alone.

This is not to say that behavioural interventions in obese individuals (including physical activity) are not beneficial – they are, just not for weight loss.

As I have said before (and restate every time I get a chance) – improving health behaviours can certainly lead to a healthier you – whether that you is leaner or not is an entirely different (and less important?) question.

It turns out that getting your cortex to run your hypothalamus is far more difficult that you may think.

As discussed in  earlier posts, the key problem with these behavioural approaches is that they are designed to change behaviour – what we need are behavioural approaches designed to change physiology – that is a very different order.

@DrSharma
Edmonton, AB

17 Comments

  1. Based on the small, but measurable, improvement, it is most likely that the effect being seen is a variation on the industrial engineering phenomenon, the Hawthorne Effect. Simply stated, that which is measured, improves.

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    • I guess that is the whole point of self-monitoring – simply stepping on the scale every day can help prevent weight gain. So measuring does work) if you can actually do it).

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  2. Daily food tracking works great for me. I disagree with some of Dr. Sharma’s statements in this article.

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  3. I found obsessively counting calories (I use a gram scale) and an hour a day of aerobics and regular walking were critical in my going from a BMI of 30 to 21.5 (I realize BMI is a poor measure, but it gives an idea of the amount of change). Twice weekly weigh-ins are also important. I found it difficult to maintain the level naturally with my new appetite (I was still weighing myself and exercising), so I went back to the calorie counting as I can’t trust my hunger signals. I’ve been holding steady for five years.

    I find it much more difficult to do this without the exercise, so it is also habit. A bit inconvenient, but I’m much healthier these days.

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  4. Interestingly enough, I just blogged about this last week. I tried food tracking for three months, although not from an intentional weight loss perspective — more a dietary analysis. Unfortunately, I found the negative effects outweighed the positive ones. It was a good learning experience, and I have no doubts it works for some people, but I don’t intend to try it again.

    But isn’t it really about finding what works for you? Bodies and the people who inhabit them can be so different.

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  5. Dr. Sharma, I respectfully disagree with your statement that most people cannot live their lives obsessing about every calorie they eat.
    The fact is, we already do.
    I obsess about everything that goes in my mouth whether it adds up to 1200 calories a day or 2500 calories a day. The difference between these is simply whether the result of my obsession is ultimately positive or negative.
    Given that we can’t change our physiology then isn’t the best alternative to learn to harness the obsession and try to get it to work for you and not against you?

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    • Lisa – unless you define “most people” as yourself, I stand by my statement that “most people” cannot do this. But kudos and respect to you if you can and do.

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  6. Dear Dr. Sharma,

    You never seem to have any positive news or studies. Is there anything out there positive?

    Can people keep it off?
    Thanks!

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  7. I don’t think we are looking for miracles, just a ray of hope. (Yes, sometimes Dr. Oz drives me nuts. If I went out and bought all the stuff his guests recommend for so many issues, my house would be crammed full of supplements, health foods and unicorn-horn-powder based drinks.) Personally, I track my food intake, and that has enabled me to initially loose over 50 pounds and pretty much keep it off. I DO have upward fluctuations. As soon as it starts to creep back on me — which happens when I stop tracking my food intake — I start keeping my diary again, and I swear that helps me know that I’m eating too much! Keeping a food diary is an awareness thing. It is a reality check which those of use struggling with food really, really need.

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    • Sounds like you’re doing just fine Gail. We do get all our patients to journal and those who do, do much better than those who don’t.

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  8. I agree that most people cannot sustain a high level of food monitoring . For me, life is too short to devote time every day to this, I think better use of my time, and better outcomes, and more pleasure, come from devoting the time to careful shopping for fresh wholesome food and cooking it. That being said, I think it is of great value to do it for a period of time so that you learn, through hands on experience, exactly how big a portion is and should be for you, and how many calories are in food. For example- no , I do not count calories any more, but I’ll never again unthinkingly pop a chocolate truffle in my mouth thinking it is ‘nothing’. The learning experience of calories counting and weighing food for a period of time can result in lifelong positive behavior change.

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  9. When I used to blog, I called my weight-loss maintenance a third- to half-time job. Most people cannot afford to give that kind of time to an avocation, and I found it onerous too. I had to do it (I felt) because I was committed to figuring out weight-loss maintenance and I was struggling to create a new workable system following some injuries and surgery that had made running an impossible exercise option for me (running is the most efficient form of exercise for weight-loss maintainers, I think, in terms of time commitment for pay-off). Now I have the “job” down to quarter-time because in terms of exercise I combine weights and aerobics and even a few daily household tasks. I don’t require my exercise to be entirely joyful. I view it stoically as a neutral thing I must do, like taking care of the dog — sometimes it’s fun, but a lot of the time it’s just neutral and occasionally it’s unpleasant.

    In terms of food-related counting, I don’t weigh or measure, because I know portions by rote, just from doing this for so long. (I’m about to enter my 12th year maintaining more than 50 lbs of loss). I don’t journal, but my head contains a scoreboard that is wiped clean daily. That scoreboard keeps cumulative calories that always total between 1,500 and 2,000. It has a secondary reading of grain-based or starchy carbs, a subtotal that can go as high as 200. It keeps a fruit/veg count that MUST exceed 5 at the end of the day. That’s the easiest number. Usually it’s 10 or 11.

    I used to read science journal articles on weight management regularly; now I just peek in on a few blogs and occasionally download a science article that I read for pleasure. What the scientific reading helped me do when I was learning maintenance was to trust that my “eat impulses” were real and based in endocrine adjustments unique to weight-reduced people. In my case they were not some psychological issue that needed cognitive treatment; I learned how to manage them by timing my exercise (in the morning) and managing my macronutrient intake. I will never be entirely “cured” of “eat impulses” — I can only manage them.

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  10. Dr. Sharma,
    Thanks for answering. I wasn’t looking for miracles. You write very well, and are very informative, however, your information sometimes scares me.

    I lost 65 pounds since August and have about 20-30 to go. From my highest, if I lose another 20, I will be down about 100 lbs from my highest.

    For some reason, one of the things that has helped (besides counting calories, and macros) has been that the hunger switch in my brain has bee

    I’ve fixed some things, such as a mild thyroid condition, a mildly low Vitamin D issue, and currently trying to fix another possible slight insulin issue, but I find very little positive information regarding weight loss, metabolism, and other such issues coming from you and others, so it has been a little terrifying.

    Thanks for the link you sent, and please try to post positive information or tips!

    Hope all is well.

    V

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  11. Why not look to naturalistic settings, where long-term success *has* been seen? It’s true, you can’t then tease out causes, but it’s simply not true that long-term weight loss *doesn’t happen*. Peer support and technologies have made a huge difference in recent years.

    Some of the barriers to calorie counting has been at least somewhat reduced by social media technologies. Pen and paper methods were onerous. Now, there are a number of websites with huge databases of foods, making it trivial to find and count most of the most commonly available foods (barring non-franchised restaurants – however, after a period of learning about portion and nutrition, it is possible to reasonably estimate calories in these settings).

    Note also that the databases are user-generated. That means there are enough people participating to sustain these sites.

    I’ve maintained a 50-lb loss for three years using behavioural methods. I’m far from the only one. From my use and observation of calorie counting websites, the general curve of successful calorie counters seems to look like this:

    There’s some precipitating life event – a divorce, a wedding, an illness – that sets up a window of strong motivation, which fuels a period of obsession that involves knowledge-seeking, intensive learning of both portion control and a folk understanding of nutrition (the state of knowledge is defined by community leaders who make some effort to engage with scientific discourse or who pass on tricks and hacks seen to work in athletics; there emerges a community decision on the few ‘correct’ ways to lose weight – right now it’s high protein diets and strength training that are pushed and reinforced by both leaders and followers.)

    This learning period involves complete immersion in a number of behavioural change efforts, from changing food preferences, to retraining the body to feel satiety differently, to practical tips on how to shop, cook, and store food; how to eat among others on special occasions; what to do about food, hunger and sleep. Because several of these sites are international, advice is available 24-hours.

    Those who can manage for a few months see enough results for this to be reinforcing. Exercise, after about a month or two, is self-reinforcing, due to endorphins.

    Once these habits have been learned, they’re available. People may slip for months at a time – life happens – but you do see return users making use of knowledge learned.

    Now, I feel policy solutions are ideal, but it’s not true that individuals are completely powerless. They do have to be lucky, in a few ways – experiencing the prompting life event in the first place, probably having some individual differences that facilitate compliance. But at least some people can benefit from behavioral methods.

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  12. Side note – the strongest motivators appear to be related to ‘surface’ concerns – e.g., vanity – coupled with high interpersonal stakes (like, the prospect of dating after divorce). Single people do better, marrieds less so, especially if both partners are overweight. These are just my observations, but there’s tons of data that’s collected on these sites. It’s not controlled, no, but I think it’d be worth recruiting from these sites for a prospective study using appropriate instructions and monitoring. You could also look at retrospective data (cleaned up and qualified with appropriate hedges). I bet many would love to offer their experience to research – converts are evangelical.

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