Calories are not all equal and all things in moderation is a

beernutz

myth. I suspect this will be a bitter pill for many to swallow because that dogma is so ingrained.

The NEJM study: http://www.nejm.org/doi/full/10.1056/NEJMoa1014296#t=comments

NYT writeup: http://www.nytimes.com/2011/07/19/health/19brody.html?pagewanted=1&_r=2&partner=rss&emc=rss

A segment of the NYT writeup:
The new research, by five nutrition and public health experts at Harvard University, is by far the most detailed long-term analysis of the factors that influence weight gain, involving 120,877 well-educated men and women who were healthy and not obese at the start of the study. In addition to diet, it has important things to say about exercise, sleep, television watching, smoking and alcohol intake.

The study participants — nurses, doctors, dentists and veterinarians in the Nurses’ Health Study, Nurses’ Health Study II and the Health Professionals Follow-up Study — were followed for 12 to 20 years. Every two years, they completed very detailed questionnaires about their eating and other habits and current weight. The fascinating results were published in June in The New England Journal of Medicine.

The analysis examined how an array of factors influenced weight gain or loss during each four-year period of the study. The average participant gained 3.35 pounds every four years, for a total weight gain of 16.8 pounds in 20 years.

“This study shows that conventional wisdom — to eat everything in moderation, eat fewer calories and avoid fatty foods — isn’t the best approach,” Dr. Dariush Mozaffarian, a cardiologist and epidemiologist at the Harvard School of Public Health and lead author of the study, said in an interview. “What you eat makes quite a difference. Just counting calories won’t matter much unless you look at the kinds of calories you’re eating.”

Dr. Frank B. Hu, a nutrition expert at the Harvard School of Public Health and a co-author of the new analysis, said: “In the past, too much emphasis has been put on single factors in the diet. But looking for a magic bullet hasn’t solved the problem of obesity.”

Also untrue, Dr. Mozaffarian said, is the food industry’s claim that there’s no such thing as a bad food.

“There are good foods and bad foods, and the advice should be to eat the good foods more and the bad foods less,” he said. “The notion that it’s O.K. to eat everything in moderation is just an excuse to eat whatever you want.”

meerkat70

Ah, but you need to be careful in interpreting risk studies, particularly in relation to the question of the operation of compound risk.

And incidentally, this article doesn't actually tell us anything about 'all things in moderation' - where did you read that in the article?

It simply identifies that risk of overweight is (perhaps unsurprisingly) associated with unhealthy food choices.

I think anyone with some common sense knows that, if you eat junk food every day, even if you're within calories, you won't lose weight as effectively as if you eat primarily home cooked and healthy food. However, this does not mean that an occasional treat is a problem - and the article you've quoted doesn't actually suggest that it does.

It's also very difficult to comment sensibly on research design in a study where only the abstract is available publicly.

kelbel76

bump so I can read later

meerkat70

as the abstract itself says:

"Specific dietary and lifestyle factors are independently associated with long-term weight gain, with a substantial aggregate effect"

It's that 'aggregate effect' that is typically the kicker in this kind of correlative research.

auntiebabs

“There are good foods and bad foods, and the advice should be to eat the good foods more and the bad foods less,” he said. “The notion that it’s O.K. to eat everything in moderation is just an excuse to eat whatever you want.”

Um, yeah...

beernutz

Ah, but you need to be careful in interpreting risk studies, particularly in relation to the question of the operation of compound risk.

Yes, every study needs to be carefully examined, however, you have not pointed out a problem with this particular study with regard to multiple risk factors.

agthorn

I'm guessing most people have only read the NYT or Huffington Post summaries of the NEJM article.

From the NEJM article: "Total energy intake, biologic factors (e.g., blood pressure), and medications were not included as covariables because such factors could be mediators (in causal pathways) or direct correlates of mediators of the effects of lifestyle on weight gain."

Meaning: They DID NOT control for differences in calorie intake. The study was designed to look at CHANGES IN HABITS, not total calorie consumption.

"The dietary factors with the largest positive associations with weight changes, per serving per day, were increases in the consumption of potato chips (1.69 lb), potatoes (1.28 lb), sugar-sweetened beverages (1.00 lb), unprocessed red meats (0.95 lb), and processed meats (0.93 lb)."

"Inverse associations with weight gain, per serving per day, were seen for increased consumption of vegetables (−0.22 lb), whole grains (−0.37 lb), fruits (−0.49 lb), nuts (−0.57 lb), and yogurt (−0.82 lb)."

Meaning: People who INCREASED their consumption of chips and sugar-sweetened beverages also tended to increase their weight. People who INCREASED their consumption of fruits and vegetables also tended to decrease their weight.

In the end a calorie is still a calorie is still a calorie. But making positive CHANGES to your diet generally correlates in better health and weight loss. It's not rocket science. It's just science.

meerkat70

That's because, as I pointed out, you can't read the full article at the link you've provided....

beernutz

as the abstract itself says:

"Specific dietary and lifestyle factors are independently associated with long-term weight gain, with a substantial aggregate effect"

It's that 'aggregate effect' that is typically the kicker in this kind of correlative research.

There is no "kicker" there. Do you know what "independently associated" means? The fact that these factors have a further aggregate affect does mitigate their independent affect. It just makes them worse when combined.

beernutz

That's because, as I pointed out, you can't read the full article at the link you've provided....

Huh? You click on 'Article'. Not that difficult.

agthorn

That's because, as I pointed out, you can't read the full article at the link you've provided....

I have access to the original NEJM article. If anyone would like to read it for themselves, send me a message with your e-mail address and I will gladly e-mail a PDF copy.

meerkat70

Thanks for that very useful summary agthorn. The abstract didn't provide enough info to be clear on that.

MrBrown72

So if it is not good for you, don't stick it in your face. Seems easy enough.
The rest is pretty common sense. I don't suppose pouring a coke in your car gas tank "only now and then" would be okay either. It says right in the write up that the major problem with conventional wisdom and calorie counting is that people are not doing it. It should be obvious that even if you only have 1400 calories a day, if they are all junk, your end result will be a body made of junk.

I like this part:
But contrary to what many people believe, an increased intake of dairy products, whether low-fat (milk) or full-fat (milk and cheese), had a neutral effect on weight.

And despite conventional advice to eat less fat, weight loss was greatest among people who ate more yogurt and nuts, including peanut butter, over each four-year period.



He was not surprised by the finding that the more television people watched, the more weight they gained, most likely because they are influenced by a barrage of food ads and snack in front of the TV.

AdAstra47

I think anyone with some common sense knows that, if you eat junk food every day, even if you're within calories, you won't lose weight as effectively as if you eat primarily home cooked and healthy food. However, this does not mean that an occasional treat is a problem - and the article you've quoted doesn't actually suggest that it does.

Regardless of what the article says, in my experience, the occasional treat IS a problem. It depends on your metabolism & genetics, of course. But some people... perhaps many people... have an addiction to certain types of foods. The most famous is alcohol: it has been scientifically proven over and over that some people have a genetic predisposition that means they will get addicted to alcohol. And their only "cure" is to go cold turkey and never have another drop. But alcohol is not the only substance like that. My body can't handle carbs, so I've had to give up all breads, pastas, & starches. Cold turkey. If I let myself slip even once, I am miserable for several days and find it very difficult to get back on the wagon.

And I really HATE it when people keep repeating the mantras "calories in, calories out" or "a calorie is a calorie." Because that is simply not true! I did that for 20 years, I counted calories, avoided junk food, and ate less than I was burning. And for 20 years, I steadily gained weight. People, including my doctors, assumed I was lying about being good. It was incredibly frustrating to do everything "right" and still be judged as lazy, undisciplined and a liar.

It turns out that as long as too many of those calories were carbs, I was going to gain weight no matter how few calories I ate. When you look into the biochemistry, you'll see that your body treats carbs, fat and protein very differently. They all produce energy, but using completely different chemical reactions. So I think it's about time that someone is getting the word out that people need to pay attention to the KIND of calories we eat! So many people could be helped by simply adjusting their ratios of carbs - fat - protein to the correct ratio for their metabolism and body type. Once my doctor put me on 5% - 30% - 65%, I have been losing weight for the first time in my life.

Thanks so much for posting this & helping get the word out!

kimmerroze

BUMP! because I am curious about the debate.

meerkat70

"Regardless of what the article says, in my experience, the occasional treat IS a problem. It depends on your metabolism & genetics, of course. But some people... perhaps many people... have an addiction to certain types of foods."

Surely this is a strong argument for learning to eat moderately, not for total avoidance. Total avoidance is how people ultimately end up crashing heavily off the wagon. Learning to manage food appropriately makes far more sense.

I've lost a lot of weight, and kept most of that off despite injury and a horrific year or two in which everything that could go wrong did go wrong. (I still have a way to go beyond that initial loss.) Like you, I went 'cold turkey' for a while. But ultimately, you have to learn to eat sensibly. And eating sensibly includes learning to enjoy a good range of foods in a sensible way. Total abstention isn't ultimately sustainable, I don't think - not in a society where temptation is everywhere. Learning to love your body, to feed it well, to treat yourself in non-food ways - these things are all key. But so too is learning how to manage just having a small piece of cake, and enjoying it without having to munch through mountains of the stuff.

I've never been a junk food eater (i.e. I don't do take outs or ready meals, I have always eaten a health diet). My weak spot is all the stuff I would add *to* that healthy diet. Learning to cope with that has been key to successful weightloss to me.

perne11

This is not true for me, but thanks for the article!

beernutz

I'm guessing most people have only read the NYT or Huffington Post summaries of the NEJM article.

From the NEJM article: "Total energy intake, biologic factors (e.g., blood pressure), and medications were not included as covariables because such factors could be mediators (in causal pathways) or direct correlates of mediators of the effects of lifestyle on weight gain."

Meaning: They DID NOT control for differences in calorie intake. The study was designed to look at CHANGES IN HABITS, not total calorie consumption.

"The dietary factors with the largest positive associations with weight changes, per serving per day, were increases in the consumption of potato chips (1.69 lb), potatoes (1.28 lb), sugar-sweetened beverages (1.00 lb), unprocessed red meats (0.95 lb), and processed meats (0.93 lb)."

"Inverse associations with weight gain, per serving per day, were seen for increased consumption of vegetables (−0.22 lb), whole grains (−0.37 lb), fruits (−0.49 lb), nuts (−0.57 lb), and yogurt (−0.82 lb)."

Meaning: People who INCREASED their consumption of chips and sugar-sweetened beverages also tended to increase their weight. People who INCREASED their consumption of fruits and vegetables also tended to decrease their weight.

In the end a calorie is still a calorie is still a calorie. But making positive CHANGES to your diet generally correlates in better health and weight loss. It's not rocket science. It's just science.

The study authors did not add energy intake as a covariable because it is a mediator not a confounding factor. Mediators are part of the causal pathway so you don't control for them.

Changing to the type of calories eaten has a positive correlation with weight loss. I don't know what you mean by "positive changes" if you claim any calorie is the same as any other calorie. If they are all the same, why are some positive and others not?

anelahm

bump, will read later too

bjalter

Instead of bumping to read the post/article later, why don't people just email the link to themselves?

Annoying.

agthorn

Changing to the type of calories eaten has a positive correlation with weight loss. I don't know what you mean by "positive changes" if you claim any calorie is the same as any other calorie. If they are all the same, why are some positive and others not?

Because making positive changes in your diet usually results in consuming fewer calories. Thus leading to weight loss. You said "everything in moderation is a myth" and that's a) simply not true and b) leads many people to perpetuate the deprive-consume cycles that are characteristic of yo-yo dieting. If you don't learn how to eat, you're always going to be dieting.

I am all for making healthy changes and replacing poor eating habits with better eating habits. But this study certainly did not say "calories are not all equal" - and this is why I loathe most 'scientific journalism.'