What Counts Besides Calories?

On July 19th, the New York Times reported that a study published in the New England Journal of Medicine found that eating certain foods is associated with weight gain and that there is more to consider than the “calories in/calories out” notion of weight loss and maintenance.

According to the Times article, the kinds of foods we eat, the amount of sleep we get, how active we are, and how much TV we watch are important lifestyle issues that may determine whether or not we gain weight.  While no one would ever argue that eating healthy, sleeping better, and getting exercise is not critical to healthy living, the idea that caloric intake and expenditure is not important runs counter to all we know about human physiology . Interestingly, this trend to ignore the importance of calories in weight loss and maintenance has begun to permeate the weight loss industry; in 2010, Weight Watchers International changed its Points Program by creating a food algorithm that focuses on fiber, fat, protein and carbs, but does not include calories in its Points formula.

When my friend, Pat , sent me the NY Times article with the subject line, “What do you think of this?”, I have to admit I was very skeptical.  So I asked Pat, who is a health sciences researcher at UCSF, to look at the original article to see if the researchers really did prove that calories in/calories out is a myth.  This is what she said:

“I think it’s important that you set your followers straight on the NY Times article because the scientific paper actually says something a bit different.  While it does find that people who eat healthier, sleep about 8 hours a night, and who exercise are less likely to gain weight over a 10-20 year period, the researchers are very clear to say that since they DID NOT ask people to provide the number of calories eaten a day, they cannot really say that calories in/calories out is an ineffective rule.”

My colleague Michelle, a nutritionist who is a Registered Dietitian, also commented on the Times article. She said:  “The study has identified eating and lifestyle factors and patterns associated with weight changes over time.

The study did not measure the effectiveness of calorie counting in weight loss and maintenance, but the findings do not surprise me. What we eat matters just as much as calories.  The participants who gained weight, gained, on an average, 3.3 pounds over four years and the average American is gaining weight at a faster rate.  Other research has demonstrated that small changes in energy intake (e.g. an extra 10 calories/day) add up over time and causes weight gain. This study suggests that there are certain types of foods that are helping to tip the scale.  I would add that in addition to the lifestyle habits associated with weight gain, short-term weight gain (i.e. holiday weight gain) also contributes to overall weight gain because people only lose about 2/3 of the weight gained over the holidays and it keeps accumulating over time.”

Michelle and Pat advise that we pay close attention to the types of foods that seemed to be related to weight gain; and while it’s still calories in/calories out, some calories really are better than others.

Pat pointed out that the researchers are very clear to say that people who eat healthier are probably lighter over time because healthy foods tend to be more filling and result in less calorie consumption. Inappropriate amounts of sleep (either too little or too much) and/or mindless eating such as snacking on auto pilot or while watching TV can lead to the tendency for people to eat more calories.

(You know, when your hand is in the potato chip bag while watching a sitcom.)

Michelle advises that we put the foods associated with weight gain in your “mistreats” category as they provide a lot of calories/energy, but not a great feeling of satisfaction.  Protein (doesn’t have to be meat), fiber, and the texture in foods are key components of food that help us feel satiated after eating.  Potato chips and other snack foods can easily lend themselves to mindless eating.  People who consume a lot of red meat tend to consume other foods that are calorie dense – these associations are important.

Americans are now consuming 20% of calories/energy in beverages. Even if it’s “organic” or “natural”, the portion sizes of sugared beverages are too big (e.g. 16 ounce).  The return of the 8 oz. soda can is a good thing. This needs to happen with juice and the other drinks on the market, but most people would benefit  from drinking more water and less of the other stuff.

“The great news,” Michelle continues, “is that lifestyle changes over time (more physical activity, and eating vegetables, fruit, grains and lean protein) are associated with weight loss. If we could only have patience!”

The bottom line:  if you just count calories you may not lose weight.



This post was co-authored by Patricia A. Areán, Michelle Kuppich and Ellen Resnick

PATRICIA A. AREÁN is a Professor in the Department of Psychiatry at UCSF and is a licensed Clinical Psychologist. Dr. Arean currently leads an interdisciplinary research team consisting of researchers from diverse backgrounds, including social work, nursing, psychiatry, family and general medicine, medical sociology and clinical psychology. Her expertise is in improving health and mental health care for older adults
Michelle Kuppich, R.D. is a colleague at the Center for Thoughtful Weight Loss and Registered Dietitian in private practice in San Francisco. Michelle has seventeen years of experience assisting clients make improvements in their health through nutrition.  She has more than ten years of experience working with people with chronic health conditions, and has advanced training in adult obesity management.  You may contact Michelle at [email protected].

Ellen Resnick

Ellen N. Resnick, LCSW is a psychotherapist in private practice in San Francisco and Redwood City, California. She specializes in Cognitive Behavioral Therapy and incorporates the use of mindfulness into the treatment of depression, anxiety, and emotional overeating. She runs a holistic weight loss program called Center for Thoughtful Weight Loss, www.thoughtfulweightloss.com. Her general CBT practice website is at www.ellenresnick.com. Ellen is on faculty in the department of psychiatry at UCSF. She lectures extensively in the Bay Area on a variety of wellness topics. Ellen is involved in getting the word out on healthy lifestyles though blogging and social media, including her Shrink and Wash (tm) Youtube videos on tools for permanent weight loss

One thought on “What Counts Besides Calories?

  • July 25, 2011 at 6:27 am

    I think genetical factors are also equally important. We have seen two different individuals eating same amount, one gain weight and the other is thin.


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