Does Measuring Your Food Add Up?Monday, March 31, 2014
Measuring 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.