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David Katz, M.D.

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How Much Do Calories Count?

Posted: 02/21/2011 8:52 am

There really can be no question that when it comes to weight management and energy balance, calories count. Calories are units of energy, and the relationship between matter and energy is -- as I have noted on prior occasion -- not up for debate.

But I hasten to add that how many calories it takes to maintain weight, or gain it; how many calories it takes to feel full; and which calories best satisfy all vary widely among us. What we sometimes overlook is that the fundamental relationship between matter and energy, calories and weight can be true; AND it can also be true that two people who consume the same calories and exercise the same amount may wind up at very different weights.

That's because we vary in such factors as our genetically endowed fuel efficiency (aka, basal metabolism), the levels of various hormones in our bloodstream, and the colony counts of various bacteria in our GI tract -- among others.

None of this, however, changes the fact that weight is about energy balance, and that means calories in versus calories out. It just means we are not personally responsible for how hard it may be for any one of us to lose or control our weight, nor for how few calories we may require for weight maintenance.

But all of that is just preliminaries -- so that I can say without controversy: calories count.

But counting calories and posting them on menu boards is not likely to be the way to get the tally right. That is the message in a recently published paper examining effects of calorie counts on restaurant menu boards on the selections made by adolescents in NY. The summary conclusion, tailor made for media headlines, is that "calorie labels don't affect kids' fast food choices."

I am a proponent of calorie labeling, because I think having fundamental information is better than not having it -- and because I think such information may confer educational value even when it doesn't directly shift behavior. But that said, I am not at all surprised by the results of this study. I never thought posting calories would have much influence on food selection by kids, or adults.

The most fundamental of my reasons is that most of us don't eat to fill a calorie quota; we eat to feel satisfied. A tally of the calories in a given menu item does not change whether or not that item satisfies you. If it doesn't, you may have to eat two.

A second reason why calorie posting may not matter much is related. If the quality of the foods selected doesn't change, the easiest way to reduce calories is to reduce portion size. But that simply means... eating less, which sounds a lot like dieting. We know how people tend to feel about that.

Yet another issue is that while calories on display may change awareness, and even attitude about food choice (as in: "I'm going to order what I want, but darn- it sure has a lot of calories and I wish it had fewer!")- it may simply not be enough to change behavior. The fact that calorie posting does not change selections does not necessarily mean it is useless! Maybe it is a necessary, but not sufficient step to get all the way to meaningful change in food choice, diet quality, weight, and health. Maybe it is useful -- just not a slam dunk.

But since I do have reservations about the utility of calorie counts on display for a variety of reasons, I tend to favor an alternative. An equally efficient, clutter-free display of overall nutritional quality. In fact, using a 1-100 scale, the higher the number, the more nutritious the dish- such a display would require less space on a menu board than calories. And convey a lot more information.

Why is this a better approach? Because for a wide variety of reasons and in a variety of ways, more nutritious food is more satiating -- it helps us fill up on fewer calories. For example, a hamburger on a whole wheat bun is more nutritious than a comparable burger on a white bun, and more filling despite fewer calories -- because of the fiber in the whole grain. Add lettuce and tomato rather than bacon -- ditto. I won't belabor the examples, because they are innumerable. Suffice to say, better nutritional quality means you can reduce calorie intake NOT by eating less, but rather by eating better.

More fiber means more satiety on fewer calories. More and better protein means the same. So does less sugar, lower glycemic load, more nutrient density and less energy density. These, and many other nutrient properties proven to influence satiety were willfully incorporated into the NuVal system for the very reason that nutrition guidance should help us get to both health, and weight control.

Advice to 'eat less' tends to go over like the proverbial lead balloon, whether it is about a diet plan, or a menu board. But trading up to foods that let us eat until full, but that make us full on fewer calories is another matter entirely. As long as such foods taste good -- and we won't know until we try them -- why wouldn't we want to get to satisfaction with fewer calories in tow? Who wouldn't want to be leaner, if it didn't mean being hungrier too?

Calories count, but counting calories is not the best way to get the tally right. Eating better is better than eating less. We have the means to put guidance for doing just that on menu boards. In my opinion, that's just what we should do. Then, let's see what results we get.

Dr. David L. Katz; www.davidkatzmd.com

www.turnthetidefoundation.org

 

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HUFFPOST COMMUNITY MODERATOR
Puffin16
82.7% of all statistics are made up on the spot
01:40 PM on 02/25/2011
Excellent article. However, I believe most overweight people eat because of reasons other than hunger. Many foods are produced so people won't feel full, so they can (and will) eat more. Any food that contains f. at, salt, and sugar will have this effect.
03:30 AM on 02/23/2011
I agree with this proposal however I would like to see more calorie posting. I'm glad that the US has begun to do this and I hope other countries follow (I live in the UK and healthy foods tend to put their calories count prominent whereas if you go to McDonalds it is very difficult to find if not entirely absent).
I would like to say however that just as the first few paragraphs explain losing weight works differently for everybody and I find myself one such example. I eat ridiculously healthy, I just eat too much. There is little I can do to improve the quality of the food I eat, except to maybe switch the flavoured soy yoghurt for plain. I still eat too much, e.g. I eat generally 8-13 servings of fruit and veg a day. I've recently tried to eat more complex carbohydrates (oat cakes, quinoa, etc) and I still eat too much. I get the ideal amount of protein. The bottom line is to lose weight I need to solely pay attention to calorie count as I do not find that better quality ingredients make me feel more satiated.

Many people need more education as to what is more nutritious, but for the rest of us who eat too much nutritious food, calories count! Eating more healthy food and fewer calories is not an easy task. The more information the better!
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HUFFPOST SUPER USER
ninetailedfox
banning people.....so childish
12:56 PM on 02/22/2011
Think about it, if someone were to eat six meal a day even small ones, do you think the sugar level for a diabetic would have a chance to maintain a balance? No, the sugar level would keep increasing ever so slightly, because people that eat 6 small meals a day wouldnt give their body a chance to go back to normal. Doctors cant be right all the time, and trust me when i say dieticians are not the sharpest tools in the shed.
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12:28 PM on 02/22/2011
I agree with a lot of the article, particularly "I am a proponent of calorie labeling, because I think having fundamental information is better than not having it". I definitely feel more is better - as long as ALL information is included - calories, carbs, protein, fat, fiber, sugar, etc. I prefer to eat at home as I know what I'm getting - and can make sure I eat real whole foods, grass-fed beef, butter from grass-fed cows, organic veggies, no grains, no sugars. But sometimes it's fun to eat out, and I can't as easily control what I get there. Sure I can MAKE choices - never eat breads, never eat desserts, etc. And I never count calories. But it's still useful to get information about macronutrient ratios.

But I admit I'd NEVER use a system like NuVal. I don't trust anyone to decide what is "healthy" for me. For example I just checked out the NuVal website and saw some things with their scores there:
bananas - 91 (make my blood sugar skyrocket through the roof)
Unprocesed wheat bran - 100 (gives me GERD, diarrhea, nausea)
fat-free milk - 91 (my doctor tells me never to eat anything labeled fat-free or low-fat, and I completely agree as this generally means "higher in sugar" which I avoid. I would never touch fat free milk)

So yes, give me as much nutritional information as possible. But don't give me one single useless number.
02:00 PM on 02/22/2011
I couldn't have said it better (and would guess that we eat a very similar diet). Ideally, full nutrition information + ingredient list would be available. Maybe it won't change everyone's behavior, but it would certainly help me make more informed decisions.

Until then, I'll be staying as far away from NuVal as humanly possible. Any system that says that Kashi TLC Tasty Little Chewy Oatmeal cookies are a better choice than ground sirloin has some massive flaws.
DrSnuggles
You label me and I'll label you
11:55 AM on 02/22/2011
Nutrition and diet are very interesting to me from a scientific perspective. I'm absolutely not qualified to have an opinion on the topic per se, but I'm more than qualified to judge the value of other's opinions.

Noone agrees, every point is valid, backed up by studies and good evidence AND completely disagrees with another equally valid scientific point of view.

I think this has a lot to do with the uniqueness of each human individual, we all need to find our own balance. The only nutrition/diet advice that everyone seems to agree on is.

1. Don't eat cr@p

2. Don't eat too much

3. Exercise
11:28 AM on 02/22/2011
One of the best articles on nutrition. As a health and wellness professional, the biggest challenge for us is trying to get on the same page as it relates to educating the masses. The problem is that it's an extremely difficult undertaking just to get people to focus on the calories let alone the quality of those calories.

What does it matter if you're eating high quality organic foods but you're taking in 500 more calories a day than you should and you're 30lbs overweight? Before we go on about insulin levels, quality of foods, and satiety we need to get the general public to reduce their calorie intake.
10:26 AM on 02/22/2011
Going to public restaurants to see if people are counting calories is a really bad idea. When I go out to eat with the wife its to eat and gorge myself, if they were at places like Wendy's or Burger King I just don't understand then(fast food maybe 2 times a year and I'll order more food then I can eat)..... the real healthy people will be at home creating good stuff.

Yes, I keep a good log of the calories I eat regularly, it actually helped my lose about 30lbs early in my college years. I do feel though that my circumstances and lifestyle allow me to easily eat excessively as opposed to defensively. Why? well, when you live a 10,000ft and vigorously exercise 4-5 times a week you eat up upwards of 3-4000 calories a day.

I think the author makes good points about eating foods that make us full, and eating more nutritiously. I think the author is focusing on people's eating habits in this article, but there is no mention of exercise. An hour of exercise a day is what most recommend for the minimum which most people might do once or twice a week. My lifestyle has me skiing 20+ hours a week in the winter, ww kayaking 30+ a week in the summer, and p90x in my off-season. With this quantity of exercise along with living at very high elevation food is your friend.
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HUFFPOST SUPER USER
ninetailedfox
banning people.....so childish
09:15 AM on 02/22/2011
I was told by a few dieticians to eat six meals a day. this is a huge mistake, because the body craves more than just a taste of food. I believe that two meals a day is fine, but its something that has to start out when youre a teen, otherwise its very hard to get used to. the dieticians are probably creating more diabetes with rotten advice like eat 6 small meals a day.
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HUFFPOST COMMUNITY MODERATOR
ConfuciusSay-
Aglets: their purpose is sinister.
09:26 AM on 02/22/2011
I disagree completely, for biochemical and physiological reasons, that eating smaller more frequent meals causes diabetes.

The exact opposite is true.
Load a days supply of food into your gut in 2 servings, and your insulin will have to cope with a massive spike in sugars, shunting the surplus into fat storage, straining the islets of Langerhans, and leading to type 2 Diabetes. Bodybuilders eat 6 times a day, and exercise hard. We'd all be well advised to take a good example from the strongest amongst us.
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HUFFPOST SUPER USER
ninetailedfox
banning people.....so childish
10:51 AM on 02/22/2011
Did you know that at one point in time people ate two meals a day? part of why diabetes is such a major issue is because people dont excercize like they used to, among other things.

thats bodybuilders, we are talking about average people here not Arnold Schwarzaneggers.
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HUFFPOST SUPER USER
ninetailedfox
banning people.....so childish
11:01 AM on 02/22/2011
Also many doctors have been sued for malpractice. Dont be surprised if someday, this becomes just another bad idea that sounded good at the time. Crap, at one point in time, people didnt realize that you should wash your hands, or that blood letting wasnt going to cure anything unless you have gangrene. Modern medicine has come a long way, but it still has a long ways to go.
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European1919
I am the Pigmâ’¶n
08:22 AM on 02/22/2011
Sounds like good advice. Now how do I best go about it?
HUFFPOST SUPER USER
onionboy
Blessed are the Cheese Makers
11:39 AM on 02/22/2011
I recommend that people (did this myself) start with food diaries for several weeks without making any attempts to change eating habits. You'll be able to do it all in your head eventually, but it's nice to see it on paper at first. Just be honest. Do them only for yourself. You can find out on the internet what your food had in it. Figure out what you really like, and is relatively good for you. Find out what is bad and that you could live without. Make some changes. Try for a few months, and have realistic expectations. Then look at it again. Everybody's a little different. Make tweaks 'til you find what's working for you. And continue to be patient with weight loss goals. Slow weight loss has a better chance of staying off for good.

For exercise, I do only muscle-building exercise. I'm sure that's not for everyone, but I don't have the kind of time for cardio wherein it could make an impact calorie-wise. I prefer to keep up muscle mass to keep my metabolism up.
HUFFPOST SUPER USER
bergerqueen
07:26 AM on 02/22/2011
I like the idea of knowing the calorie count of a given item. It may not change my choice but at least I'll have informed consent. Also, I think patrons think certain menu items are healthier than they really are and seeing the calorie count would lead to thinking about how that item was prepared. It is true that certain foods are healthier for you even if they have a higher calorie count i.e. nuts, avocados, so knowing the nutritional value of the food you are eating is relevant, but it can be confusing when a restaurant proports to have a healthy choice that is not so healthy. At least with a calorie count, you know where you stand.
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HealthHabits
07:18 AM on 02/22/2011
IMHO, body composition is determined by:

1. What you eat (quality)
2. How much you eat (quantity)
3. When you eat it

re Quality - an equal sized serving of colorful vegetables is going to be more nutritious (vitamins, minerals, enzymes, etc) than a bowl of rice.

re Quantity - an equal sized serving of colorful vegetables is going to have fewer calories (quantity) than a bowl of rice.

re Meal Timing - Food eaten before or after exercise is going to be used to re-fuel muscles thanks to our good friend insulin. Conversely, a bowl of ice cream eaten before going to bed is going to be used to fill or create new fat cells...thanks to our good friend insulin

Body composition is not as simple as calories in v calories out
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HUFFPOST COMMUNITY MODERATOR
ConfuciusSay-
Aglets: their purpose is sinister.
09:27 AM on 02/22/2011
+1
10:50 AM on 02/22/2011
Body composition is determined by: How much you eat, Period.

Granted if you eat high quality foods as you described I suppose you'd be "healthier". If you're 8% body fat and eat like crap, you're gonna be healthy too. Now I would argue you'll stay satisfied longer when eating higher quality foods. But if we are strictly talking about body composition, it doesn't matter what those calories are made of. Quantity is the key.

For my clients, I recently did an experiment on myself proving just that fact. For a month I weighed and measured all food intake, tracked my macro-nutrients daily (drove my wife crazy). The following month I only counted the calories of food. Both months the calories were equal.

Do you know what happened? Nothing, my body looked absolutely the same, my body fat and weight stayed the same. I challenge anyone to try it and see for themselves.

Meal Timing: I would spend hundreds of $$ a month on nutritional supplements to help with Pre-Post Workout nutrition. In a lab, meal timing may have an impact but in the real world it has no bearing on exercise. The quality of the exercise determines the outcome.

A bowl of ice cream eaten before be won't be used for anything if you're still in a calorie deficit. Excess calories creates fat cells. It's the Law of thermodynamics.
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HealthHabits
02:47 PM on 03/07/2011
The first Law of Thermodynamics, or energy balance, basically states that in a closed system, energy can neither be created nor destroyed, only transformed or transferred.

Unfortunately, for proponents of the "Calories In v Calories Out" argument, the human body is not a machine. There are countless, wildly varying, variables involved that affect the efficiencies of a system. Understanding this helps to explain why calories cannot be balanced like a checkbook.

Balance in an open system, like the human body, is when all energy going into the system equals all energy leaving the system plus the storage of energy within the system. But energy in any thermodynamic system includes kinetic energy, potential energy, internal energy, and flow energy, as well as heat and work processes.

In other words, in real life, balancing energy includes a lot more than just the calories we eat and the calories we burn according to those exercise charts. The energy parts of the equation include: calories consumed; calories converted to energy and used in involuntary movement; calories used for heat generation, calories used with inflammatory and infectious processes; calories used in growth, tissue restoration and numerous metabolic processes; calories used in voluntary movement; calories not absorbed in the digestive tract; calories stored as fat, and fat converted in the liver to glucose. Each variable affects the others, varies with mass and age, involves complex hormonal and enzyme influences, and differs in efficiency.
http://junkfoodscience.blogspot.com/2008/10/first-law-of-thermodynamics-in-real.html
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HUFFPOST SUPER USER
HealthHabits
techjockey
Keeping My Gratitude Higher Than My Expectations..
02:17 AM on 02/22/2011
Having calorie counts up at takeout restaurants will definatly influence the behavior of someone watching their weight.
There is a healthy mexican takeout in my area that posts calories. It is really eye-opening. I now choose fish tacos at 259 calories each rather than an 800 to 1100 calorie burrito.
Soda pop in that large size is 600 freakin calories... Wow!
If lots of people choosea grilled chicken sandwhich at 450 calories rather than a 900 to 1800 calorie burger, perhaps some more healthy options may start showing up on more menus.
01:35 AM on 02/22/2011
Labels rating overall food quality is an interesting idea -- if it were done honestly. Maybe in Europe..... But American politicians and the FDA are so owned by the corporate overlords that they even oppose labeling genetically-modified Frankenfoods dripping with Roundup pesticide. LOL

"Be careful what you wish for."
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HUFFPOST COMMUNITY MODERATOR
Pennsanic
Be nice to the US or we'll bring you democracy too
06:57 AM on 02/22/2011
Ain't that the truth. I only just recently learned how huge lobbying groups (like the Dairy Council) spend big $ to influence the gov't food guidelines for children...
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HUFFPOST BLOGGER
David Katz, M.D.
Director, Yale Prevention Research Center; Editor-
07:53 AM on 02/22/2011
Perhaps so- but we have an honest system. The development of the Overall Nutritional Quality Index (ONQI) used in the NuVal system (www.nuval.com) was my idea- I am a Preventive Medicine and Public Health specialist, whose one and only mission is advancing the health of our population, and my patients. I did, in fact, propose the idea to the US Secretary of Health, and the Commissioner of the FDA back in 2003, but they did not take up the challenge.

When I did so, it was by convening a group of top experts in public health and nutrition from the US, and Canada. They came together to develop the nutrition guidance with nominal compensation for their time from a not-for-profit, Yale-affiliated, community hospital- Griffin Hospital in Derby, CT. The system is owned by the hospital, and is entirely independent of both the food industry, and the government, and is in fact independent even from the business side of itself! In other words, scientific oversight of the nutrition guidance cannot be influenced by business-side concerns about how best to grow the business. And, as noted in other comments, the system has been tested in over 100,000 people and shown to correlate with health outcomes: http://www.fasebj.org/cgi/content/meeting_abstract/24/1_MeetingAbstracts/lb383

We've all learned to be dubious; but this is the real deal.
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HUFFPOST SUPER USER
Djabout Mauren
Shameless huffjunky
01:27 AM on 02/22/2011
Nothing could be truer. Foods with high nutrition quality satisfy with fewer calories for longer. The primary reason is probably fiber. Real foods have lots of fiber. And while Dr. Kats promotes protein consumption, many common sources for protein in the American diet hardly count as real food. Beef which is grain fed is much higher in fat (low quality fat). Hot dogs contain God knows what. I'm with the good Dr. but I think minimizing animal products and refined foods is the best approach to managing healthful nutrition. It's not rocket science, and it's no secret--despite the endless halls of gimmicks and diet books that continue to swindle a tubby nation.
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HUFFPOST BLOGGER
David Katz, M.D.
Director, Yale Prevention Research Center; Editor-
07:55 AM on 02/22/2011
Not sure where this notion came from; I do not 'promote protein consumption,' other than that required for optimal health and vitality. My diet is mostly plant based. The NuVal system gives highest scores to vegetables and fruits- and considerably lower scores to almost all meats (wild salmon scores quite high). Grass fed beef scores considerably higher than grain fed.
11:05 PM on 02/21/2011
Thanks for the article! I agree completely that a more comprehensive indication of nutritional value (vs. just calories) is more useful, but it still falls into the trap of thinking we're going to prompt behavior change by merely providing information. Public health really needs to do more behavioral econ and marketing thinking - people aren't always rational, so information is not going to change behavior. Food companies get this, but public health folks often don't. And then of course, there's the broader systems level changes we need - not better nutritional value/calorie labeling in restaurants, but actually healthier food in restaurants.

(www.pursuitofpublichealth.com)