by Marion Nestle
Apr 13 2012

Another Q and A on Why Calories Count

NYU did an interview for the Steinhardt School’s website:

Why did you write this book?

Calories are critical to the most important public health, social, and economic issues facing the world today. About a billion people in the world do not take in enough calories to maintain health and are hungry and malnourished and another billion or so take in so many that they are overweight or obese and have higher risks for chronic disease and disability. The food industry takes in more than a trillion dollars a year in the United States alone. The U.S. diet industry is worth about $60 billion a year. The public is demonstrably confused about the meaning of calories and their relationship to food intake and weight loss. We thought it would be useful to write a book that provided accessible information about calories in all of their dimensions—scientific, health, and political.

What is a calorie?

Calories measure energy to keep bodies warm, power essential body functions, move muscles, or get stored as fat.

Why are calories a problem?

You can’t see, taste, or smell them. The only way you can recognize them is by their effects on your waistline or on a scale. They are not easy to count accurately and the best way to measure them is to weigh yourself regularly.

What are some of the themes of the book?

If you want to understand calories, you need to know the difference between calories measured and estimated. Most studies of diet, health, and calorie balance depend on self reports of dietary intake and physical activity or educated guesses about the number of calories involved. Most diet studies rely on estimates. When it comes to anything about calories in food or in the body, you have to get used to working with imprecise numbers. That is why it works better to eat smaller portions than to try to count calories in food. Even small differences in the weight of food will throw calorie estimations off.

Politics? What’s political about calories?

As with everything else having to do with food and nutrition, many groups have a stake in how calories are marketed, perceived, labeled, and promoted. As we’ve already said, eating fewer calories is bad for business. Efforts to do something about obesity in adults and children focus on eating less or on eating better, meaning eating more fruits, vegetables, and grains but consuming less of sodas, fast food, snacks, and other highly profitable items. Such matters as soda taxes, listing calories on food labels or menu boards, or campaigns to promote smaller portions are all political responses to concerns about calorie consumption. Here’s one example: for years, consumer groups have pushed for calorie and nutrition labeling on alcoholic beverages, but the Treasury Department (not the FDA) regulates such things and responds to the wishes of the industry.

What are the most important conclusions of the book?

If you want to eat well and maintain a healthy weight in today’s food environment, we advise: First, get organized; get motivated, monitor your weight regularly, join a weight loss group. Then eat less, move more, eat better and get political; work to change the food environment to one that makes it easier to eat healthfully, support labeling laws, nutrition education, controlling advertising to children, agricultural policies that encourage consumption of fruits and vegetables and local food systems, and environments that encourage physical activity.

And for another view: My co-author, Dr. Malden Nesheim, did a Q and A on the book with Diets in Review.

  • brad

    For long-term studies, I think the challenges have less to do with funding and more to do with finding enough people who will successfully sustain a given diet over the long term, plus getting approval by human subjects committees for long-term studies of diets that are seen as potentially dangerous (e.g., with high quantities of saturated fats).

    Science isn’t done by vote: it could turn out that Gary Taubes is right and everyone else has been wrong all along. But until we know that, it’s irresponsible to base medical and dietary advice on what is still a minority view. There’s still a lot of evidence to back up the conventional wisdom; Taubes has pointed out many of the flaws in the science that underpins the conventional wisdom but some of the studies he cites to support his arguments are plagued with the same flaws.

    The dietary establishment also isn’t as rigid and unwilling to accept new findings as many people think. Go to the Harvard School of Public Health’s nutrition pages and you’ll see that they have completely changed their advice on “low fat” diets and no longer advocate them. Diet and nutrition is a rapidly evolving field, and it takes time to sort through all the conflicting findings to arrive at the truth. If you’re going to change medical advice you need to wait until you’re sure you’ve got strong evidence to back up your decision. I don’t think we’re there yet.

  • Alice in Wonderbread Land

    @Brad – So how is it again that my body can tell the difference between “high” GI foods and “low” GI foods? I’m not familiar with this particular biochemical mechanism. Most science (including the Dietary Guidelines Advisory Committee Report 2010) indicates there’s no relationship between GI and body weight: “Strong and consistent evidence shows that glycemic index and/or glycemic load are not associated with body weight and do not lead to greater weight loss or better weight maintenance.”
    Try looking at the science (you seem to have access to it) that happened BEFORE the Guidelines. We do have 30-40 years of evidence that Americans were not getting very fat very fast BEFORE the Guidelines that told us to INCREASE our carbs came along. In fact, IF calories count as much as MN seems to think they do, why don’t we go back to pre-Guidelines eating styles, as the decade before the Guidelines came out, Americans actually DECREASED their calorie intake?
    Until Americans figure out that everything they THINK they know about the definition of a healthy diet is based on politics–and not just from industry, but from the scientific-academic-industrial complex of which MN is a member–they will spend their days counting and measuring and basically having an abnormal relationship with food. How did we all manage before BOXES of food with CALORIE COUNTS came along? We simply ate meat, fat, veggies, and fruit in season. With the occasional bowl of Jello. Forget Gary Taubes. Read “Toward Healthful Diets” by the Institute of Medicine’s Food and Nutrition Board (1980) if you are concerned about sweeping dietary statements made before there is adequate evidence to support them. That’s exactly what happened with the 1977 Dietary Goals for Americans and we’ve been paying the price ever since. There’s a beautiful graph of it here:
    PS – In every “long term” low-carb study ever done, carb intake tracks with weight gain. See Gardner et al. 2007 As they “add in” carbs toward the end of the study, weight loss decreases & weight regain begins. It’s part of the study design. I don’ think it is deliberate–but it minimizes the effects of a low-carb diet.
    As for the long term effects of sat fat consumption, Med Diets are touted as the “heart healthiest” of diets. Sat fat levels of med diets can be over 13% (Trichopoulou et al NEJM 2003). Oops. 13% sat fat is where the American diet was BEFORE the Guidelines came along.

  • Greg

    “If you’re going to change medical advice you need to wait until you’re sure you’ve got strong evidence to back up your decision.”

    I agree with you 100%. Unfortunately, the nutrition establishment has been changing medical advice for the last 30 years without hard evidence, specifically advocating low-fat diets and telling people to avoid saturated fats.

    May I direct you to p. 36 of the 2000 (12 years ago!) DGAC report to find out how much we already knew about the long-term effects of low fat diets.

    So why didn’t the prescription change?

    And here we have a study refuting the recommendations against sat fats:

    Or if you really want to get deep in the weeds on how much we know or don’t know about sat fats, go here:

    So yes, it would be lovely to have strong evidence to back up the nutrition recommendations — codified into law and policy via the guidelines! — that we’ve been using for the past 30 years.

    But the evidence isn’t really there, is it?

    The USDA Guidelines and the ADA/AND are still up in amrms

  • brad

    @Alice: I think the Gudelines said to decrease fat intake, which meant you had to increase your carb intake in order to meet your daily energy needs. If you read “Why Calories Count” or any other recent examination of those earlier guidelines, you see that what happened is that people dutifully sought out “low fat” foods, but those foods in most cases were high in calories. Take a look at the calories in a container of no-fat yogurt or a box of low-fat cookies, for example. And because a low-fat diet tends to leave you feeling hungry, people overate and thus consumed more calories than they expended. So they got fat.

    If you have iTunes, you can download a free talk via iTunes University by Walter Willett of Harvard, from a few years ago where he discusses the changes in dietary establishment thinking over the past few decades and the evolving state of knowledge. He’s pretty honest about uncertainty and how much we don’t know and still have to learn. The scientists I trust the most are the ones who don’t claim to know the answers.

    It’s clear that high-GI foods do have a very different effect on blood sugar levels than low GI foods, with low GI foods acting like a “timed release” for blood glucose compared with the rapid spike caused by high GI. That’s why low GI foods tend to leave you feeling satisfied longer whereas high-GI foods tend to cause you to overeat because you’re hungry again in an hour. Nestle and Nesheim talk about that in their book too.

  • Greg

    Forget GI, forget calories. Those dance around the real issue.

    Here’s what IS known:

    We need water.
    We need protein.

    People will chase protein until their body is satisfied. Protein in a natural state (think eggs, nuts, meat) almost always has some fat with it. By reducing fat, we reduced protein. By reducing protein, our bodies received the messages programmed into us by evolution that we had a dodgy food supply and we’d better stock up on whatever was available. So we ate more.

    What is so remarkable — and depressing — is that the very prescription given to prevent chronic health problems actually contributed to them.

  • Margeretrc

    “the thing that worries me the most about low-carb diets is that we still don’t have enough data to show what the long-term impacts might be.” Actually, that is not true at all. We have studies of current hunter gatherers who have lived this lifestyle traditionally and for a long time. For example, it’s tradititional for mature Maasai men to spend 30 – 40 years of their lives consuming only milk, meat, blood and fat. Inuits consuming a traditional diet of mostly meat, fish, blubber, etc. were healthy until they started consuming starches as part of a western diet. Evolutionary data on the human diet says that for millions of years, we thrived on a low carbohydrate, high fat diet. Oh and then there’s the experience (documented in his book) of Viljammer Stephannson, who lived with the Inuit for 10 years, then purposely, under medical supervision, spent two years following the same diet wherein the only carbohydrate he and his friend who joined him in the study consumed came from the animal products they ate and came out as healthy as when he had entered the study. So that argument, I’m afraid, is a straw man. I’m currently reading “The Art and Science of Low Carbohydrate Living” by Dr. Jeff Volek and Dr. Stephen Phinney and they make a very clear case that, while an eat less move more approach may work for those whose metabolism is functioning normally, anyone whose metabolism is damaged–i.e. they are insulin resistant–it is doomed to failure, not because they won’t stick to it, but because they CAN’T stick to it. The constant presence of circulating insulin inhibits lipolysis in the adipocytes and gluconeogenesis in the liver so that, once the energy from what food they have eaten is depleted, their cells literally starve and drive them to eat more to supply the energy they are lacking by eating again. It’s a good book. I recommend it. They have done hundreds of scientific studies over the course of their 30+ year careers to back up their claims. The question we have to ask is why are so many people’s metabolisms damaged now as compared to before the dietary guidelines were introduced in the 70s and what can we do to help them? Eat less, move more is not it.

  • Margeretrc

    “obesity is a complex phenomenon with multiple causes. I find it hard to accept that one factor (such as insulin) is driving it for everyone. Psychology, genetics, living environment, access to food, sleep deprivation, and many other factors play roles in obesity; what works for me may not work for you.” True enough. But I think, thanks to the Guidelines, insulin is the driving force for more people than any of the other factors. Dr. Robert Lustig has said that it’s a factor for at least 67% of the overweight/obese population and I suspect he’s pretty much on target. Telling them to eat less, move more is not helpful. And, as he points out, there is a growing number of obese infants and children. How do you tell an infant or young child to “eat less, move more”? We need to concentrate on finding strategies that work for the majority of people with a problem, including the very young. Eat less, move more is not it.

  • brad

    I’ve never found the studies of diets of people from other cultures very convincing, because you can just as easily point to people in still other cultures who eat diets of nearly 100% refined carbohydrates (e.g., white rice) while maintaining low rates of obesity. It seems like there are too many other variables at play: genetics, activity levels, etc. to be able to draw definitive conclusions. And studies of prehistoric diet aren’t very enlightening because of the shorter lifespans of those populations. Cancer and other diseases associated with diet tend to emerge well past the age at which most prehistoric individuals were already dead. I used to share a house with two prominent researchers on prehistoric diet, and they both thought the proposal that modern-day people should follow a paleo diet was strange. Humans evolved as opportunistic omnivores.

  • Margeretrc

    “I’ve never found the studies of diets of people from other cultures very convincing, because you can just as easily point to people in still other cultures who eat diets of nearly 100% refined carbohydrates (e.g., white rice) while maintaining low rates of obesity.” Maybe, but the fact that there are cultures that can and do live on a very low carb diet speaks to it’s safety, which is the issue you raised. I am by no means claiming that a low carb diet is the only good diet for anyone whose metabolism hasn’t been messed up. There are a wide variety of cultures living healthy lives on a wide variety of traditional diets–no argument–but some of them are very low carbohydrate diets and they seem to suffer no ill effects from it.
    “And studies of prehistoric diet aren’t very enlightening because of the shorter lifespans of those populations.” You mean the shorter AVERAGE life spans? There were many things unrelated to diet that ended their lives, often at a very young age, which tends to make the average life span shorter, yes. But that doesn’t mean that those who survived all that didn’t live a long and healthy life. And current hunter gatherer populations likewise may have a somewhat lower average life span, but those who survive all the non diet related causes of early death live to a ripe old age and yet do not often, if ever, suffer the diseases of modern society–cancer, heart disease, T2 diabetes, etc. Whereas some of those populations that eat a traditional diet high in refined and other carbohydrates (India, for example) do. Rates of heart disease, metabolic syndrome, and T2 diabetes are rising at alarming rates in India, particularly among the vegetarian peoples of southern India.

  • Alice in Wonderbread Land

    @brad – So why do you trust MN since she “knows” the most important factor is simply calories in-calories out? You’ve already admitted there’s more to it than that: “because a low-fat diet tends to leave you feeling hungry,” “high-GI foods tend to cause you to overeat.” So some foods offer more satiety than others? Isn’t that going beyond calories in/out? If there are foods that CAUSE overeating and other foods that REDUCE overeating, it’s not JUST calories now, is it? Willett is right. There IS a great deal of uncertainty, yet there is only ONE definition of a healthy diet: low sat fat, low cholesterol, low sodium, low calorie, high fiber, high carbohydrate–which BTW isn’t working.
    What about people with Type 1 diabetes? They can eat 5000 calories a day and can’t gain weight. (oh, but they are metabolically “dysfunctional” right? How is that different from an overweight, post-menopausal female who can’t lose weight eating 1200 kcals/day?) How do you explain Jeff Volek’s study that shows that people on an ISOcaloric diet (low carb vs high carb) lost more weight with fewer carbs? Whassup with that?
    Humans are opportunistic omnivores who have always included meat and fat in traditional diets; there are no indigenous veg*ns. I’ve never found studies conducted on mostly white males all that convincing either.

  • Margeretrc

    BTW, @Brad, this may be nit picking as I think you didn’t really mean you think any cultures live on a nearly 100% refined carbohydrate diet as that would, by all measures, be unhealthy. Whereas carbs are not essential for the human condition, protein and fat are. Any diet that doesn’t meet the individual’s requirement for protein and fat is a fast ticket to dis ease, so the most % carbs a traditional diet can have and still be healthy is abut 75%, no? allowing for 15% protein and 10% fat. Just saying….

  • brad

    You all are ganging up on me 😉 I don’t have time to respond and research all of your points, and it’s going to be a busy week for me so this will be my last comment here.

    Two notes to Margaretrc: 1) in fact there are millions of poor people in Vietnam, for example, who live on almost nothing but white rice. They do in fact have a very poor diet; supplementing this diet with small amounts of protein (e.g. shrimp) and veggies does wonders for the health of their kids. 2) yes, I was referring to average lifespan in prehistoric people, which based on papers I remember reading years ago was something like 35 years. Of course some individuals lived longer and I wasn’t saying that diet contributed to short lifespans. I was just saying that you can’t look at a culture with a short average lifespan and make conclusions about the risks of diet for diseases like cancer that tend to emerge later in life. Most of those people probably didn’t live long enough to develop cancer.

  • Margeretrc

    As you point out, the poor people in Vietnam who subsist on mostly white rice with little protein or fat can hardly be said to be eating an optimal diet, or even a healthy diet! I was talking about traditional diets that supply a person’s minimum needs for protein and fat, which this clearly doesn’t.
    If the prehistoric human’s average life span was 35 years, I’d say some individuals must have lived a good long life as many died in infancy and childhood! But whatever. I think current hunter gatherer populations provide enough information. People like the Maasai and the Inuit living on their traditional diets do not develop heart disease, T2 diabetes, or, as far as I know, cancer–certainly not at the rates found here, or in India, for that matter. In fact, the evidence is growing that cancer, in particular, is linked to high carbohydrate consumption. Cancer cells depend on glucose for energy. A low carbohydrate diet, if anything, could turn out to be a hindrance to the growth of cancer. I think I even remember reading recently that they are experimenting with LCHF as a possible treatment for cancer patients. But whether or not that turns out to be the next great breakthrough, I think cultures that traditionally eat a low carb, high fat diet have at least demonstrated that it is safe for humans in the long term. Thus, safety should not be a consideration in recommending it to those for whom the conventional approach does not work. I would argue that for them, it is not only safe, but the safest of all possible options.

  • Alex

    Thanks to Brad and others that have kept this conversation civil. I can tell this topic ranges from a fascinating interest to some commenters to a very personal/ emotional matter to others. One aspect that has struck me as being absent in this particular conversation is a focus on the folks of lower social-economic status that may not have access to “healthy food” (whatever your definition of that is), cannot afford healthy food and/or do not know what the very basics of healthy eating is. Everyone on this site seems to know a good deal about nutrition but there is a large segment of the population that has no idea what a carbohydrate is (no numbers to back me up on this). A lot of this segment also succumbs to T2 diabetes, and you can debate why that is, but what do you think about extra calories coming in from soda, sweets, fatty meats, salty snacks, etc? You can debate all you want about high vs. low carb but for a large swath of the country it seems like it still boils down to (at least initially) how many extra calories are coming in. I know this is beside the point for those of you personally affected by diabetes, etc but I’m curious on your thoughts of the picture as a whole, especially if we want to reduce the “obesity epidemic” in general.

  • Hammer

    @Alex – So what do you mean by “healthy food”? If–again–it’s all about the calories in/out, ask yourself this question: Why are these low-income folks (theoretically) eating more calories? Because they don’t have access to fresh fruits & vegetables? (If they did, would that reduce their calorie intake? No studies have shown this to be the case.) My kids went to school where the vast majority of the kids were eligible for free/reduced lunches, i.e. low SES. The moms of those kids may not have known what a carbohydrate was, but they did know one thing: FAT is BAD. Is it possible that a diet that was normed on white guys (pre 1977 Dietary Goals) is not appropriate for women and/or people of color? Zamora 2010 has demonstrated that African Americans eating a “high quality” diet according the Healthy Eating Index (based on the Food Pyramid’s principles) get fatter faster than African Americans who eat a diet that is actually *lower* in quality. We do know that women and minorities tend to have higher insulin levels than white dudes(this would explain some of the T2DM disparities as well). Maybe a high carb/low fat diet (whatever the GI/GL is) is simply not appropriate for them. And considering that when we remove fat from the diet, we tend to remove the whole foods that fat is–in its natural state–attached to, we remove protein. As an earlier commenter noted: perhaps these folks are “chasing protein” all day, and accumulating an excessive number of insulin-stimulating carbohydrates (which allow fat storage to happen) and excess calories (which then get stored as fat) to happen. The answer is not to simply lower calories or make fruits & veggies “accessible” to poor people. We certainly don’t need additional “nutrition education” for the masses when the message we are sending now has been inappropriate & lacking in solid scientific evidence for 30 + years. Sugary drinks and salty snacks have limited nutrition; fatty meats on the other hand provide the body with *essential* nutrition. What is actually in a bag of pretzels and what can the body can do with that stuff? What is actually in a pork chop and what can the body can do with that stuff? If your body can actually *use* the material for creating enzymes and hormones, transporting essential vitamins, and building/maintaining structure–are those “extra” calories? The only thing the body really uses carbohydrates for is “energy”–body fat is stored “energy”–those “calories” are different from protein and fat *calories.* The fact that there are lumped together as if they are nutritional equivalents demonstrates the extent to which the default definition of “healthy” has permeated our mental landscape. This definition is not likely to be appropriate for all people, but as long as the conversation remains focused on sheer caloric intake, the fault will always be with the people who fail to “restrain” their eating habits, even though we know that fat people often don’t eat more than their normal weight counterparts (although we can’t prove this because fat people lie about how much they eat). If you shift the blame to the obesogenic environment, the message then becomes to “make the healthy choice the easy choice.” I’m not sure which message is more insulting.

  • Michael Bulger

    Margaret. We’ve gone over this. The populations you point to (Maasai, Inuit) have had traditionally low life-expectancies. There are also a host of major differences in confounding factors that prohibit extrapolating their full morbidity and mortality data to the US population. For example, the Maasai are traditionally extremely active and therefore burn far more calories than the average American.

    brad, I wouldn’t sweat it too much. Of course there will be exceptions (and dissenters) to population-level recommendations. There will also be people who confuse recommendations with what the population actually practices.

  • Eric

    Life expectancy is a poor metric for health in a population that has no access to antibiotics, trauma surgeons, vaccines, and all other aspects of medical science that the modern world is actually good at, as opposed to nutrition, which we are not. What are good indicators of health are lab values like HDL/TG ratio and A1C which reliably improve on a carbohydrate restricted diet.

  • Alex

    @Hammer- Thank you for your response. I don’t think we are arguing that different of things here. You are saying the message is bad and has lead to many of our problems. I agree that the Food Pyramid with its 6 to 11 servings of grains did more harm than good, but that hasn’t been used in years. MyPlate only has 1/4 of the plate as grains. When I am thinking about the environment, I’m not trying to ignore the message, I’m just trying to consider what is real for a lot of people. Take a McDonald’s Value Meal for example. The calories in the burger can be significantly less than the calories from the medium fries and the 24 oz soda combined (medium fries = 380 kcal, 24 oz Coke = 290, burgers range from 250 to 670). My point is that it is not the message of “fat is bad” that makes a person buy a Value Meal, it’s just what is available and the norm. Buying two hamburgers would be much more expensive than the Value Meal. If sugary beverages and salty snacks are what’s available and affordable and fill someone up cheaper than three solid meals per day, isn’t that what someone will gravitate towards? The message that “fat is bad” may still permeate but people have also been told to avoid soda, chips and fried potatoes for a while too. Isn’t it possible that for some people the message doesn’t matter? I’m not focused on reducing “sheer caloric intake”, which I agree could lead to relying on excess carbs. Intead if you set people up to rely less on refined carbs like soda, chips and fries that will in turn bring down excess calories.

  • I have been strugling with my weight for years now and have began with a
    koolhydratendieet i hope i will get good results…. will be back for updates keep up the good work

  • Margeretrc

    Indeed, Eric. And Hammer. Michael, as to the activity level of the Maasai, the question then becomes are they active because they are eating a diet that encourages the body to burn, rather than store, excess energy? Or are they naturally thin and free of heart disease, T2 diabetes and metabolic syndrome despite their high fat low carb diet just because they are (maybe) more active than the average American? Basically, then, you’re saying that the 67% of the Americans, including a growing number of infants and children, who are overweight or obese are just gluttonous sloths? Sorry, I don’t buy it. Calories do count, but so does where the calories we eat come from.
    Other than not having as much access to some of the wonders of modern medicine, which does lower their average life expectancy, but not their life span, how are the Inuit and Maasai so different than the US population? Genetically, we all belong to the same species. What are these other (besides activity) confounding factors you speak of? The Inuit eat a low carbohydrate diet because they don’t (or didn’t) have much choice. The Maasai choose to eat a low/no carbohydrate diet, despite access to a plentiful supply of carbs. Why would they do that generation after generation if it had proven detrimental to health? Again, I’m not saying low carb or zero carb is the only healthy way of eating. I’m saying it is one of many that humans are well adapted to and to tell those who need to eat that way (or choose to) that it isn’t safe is wrong. As far as I’m concerned, it is a darn sight safer than a low fat, high carb diet!

  • Michael Bulger

    Margaret, you used the words “gluttonous sloths”. I find your choice of words very distasteful.

    Beyond your dismissal of confounding factors (cigarette smoking, sedentary occupations, etc.) which makes your argument one-dimensional and unrealistic, the fact that you attempt to accredit those words to me ends this conversation.

  • Margeretrc

    Michael, you didn’t use those words and I’m glad you find them offensive. I do, too. But, like it or not, that is the implication whenever anyone says–or implies with comments about the activity level of other cultures that aren’t as overweight or obese–that the reason so many Americans are fat is because they eat too much and move too little, without raising the question of why they eat too much and move too little–or acknowledging that it might not be as simple a matter as a lack of willpower or discipline. If that’s not what you think, then I apologize. “sedentary occupation” is still about activity, BTW.

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