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David Katz, M.D. Headshot

How Much Do Calories Count?

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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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