Why Calories Count: From Science to Politics

Weight loss is a national obsession. Magazines, books, television shows – and yes, websites like this one – regularly highlight the current "epidemic of obesity." Many of these pieces are exhortations to eat right; some are how-to lose weight, whether by using smaller plates, by skipping snacks, or by not eating after 7 pm. Some tell us to eat one way and not another, having us focus on a low glycemic index, or low-carb, or high protein or low-fat diet. All this information is good, right?

I am not so sure.

I realize my work here at TheDoctorWillSeeYouNow.com has me reading more than my fair share of these urgent pitches, but it seems as though diet hype may be obscuring what the issues really are. Luckily, we have a book by two esteemed professors of nutrition, Why Calories Count, From Science to Politics by Marion Nestle and Malden Nesheim, to set us straight. Dr. Nestle is a professor in the Department of Nutrition, Food Studies and Public Health and the Department of Sociology at New York University and Dr. Nesheim is a professor (emeritus) of Nutritional Sciences at Cornell University. Dr. Nestle's blog can be found at FoodPolitics.com.

This is not your standard diet book. It offers both the scientific facts about calories and the corporate and governmental politics affecting our diets and the food we produce. It also just may be the book you need to finally understand how to eat, and, if you are overweight, change the way you eat.

The excerpt below outlines the reasons why calorie counts and counting calories are not quite what they seem on the surface. -- Leslie Carr

As we demonstrated in the previous chapter, studies using doubly labeled water—as close to a gold standard as exists—find that the average non-overweight adult man needs about 3,050 calories a day to maintain a stable body weight, and the average woman about 2,400. The FDA’s 2,000-calorie standard for food labels is 50 percent lower than the average for men and 20 percent lower than that for women. But many—if not most—Americans are gaining weight. Therefore, they must be eating more calories each day than they need to maintain a stable weight. (How many more? See chapter 17.)

Research on diet and health in general, and on weight gain in particular, depends on knowing what people eat. But outside of a whole-body calorimeter or a controlled environment for metabolic studies, getting even reasonably accurate information about dietary intake is, to say the least, challenging. Indeed, we consider finding out what people eat the greatest intellectual challenge in the field of nutrition today. Why? We have no nice way of saying this. Whether consciously or unconsciously, most people cannot or do not give accurate information about what they eat. When it comes to dietary intake, pretty much everyone forgets or dissembles. This problem makes surveys of dietary intake exceedingly difficult to conduct and to interpret.

As we keep saying, doubly labeled water methods make it possible—although at considerable effort and expense—to measure average calorie expenditures in individuals going about their daily lives for periods of up to about three weeks. The number of people whose calorie needs can be determined this way is limited. To date, scientists have not come up with any simple, inexpensive way to measure calorie intake accurately in large groups of individuals who are not incarcerated in a laboratory but are “free-living” and going about the normal business of daily life.

Short of duplicate meal analysis, a method in which chemists analyze the nutrient composition of an exact duplicate of everything someone eats, all other methods for obtaining information about dietary intake depend on self-reports. These are, again to understate the matter, inconsistent and unreliable. Merely asking people about what they eat influences what they tell investigators. Even duplicate meal analysis has its hazards, as knowing your meals will be checked can be enough to change your normal eating behavior.

The usual methods for obtaining information about dietary intake ask you to do one of three things:

• Report what you remember eating and drinking in the previous day (this is called a retrospective twenty-four-hour diet recall).
• Keep a record of what you eat for a day or more (concurrent diet record).
• Mark off on a long list of foods the ones you ate within the past day, week, month, or year (retrospective food frequency questionnaire).

The lack of precision in these methods is legendary. People do not easily remember what they ate. You might forget or be uncomfortable about reporting late-night snacks, candy picked up on the run, something you ate in a car, alcoholic beverages, or the amounts of foods you are eating. Like most people, you probably tend to underestimate the sizes of your food portions and overlook intake of foods you perceive as unhealthy. And, of course, you do not eat the same foods every day.

Nutrition scientists have put enormous effort into trying to evaluate the magnitude of reporting errors. They find that people underestimate their true calorie intake by astonishing percentages, typically 30 percent, with a range of 10 to 45 percent depending on such factors as age, sex, body composition, and socioeconomic status. Underreporting of food—and therefore calorie — intake increases with age and is greater among women, people who are overweight, and those of low education and income status. People also tend to exaggerate intake of foods they think are supposed to be good for health.

Researchers are still debating whether one survey method is better than another, whether collecting information about portion sizes is either useful or necessary in dietary intake surveys of populations, and indeed whether any method can capture the complexities of diets that vary so much from person to person and from day to day. As an example of how hard it is to draw conclusions from surveys based on one day’s reported food intake, a decades-old study done by the USDA deserves careful attention.