Calories Still Count—And So Does Quality

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With so many of us now overweight or obese, scientists are trying to figure out what causes us to gain excess weight.

Some researchers are sticking with the long-held idea that we become too heavy when we take in too many calories and don't burn them off through physical movement. Others take a different view. 

"The older idea underlies the standard advice that everyone has heard for years, that to lose weight, a person should just eat less and move more," says Michelle Pearlman, M.D., a gastroenterologist with the University of Miami Health System. This approach is called "the energy-balance model." Through the many decades that this model has held sway, Americans and people worldwide have grown heavier.  

An alternative model calls for a shift in our focus to the kind of food we eat, not just the amounts. A team of scientists promotes this view in a recent article in the Journal of Clinical Nutrition. They call their idea "the carbohydrate-insulin model."  

Problems with the standard thinking about obesity

The energy-balance model involves calorie counting. Calorie counting, the authors state, has not proven a helpful approach for people who want to lose weight. Dr. Pearlman agrees; she points to decades-long trends in obesity in the U.S. as proof of this model's general failure.

"Today, about two-thirds of Americans are overweight or obese," she says. "And while the fraction of the U.S. population who is overweight or obese has been holding steady in recent years, the problem of morbid obesity, of people having a BMI over 40, is still climbing." Dr. Pearlman says. 

Morbid obesity, she adds, mostly affects people of color and those with lower incomes.  

"Certainly, we are eating too much and not moving a lot," she says. "But it's just not a simple matter of 'calories in and calories out' when people are trying to maintain or lose weight." 

For instance, she says, honey or ordinary white sugar may have the same calories as high-fructose corn syrup, but the syrup affects our body differently and in ways that promote weight gain. Furthermore, other factors such as stress, poor sleep, alcohol intake, medications, and other habits also play a role in excess weight gain. 

Calories do matter, but quality does too

"Calories do matter, but the problem is not just about calories," she says. Many of us consume large amounts of ultra-processed foods that are loaded with sugar, fats, and industrial chemicals. 

We often expend little or no energy to obtain or prepare these super convenient foods. "We zip through a drive-through, order food to be dropped on our doorstep, or nuke a frozen, microwavable dinner," says Dr. Pearlman. 

Eating like this runs counter to the way we humans have consumed for tens of thousands of years.  

Before farming was devised about 10,000 years ago, we worked hard to eat, and we did so erratically, she says. Every bite of food our ancestors ate came from foraging, fishing, and hunting, anthropologists tell us. Weather conditions and luck would affect how much adults could gather for themselves, their children, and their fellow tribe members. 

Ancient humans had no fridge

"It's trendy now to talk about intermittent fasting as a way to lose weight," Dr. Pearlman says, adding that ancient humans did it because they had no choice. "We had to actually run and hunt to get our food," she says. "Then when we finally had it, we ate only a small portion because we had to share." 

In sum, when our bodies were evolving, food was extremely inconvenient. "Now, food is way too convenient, and it's engineered to be way too tasty," she says. Also, much of our food is full of industrial chemicals that extend shelf life and alter appearance, flavor, and texture to create highly edible products. 

Food manufacturers value these chemicals because they help to reduce waste and spoilage. At the same time, they boost sales. Meanwhile, these chemicals appear to be key actors in the tendency of today's humans to grow too large, starting in childhood. 

Various forms of sugar figure largely among the most common food additives. You've probably heard guidance to avoid high-fructose corn syrup. In fact, some prominent experts believe that all forms of fructose are a root cause of serious health problems for people who eat a great many processed foods. 

Additives like sugar mess with our minds and our bodies

"Sugar, in general, is a drug. It stimulates the same reward centers in the brain as cocaine and heroin," Dr. Pearlman says. Research bears this out. In one study, Oreos proved to light up more neurons in the pleasure centers of rats' brains than cocaine did; what's more, the rats ate the icing first, just like so many of us. 

The difference between sugar and those illegal drugs, Dr. Pearlman says, is that the media aren't bombarding us with commercials for cocaine and heroin. All of us – children included – constantly encounter sales pitches for sugary foods and beverages.

Sugar is only part of the problem

Sugar poses only part of the problem with ultra processed foods. These products contain a raft of chemicals that weren't in foods of earlier times. "Some of the chemicals that are added to food today disrupt the hormones that control our metabolism," Dr. Pearlman says. "They disrupt our ability to sense that we have eaten enough when we have, in fact, eaten enough." 

 Children who consume a lot of ultra processed foods tend to gain weight faster and to have BMIs that increase more rapidly than peers who don't. Heavy consumers also face higher risks for obesity-related problems such as diabetes.

The pandemic only intensified our addiction to convenience 

The problem with food being way too convenient has only intensified with COVID-19. "We haven't been leaving our homes, and nobody orders a salad from Uber eats," Dr. Pearlman says. 

When we order meals to eat at home, she says, we often want to get the most for our money. To do this, we order even more food than we would if we were dining in a restaurant, where meals already tend to have much higher calorie and sugar contents than meals we cook at home. 

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Cook simple meals at home 

"Cutting down on deliveries will mean you spend more time preparing your food, but you don't need to spend hours preparing meals in the kitchen," Dr. Pearlman says. 

Simple meals often prove to be delicious, and lots of food gets better served the next day as leftovers. If you fix a salad or sandwich for dinner, there's not a single pot to wash. Breakfast for supper can be quick and a nice change of pace. 

Ease your shift from frequent takeout or deliveries to home cooking with these tips. 

First, stock your pantry and fridge with quick, easy, healthy items like fresh fruit or carrots and hummus. 

Second, when searching online for meal ideas, choose quick, easy recipes without too many ingredients. And third, don't compare your cooking to restaurant food. Home cooking isn't meant to mimic dishes offered by professional chefs, but it can still be scrumptious.

Eating right: simple but not easy

The formula for a good diet is quite simple, although changing bad food habits is not easy. "We just want to get rid of the heavily processed foods and eat more veggies, whole grains, lean protein, nuts, and seeds," Dr. Pearlman says. "If you want to eat animal protein, keep it lean, or choose plant-based options like tofu and tempeh."

Quality foods that go into a sound diet often cost more than fast food on a per calorie basis, but better foods cost less on a per nutrient basis. "Highly processed foods are often cheaper and calorie-dense, but often they don't contain essential nutrients that your body needs to function properly," she says.

Try these suggestions for obtaining high-quality foods economically

"You get to choose — invest in your health now, or invest in your sickness later," says Dr. Pearlman. 

Her warning is no exaggeration. Poor eating habits contribute heavily to all the major chronic illnesses that cause the most sickness and premature death — including diabetes, heart disease, and many forms of cancer. 

Could regulations help?

Some public health experts believe that our society needs to regulate the sale of foods high in sugar. According to an article in Nature, a team of leading researchers said that global sugar consumption – and the calories that come with it – has tripled over the past 50 years.

They stress that people become addicted to sugar, much as they become addicted to tobacco and alcohol. They propose taxing foods high in sugar. Other proposals are to limit the sale of high-sugar foods during school hours or in outlets close to schools and set age limits for such purchases. 

Internationally, taxes on sugary food are common

Dozens of countries tax sugar-sweetened beverages; these include Ecuador, the United Kingdom, many other European nations, and South Africa. Some studies have found that such taxes can curb consumption.  

Accordingly, public health leaders have also tried to secure the passage of such taxes in certain parts of the United States. In 2014, Berkeley, California, became the first U.S. city to pass such a tax. A related effort in New York City failed. 

Americans must choose wisely without regulatory nudges

Starting in 1897 with a law banning the importation of impure tea, the federal government has used regulations to improve the way Americans eat and to protect us from harmful items.

Yet, when it comes to sugary foods, we are left to make our own choices. Advertisers intensely market these delectable foods, and we're on our own to avoid the temptation. 

In light of this reality, Dr. Pearlman arms her patients with materials she created based on scientific evidence. "I also steer my patients to good websites," she says. "I highly recommend that they visit the Physicians Committee for Responsible Medicine, which promotes whole food and plant-based diets."

Are you too busy to be healthy?

Dr. Jane Katz, the author of books about swimming, always says, "If you're too busy to swim, you're too busy." The same logic may apply here – if you're always too busy to cook, then perhaps you are too busy. 

Yes, grocery shopping takes time. But if you have kids, you can do it together and make it a learning experience. Prepping meals takes time too. But again, that can be a time for family members to work together while chatting about the day.

As for cleanup, you can always listen to music or a podcast while washing dishes. 

"One of the very nicest things about life," said the great Italian opera singer Luciano Pavarotti, "is the way we must regularly stop whatever it is we are doing and devote our attention to eating."

Perhaps it will help to think of daily cooking as an act of love for everyone who enjoys the food you prepare, including yourself. 


Milly Dawson is a contributing writer for UMiami Health News.


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