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Calories In – Calories Out

There is general agreement that the US, and the West in general, is in the midst of an obesity epidemic. Even if you think this is alarmist or overstating the situation, the data clearly shows a steady expansion of the American waistline. Weight loss is a multi-billion dollar industry and is an active area of research, and yet all the self-help books, low-carb diets, and whole grain foods do not seem to be translating into successful weight loss for the public. Why is this?

From my perspective the failure of the weight-loss industry and public health measures is due to a failed approach – focusing on factors that have a small overall effect on weight loss while neglecting those that have a huge impact.

From an individual perspective, weight loss is simple (although not easy). It is a matter of calories in vs calories out – you cannot escape this equation. This means eating less and moving more. Simple, basic strategies to help reduce caloric intake seem to be the most effective. This means portion control, and limiting calorie-dense foods. The latter requires knowing how many calories are in food you are likely to consume (that Starbucks Mocha Breve has 580 calories). Limiting total caloric intake also means keeping track of how much you eat – which is deceptively difficult to do. Most people fail on diets because they simply underestimate their total caloric intake.

A recent study published in American Journal of Preventive Medicine showed that simply keeping a daily diary of food intake doubled total weight loss in a 5 month study (participants who kept a diary lost an average of 17.5 pounds). This is a significant difference, and the amount of weight lost was also significant. This supports other evidence that methods for estimating and keeping track of caloric intake are very predictive of successful weight loss.

And yet this huge effect from a simple technique was overshadowed in the media by another recent study that showed that those on a low carb diet lost an extra four pounds over 2 years over low-fat dieters (for a total of about 10 pounds). Wow – 4 pounds over 2 years. The media touted this as vindication for low-carb dieting, when it really showed that the diets did not work very well, and any differences among them were practically insignificant.

Now we are told that a pill can reproduce the effects of exercise. The media hails this as a boon to couch potatoes. It did not take long, however, for others to point out that the studies performed on mice did not consider many of the known benefits of exercise. At least for now, there is no exercise in a pill.

The pattern is clear – the media thinks (and they may be right) that the public is interested in learning how to lose weight without calorie restriction and exercise. They would rather eat different food than less food, and exercise “smart” rather than frequently. But the data does not comply.

By obsessing over effects so small that it is controversial if they even exist, and if they do their impact would be minor – the media and self-help industry are likely worsening the obesity problem. Rather there should be an emphasis first on what does work. Here is a quick summary: (Standard disclaimer – this is for information only, not individual medical advise. Many people have individual health concerns that affect their diet and ability to exercise, so if necessary consult your physician.)

- Eat fewer calories. Do this by:

- Choosing lower calorie and less calorie dense food, and by avoiding large calorie extras.

- Avoid drinking calories.

- Use portion control (just don’t take that second helping).

- Track your food intake with a convenient and simple system, at least until you get a better feel for where your calories are coming from.

- Increase your calorie output by exercising more, at least three days a week, but more is better.

- Do something you enjoy as you are much more likely to keep up with it. Likewise, make it as convenient as possible.

- Little activities add up, so take the stairs when you can, walk when you can, and spend more time in recreation that involves moving rather than sitting.

- Weigh yourself weekly to assess how you are doing so you can make adjustments as necessary.

Those are the basics – you should at least start with these steps. The goal is long-term weight control, not a quick fix. That is the other problem with most “diets”- they emphasize short term weight loss rather than long term health and weight control. Forget about highly restrictive diets – no one sticks with them. Forget about really complex diet plans – no one sticks with them. Forget about plans where you have to buy special food – no one sticks with them.

Basically – do not think to yourself, “I just need to get these X pounds off then I can switch to long term maintenance.” The problem with this approach is that almost everyone gains all the weight back. You are better off just going to the long term plan initially – don’t be lured by the promise of rapid weight loss.

From a public health perspective the issues are more challenging. Education can help individuals, but does not have a huge statistical impact on the public. Measures that are helpful are those that make better food choices easier. At my hospital cafeteria, for example, the sandwich counter used to offer two choices for sides, pretzels or potato chips. That was it. Now they off carrot sticks or celery, so that’s what I get. The default choice contains many fewer calories. Those types of measures work.

The trend in marketing, however, has been counter productive. Products are promoted as low-fat or low-carb (depending on your preference) – but neither are necessarily low calorie. They simply replace fat calories with carbs, or vice versa. So people end up eating more total calories because they think they are eating healthy. It’s counter productive. Printing nutritional information on the side of the package is nice, but it hasn’t helped.

Bottom line time

The public would be better off if they completely ignored the weight loss industry, avoided self-help weight loss books and diets, and simply focussed on some basic principles, as outlined above. Public health measures should focus on making default choices more healthful and lower calorie. We are starting to see a trend in this direction, in response to public demand. You can now get apple slices instead of french fries as a side in your kid’s Happy Meal. I can get carrot sticks instead of potato chips with my tuna on rye. But if there is going to be a reversal of the obesity trend in the West much more has to be done.

Posted in: Public Health

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202 thoughts on “Calories In – Calories Out

  1. Gib says:

    I agree that just keeping track of calories is a great help. I’ve started doing that, and losing heaps of weight.

    I use a program on my blackberry which contains a big database of different foods, from raw ingredients to particular items at fast food restaurants. When you eat something, you just type in the name, select the quantity, and add it to the day’s tally.

    Or when you’re choosing what to eat, you can look up the calories for each option. Just doing this for a few weeks will make it much easier for you to eventually assess the calorific content of meals without having to use the device at all, which will continue to help you after you’re reached your ideal weight.

    I also use it to plan my evening meals, based on what I’m about to eat for lunch. Or, to change my lunch meal based on what I have left at home and are planning to eat that night (and have already entered into that day’s tally).

    The program also keeps track of daily weight measurements, does graphs etc.

    There are a few programs out there, for all sorts of devices, but I definitely recommend one which has a big database of foods and a simple interface. Otherwise you won’t bother entering the information into it, and you’ll lose interest fast.

  2. Fifi says:

    I’ll second Gib’s thumbs up for digital food/exercise diaries as very useful (whether online or hand held), I’ve found that people often find it easier to use a program than to keep an actual food diary for a number of reasons (not having to do the math oneself, it feels more like entering data than making a confession and makes it into more of a “game”). Of course, real desire and motivation is still needed but it does help support making healthy lifestyle changes (and educating yourself if you don’t have a grasp of energy in/out ratios). In many ways, the program becomes a virtual life coach – though it won’t charge you for not showing up at the gym or give you emotional support! ;-)

  3. Harriet Hall says:

    A few thoughts:

    (1) Even when they look up the number of calories, people tend to underestimate portion sizes and report fewer calories than they are actually eating. This doesn’t matter as long as they keep adjusting downward until they are losing weight.

    (2) Some people can’t exercise or don’t want to, and it’s important to remember that it’s the calorie in/out balance that matters. My husband lost 60 pounds in 5 months without exercising or increasing his activity level at all. And it stayed off because he didn’t return to his pre-diet eating habits.

    (3) I practiced in the Air Force; they required overweight personnel to enter a weight control program and lose down to their allowed maximum. Everyone succeeded (except for the few who were discharged). The next time they’d come in, they’d be over their maximum again. I would ask, and they’d say they hadn’t weighed themselves at all in the interim. I’d ask why, and they’d offer some lame excuse like they “just wanted to see what would happen.” It was denial pure and simple.

    (4) I used to tell people to weigh once a week, but now I’m thinking every day is a good idea – as long as you realize there will be daily fluctuations due to salt intake, hormonal changes and other unpredictable factors.

    (5) I’ve seen people lose over a hundred pounds in a year and tell me it was effortless and they were never hungry. It’s all in choosing the right foods so you feel fuller with fewer calories. One woman told me she couldn’t eat all she was allowed on her TOPS diet.

  4. quackdoctor says:

    Well the thing is that different people are different. And not all people may have what it takes to follow a low calorie diet. And the facts are that they do not. Many times. It is not all just calories. The types of foods one eats are important as well. However.

    Even people that eat “right” are not in the best situation. If you want to live the logest you will eat very very little. I belioeve a diet just above starvation. It is best to eat like a bird.

    People will say. “Eat a healthy diet…With lots of fruits and vegatables”. Tis is not good advice. If you want to put odds in your favor you will eat like a bird. A very very small bird. Much less than even the health professions advise.

    But as far as losing weight a lot needs to be considered. Not just calories. Sure it may work for some and certainly if one ios able to dramatically decrease calories then they will lose weight. But there are human factors as well. And also when you eat is important and what you eat. So it is not all calories on a clinical level. People are not lab rats and you just cannot restrict them like a rat.

    But all this aside if you can do it the goal should be a diest just above threshold for starvation

  5. Fifi says:

    Harriet – I’ve found measuring tapes work better for a lot of people than weighing themselves (and using both together is even better). One reason is that if people are exercising then they won’t necessarily see fat loss realistically reflected on the scale (since muscle weighs more than fat). The other is that it emphasizes how fitness influences how we look and how we FEEL in our body, it’s not just about what we eat (after all, it’s about getting healthy not skinny so why not focus on those aspects as well as “looking good”). Also, it gives people another “reward” for exercising and shows them how exercise influences body shape. Quite a lot of people need exercise to be able to stay on course with lifestyle changes – particularly if their eating is stress related, they eat because they feel low energy and are tired, or they’ve got some depression going on that’s contributing to using food to feel “good”.

  6. There’s a lot of anecdotal advice being handed out .

    Quackdoctor – my opinion, based upon the published literature, is that what you eat has a tiny and ambiguous overall effect on weight (which is not to say that it is not important for overall good nutrition, heart health and glycemic health – I’m just talking about weight loss).

    I also think the variabilities among people is overplayed. the basic calorie formula rules all and is a huge factor, everything else is tiny. That’s what the evidence overwhelmingly says.

    The starvation diet is largely based on mouse data. There is insufficient human data to recommend it. Following a near starvation diet may (emphasis on may) provide some metabolic benefits for longevity, but they are likely to be countered by malnutrition if one is not exceedingly careful. Bottom line – current evidence does not support the recommendation for a near-starvation diet.

  7. quackdoctor says:

    Well I do not disagree with you. All I am saying is that we must consider the human factor. And people think differently. I am not so much saying that theoir basic chemistry is different. But their minds are different. That is all. Some people do better on lower carb diets and other people so better on soley restricing calories. I am not talking about what works better in the ideal situation. We both know that some people cannot restrict their calories and a different approach is in order.

    No what I mean by it mattering what one eats is that this may effect their ability to stay on the diet and how they feel. If a person is eating muffins and soda for breakfast despite the fact that they are within caloric dietary guidlines they will make their blood sugar wacky. And this can cause them ot get hungry and violate the diet.

    So I am talking about the human side. From a physiology side I have no argument basically.

    Yes and I agree my opinion of the near starvation diet is not based in proven science. Maybe I should replace the word “near starvation” with “Eat very little”. You see my theroy is that we need to eat far far less than we do. And we do not get malnorished as easily as we think. And I think we need less nutrients than even most of the RDAs say we do..

    On a sidenote I wonder if there was ever a study on the incidence of CV disease in people who were in concentration camps for extended periods. It is neither here nor there but I have always wondered that.

    I cannot prove it but from my view the only reason for a person to carry any weitht above whgat is needed to avoid getting sick is if for example one did get sick and needed surgery. Like in the elderly.

  8. Fifi says:

    Dr Novella – Yes, we all tend to be a bit anecdotal about our personal observations (whether these observations took place in a professional or everyday context) and what we’ve found works or doesn’t work in the contexts we’ve been in. I noticed you’ve included some of your own anecdotes and personal experiences in your blog post too :-)

  9. overshoot says:

    Weigh yourself weekly to assess how you are doing so you can make adjustments as necessary.

    Eeeeep!

    I was ready to rant about the term “weight control,” which is bad enough but hard to avoid. “Waist control,” maybe. “Fat control” is better yet.

    However, weighing is a known contributor to exercise program failure. It’s simple enough: fat clocks in at 3500 cal/lb, muscle at 1200 cal/lb. In the early stages of an exercise program, people tend to turn calories from fat to muscle at more than a 1:1 rate. In other words, they use up two pounds of fat (7000 calories), build three pounds of muscle (3600 calories), and burn off the 3400 calorie difference. All good — but the scales show a one-pound weight gain. Result: discouragement, end of program. (Specific numbers for illustrative purposes only.)

    I can’t give you sources right now, but an alternative advice is to take measurements monthly. How your clothes fit is a much better long-term metric and, especially for women, much more rewarding. Once it gets going, the rewards are daily because we can feel how they’re getting looser, and eventually the wardrobe adjustments are another reminder [1].

    In my case, $HERSELF reminds me on a regular basis with tummy rubs — and comments on relative convexity. Serious motivator, that.

    [1] OK, there is one minor disincentive: a lot of women lose fat from the chest first. Going down a cup size was annoying to my daughter, but she likes the rest of the effect and has enough self-confidence that she can do without any men who would like her less with less chest.

  10. JustinWilson says:

    Is it just me or is “easy” winning out over “better.” Every time we make something easy, it’s taken to excess. Getting food through a window is easier than making your own nutritious lunch. Finding out what misinformation celebrities are spouting is easier than finding research data to prove them wrong. When new weight-loss “breakthroughs” are found, everyone wants to jump on board because it’s an easy way to get slim.

    I hope the diet-drug pans out. I know there are a lot of people out there that can’t safely exercise that could use it to get to a safe weight so that they can exercise. That would be nice.

    I read about this research a few days ago and I’m glad you brought it up. It also reaffirmed my own weight loss goals and methodology. Thanks again!

  11. Harriet Hall says:

    overshoot,

    If you know about the effects of exercise, you can take that into account and not get discouraged. The same argument applies to someone whose weight appears to go up because of fluid retention but who is actually losing weight. And to people who initially lose water weight and think their diet is successful when it isn’t.

    If weighing sometimes contributes to weight loss failure, I’d bet that NOT weighing contributes far more often. It’s just too easy to talk yourself into thinking you’re eating less than you really are. And if you find out you’re wrong after you’ve gained a pound, it’s easier to lose that pound than to wait a month and have to deal with 5 or 10 pounds.

    That said, everyone’s psychology is different, and the whole weight loss thing depends on figuring out how to talk yourself into doing what you need to do. Whatever works for you to fix that calories in/out balance.

  12. overshoot says:

    If you know about the effects of exercise, you can take that into account and not get discouraged. The same argument applies to someone whose weight appears to go up because of fluid retention but who is actually losing weight. And to people who initially lose water weight and think their diet is successful when it isn’t.

    The problem is twofold:

    1) Most people don’t understand this
    2) Even for those who do, there’s a difference between “understanding” and “tak(ing) that into account” at the emotional level.

    If weighing sometimes contributes to weight loss failure, I’d bet that NOT weighing contributes far more often.

    Weighing works for intake, since intake doesn’t add muscle weight. It’s a demotivator for exercise. In the Air Force, where the exercise part of a program is easier to enforce (if only through working around people serious about fitness and with plenty of opportunities) I would expect the intake side to dominate.

    FWIW, I’m currenlty down about 15 pounds from the start of the year. This has me bummed out, because I strongly suspect that a good bit of it is lost muscle mass due to enforced inactivity (several injuries that have limited my lower-body weight bearing limits.) The subject is not remotely academic to me.

  13. Joe says:

    quackdoctor on 06 Aug 2008 at 12:25 pm wrote:

    “… my opinion of the near starvation diet is not based in proven science.”

    “I cannot prove it but from my view …”

    Why do you think anyone should care? Nothing in true chiropracty is proven. We already knew that.

    Silly chiropractic advice about obesity prevention http://www.chirobase.org/14Misc/acaobesity.html

  14. Fifi says:

    I’m with overshoot here (for the reasons we’ve both mentioned). I also don’t think (nor is it my experience) that weight loss or fitness is “academic” for most people. Both exercise and food can be very volatile emotional and psychological areas for many reasons for a lot of people, if not most. So much so that some people avoid exercise and will go to great lengths to do so (and the health benefits of exercise have to do with mental health, spacial relations and balance, and all other areas where just changing diet does little or doesn’t confer the same benefits). And please let’s not promote the totally erroneous idea that thin=healthy, anorexics aren’t healthy and being skinny doesn’t necessarily mean one’s fit or healthy (sometimes quite the opposite).

  15. I don’t think anyone said thin = healthy. The data is a bit unclear, but suggests that having a few extra pounds may be ideal, but being obese comes with a host of medical risks (putting the problems with BMI aside).

    Regarding weekly weighing – the evidence shows this is associated with greater success in weight loss and maintenance. (for example: http://care.diabetesjournals.org/cgi/content/full/31/7/1299, but I remember there are other studies as well).

    The muscle gain effect probably does not apply to most people in most situations. If you are doing muscle building exercise enough to more than offset loss of fat, then don’t rely on the scale. Positive changes will probably be visible anyway.

    Other methods can work also – the idea is that there is some net-effect feedback mechanism to judge the results of your current caloric intake and exercise.

  16. pec says:

    I think the obesity epidemic is caused mostly by extreme inactivity. Americans don’t realize that they spend almost all their waking hours sitting, either at work or in the car or at home. I don’t think you would have to count calories or worry about weight if your lifestyle required even a small amount of motion every day.

    I think we should have at least 2 hours of physical exercise every day, but probably much less is required to prevent obesity. People who live in cities who don’t drive cars are much thinner than those who live in the suburbs. And maybe it’s all because of the small amount of walking they do every day between subway station and office.

    However I agree that the diet crazes are counter-productive. And the food companies can be so deceptive and misleading — like non-fat yogurt that’s full of sugar and corn starch, pretending to be the best thing for your health.

  17. Fifi says:

    Dr Novella – I brought up the thin=healthy misconception because it’s a common one and there was discussion of weight loss without exercise. If we’re making lifestyle changes to improve our health, exercise is a pretty powerful part of the equation for a number of reasons. Additionally, there’s a synergistic effect because building more muscle makes our metabolism more efficient (plus exercise helps regulate hormones). There are, of course, situations where people can’t exercise and so bringing down calorie consumption is the only way to lose weight. Obviously someone who is very obese is going to be dealing with a whole host of physiological and psychological challenges when they try to lose weight and needs medical supervision. It’s a bit of a different kettle of fish than it is for someone who can implement lifestyle changes themselves or with their family.

    I don’t have any data on the muscle vs fat weight question, do you? I’d be interested to see it (and quite willing to change my perspective on the matter if my subjective observations have led me astray). I suspect it’s less relevant in people who are grossly obese and more relevant to people who are overweight or verging on obese – but that’s speculative on my part. Weighing oneself is useful, it’s just also useful to use other markers for a lot of people. One reason for this is that people often have distorted body images and it often takes a while for their mental image of their body to catch up when they lose weight (including spatial relations, how big their body is navigating through space).

  18. overshoot says:

    The muscle gain effect probably does not apply to most people in most situations.

    That’s a pretty straightforward science-based medical question; my own totally unscientific observations are that a large percentage of the more-than-trivially fat population has a very low activity level — low enough that even the canonical half-hour of walking a day will add quite a bit of muscle mass.

    Just doing enough abdominals to prevent back pain is “muscle building,” and that’s a huge part of the over-40 population right there.

    putting the problems with BMI aside

    Thank you! Being a few sigma to the right on the height curve makes the BMI a sore spot, especially since it’s starting to be enforced in some quarters. My favorite is comparing the “obese” Shaquille O’Neil (325 pounds, 85 inches, BMI=31.6) to a similarly “obese” woman (173 pounds, 62 inches, BMI=31.6). Which is more in need of a fitness program?

    For an “ideal” BMI of 21.7, Mr. O’Neil would have to lose 102 pounds. Anyone care to imagine what he would look like at 223? Any of the medically educated care to speculate on the health consequences?

  19. dmmiles says:

    I also follow the Weighty Matters blog. He recently commented on the calorie out portion of weight management.

    http://bmimedical.blogspot.com/2008/08/obesity-is-not-about-inactivity.html

    The article he is referencing studied the (lack of) change in physical activity energy expenditures in the last 30 years.

  20. quackdoctor says:

    Joe…

    You are being a complete jerk. My statment has nothing to do with chiropractic. I never was involved in nutrition. I was just saying what I thought could be. And where I read about what I said had nothing to do with chiropractic. You are being very immature. Remember Mr Rocket Scientist I have a PhD as well as a DC and in a few years will have an MD. So I would not be so fast to be abusive. I never bought up chiropractic in this discussion. I am a bit more flexible in trying non evidence based methods than folks here. That may be true. But I did not EAT STUPID FOR BREAKFAST. You do not hewre me slamming good medical care. I am not against vaccines and drugs and surgery

    But since you ask…Yes people from all educational backgrounds have some wacky ideas. I do not need to remingd you that a lot of these diet books with new crazy diets are written by MDs. In fact I cannot think of one new diet scam that was invented by a DC.

    And my bringing up the concept of -patients possibley doing better on very low amounts of food is not something DCs made up. It never came from chiropractic. I read about it in medical journals. And I said it was not proven.

    And do not be so arrogant. Because you see if the current methods of manageing patients in theis country were working well we would not have the severe obesity problems we have. If medicine was adaquately handling the population. And I do not have all the solutions but I am open minded.

    Hell Joe I am pretty conservative. As I said I suspect that even the current RDAs in many cases may be too high.

    Now as far as DC education goes. The following is what students are TAUGHT at National. It is standard mainstream medical nutrition.

    BC5308 Nutritional Biochemistry – Credits 2.0
    Vitamins and minerals will be studied with an emphasis on their biochemical involvement within human metabolic pathways and physiology. Non-essential nutrients will also be investigated with respect to their role in biochemistry and physiology.

    Prerequisites: BC5104, BC5105

    NN5406 Science of Diet & Nutrition – Credits 3.0

    This course provides a basic understanding of the fundamentals of human nutrition and stresses the essentials of the basis for good nutritional status. It serves as the basic nutrition course that follows the basic science presentation of the macronutrients and the micronutrients presented in the Nutritional Biochemistry course (BC5308). Topics presented in this course include a review of the macronutrients and micronutrients with emphasis on the health properties of each as well as the severe deficiency states for both micronutrients and macronutrients. Digestion, absorption and transport of the nutrients, and consequences of malabsorption care are covered. Energy production, energy balance and weight management are also described. Food habits in the United States and nutrition across the life cycle are discussed in the course. Male and female health, sports and exercise nutrition, enteral and parenteral nutrition procedures as well as an introduction to the science of food preparation and handling are included. An introduction to nutritional status assessment using food frequency questionnaires and diet history is given.

    Prerequisite: BC5308

  21. Nice article Steven. I lost 56 pounds. I did not look for the miracle diet I did it the old fashion way. I earned it. I learned about weight loss and I also learned to feel good about myself. That was just the beginning.

  22. Harriet Hall says:

    Joe and quackdoctor,

    Let’s try to avoid personalities and insults and stick to the subject of this post.

  23. Dacks says:

    I think there should be a distinction made here between a weight- loss program and a lifetime weight regimen. Do people need to embark on a weight-loss program before stepping up to a long term weight control plan? If so, a weekly weighing might be appropriate. But if weight control is a daily activity, then daily weighing might be more useful.

    In my experience, “a little bit, often” is what works for many endeavors, including weight maintenance.

  24. daedalus2u says:

    Very nice article. Weight gain is purely a material balance issue. Calories in minus calories out equal calories accumulated.

    What is not well appreciated is how small that imbalance can be and still result in weight gain (or weight loss). A pound of obese tissue represents about 3500 calories. The metabolic rate of that adipose tissue isn’t very much compared to the metabolic rate of lean tissue, so we can neglect it. A gain of 10 pounds represents an excess of 35,000 calories. The time frame over which those excess calories have been consumed doesn’t really matter; a month, a year, or 10 years. In 10 years at 2500 calories per day, an excess of 35,000 calories is only 0.4% or less than 10 calories per day in excess.

    It is pretty obviously a setpoint issue. What ever control system our physiology has to keep our bodies in calorie balance has a setpoint that is out of whack.

    That is why trying to pick a magic food or a magic diet doesn’t work. The problem is the physiological setpoint that controls how many calories are eaten, not the source of those calories. It is difficult for people to starve themselves to death when food is available to them because there are powerful physiological compulsions to eat until the physiological setpoint is reached.

    If the setpoint for converting blood glucose into depot fat is less then the setpoint that triggers satiation, you will never be satisfied because blood glucose never reaches the level that does so, it gets converted into depot fat first. Obviously that setpoint is very complicated and is a function of many things and is regulated somewhat independently at different parts of the body in ways that are not fully understood.

  25. bonedoc says:

    I wonder why BMI is calculated using the square of measured height, when our volume should be proportional to the cube of our height. Doesn’t BMI understate obesity in shorter people and overstate it in taller people? Indeed if we hypothesize the 70Kg man 1.7 meters tall (roughly 154 lbs and 5’6.3″) then the weight (in pounds) divided by height (in inches) is 0.000528; Using the numbers above for Shaq yields 0.000529, but using the mildy obese woman numbers yields 0.000726. Does anyone know if this would better reflect obesity? It still doesn’t account for the difference between muscle mass and adiposity. Body builders may have an elevated BMI due to added muscle mass, but clearly are not obese if the added mass is all muscle. I hope this isn’t too far off topic.

  26. Jeff says:

    This is a great post. I host a podcast called “Fat 2 Fit Radio”, and this is the common sense stuff that I struggle with every day to get across to our listeners. The average person actually has a very hard time believing me when I talk about the caloric balance principle.

    This is my show’s philosophy for dieting and weight loss:

    “Eat and exercise like a thinner person to become that thinner person. Figure out your calories that you would eat at you goal weight and eat at that level for the rest of your life for long-term weight loss success.”

    Here are some numbers that show just how little difference there is for someone who wants to lose 50 lbs.

    5′5″ woman, 30 years old who exercises lightly (BMR x 1.375)

    175 lbs – 2165 calories per day
    125 lbs – 1850 calories per day

    That’s only about 300 calories difference.

    5′10″ man, 30 years old who exercises lightly (BMR x 1.375)

    225 lbs – 2950 calories per day
    175 lbs – 2550 calories per day

    That is only about 400 calories difference.

    I agree with everyone here that the weight loss industry has done nothing more than confuse the general public. They begin to think that there is some sort of secret to maintaining a healthy weight. They only seem to care how fast the weight will come off and the “calories in vs calories out” is very 1980′s and they are not interested in hearing it.

    I also think that the media paralyzes the average person by giving them too much irrelevant diet information. After hearing week after week about the latest study that says to eat this or that, or some sort of supplement may help, or drink green tea, or eat lost of garlic…. they get to the point that there are so many things that they are supposed to do, that they end up doing nothing.

    I must say that Dr. Novella has been a unknowing positive influence in my podcast. The SGU has really helped me to tackle all of the fad diets, supplements and weight loss schemes in an intelligent and non-belittling manner. This topic should really be covered in detail on a future SGU show.

  27. Harriet Hall says:

    “there are powerful physiological compulsions to eat until the physiological setpoint is reached.”

    I’m not so sure. Plenty of people do lose weight and keep it off and don’t describe feeling strong compulsions, so it seems the setpoint can be re-set.

  28. quackdoctor says:

    Well I just wanted to say that even though the calories in and out is totally true. It is not always that easy for the individual person to lose weight. I tried but just was unable to do it. But I was able to lose weitht by going almost zero carbs and getting myself into ketosis and gluconeogenesis. I tested my urine every day and was able to lose weight very fast. 30 pounds in a month. Then I shifted over to smaller portions and went to a reduced carb diet. But not an extremely low one.

    Also when I went to the zero carbs within about 2 weeks my BP was down and I had less reflux. So for me there was another way of doing things.

  29. nwtk2007 says:

    I opened my first clinic back in 1994. From the first day I opened I was swamped by diet peddlers who would stalk patients as they came out of the clinic.

    I didn’t get into any of their programs and began to write a brochure for my patients about basic dieting without frills or schemes. It eventually grew into a book (copy written but not published).

    The main theme was exactly what this article is based upon, only I said that ultimately the only way to lose weight is by burning more than you consume. Essentially the same idea.

    I emphasized the basics: less fatty foods, less sugars and less calories consumed in liquid form (even fruit juices which are mostly empty calories) and also recommended complex carbs over proteins. To me, biochemically, it is a cleaner diet and, of course, higher in fiber.

    But no matter what the combination of foods, the bottom line was always, less intake and burn more.

    Over the years I have come to think that my basic premise is correct and in the long run, it really doesn’t matter if your diet is high protein or high carb, as long as you reduce your consumption. Consumption is a killer, especially as we grow older,loving and appreciating our foods even more while at the same time, losing muscle mass and having our metabolic rates gradually decrease.

    The true emphasis was that true weight lose involves eating less, not necessarily exercising more, although, as long as you don’t get injured, more exercise is better.

    And yes, thin does not equal healthy. Thin means thin, with a whole host of potential problems.

  30. nwtk2007 says:

    Quackdoctor – “Well I just wanted to say that even though the calories in and out is totally true. It is not always that easy for the individual person to lose weight.”

    Total understatement. It is not easy for anyone to lose weight. It sucks to stay hungry.

    The zero carbs is probably not a good idea. For one, you establish the basic biochemistry of a diabetic without the high blood sugar. For two, you can’t have low blood sugar, so replacement, once your stores are empty, come from the breakdown of protein and subsequent conversion to glucose. (Your neurons in your brain have a great affinity for glucose as just about the only thing they will eat, for the most part.) And three, you can’t burn fats without carbs to prime the fat burning pump, so to speak.

  31. quackdoctor says:

    Well actually your primary production of glucose comes from fat until you use it up. Then you procede to move to protein. And actually on a very low carb diet you will see muscle mass go up if you are eating meat and excersizing. And there is no real evidence that being in ketosis for a while to lose weight is a bad thing. But I do agree that if you decrease calories y9u will lose. But as I said if you take in simple carbs you will get your insulin going crazy and your blood sugar will flux. And that can make it harder to lose weight. And carbs will raise your triglycerides for one thing. But all that aside, Check out this video. It is very very worth watching. It is by a DC that is quite knowledgeable. He gets into obestity and diabetes after a while. I went to National with him. Real smart guy…
    http://www.thewellnessdoc.com/custom/dr.ungar/videos/video.asp?Video=cardiovascular&VideoPart=1

  32. Jodyw1 says:

    Without sounding too much like a troll, what is the evidence that people who weigh less live longer, healthier lives than those who weigh more?

    From what I’ve read — and I’m the first to grant I’m not an expert — the actual correlations aren’t as great as the popular press makes it out to be.

  33. kathleen says:

    nwtk2007 says “It is not easy for anyone to lose weight. It sucks to stay hungry.”

    I really believe that people can lose weight without feeling hungry. That’s what I’m doing. I have lost 16lbs in the last few months and am still losing simply by doing what Steve Novella recommends “Choosing lower calorie and less calorie dense food”. So I try to eat healthy filling meals consisting of some carbs, a little protein and loads of veg. I don’t calorie count, I don’t weigh anything and I don’t get obsessed with it – but I’m not hungry.

    What is difficult is being surrounded by (and tempted by) high fat, high sugar food whenever I go out or in adverts on the TV/in magazines.

    I also weigh once a week as I find any upward fluctuations in daily weighing very discouraging! But maybe that’s just me :-)

  34. Owen says:

    Wait, wait, wait. I’ve looked at that study, and I’m confused.

    According to the summary, the participants all lost a lot of weight very quickly (regardless of diet), starting increasing again, then reached a plateau (I’ve got a separate question about that; maybe later).

    My confusion is this: if “calories-in/calories-out” holds, then why didn’t they have continued loss throughout the programme? How could they plateau at all, when they were still eating less than when they started, and exercising more?

    Seriously, I’m confused about this.

    (This info from their chart at http://content.nejm.org/cgi/content/full/359/3/229/T2)

  35. daedalus2u says:

    Harriet, yes the setpoint can be reset. But it is a physiological setpoint issue, not a choice issue.

    Every organism eats a diet that supplies its entire nutritional requirements. There has to be lots of physiology that regulates diet according to what that organism needs. That physiology dates to early evolutionary time and is no doubt fully integrated into every other bit of physiology.

    The “setpoint” is not a simple or single valued parameter. People eating ad lib (in general given the opportunity and access to sufficient diversity of foods) select a sufficiently balanced diet that deficiency diseases are rare. This is what people instinctively did for millions of years. They didn’t just balance calories, but fat, protein and carbohydrate as well as vitamins, minerals and trace minerals. There has to be lots of physiology involved in compelling people to choose the proper diet without conscious effort on their part. Diet preference determined by physiology can be overridden by people who don’t “listen” to what their body is telling them to eat.

    People living in the rural third world don’t become massively obese. They also don’t know the nutritional content of the foods that they eat, they only know what they want to eat and what they have learned about how they feel when they have eaten certain foods.

    Why the setpoint is inappropriate for some people is not understood. I think the difficulty in appreciating that is because each person has experience with their own dietary setpoint and they assume that everyone else has a similar setpoint and a similar compulsion to eat. The setpoint induced compulsion to eat is purely subjective.

    Things to modify the setpoint. Stress increases food intake. Calling it “comfort food” doesn’t change the fact that it is physiology that is compelling consumption of more food. Stress has changed the setpoint. Similarly, if the stress is high enough food intake goes down, and can go to zero. Why? I think because digestion of food takes resources that under conditions of high stress are better kept in reserve in case they are needed. Digestion takes time. The metabolic resources obtained by eating do not become available immediately and impose a cost in terms of ATP consumption for digestion before those resources become available.

    The example I like to use is running from a bear. When you are running from a bear, what kind of food are you going to want to eat? Nothing that takes a lot of resources to digest. Calorie dense foods rich in fat and sugar. Enough stress can even cause vomiting, getting rid of food that you have already eaten. Why? I think to free up the metabolic resources necessary to digest that food so they can be used to support gluconeogenesis and power the escape from the bear.

    Those stress responses are from deep evolutionary time. Stress responses are highly conserved and occur automatically. If those stress responses are invoked inappropriately, people would have enormous difficulty overriding them cognitively. It is easy to for people not overweight to denigrate people who are overweight as being weak-willed. Without actually knowing the magnitude of the compulsion such people have to eat, that is psychological projection, not a scientific conclusion.

  36. nwtk2007 says:

    Quackdoctor – “Well actually your primary production of glucose comes from fat until you use it up. Then you procede to move to protein. ”

    This is one of the oldest of dieting myths. The fact is, we lack the biochemical machinery to convert fat into carbohydrate, ie – glucose. This is why fasting is such a poor way to lose weight. When stored carbohydrates are used up, the ONLY source of glucose is thru the conversion of protein.

    So any diet, if it isn’t going to result in the breakdown of muscle, requires some carbohydrate.

    Kathleen – “I really believe that people can lose weight without feeling hungry.”

    You’re right I think, but the “not so hungry” method of weight loss is a slow method. However, I also think that the slower you lose weight, the longer you are likely to keep it off. Gradual changes are less stressful and the habits you develop during the time involved will also stay with you longer, if not becoming a permanent part of your life.

    Jodyw1 – “what is the evidence that people who weigh less live longer, healthier lives than those who weigh more?”

    I personally have only seen one study where longevity was increased and that by cutting calories consumed 50%.

    I think that is one of the dieting myths that might be possibly true in the sense that eating right and being at a reasonable weight reduces your risk from illnesses that hit the unhealthy and possibly the over weight person as well. The real gist of good diet and good health is increased quality of life, not longevity.

    Owen, I have not read that study yet, but if a plateau is reached where there is no more weight lost, then at that point, the participants must be burning essentially the same number of calories as they are consuming, or rather assimilating. A possible explanation is that when less calories are consumed, there is a corresponding drop in metabolic rates, although this would also be effected by numerous factors. But the bottom line is that when weight is stable, burning and assimilating are equal. It simply has to be. Weight gain means assimilating more than you burn and weight loss means burning more than you asimilate.

  37. Owen says:

    nwtk2007: “if a plateau is reached where there is no more weight lost, then at that point, the participants must be burning essentially the same number of calories as they are consuming, or rather assimilating.”

    I urge you to read the study, and look at the graphs, taking into account the recorded exercise and food intake (all nicely made available for us).

    It’s worse than you may first suppose. For the first 3 to 6 months, all the participants lose a substantial amount of weight. Then, while the study indicates they are still exercising and eating about the same amounts, they stop losing weight, and start putting it back on. How can that be?

    (I think the plateau may actually be a mirage: people who dropped out were kept in for analysis purposes, using their last-recorded weight for the remainder of the study period. This would tend to flatten any continuing rise, wouldn’t it?)

    Nobody has claimed this is a poorly run study. People (including Mr Novella) have been happy to quote its end result.

    But — assuming my reading is correct, please advise otherwise — this study simply does not support the prevailing “calories-in/calories-out” wisdom.

    It seems too clear cut. What am I getting wrong here?

  38. Owen says:

    kathleen: “So I try to eat healthy filling meals consisting of some carbs, a little protein and loads of veg. I don’t calorie count, I don’t weigh anything and I don’t get obsessed with it – but I’m not hungry.”

    I’m pleased that works for you (really). But I don’t like veg. Eating enough of the stuff I’m allowed to eat is real chore. To lose weight, it’s either dull, tasteless or even horrible food, or I go hungry.

    Sucks to be me :-(.

  39. Fifi says:

    Owen – Perhaps you need some help in learning how to cook and prepare vegetables in a way you find appealing? Taste is a learned thing, we get used to certain levels of things and it takes a while to change our tastebuds and perceptions about how something tastes. (And people do go from loving only junk food to really loving vegetables, whole grains and healthy foods – sometimes to the point where they no longer enjoy the taste of fast food.) Even basic things like how much sugar tastes sweet to us or how much salt tastes salty are acquired tastes (people – and the food industry – use salt and sugar to try to make up for the blandness and lack of essential taste!).

    I’ve found that people who eat lots of prepared foods and grew up on a diet of tinned, junk and preprepared food often have problems with how much taste real food has (though a lot of factory farmed veggies are pretty bland!). Also, their idea of vegetables tends to be carrots, iceberg lettuce and those weird pinkish things that pretend to be tomatoes – probably the least tasty veggies out there (particularly the factory farmed kind). Processed food has lots of salts and sugars that stimulate our taste buds but don’t actually deliver much taste other than salty or sweet. Processed foods also tend to not have much texture so people get used to eating mush that they kind of bite into and swallow whole instead of really chewing and tasting.

    Not consuming calories through drinking them (juice, soda, alcohol) can also make a big impact in a lot of people’s daily calorie consumption.

    Granted, America’s not a great country for food in general. Not that one can’t get good food, it’s just easier to get crappy food (in super-sized portions!). The other option if someone doesn’t like restricting calories is to burn more. Someone who increases their physical activity and burns more calories will be able to eat more.

    At the end of the day, it comes down to how much you value your own health and respect your body and mind (our brain is part of our body so both diet and exercise have big impacts upon how our brain and mind function). Personally I believe everyone has the right to trade off health and longevity for pleasure in the moment – or to manage their body how they choose. It’s also been my experience that if someone doesn’t really want to make lifestyle changes and see it as being some horrible form of punishment being imposed upon them, they won’t make the changes or have the motivation necessary to get over the first hurdles. People often have very childish relationships to food – particularly if their parents used it as an emotional reward or used food to medicate themselves and their children.

  40. Fifi says:

    One thing to consider is that feeling hungry isn’t a bad thing, particularly if one is trying to lose weight, since it’s a sign that you’ve started to burn fat and not just the calories you’ve consumed. In this case, hunger is a sign of success! Changing one’s perspective on feeling hungry can be very useful (as can learning to delay gratification). I’ve found a lot of people who have chronic weight issues aren’t particularly comfortable with feeling and acknowledging what’s going on physically in their body (particularly if they use food or alcohol to change how they feel as a means to avoid their emotions – emotions being physical sensations) and often can’t distinguish between feeling thirsty, hungry, bored and other desires. For many people there’s quite a substantial learning curve when changing lifestyle habits – they need to learn all the basic stuff their parents didn’t or couldn’t teach them about delaying gratification, managing feelings (be they hunger, sadness, anger or boredom) and they need to consciously change habits (which is made much easier in a supportive environment where temptation is minimized).

  41. sjones says:

    Data I saw recently suggests that the upper 1/4 of the income scale has seen little increase in weight during the obesity crisis and that the growth in overweight is generally related to income. We have surveyed self-reported health issues in rural (fishing, not farming) areas for several years. Our respondents consistently report that obtaining nutritious food is the number two problem (behind access). Colleagues who study food security in the same areas have also found this and their more detailed studies suggest that the problem is both cost (fresh fruits and vegetables and good quality meat have been rising in cost for a number of years) and time (having to work multiple jobs in a household, with irregular schedules leaves too little time for meal preparation). And the problem is not people snacking on McFood or chips, they can’t afford them either. There are also some cultural issues in food preparation (fire departments in the area regularly issue warnings about deep fat fryers in the home). In short, just hectoring people about something they have little ability to modify isn’t going to solve the problem any more than the “exercise pill” is. And while it is nice some of you can keep track of things on your Blackberry, most of the people with the biggest weight problems have trouble keeping their pay as you go cell phone active.

  42. nwtk2007 says:

    Owen, I sympathize with you whole heartedly. I mean, FiFi is right, but when faced with a plate full of bacon, biscuits, fried potatoes, and fried eggs all smothered from thick creamy gravy made from the bacon fat, it is pretty hard to say no.

    Or chicken fried steak, mashed potatoes, fried okra, blackeyed peas (seasoned with bacon grease), and, of course, thick creamy white gravy smothering the steak and potatoes. Or …..

    Very tuff indeed. And I grew up in a family that raised almost all of their vegetables on the farm and slaughtered their own beef, pork and chickens. And there ain’t nothin’ as good as those home grown vegies. How are we supposed to eat less of those.

    Some people eat to live and some of us live to eat. It is fun and social and sometimes you just have to say “to heck with it”. And work out even harder and go at least a few more days before indulging in those delectable urges.

  43. Fifi says:

    Kathleen – Sounds like you’re making practical lifestyle changes that will be easy to maintain once they’ve become your new habits. In my experience, most people seem to do best with weighing in once a week.

  44. Owen – You are assuming that the people in the study were accurately recording their caloric intake and activity level throughout the study.

    The amount of weight lost was so small over the two year period that small changes in unreported snacking, snacking portions, or activity level could affect the outcome. The study simply does not contain the data necessary to say that it contradicts calories in-calories out.

    Also – keep in mind that weight (also considering proportion of lean mass, water content, etc.) has to be a function of calories in – calories out otherwise you violate the laws of physics. I think you are equating calories in with what you eat (when it also may depend on how much you digest and absorb) and calories out with how much exercise you do (when it also is a function of metabolic rate and other activity variable other than deliberate exercise).

    Another variable that is separate (in a way) from calories in-calories out is metabolic efficiency. Perhaps it costs more energy to metabolize some calories that others. To lose weight you would therefore want to eat inefficient calories. Interstingly, Barry Sears, author of the Zone diet – a low carb diet – argued that his diet was metabolically efficient, which is the opposite of what you would want is a weight loss diet.

    While this is still an area of research, the bottom line at present is that no one has been able to demonstrate that calorie efficiency is a significant effect. Again – it’s focusing on tiny theoretical effects, when simpler factors have a demonstrable dramatic effect.

  45. Fifi says:

    Jeff – Kudos on doing a much needed public service. People get very mixed messages from the media. On the one hand there’s advertising which promotes desire for junk food and immediate gratification alongside slim models that are an ideal that few of us can attain (even few models!) – it’s almost designed to create depression, defeatism and compensatory eating! On the other there’s the diet industry (with lots of doctors involved, some ethical some not, alongside the celebrities and occasional chef), which clearly is invested in selling imaginary silver bullets most of the time. Then there’s the commercial end of science and a tendency to over-promote and exaggerate any discoveries regarding weight loss/appetite by both the institutions/corporations as well as the media.

    And, of course, a lot of people want to be magically thin and attractive (health is often not the primary impetus for a diet) without expending any effort (they want to continue taking energy in but not exerting any). The fact that anyone would even be interested in a product that causes “anal leakage” because it means they could eat more chips without gaining weight is an indicator of how some people are more interested in the aesthetics of weight loss not the health aspects (though healthy people are innately more attractive for obvious reasons).

  46. AgnosticOracle says:

    Quick question about the study. You state:

    A recent study published in American Journal of Preventive Medicine showed that simply keeping a daily diary of food intake doubled total weight loss in a 5 month study (participants who kept a diary lost an average of 17.5 pounds).

    But following the link to the abstract:

    The Phase-I follow-up rate was 92%. Mean (SD) weight change was -5.8 kg

    5.8 * 2.2 = 12.7

    Are you citing a different number from elsewhere in the full article?

  47. quackdoctor says:

    “This is why fasting is such a poor way to lose weight. When stored carbohydrates are used up, the ONLY source of glucose is thru the conversion of protein.”

    Look. That just is not true. Besides known science. There is just common sense. If someone eats no carbs and the glycogen reserves are gone and a lot of time goes by they loose o lots of body fat. And people on a zero carb diet do not loose muscle mass. In fact if they are eating high high protein and lifting weights their muscle mass increases.

    I man I just do not see how you can say that gluconeogenesis does not happen via stored fat and only protein.

  48. Fifi says:

    sjones – You’ve just pointed out very well why weight loss and maintaining health are lifestyle and environment/context related issues. (It’s also true in the US, Canada and Australia that the poorest neighborhoods often have the worst access to healthy food unless there’s been an effort from within the community to address these issues. The food industry quite consciously exploits the poor and ignorant as much as they can get away with, like all corporations.) How weird is it that people in RURAL areas don’t have access to farm fresh food? Think about that for a minute! Surely that’s a relatively new development in the last 40 or so years?
    It’s also an education and priorities issue – often eating a healthy diet isn’t actually more expensive (you eat less and it’s better quality food, you only really need to be eating meat a couple of times a week). Obviously, over time, staying healthy saves money in all kinds of different ways.

  49. wisnij says:

    John Walker’s excellent book “The Hacker’s Diet” suggests exactly these points — portion control and weight monitoring to determine calorie excess/deficit — and for the same physiological reasons. It also supplies a web tool for tracking daily weight measurements, which does a weighted moving average to smooth out the noise due to changing water weight:

    http://fourmilab.ch/hackdiet/online/hdo.html

    It’s also a wonderful source of motivation: seeing that trend line go down smoothly and steadily is a great confidence boost. It lets you see when you’re doing making progress or doing something wrong, without having to guess. Marketing can lie, but the scale won’t.

  50. quackdoctor says:

    Well I think that man is not designed to eat all these foods today. I mean before there were hybrids of fruits and vegatables there were not these big things we have today, So man might have eaten like small things maybe like berries and roots and rodents. And basically grubbed for food. So there are not all these “whole gains” and apples and oranges and all that like we have today. So man was a scavanger for what he could get. He possibley went for days without food at times falling in and out of ketosis..

  51. daedalus2u says:

    quack, nwtk2007 is completely correct. Glucose cannot be made from fat. This is an extremely important factor in physiology. Glucose can only be produced from 3-carbon precursors, humans metabolized fat in 2-carbon increments as acetyl groups. Even carbon number fatty acids (which are most all fatty acids) can only generate even carbon number metabolites. Glucose cannot be made from them.

    You might think it is common sense, unfortunately physiology isn’t determined by common sense but by what actually goes on and glucose production from fat doesn’t happen.

    The liver can make ketone bodies from lipid, but those are even carbon number molecules and they cannot be used to make glucose. As nwtk mentions, in the absence of carbohydrate consumption glucose can only be made from protein. The glycerin that is a part of lipids is a 3-carbon precursor and glucose is made from that glycerin but that is a relatively small amount.

    One of the reasons that weight loss is easier when you are in ketosis is because transport of ketone bodies is not regulated the same way that glucose is regulated. Glucose transport into cells is active and saturatable. There comes a point when cells cannot take any more glucose in because there are not enough transporters (i.e. glucose resistance). Insulin causes more glucose transporters to be inserted into the cell membrane which causes the cell to take up more glucose. There comes a time when more insulin can’t cause more glucose transporters to take up more glucose (i.e. insulin resistance).

    During lactation, there is an absolute need for glucose to make lactose. This glucose cannot be produced from fatty acids. Being in ketosis is incompatible with lactation (for humans). Cows can lactate when in ketosis, but they use propionate which is a 3-carbon precursor which they get from their rumen (the bacteria in their gut metabolize cellulose into propionate).

  52. bonedoc says:

    It is not quite as simple as only calories in vs. calories out, though that is clearly most of the story. It turns out that meal frequency influences efficiency of calorie retention. In 1975 I was working in a research lab (at Samuel Hahnemann Medical School, by then not at all homeopathic). We were studying the effect of meal eating on drug metabolism in rats. Rats are typically opportunity eaters, and will eat throughout their waking hours, but learn to eat in a “meal” if food is only available 1 hour per day. After they reached a stable weight on one meal daily we noted that it took fewer calories to maintain the same weight than for the continuous eaters, and that this also influenced enzymatic pathway activity in the liver leading to different rates of drug metabolism (for drugs whose metabolism required those pathways). There is some evidence in humans for a similar effect, that we require fewer total calories if we eat fewer meals daily. Patients on continuous tube feedings will also require different dosing of some drugs.

  53. daedalus2u says:

    bonedoc, that is interesting that meal frequency changes metabolic efficiency, but the material balance calories in minus calories burned equals calories stored remains absolutely correct.

    An exact analogy occurs in automobiles. Gasoline in minus gasoline burned equals gasoline accumulated. When you fill your tank, you accumulate gasoline in it. As you burn the gasoline in your engine the tank becomes depleted. When the tank is empty, either you refill it or the engine will not run.

    If you drive one mile per day a tank will last a longer time than if you drive 100 miles per day. But when the tank is empty, the same number of gallons of gasoline have been consumed regardless of the rate.

    Metabolism is more complicated, there are multiple fuels, with distributed consumption and storage. Metabolic efficiency is highly variable at doing a large and diverse number of different tasks. The fundamental energy balance is the same. Calories in minus calories out equals calories accumulated.

    In thermodynamics that is known as the First law, the conservation of energy. So far as is known, it holds for each and every system to the limits of the most precise measurements that have been made. There is no serious thought that it does not hold in each and every case. Showing that it did not hold in living systems would be front page news in every science journal in the world and would be a guaranteed ticket to Stockholm…if the result was correct.

  54. Owen says:

    I’ll get this part out of the way first: I’m not imagining that any physical laws are being violated! When I hear “calories in-calories out”, it’s usually in contexts where I’m being told that “all” I have to do to lose weight (and, importantly, keep it off) is eat less and exercise more. This study (and another one I’ve just found) seem to cast doubt on that. I don’t know what the underlying mechanisms would be, but I imagine the body doesn’t have to process food with exactly the same level of efficiency at all times and in all circumstances. In fact, as Steven indicates later in his reply to me, that statement isn’t controversial per se. The debate (if any) would have to be about how big a change in efficiency is possible.

    Steven: “Owen – You are assuming that the people in the study were accurately recording their caloric intake and activity level throughout the study.”

    Well, yes — is that a particularly unreasonable thing to do? Are there any studies on weight loss that are immune to this problem? (Genuine question. I have no idea.)

    But either way, here’s a section from their Discussion section:

    study: “one might argue that the unique nature of the workplace in this study, which permitted a **closely monitored dietary intervention** for a period of 2 years, makes it difficult to generalize the results to other free-living populations. However, we believe that similar strategies to maintain adherence could be applied elsewhere. The strengths of the study include the one-phase design, in which all participants started simultaneously; the relatively long duration of the study; the large study-group size; and the **high rate of adherence**.” (my **emphasis**)

    Closely monitored, with a high rate of adherence. That’s got to count for something, surely?

    Steven: “The amount of weight lost was so small over the two year period that small changes in unreported snacking, snacking portions, or activity level could affect the outcome.”

    If the weight loss was constant, then sure, but it wasn’t. Really, you have to look at their own graph that shows this: significant weight loss for 3 to 6 months, then gain (and possibly plateau) for the rest. Calculating the overall average rate of loss gives a very misleading impression. It wasn’t a shallow, long-term drop — it was more like a wonky “V”.

    Now, I *know* that diets can and do work in the short term. I’m aware of plenty of reports of short-term successes, and can contribute to them myself. But how many *long-term* successes are there? This study, and one other I’m aware of, are the only ones I know that take a longer view, and they both suggest that short-term success is all you get.

    Steven: “While this is still an area of research, the bottom line at present is that no one has been able to demonstrate that calorie efficiency is a significant effect.”

    Couldn’t this study be exactly that demonstration? Are there any other long-term studies that would contradict?

  55. Owen says:

    PS Thanks to those offering advice on dieting. The effort is appreciated, but it’s not my first time round the block, as it were. I’m not optimistic I’ll be able to find a new way of approaching vegetables that will substantially alter my opinion of them after all this time. I have tried though, honest… but my food-related-pickiness is legendary amongst those who know me.

  56. Greg Veal says:

    Dr. Novella,

    I think you’d agree with me, the issue is not overwight, but overfat. That reality should end once and for all the discussion of whether the scale is a good tool. For very overweight and obese people, weight and fat are highly correlated so weight is a convenient and fairly accurate measure.

    But as people approach a healthier, leaner state, percent body fat is a more accurate ad useful measure. Time to buy a scale that measures % body fat.

    I agree in general that the vast majority of overweight people would benefit from reduced intake and increased activity (exercise). But fat management is so much more compex than that. And to take caloric intake out of the context of total health and nutrition is a mistake. (One of best marketing but worst health strategies I’ve seen lately is the “100 calorie snack”. You’re better off with 200 calories of avocado than 100 calories of processed flour and sugar.) If you live on sodas and twinkies and reduce your intake to 100 calorie portions, you could possibly lose weight but you will not be healthy.

    Now, I’ve been researching this area for some time and it’s not all clear to me yet, but I’m sorry Dr. Novella, the simple equation doesn’t address the complexitites of metabolism. Part of the fallacy of the “Colories in – Calories out” equation is the assumption that every “calorie in” either gets burned (converting it’s potential energy into heat, mechanical, and chemical energy) or is stored as fat.

    First, we know that some calories may exit the body unburned due to incomplete digestion. But more importantly, calories may be stored in forms other than fat, the best example being muscle tissue. That’s one reaso why resistance training is so important to fat reduction (notice I don’t say “weight loss”.)

    The other side of the coin, concerning exercise, is that calories consumed to fuel aerobic and other types of exercise can be supplied by fat cells or by several other sources including muscle tissue. The goal then is to exercise in a way as to burn fat. Readers are probably aware of sources for related information.

    All-in-all, I enjoyed your blog and the many replies.

  57. Fifi says:

    Owen – May I suggest that rather than “dieting” you look at making permanent lifestyle changes if you have a genuine desire to be healthier. Diets generally don’t work for most people and often result in actually gaining more weight in the longterm (rebound eating, priming the metabolism to need less calories, etc). Or, of course, you could just accept the choice you’ve made to potentially trade-off longevity, general health and the pleasures of being healthy for other immediate pleasures and avoidance of things you’ve decided you don’t like and don’t really want to change (even if you or someone else in your life thinks you “should”).

  58. nwtk2007 says:

    So just how big are you FiFi? How tall and how much do YOU weigh?

  59. nwtk2007 says:

    Veal is right about a good bit of what he says.

    The real question is whether or not a person is healthy given their size, weight, height, activity levels, etc.

    But the bottom line still remains and is, if one eats too much and doesn’t burn off enough, then the weight will remain. No matter what.

    I am continually amazed by the people who are obese and fat and out of shape and try to pretend they have some special condition that makes it impossible for them to be any different. The excuses I hear from people with high Bp and are in denial are endless.

    They would be better off just admitting that they are not going to change and will not change and like the lot in life that they have chosen.

  60. Fifi says:

    nwtk – What relevance does my height and weight have to do the conversation?

  61. CarolynS says:

    I am kind of impressed by the apparent naivete on this subject on a supposedly science and evidence based blog. Almost all weight loss studies show initial weight loss for approximately a 6 month period, followed by slow regain until the weight of the controls is reached. This is true for most different approaches to weight loss. So many approaches show good success for a few months but not in the long run. The physiology of this is not well understood. However a number of studies (most particularly those done by Rudolph Leibel in NYC) suggest that ‘reduced weight’ individuals in order to avoid gaining weight actually need to eat less than comparable weight individuals who are not reduced weight. People forget that “calories in, calories out” does not refer to physical activity, which is actually a very small part of energy expenditure. Most energy expended by the body is just to keep itself functioning. Simplistic prescriptions (smaller portions, keep diaries, just put down the doughnut, eat more vegetables etc etc) have never been shown to work in intervention trials, even though of course for some individuals they do work. This advice is repeated over and over again everywhere you look and it is simply not working and is not likely to work in the future either. Read Gina Kolata’s book “Rethinking Thin” to find out more about this.

  62. nwtk2007 says:

    You’re right, there is no simple solution to health, nutrition and weight. Changes in food intake and activities all result in changes in metabolic rates, distrubution of tissue types, etc, in accordance with the genetics each individual is ruled by.

    But the bottom line of intake versus expendatures is a thermodymic fact.

    Eating less will result in shifts in all variables to a new equilibrium. The new equibilibrium might weigh less or be basically the same.

    Eating more will also cause resultant shifts to a new quilibrium which also might weigh more or the same.

    The “simplistic prescriptions” are nothing more than gimmicks to aid a person in changing their diet and lifestyle in order to attempt to be healthier and possibly weigh less in a healthy manner, but we cannot escape physical laws and thermodynamics.

    If you want to weigh less you pretty much have to eat less and if you want to gain you pretty much have to eat more.

    Dieters just don’t want to admit that their weight problems are due to their own habits and are basically their own fault. They don’t want to admit that they eat too much and they don’t want to admit that they don’t get any exercise because that would be admitting that their weight/health problem is their own fault.

    I’m telling you, it is easier to change religions than to change dietary habits.

  63. Fifi says:

    CarolynS – I agree that losing weight is not quite as simple as it’s sometimes made out to be or as it sounds logically when talking about it (theory and practice are always somewhat different!). This is for a number of reasons which vary from individual to individual and range from individual metabolism to underlying emotional attachments/issues regarding food and/or exercise and/or their body (so from the purely physical to the psychological). For instance, women (and men) who have been sexually abused can have a wide variety of very intense issues to deal with regarding being looked at with desire, being desired and looking/feeling sexy – it’s an issue of safety. And some people do actually have a thyroid dysfunction which will effect weight (though being obese can also damage thyroid function so there’s a chicken and egg aspect here in some cases). Then there are the challenges of changing habits (particularly ones with an addictive component – sugar and fat are very good at changing our feeling state, like tobacco or any drug, or exercise if we’re going to choose a healthy option). One challenge is environment – it’s hard for anyone to constantly resist temptation (I’d have to look up the study but, as most people have experienced, we have a finite ability to repress so trying to repress urges towards pleasure all day while other people are visibly indulging them is a pretty gargantuan task!) and if people around you (as well as the general culture) aren’t supporting you and are actually promoting the kind of behavior that one is trying to change, it’s a pretty strong recipe for failure. It doesn’t matter how hard you try if you’re setting yourself up for failure from the beginning (the idea that people who are overweight are just “weak” is inaccurate and is often thrown out at people in an abusive manner).

    There’s still a lot that’s not known about weight gain and loss, and appetite, metabolism and hormones, but for most of us the rather simple calories in vs calories out works quite well if we know how to apply it and have the tools to do so (and don’t have people in our lives sabotaging us). On many levels it’s really a matter of self care and making conscious choices. From what I observed when I worked with people around changing lifestyle there are many factors that contribute to success or failure, and the degree of that success. The most essential thing off the top though is that a person has to want to get healthier or lose weight (I always focused on the first because losing weight and looking better naturally follow and the real benefit from being healthier is how one feels), otherwise it’s a waste of everyone’s time and a recipe for further feelings of frustration, failure and a whole slew of other unproductive emotions (that can even be destructive and lead to further weight gain and lack of motivation to move).

    It’s also worth noting that when someone loses a substantial amount of weight that it takes quite a long time for their internal body image to catch up – this means not only the visual image we have of ourselves but also our 3d image of ourselves we use to navigate the world). There are also habitual movements, like walking, where people sometimes still walk in a way that “takes into account” fat that is no longer there (which is one reason why exercise helps, not only does it burn calories but we experience our body in space and motion while exercising so we’re creating a new internal body image as we’re changing our body).

  64. CarolynS says:

    I don’t want to get into arguments here, but again I am impressed how people are ignoring the actual evidence on this supposedly evidence-based blog and just substituting their personal prejudices. These are very complex metabolic and hormonal effects involved with weight, weight gain, weight loss and weight regain.

  65. Fifi says:

    CarolynS – Studies have shown that making lifestyle changes results in longterm weight loss – that means changing habits so that one routinely eats less and burns more calories. It’s often the “small” things that make all the difference (whether it’s a “small” piece of food that’s dense in calories but low in nutrition or taking the stairs up three flights instead of the elevator). For instance, people who live in cities generally weigh less than people who live in the suburbs – a lot of that is due to the fact that urban dwellers tend to walk more than people in the suburbs.

    It’s not actually that difficult to change eating habits but, like changing any habit, it’s about creating an environment that supports the change so that one isn’t relying upon willpower (which isn’t what changes habits anyway and is a limited resource) and also about finding ways to create a new way of eating that is pleasurable, re-educating one’s palette, learning to actually savor food and finding lower calorie ways to prepare one’s favorite dishes. And, ultimately, it’s about making choices and being conscious of making those choices. I really don’t see the point in feeling guilty about not being healthier unless that guilt actually works to motivate one to make different choices. Rather it seems to me that feeling guilty if it’s a result of not living up to someone else’s “should” tends to make people obstinate and rebellious and then it’s about a power struggle between two people not health anymore. Feeling guilty (or feeling ashamed, which can be even more difficult) because of one’s own internal “should” or the state of one’s body can also result in rebellion but more than anything else it’s a constant self imposed message that’s ultimately pretty self negating and diminishing, and poor self worth tends to lead people to comfort themselves with food and so the cycle goes.

    So, while some people just need to modify some of their habits to lose weight and become fitter, other people need to make radical lifestyle shifts that require quite a lot of support and eduction to realize, and yet others need to grapple with intense emotional and psychological issues like being sexually abused as children and accompanying body and identity issues. They all need to modify calories in vs calories out (that’s pretty much the basics of losing weight), however keeping weight off and sticking to a plan can often require other kinds of emotional, physical and psychological support too if someone’s going to have a fighting chance at achieving their goals.

  66. CarolynS says:

    Here’s a reasonably brief article for those who would like to know a little more about this topic

    http://www.iht.com/articles/2007/05/08/healthscience/snfat.php

  67. Fifi says:

    CarolynS – Um, I actually agreed with you that there is much research to be done and some confounding factors for individuals so it’s unclear to me as to whether you read my post (granted it’s rather long!). Can you post links to some of the evidence you feel is being ignored? That way it can be discussed (at the moment you just seem to be dismissive and insulting but have offered no evidence of your own, clearly you may not intend to just be insulting and have something constructive to contribute to the conversation).

    It seems to me that you’re talking about a relatively recent meta-analysis (if I remember correctly) of low-carb and low fat weight loss diets – but of course I’m just speculating because you’ve offered no evidence to support your assertions.

  68. Fifi says:

    CarolynS – Thanks for the link to the article. It adds to the reasons why I personally believe that putting the focus on health not weight is more constructive and important. People can be overweight and healthy if they get enough exercise and generally eat a healthy diet. People can also be slim or skinny and very unhealthy – it’s just that the currently fashionable image of beauty/health/desirability tends towards very skinny (partly because it requires more wealth to be skinny than it does fat these days, a reversal from a century or two ago…tans also became socially desirable once plebes left the sunny fields for the darkness of the factory). Interestingly women stop menstruating and become less fertile at both ends of this spectrum due to the hormonal effects of both starvation and obesity.

  69. Fifi says:

    CarolynS – You’ll note that while the doctors in the article conclude that there’s a strong inherited component to someone’s basic metabolism that calories in vs calories out isn’t discounted as the way to lose weigh (in fact, that’s exactly how they conducted their studies, by limiting the calories in!). All this makes evolutionary sense, there’s also some research that indicates the mother’s weight and calorie intake during pregnancy has a big effect, which also makes evolutionary sense and shows that both nature and nurture are involved, I’ll see if I can dig up the study or an article on it for you.

    We’re all born with genetic predispositions of various kinds, what we make of them – for better or worse – is up to us. We can’t control our genes or what our mothers did while we were in the womb and while we were children but as adults we can make conscious choices and deal with our own unique situations in a way that’s appropriate for us. Personally I’m starting to view parents who don’t teach their kids how to eat or exercise as being abusive and neglectful (and on top of it they’re usually setting their child up to be less capable than their potential in any number of ways, from nurturing a lower intelligence level to setting their child up for behavioral problems). I understand it’s usually a result of the parents’ own ignorance (and that of their parents before them) but the same can be said for beating one’s children or all other manners of child abuse.

  70. CarolynS says:

    I am not trying to be “dismissive” and “insulting.” People are presenting personal opinions and not evidence, which seemed odd on a blog devoted to evidence. I don’t think it is “insulting” just to point this out. Yes, IF people could follow all this good advice, it SHOULD work. But maybe that’s like trying to “cure” homosexuality by telling people to just have sex with partners of the opposite sex instead of with partners of the same sex and announcing that this is very simple. There are hundreds of studies out there that show very very small weight losses from many different types of interventions and show over and over that there is weight regain for probably very fundamental physiologic reasons. The control of body weight is not simply a matter of keeping a food diary or avoiding temptation, because body weight is under a tremendous amount of metabolic and hormonal control as well. The second law of thermodynamics has not been repealed, but again most of the body’s energy expenditure has little to do with physical activity and is under metabolic and hormonal control.

    There are many articles and books on these topics. I referenced Gina Kolata’s readable article in the IHT and she has also written a book called “Rethinking Thin.” Another good book is the Hungry Gene by Ellen Ruppel Shell. And I strongly recommend that you look for video lectures or news stories about Rudy Leibel’s work. Dr. Leibel is a very well respected obesity researcher.

  71. weing says:

    I’ve never heard of Gina Kolata. Is she an obesity researcher?

  72. CarolynS says:

    Gina Kolata is a well-respected science writer for the New York Times (she used to write for Science magazine). She summarizes a lot of evidence in an accessible way.

  73. weing says:

    Thanks.

  74. Fifi says:

    CarolynS – It’s not what was pointed out but how you did so that seemed rude – if that wasn’t your intention then there’s some miscommunication going on (it happens, shall we clear it up?) You yourself did not present evidence in your first post, if you had the conversation would have continued discussing the evidence. Are you actually reading what I have written? I ask because you seem to repeating some of the things I’ve already said back to me (and there doesn’t seem to be much point trying to discuss this with you if you’re not actually engaging to do anything but promote something).

    While I appreciate the article you posted there’s also lots of other research going on that points to some other contributing factors as well and there are still many mysteries to be solved regarding appetite, weight gain and metabolism. I agree that the original blog post by Dr Novella may have been a bit lean on evidence and big picture understanding in some ways. That said, it’s also a topic where there’s still a lot of controversy, not to mention an area where everyone assumes that everyone else is just like them (a common human cognitive issue related to empathy and, conversely, antipathy) and so on. Thanks for bringing a different perspective and info to the conversation. I’ll obviously leave Dr Novella to answer your charges against him :-)

    Clearly people can get down to and maintain a healthy body weight after being obese by changing their calories in vs calories out equation, we know it’s possible because people do it. That doesn’t mean it’s easy, it just means it’s possible.

  75. Fifi says:

    CarolynS – Re-reading Dr Novella’s blog again it doesn’t seem to me that he’s excluding genetic factors or saying weight loss is easy (in fact, he says he’s not saying it is easy even if his suggestions seem simple). Rather, he seems to me, to be merely talking about some basic/simple and very practical steps that can be implemented that lead towards a healthier lifestyle (and associated weight loss). Clearly these actions will have more obvious results for some people than others but life isn’t fair (and we don’t have a pill to fix that condition yet) and we’ve all got to work with the genetic cards we were dealt, as well as the constructive and/or destructive nurture of our parents. It’s unfortunate that obesity is dealt with as a “moral issue” and seen in terms of personal willpower since this approach does little to actually help people facing the challenges of lifestyle change nor does it bring any understanding of the practical challenges people face on all fronts – emotional, physical and psychological.

  76. nwtk2007 says:

    The bottom line gist of the thing is that, no matter what the circumstances are as to why one would be over weight, one cannot loose weight while taking in and assimilating more calories than are burned.

    No matter the psychology or hormonal/chemical problems that exist, we all have to eat less and burn more to lose weight, should we desire to do so.

  77. Fifi says:

    Carolyn – You may find this article on maternal obesity interesting.

    http://news.bbc.co.uk/2/hi/health/7508034.stm

  78. daedalus2u says:

    Fifi, that is an interesting article. There is a good review of intrauterine programming of adult physiology (open access)

    http://physiologyonline.physiology.org/cgi/content/full/21/1/29

    Virtually every aspect of physiology is subject to epigenetic programming. We need to remember that the only difference between the different cells in the body is how they are epigenetically programmed during development and differentiation. The best time to “tweak” that would be in utero. A major mechanism is DNA methylation controlled in part by folate which is controlled in part by my favorite molecule nitric oxide. I strongly suspect that low NO from stress is one of the mechanisms by which stress epigenetically programs fetal development.

    http://jp.physoc.org/cgi/content/full/572/1/31

    The largest class of transcription factors are the zinc finger transcription factors and NO does regulate the transfer of zinc off of the main zinc storage protein metallothionein. It doesn’t take very many molecules of NO to do that, so the research to understand these details will be challenging.

    Where my research intersects this is that by the loss of the bacteria I am working with, the basal NO level will be skewed lower, and will affect all of the NO mediated pathways that are in the range where NO is actively controlling them. I would predict a skewing of physiology in a higher stress direction. I think we are already seeing that in humans.

  79. LisaR says:

    This is how the law applies in biology. You take an organism, or a biosphere, or any slice of biology you want. Put boundaries around it. Measure input and output and you get a result that complies with *all* of the laws of thermodynamics.

    But we’re intersted in what happens within those boundaries: how much food is converted to fat storage. The Second Law of Thermodynamics makes no predictions about that.

    Proponents of this psuedo- scientific application of the Second Law of Thermodynamics make an incorrect assumption . They are assuming that chemical energy in =chemical energy stored + heat energy relased metabolically. That simply ISN’T the case.

    You can assign a caloric value to food But some food is never metabolozed into heat energy at all. Some is used as building blocks in cells. Some is eliminated as waste, its heat potential never used.

    How much caloric intake is never converted to heat or stored as fat? That’s influenced by a whole slew of variables- some of which sceince doesn’t even know yet.

    Symbiotes, pathogens, toxins, food quality, activity level, environmental factors, stress, and genetics are just a few of ther many categories of variables which influence fat storage.

    None of this is a violation of the Second Law of Thermodynamics, because if you take a biological organism and put boundaries around it , then measure input and out put, you’ll get a result which complies with the law. How fat the biological organism sitting within those boundaries is subject to other variables.

    It seems to me that disproving the calorie theory of weight loss is extremely simple.

    If it were true then an experiment I’ve previously discussed would not have come out the way it did.

    Researchers took obese mice, and extracted gut flora from them, and transplanted it into thin mice. Geneticals amoung the mice were identical , and so a controlled variable. Food was also a controlled variable – all the mice ate exactly the same foods and got exactly the same calories each day. The thin transplanted mice became fat. The controlled thin mice remained thin.

    This experiment shows that intestinal flora is one of the variables affecting obesity, and it shows there are circumstances where you can get results ranging from thin to obese with ABSOLUTELY ZERO MODULATION OF CALORIES.

    Caloric intake is just one variable amoung many affecting obesity. An important variable true, but to focus on it to the exclusion of all others is PURE NONSENSE.

    Psuedo – science often grabs valid sceince and misuses it. The “calorie theory of weight loss ” is a pretty good example of it.

    LisaR

  80. Harriet Hall says:

    Your example doesn’t show what you seem to think it does. Given any single mouse in the study, if you cut down on the calorie intake, it would lose weight.

    We know that individuals differ in factor like basal metabolic rates, genetic makeup, and intestinal flora. But once you establish an individual’s baseline, calories in/out works.

  81. LisaR – As Harriet implied – you are addressing the wrong question. You are talking about why person A is thin and person B is fat. There are many variables that determine this, and you list many of them.

    But this article is about how person B can become thinner. They cannot change their genetics. At the moment there is no way to significantly change their intestinal flora. Maybe that will be an intervention in the future.

    There are two things they can do – reduce their caloric intake and increase their caloric expense.

  82. anoopbal says:

    Hi LisaR

    Could you please reference the study about mice and intestinal flora pls

    Thanks

  83. daedalus2u says:

    I have read this study.

    http://www.ncbi.nlm.nih.gov/pubmed/17183312

    In no way does this invalidate the calories in calories out paradigm. The correct boundary condition is the surface of the organism, including the surface of the gut. Material that stays in the gut isn’t absorbed and so can’t contribute to a weight gain.

    Many of the compounds in the diet are not absorbable except after metabolism by gut bacteria. This was the case here, where the gut flora from the obese rats increased absorption of dietary calories resulting in decreased calories in the feces (as measured by bomb calorimeter (but they didn’t give enough information to calculate a fractional change).

    The mice colonized with the obese microbiome ate a little bit more food (~2% more) and gained fat equivalent to ~2% of calories consumed.

    There are multiple mechanisms by which gut bacteria can change energy absorbed. They can increase it by aiding digestion and absorption. They can decrease it by causing energy loss via methane.

  84. LisaR says:

    Jon Gabriel lost 230 pounds. Have any of YOU done this? I think what he has to say IS important. He is ripped to shreds now.

    Mark Sisson is another man ripped to shred who dnies the nonsensical calorie theory. HORMONES are the main controlers of fat loss and fat gain. Check him out he’s 55. WEIGHT LOSS IS A BIOLOGICAL PROCESS ., NOT A MATH GAME

    I saw the pictures of several of the commentors on here and they look fat to me……

    Calories in and calories out are DEPENDENT on one another. You can’t just eat less and move a lot more LONG TERM.

    LisaR

  85. LisaR says:

    The calorie theoiry does NOT address why WOMEN have a much harder tim elosing weight than men.

    It also does NOT address why the first 7 pounds are far lost far quicker than the last 7 pounds.

    There are NUMEROUS THINGS WRONG with the calorie theory

    Calorie theory proponents need to realize humans are NOT machines. They are applying the Laws of Thermodynamics psuedo – scientifically, as mu FIRST POST EXPLAINS.

    A calorie is NOT a calorie and your body reacts much differently HORMONALLY from 1800 calories from twinkies compared to 1800 or even 2,200 calories of healthful saturated fat rich meats and veggies.

    The guy consuming the 2,200 calories vs 1800 calories of just twinkies will have THE BETTER BUILD

  86. LisaR says:

    h t t p : // w w w . s e c o n d o p i n i o n s . c o . u k / d o – c a l o r i e s – c o u n t .

  87. weing says:

    What are you talking about? Just count the freaking calories that they took in and you’ll see why they lost weight. You may not have the objective data and may be relying on self reported intake of calories from memory, that’s like believing the check is in the mail, I gave at the office, etc.

  88. daedalus2u says:

    Lisa, weight gain and loss in humans and other organisms is not simple. That lack of simplicity occurs because organisms are very complicated and there are many very complicated things going on. Many different chemical reactions occur which are under feedback control and the regulation of the pathways for food choice (type and amount) change over time and are dependant on the state of the organism.

    The lack of simplicity does not occur because humans and organisms are not subject to the laws of thermodynamics.

    Yes, diet choice does have an effect on efficiency of digestion and conversion of complex foods into biomass. The growth of animals for food is based on conversion of feed into animal biomass. The science of that has been pretty well studied because feed conversion efficiency is one of the major parameters in farming productivity and profit.

    There is not a hint that there is any violation of the laws of thermodynamics. That would violate so much that is well known and would invalidate virtually all chemistry and physics.

    Different foods do have different conversion efficiency of calories in consumed food into calories of biomass. That conversion efficiency difference is due to differences in digestion, absorption, metabolism, storage and excretion. There is 100% conservation of energy at every step along the way. Calories in equals calories out plus utilization and storage. This is true for every bulk food, it is true for every component of food. It is true for sugar, it is true for fat, it is true for everything.

    Calories of different foods do react differently, but this is not due to any violation of the laws of thermodynamics.

  89. LisaR says:

    Also:

    You need to control hunger. Saturated far rich, energy dense food, with protein and fiber also control huner.

    DON’T eat low fat or low energy density foods.

    Do SPRINTS 3 times a week TOPS. maybe just twice. One more day piddle at alow intensity.

    The chronic cardio model is WRONG. No animal in nature does this. Too much exercise will make you lead to adrenal burnout, much increased eating, more stress hormones, making you fatter.

    LESS IS MORE with exercise. Follow men WHO KNOW what theyt are talking about.

    ART DEVANY for one.

  90. LisaR says:

    daedalus2u

    I am AGREEING with you about Thermodynamics.

  91. Harriet Hall says:

    I did two experiments that support the calories in/out method of weight loss. I got my husband to reduce his calorie intake by simply choosing fewer calorie-dense foods, and he lost 60 pounds in 5 months without exercising or making any other changes. We got an obese adopted dog to lose 50 pounds slowly and steadily by controlling the quantity of his food. He’s now at ideal weight and staying there.

    Yes, there are many factors that make it harder for people to stick to a diet, and many individual differences. But there is no case where you couldn’t make someone lose weight by reducing their calorie intake.

  92. Mojo says:

    @LisaR:

    The calorie theoiry does NOT address why WOMEN have a much harder tim elosing weight than men.

    Why should it?

  93. LisaR says:

    If you can’t figure that out Mojo , you’re hopeless

    Spritning is great for fat loss. Sprinting does not burn as many calories as steady state, as steady state can be continued longer . Then WHY are persons who sprint leaner? There is obvioulsy soimething HORMONAL going on.

    Olympic elite SPRINTERS have the lowest bodyfat of all atheletes.

    Studies show INTERVALS (which do not burn as many calories as steady state) are better for fat loss.

    Also to Harriet:

    Your husband lost WEIGHT, but how much was fat? It means NOTHING until he has his BODY FAT MEASURED.

    A significant mucle loss IS NOTHING to brag about.

  94. LisaR says:

    @Mojo

    If the calorie theory was sound it could account for WHY women tend to store bodyfat much more thsan men and have a MUCH harder time losing it.

    I GOT you and you KNOW it……

  95. David Gorski says:

    Your husband lost WEIGHT, but how much was fat? It means NOTHING until he has his BODY FAT MEASURED.

    All I can say after reading this comment is: WTF?

  96. weing says:

    You sure got him….not! You must be a legend in your own mind. I bet you would’ve gained weight in Auschwitz.

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