Tuesday, February 26, 2013

New England Journal of Medicine Debunks Calories-in/Calories-out

I had a completely different post lined up for today, but, upon reading the January 31 edition of the New England Journal of Medicine, I figured this was worth pushing to the front of the line. (Fear not, the post on Joint Health is still forthcoming and you will be riveted!

The article, titled "Myths, Presumptions, and Facts About Obesity," breaks down seven myths that are pervasive in the conventional wisdom about dieting and weight loss. First among them: calories in/calories out.

According to the article:
  • "For example, whereas the 3500-kcal rule predicts that a person who increases daily energy expenditure by 100 kcal by walking 1 mile (1.6 km) per day will lose more than 50 lb (22.7 kg) over a period of 5 years, the true weight loss is only about 10 lb (4.5 kg),6 assuming no compensatory increase in caloric intake, because changes in mass concomitantly alter the energy requirements of the body."

What does this mean?
For 50 years, doctors have been prescribing calorie reduction/ control ("diets") as the only reliable method for weight loss. This has all been based on the assumption that the human body operated under the First Law of Thermodynamics, which states that energy cannot be created or destroyed, only transferred. The problem is that the human body is an adaptive machine that is bent on, above all else, maintaining balance among a score of different systems while compensating for hundreds of variable factors. And the human body is masterful at conserving energy.

That's right, metabolism is a moving target

In the 1940s, a University of Minnesota study confirmed that long-term, extremely low calorie diets did not result in a continuous linear progression of weight loss. In fact, after a couple weeks, the body completely adapted, cutting energy levels, making the participants lethargic and chronically cold, and the weight loss slowed to a crawl or halted altogether.  The subjects also became obsessed with food to the point that many had complete mental breakdowns. After the completion of the six month study, all rebounded and gained, on average 10 pounds above their pre-study starting weight.

Does this sound like the dietary woes we have all heard of and experienced?

Furthermore, many studies have confirmed that overweight or obese people don't necessarily consume more calories than those who are not.

The basic concept of needing to expend more energy than you take in still stands. BUT - it is impossible for anyone to exactly and consistently calculate their actual energy expenditure on any given day, let alone over a period of time. Those calculators on the treadmills and on websites are estimates based on models.  They are directionally correct for populations, but exactly wrong for individuals.

If not calorie counting, then what?

So if the NEJM is finally refuting the concept of sustained weight loss based on reduced calories consumed or increased calories burned, and this is supported by our own observation time and time again, what do we do about it? For starters, stop counting. It makes people crazy and it doesn't work.

The heart of our obesity problem is not total calories, but the quality of those calories we take in. Studies on metabolic syndrome have repeatedly shown that the heart of the issue is a sustained bombardment on our systems of sugars and refined carbohydrates. Our body does its best to deal with the issue, but over time, the overload takes its toll. The liver becomes fatty, your muscles become resistant to insulin, your hormone levels are impacted, and LDL cholesterol goes through the roof.

Consider this: what would it take to remove 80-90% of the refined carbohydrates and sugars from your daily consumption and replace them with foods your body can actually use? It requires a mindset change and some planning, but are baguettes, bagels, potatoes, and white rice worth the road to diabetes? All we have to do to reverse the damage is stop inflicting more damage. Once your metabolism is no longer at war with you, you might be surprised to see the weight steadily coming off.

I'm not saying to purge any and all carbohydrates from your diet. You need them. Just choose the ones that have the lowest glycemic index: vegetables, whole grains (actual whole grains, not a label on a box), and fruits in moderation.

In upcoming posts, I will be publishing a three-part series called Mastering your Macronutrients, which is aimed at equipping people to make the very best selections for their health possible.  In the meantime, keep reading, learning, and sharing what you find.  Together we can overcome this.


  1. What the article in question is saying and what you think it is saying it says are not even in the same ballpark. Read this.


    1. Lyle, thank you for reading and taking the time to comment. I have visited your site many times, and have read the post you reference. All positions are welcome and I encourage readers to review your counterpoint.

      I admit that today's post may be over-simplifying the matter. Interestingly, I think you actually help make my point on calorie counting for the general public. The formula you propose is certainly a more accurate means of calculating a person's energy balance at a specific point in time, were the data able to be gathered. And therein lies the problem. The count is good for one day (or at least a very short period) and is more complex than the average person's ability to measure, factor by factor. This makes for a very poor measurement system, as it is confounded by so much variability to make creating a sustained specific deficit essentially impossible.

      In your analysis, you seem to gloss over two key elements: the impact on a person's metabolism from a sustained extremely calorie-restricted diet, and the critical difference between caloric quantity and nutritional quality. The reduction of base metabolic rate in study subjects outpaces the caloric deficit over time, making even near-starvation levels insufficient to sustain weight loss. As to the point of nutritional quality, the balance of carbohydrate intake (particularly highly refined, high GI versions) is central to enabling the body to consume stored fat for energy. Much of the field of weight loss is in debate, but those to points are as well established as any.

      Our purpose in writing this post, as with all of our content, is to inform and empower the general public, our peers, to make simple changes in mindset and lifestyle to give them a healthy, strong, capable body, and to do so with the support of the best results-driven resources we can find. Our commentary and recommendations are reflected in our own lifestyle and demonstrated success. We believe there is no more important message.

      A final note: though I appreciate your participation, and encourage your input, even if we disagree, it seems to me that it's rather poor form to "trash and dash" with little more than a link to your own forum to support your statement.

  2. " The reduction of base metabolic rate in study subjects outpaces the caloric deficit over time, making even near-starvation levels insufficient to sustain weight loss. "

    Stop making things up. The Minnesota Semi-starvation experiment disproved this over 50 years ago.

    " As to the point of nutritional quality, the balance of carbohydrate intake (particularly highly refined, high GI versions) is central to enabling the body to consume stored fat for energy."

    No it isn't. Fat loss will occur in a caloric deficit regardless of nutritional quality or GI.

    1. I appreciate that you took the time to read and comment. There is clearly a lot of passionate disagreement about the subject of calorie counting and quality weight loss, which feeds the confusion for the general public.

      We interpret the results of the Minnesota semi-starvation experiment quite differently, but readers are welcome to make their own determinations.

      As to your final statement, I would add some conditions, such as: "under near starvation conditions" or "for a finite period of time". The first option is certainly not a prescription for healthy weight loss. The second doesn't present a long term sustainable solution. Furthermore, while extremely low calorie levels will result in weight loss, a significant portion of the loss comes in the form of muscle wasting if macronutrients aren't managed effectively. Again, its not the sort of choice that makes for a healthy and sustainable program of losing fat and promoting a healthy body.

      I'd be interested in hearing more about support for your assertions and your own experience in applying them in your life.

  3. Thanks! I don't have any scientific evidence to support my position, but I agree with this post. I ate clean for 10 months, did p90x and c25k, and barely lost any weight or inches. I knew something was wrong. Finally found out that my blood sugar was the issue. Once I cut out most of the fruit (had already limited grains), I started losing. In my life, it's definitely been true that it's not so simple as calories in / calories out. Thanks for posting this!

    1. Thanks for the read and feedback, Marcy. It's good to hear from you again. Congratulations on your accomplishments. Sometimes, just the simplest tweak can uncover what was holding you back. Focusing on macronutrient management rather than calorie counting has proven hugely successful for us. Weighed in today and we both have exceeded our fat loss goals without losing lean body mass in the process.

  4. I found this is an informative and interesting post so i think so it is very useful and knowledgeable. I would like to thank you for the efforts you have made in writing this article.
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