Math, Obesity & You: Is a Calorie Still a Calorie?

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Math, Obesity & You: Is a Calorie Still a Calorie?

Postby JeffN » Tue Apr 21, 2015 7:40 am

I just posted the following as comments in the Lounge and thought I would repost it here. I wrote most of it a while ago in a discussion with my colleagues when the new equation first came out. Here is the link to the discussion in the Lounge

viewtopic.php?f=1&t=47820

Math, Obesity & You: Is a Calorie Still a Calorie?
Jeff Novick, MS, RDN

A few years ago, Kevin Hall proposed a new mathematical model of calories and weight loss to help predict weight loss more accurately. The headlines that followed claimed that the 3500 calorie rule (you have to burn 3500 calories to lose a pound of fat) was wrong and and that a calorie is not a calorie.

The work on this topic is excellent and, for those interested, a well deserved read.

Here are a few related articles (some of which are in my BMI thread) by Kevin Hall..

Energy balance and its components: implications for body weight regulation1
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3302369/

Quantification of the effect of energy imbalance on bodyweight
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880593/

Short and long-term energy intake patterns and their implications for human body weight regulation
http://www.sciencedirect.com/science/ar ... 8414001140

This is the article in the Lancet that challenged the old equation.

http://www.thelancet.com/journals/lance ... X/abstract

This is a WSJ article on the above published article. Not sure if it is public or you need a log in.

http://online.wsj.com/article/SB2000142 ... 10584.html

This is the new weight loss simulator from the NIH that is supposed to be more accurate

http://bwsimulator.niddk.nih.gov/

For the record, the lancet article came out with a new formula and calculator which is still a "rule of thumb" and is only trying to better account for and calculate some of the issues discussed.

This is an interview in the NY Times a few years back with Carson Chow, PhD, a colleague of Kevin Hall's...

http://www.nytimes.com/2012/05/15/scien ... ref=health

As pointed out, the actual title of the thread in the Lounge, "3500 calories less =1 pound weight loss myth now debunked," is not the main point of the article.

He argues that a calorie is a calorie but that many equations have not taken into account adaptions the body makes during the process of weight loss, one being as simple as that as we lose weight there is less of us, so our metabolic rate goes down accordingly and we burn less calories.

There are some variables that impact the equation that we know & can account for. However, there some we either don't know or that we can’t measure very well and therefore, cannot account for them.

This is the point I make, though in much simpler terms, in these articles...

How To Successfully Count Calories
http://www.jeffnovick.com/RD/Articles/E ... ories.html

Do You Know How Many Calories Are In The Food You Eat
http://www.jeffnovick.com/RD/Articles/E ... u_Eat.html

And this recent discussion on losing weight and is food really unlimited
viewtopic.php?f=22&t=27333&p=272969#p272671

He even concludes "You simply have to cut calories and be vigilant for the rest of your life."

And that the problem is simple a matter of excess calories.

"The price of food plummeted, while the number of calories available to the average American grew by about 1,000 a day. Well, what do people do when there is extra food around? They eat it! This, of course, is a tremendously controversial idea. However, the model shows that increase in food more than explains the increase in weight."

So, a calorie is still a calorie, and the 3500 calorie "rule of thumb" (which I will address below) still works, but the equations trying to explain calorie math, were wrong.

The following is from a personal conversation with Kevin Hall...

"In the Consensus Statement paper where it says it takes 3 years to achieve 95% weight loss, that is specifically for when 500 calories is lobbed off starting-weight-energy-needs and never adjusted any further. If you maintain a 500-calorie deficit however (which requires ratcheting your EI down along with weight loss), weight loss follows the 1st law of thermodynamics as expected."

In regard to the rule of thumb, "you have to burn 3500 calories to lose 1 lb"....

There are many rules of thumb that are used in medicine, nutrition and fitness that, while they may just be rules of thumb and not perfect, they do not invalidate the science (or laws) they are based on. It is the same with all the markers, risk factors and screening tools we use from BMI, cholesterol, waist circumference, etc.

For instance, we say, walking or running a mile burns the same calories, which is about 100 calories. Some nutritionists use body weight x 10 for an estimate of RMR. Both of these 2 examples have been used for a very long time. However, neither of them are accurate if you actually measure them. It does not invalidate the principles they are based on. They are just a simplified way of estimating these issues.

The numbers we use for the caloric value of protein, carb and fat, The Atwater Values, of 4/4/9 (calories per gram), are also rules of thumb. This does not invalidate the science and principle they are based on.

In addition, there are about 4 different ways the FDA allows the industry to calculate them so even similar products can have different values on their labels. Knowing this helps to understand why the "rule of thumb" of 4/4/9 does not always work out perfectly and why some differences exist.

Accuracy In Nutrition: How Accurate Are The Atwater Values
http://www.jeffnovick.com/RD/Q_%26_As/E ... alues.html

The 3500 was also a rule of thumb and there are very good reasons why it does not work 100% when applied to real people, but that in no way invalidates the science and the physics behind it. .

Where did the rule come from?

They say 1 gram of fat is 9 calories. However, as I showed in my linked article on where these numbers come from, this is also just a “rule of thumb” and not very accurate so we have an issue right there. It may range from 7-10. Second, a pound is 454 grams which, x 9 is 4086 calories, not 3500. So where did 3500 come from?

If you reverse the math, and divide the 3500 by 454, you get 7.7 calories per gram. So, where did they get the 7.7 or the 3500?

The difference is the fact that fat tissue is not 100% pure fat. It also has varying amounts of protein and water, which also varies depending on the type of fat and where it may be located.

So, based on the 3500 calories being the number commonly used for a pound of fat tissue and based on 9 calories per gram, we can say fat tissue is about 85% fat. (as a rule of thumb) :)

(It is actually less and some of the remaining tissue is protein which yields a few calories too. So it is more like 75-80% fat and a few percentages of protein and a few of water). But for simplicity sake, lets use 85%.

However, as we all know, people are different and some lose weight quickly and seemingly effortlessly and others experience very slow and laborious weight loss.

And we are learning more and more as time goes on, some of which we can measure and add to the equation. For instance, one factor in regard to energies out that has come to light is NEAT (non exercise activity thermogenesis) which was never accounted for in the old energy balance equation and can have an impact of 300-400 calories day.

We also all know that there are confounding factors including actual intake vs. assumed intake, body composition factors and activity level, etc. etc. etc.

Let’s say muscle tissue is about 30% protein and fat tissue is about 85% fat (see above).

There is an assumption that 100% fat is being lost for each pound of weight lost but as we all know, it’s not true.

So, lets just look at two extremes.

If the weight lost was 100% fat tissue, that would provide the 3500 calories (454 gm x .85 (85% fat) = 385.9 x 9 (calories per gram) = 3473 (which is rounded up to 3500). Now we see where the 3500 came from.

However, if the weight loss was 100% muscle tissue, that would provide about 600 calories. (454 gm x .3 (30% protein) = 136.2 x 4 (calories per gram) = 544 calories, and lets round up to 550.

Knowing this, we can easily see how two people could lose different amounts of weight on the same calorie deficit depending on what percentage of fat or muscle the loss came from.

If you had an energy deficit of 3500 calories and it came 100% from fat tissue, it would be 1 lb of weight lost. However, if the 3500 calories came from 100% muscle tissue, it would be 6.36 lbs of wt lost. And, if the 3500 calories came from 50% fat and 50% muscle, the weight loss would be 3.68 lbs.

So the varying amounts of weight loss, from 1 to 6.36 pounds, do not in any way invalidate the formula or the science.

And, it turns out that the amount of fat and/or muscle you lose during weight loss (or gain) is influenced by your starting body composition.

viewtopic.php?f=22&t=8079&p=58408#p58408

The new equation is fascinating as is the work it is based on. That is how science works. :) However, I doubt it will have any impact on the obesity epidemic or any individuals efforts to lose weight. It is still a "rule of thumb," not 100% accurate and only trying to better account for and calculate some of the things discussed.

This is where calorie density shines.

The principles of calorie density are so much easier for anyone to understand, to apply and to adjust as needed to manage their weight.

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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby geo » Tue Apr 21, 2015 11:23 am

Excellent! Thank you yet again for a thorough, cogent discussion. Its interesting to see that no matter how hard people try to "prove" a calorie is not a calorie, they always end up showing (when the study is critically evaluated and thought through) that a calorie really is just a calorie. Now if only more people would just simply follow the program as written, there wouldn't be any need to even discuss calories. Just eat, be happy, and get on with life.
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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby JeffN » Tue Apr 21, 2015 12:59 pm

geo wrote: Excellent! Thank you yet again for a thorough, cogent discussion.


Thank you.

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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby susie » Sun Apr 26, 2015 2:27 am

Great explanation Jeff. Interesting stuff indeed.
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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby JeffN » Wed May 13, 2015 9:53 am

An excellent interview with Marion Nestle on the topic..

Clearing Up the Calorie: The Science of Nutrition, with Marion Nestle (33 minute podcast)

"This week on Point of Inquiry, Lindsay Beyerstein takes a closer look at what science tells us about our diets as she talks with nutritionist and author of Why Calories Count, Marion Nestle. She's the Paulette Goddard Professor of Nutrition, Food Studies, and Public Health at New York University and works extensively to research and educate what our bodies do and don’t need to work their best."

http://www.pointofinquiry.org/clearing_ ... on_nestle/

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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby JeffN » Tue Jul 07, 2015 7:37 am

Not only is perception & accuracy of how many calories people consume or burn, skewed, so is their perception of changes in body composition.

This study was done on athletes, who may be more aware of changes in body composition and found that, "Although some athletes partially detected changes in the lean and fat tissue of particular regions, the vast majority of players cannot detect the type, or amount of tissue gained and lost across the overall body."

Follow the principles of the program, adjust as needed, and let time and adherence pave the way for success.

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Do Canadian Collegiate Hockey Players Accurately Perceive Body Composition Changes after Unmonitored Training and Diet? Applied Physiology, Nutrition, and Metabolism, 10.1139/apnm-2015-0114

ABSTRACT

Collegiate athletes often use nutritional programs and supplements to elicit body composition changes in muscle or fat. It is unknown if athletes can accurately perceive their fluctuations in body composition, yet their understanding may help them make more accurate interpretations regarding the success of potential nutrition or exercise regimens. The purpose of this study was to investigate if collegiate hockey players could accurately perceive a change in body composition during a 3-month period within their regular season, in which no pre-determined nutritional or exercise program was provided. Twenty-four male Canadian collegiate hockey players completed pre-season and mid-season body composition assessments using dual energy x-ray absorptiometry. Immediately before the mid-season scan, players attempted to accurately match their perceived fluctuation in composition, with pre-determined categorical ranges of relative body composition and strength. Two thirds of players and one-half of players accurately perceived changes in arm-lean and arm-fat tissue respectively. Approximately two-thirds of players did not accurately perceive gains or losses of lean or fat tissue within their leg and overall body. Although some athletes partially detected changes in the lean and fat tissue of particular regions, the vast majority of players cannot detect the type, or amount of tissue gained and lost across the overall body. Body composition assessments, rather than an athlete’s perceptions should be used to help interpret the success of a sport nutrition or exercise program. Athletes should be aware that physiologic adaptations might take place unnoticed, which could affect the acceptance and adherence of nutrition or exercise interventions.
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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby jay kaye » Wed Jul 08, 2015 12:34 pm

One of your best discussion ever, concise and complete.

Now, if you could just make this into a required (mandatory) middle or high school health science class together with your "healthy eating place mat" and "reading food labels" maybe our next generation will no end up being sicker than their parents.

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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby JeffN » Tue Aug 11, 2015 2:01 pm

For those interested in the issues of weight management and obesity, this is an amazing read. It is written by one of the centuries leading researchers in the field. I was fortunate to visit him while he was at the Pennington Research Center and see the metabolic testing ward.

Why Obesity?
Annu. Rev. Nutr. 2015. 35:1–31
George A. Bray
Pennington Biomedical Research Center,
Louisiana State University,
Baton Rouge, Louisiana 70808;

Full Text
http://www.annualreviews.org/doi/pdf/10 ... 214-104412

Abstract
As Erwin Chargaff observed, “Scientific autobiography belongs to a most awkward literary genre,” and mine is no exception. In reviewing my scientific life, I contrast the nutritional influences that would have existed had I been born 100 or 200 years earlier than I actually was. With this background, I trace the influences on my formative years in science beginning in high school and ending as a postdoctoral fellow in Professor E.B. Astwood’s laboratory, when my directional sails were set and obesity was the compass heading. With this heading, the need for organized national and international meetings on obesity and the need for a scientific journal dealing with obesity as its subject matter became evident and occupied considerable energy over the next 30 years. The next section of this memoir traces the wanderings of an itinerant academic who moved from Boston to Los Angeles and finally to Baton Rouge. The influence of Sir William Osler’s idea that there is a time for education, a time for scholarship, a time for teaching, and time to retire has always been a guide to allocating time ever since I was an intern at Johns Hopkins Hospital. It was in Baton Rouge that the final phase began: I agreed to become the first full-time executive director of the Pennington Biomedical Research Center, a decision that changed my life. The article ends with a quotation from Tennessee Williams that reflects the theater, which has given me so much pleasure over the years: “There is a time for departure even when there’s no certain place to go.”
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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby JeffN » Thu Aug 13, 2015 11:46 am

Too short term for me (only 6 days on each diet) as there are more metabolic adaptions that happen over time, but you don’t get better controlled then this...

"confined to a metabolic ward where they exercised daily.” :)

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Cell Metabolism: Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity
Kevin Hall, et al.,
Cell Metabolism 22, 1–10, September 1, 2015
DOI: http://dx.doi.org/10.1016/j.cmet.2015.07.021

http://www.cell.com/cell-metabolism/ful ... 50-4131(15)00350-2

SUMMARY

Dietary carbohydrate restriction has been purported to cause endocrine adaptations that promote body fat loss more than dietary fat restriction. We selec- tively restricted dietary carbohydrate versus fat for 6 days following a 5-day baseline diet in 19 adults with obesity confined to a metabolic ward where they exercised daily. Subjects received both isoca- loric diets in random order during each of two inpatient stays. Body fat loss was calculated as the difference between daily fat intake and net fat oxidation measured while residing in a metabolic chamber. Whereas carbohydrate restriction led to sustained increases in fat oxidation and loss of 53 ± 6 g/day of body fat, fat oxidation was un- changed by fat restriction, leading to 89 ± 6 g/day of fat loss, and was significantly greater than carbo- hydrate restriction (p = 0.002). Mathematical model simulations agreed with these data, but predicted that the body acts to minimize body fat differences with prolonged isocaloric diets varying in carbohydrate and fat.

Highlights

- 19 adults with obesity were confined to a metabolic ward for two 2-week periods

- Cutting carbohydrates increased net fat oxidation, but cutting fat by equal calories had no effect

- Cutting fat resulted in more body fat loss as measured by metabolic balance

- Mathematical model simulations predicted small long-term differences in body fat

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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby JeffN » Thu Aug 13, 2015 9:38 pm

NPR Health & Science Podcast interview with lead author Kevin Hill on the above study

You Don't Need To Go Low-Carb To Burn Body Fat, Study Says
AUGUST 13, 2015
RICHARD HARRIS


http://www.npr.org/sections/thesalt/201 ... study-says

Low-carb diet or low-fat one? Either diet will trigger the body to burn off fat, a new study finds.

If you've ever tried to lose weight, you've probably gotten drawn into the argument over whether it's better to cut carbs or fat from your diet. A new study doesn't completely resolve that question, but it does provide an important insight.

Some proponents of the low-carb diet insist that you must cut carbs to burn off body fat. Their reasoning goes that when you cut carbs, your body's insulin levels drop, and that's essential in order to burn fat.

To put that question to the test, Kevin Hall at the National Institute of Diabetes and Digestive and Kidney Diseases and colleagues recruited 19 obese volunteers (average weight over 230 pounds) to participate in a rigorous study.

For two weeks they were kept in a lab around the clock, where scientists could provide them a precise diet. One group got a low-carb diet that reduced their total calories by 30 percent. Another group went on a low-fat diet that also reduced their total calories by 30 percent. Then, after a few weeks of rest, the two groups switched diets.

As Hall now reports in the journal Cell Metabolism, cutting carbs did work.

"We cut the carbohydrates, insulin went down, and fat burning went up, exactly the way that theory predicts, and people lost fat," Hall says.

The average participant lost about a pound of fat over two weeks, and about 4 pounds of weight total (the rest was probably water).

But Hall's study also showed that the low-carb, low-insulin conditions were not necessary to shed body fat. In fact, the low-fat diet also led to the loss of about 1 pound of body fat. So it was just as good.

Hall says, so much for the idea that only low-carb diets can help people shed fat. "That theory, as it stands — that very strong claim — is certainly not true," he says.

Instead, his evidence favors those who say if you want to lose body fat, total calories matter most.

"All calories weren't exactly equal when it came to losing body fat ... but they were pretty close," he says.

"I love this paper!" says Susan Roberts, a professor of nutrition at Tufts University, who was not involved with the research. She says it cuts through an amazing amount of noise that surrounds diet advice.

"There are too many commercial interests, there's too many bad research studies ... that get too much attention. And this a really good, high-quality study that helps get rid of some of the confusion," she says.

She agrees with Hall that it dispels the notion that fat loss absolutely requires a low-cab diet. "They've shown that that's bogus," she says.

Roberts wrote a commentary that accompanies the research paper. She says with this bit of physiology settled, researchers can step back to ask some more practical questions, such as what is in fact the best diet to reduce body fat. That's not just a matter of body chemistry.

"This [paper] doesn't say anything about how easy it is to stick with a high-carb or a high-fat diet," she says. And it's no use having a diet that people can't maintain.

Hall says some people might find it's easier to cut calories by limiting fat. Other experiences suggest that some dieters do better on a low-carb diet. He cites some studies that show that, over a six-month period, people do tend to lose more weight on a low-carb diet compared with a low-fat diet.

"We would suggest that that's probably because they end up eating [fewer] calories in total," he says, not because physiology favors one approach over another.
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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby JeffN » Thu Aug 03, 2017 2:37 pm

"Calories in, calories out" and macronutrient intake: The Hope, Hype, and Science of Calories.
Howell S, Kones R.
Am J Physiol Endocrinol Metab. 2017 Aug 1:ajpendo.00156.2017.
doi: 10.1152/ajpendo.00156.2017. [Epub ahead of print]
PMID: 28765272

http://ajpendo.physiology.org/content/e ... 00156.2017

Abstract
One of the central tenets in obesity prevention and management is caloric restriction. This perspective presents salient features of how calories and energy balance matter, also called the "calories in, calories out paradigm." Determinants of energy balance and relationships to dietary macronutrient content are reviewed. The rationale and features of the carbohydrate-insulin hypothesis postulate that carbohydrate restriction confers a metabolic advantage. According to this model, a large amount of fat intake is enabled without weight gain. Evidence concerning this possibility is detailed. The relationship and application of the laws of thermodynamics are then clarified with current primary research. Strong data indicate that energy balance is not materially changed during isocaloric substitution of dietary fats for carbohydrates. Results from a number of sources refute both the theory and effectiveness of the carbohydrate-insulin hypothesis. Instead, risk for obesity is primarily determined by total calorie intake.

From the study...

Conclusion
The CHO-insulin hypothesis predicted that lowering dietary CHO significantly should cause insulin levels to fall, leading to release of fat from adipocytes that would a) increase fat loss, and b) increase energy expenditure to claimed amounts in the range of ≥350 cal/day (range 400-600). Neither of these effects was observed in two current and highly rigorous metabolic ward studies, one of which was the actual NuSI study being discussed. Weight gain or loss is not primarily determined by varying proportions of CHO and fat in the diet, but instead by the number of calories ingested. Changes in energy expenditure, which metabolic pathways are used and other considerations are quite modest when compared with caloric intake. Until high quality, metabolic ward primary data become available indicating otherwise, a calorie is still a calorie.
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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby JeffN » Mon Feb 19, 2018 10:07 am

Tomorrow morning, the "Landmark" DIETFITS trial results will be published in JAMA. It pitted a "healthy" low(er) fat diet vs a "healthy" low(er) carb diet for one year with close tracking.

My guess - in the end, it will be the calories (and adherence) that mattered most.

Of course, as we know, how you get those calories (limiting total food vs adjusting calorie density of the food) is the real issue for longterm compliance.

We will see.

More to come...

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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby JeffN » Tue Feb 20, 2018 10:43 am

JeffN wrote:Tomorrow morning, the "Landmark" DIETFITS trial results will be published in JAMA. It pitted a "healthy" low(er) fat diet vs a "healthy" low(er) carb diet for one year with close tracking.

My guess - in the end, it will be the calories (and adherence) that mattered most.

Of course, as we know, how you get those calories (limiting total food vs adjusting calorie density of the food) is the real issue for longterm compliance.

We will see.

More to come...

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Jeff


Here you go...

As I guessed... :)

In the end, it will be the calories (and adherence) that mattered most.

Of course, as we know, how you get those calories (limiting total food vs adjusting calorie density of the food) is the real issue for longterm compliance.

A few more quick points


Point 1: Neither diet matched the true diets advocated by the proponents of either type of diet (low-fat or low-carb)

In regard to low fat, most all popular low fat diets from Pritikin, Ornish, McDougall, Esselstyn, Barnard, aim for about </= 15% at most. In one of McDougall’s studies, they patients maintained 15% for the full year. The starting diet clearly represented the SAD diet, with about 35% fat, 45% carb and 17% Pro. But the low fat diet at its lowest was 24% fat, was 26% by 6 months and was 29% by a month.

Same with low carb. Most advocates want Carb much lower that the study had, usually less than 20% if not lower. They started at 23%, then went to 27 by 6 months and 30% by 1 year.


Point 2: Regression to the mean

The study highlights what happens in real world application which is that diets are hard to follow and as time passes they “regress to their former mean” and results fade. Over time, we see a clear direction of this regression with less and less success. If they kept their regression pace up for 18 months to 2 years they would both be very close to the starting diet. Or again they would have just quit from lack of success and gone back to their original diet.


Point 3: Diet Quality vs Calorie Density

The authors, and several of those who were interviewed for articles, discuss emphasizing diet quality over quantity or counting calories. However, "quality" is a generic widely misused term like "natural, organic, and whole" that doesn't have any real meaning and in the end won't help. What we need is to focus on understanding calorie density, satiety, intact fiber/cal, avoiding liquid calories, etc. The author of the study said to focus on

- More whole foods
- More vegetables specifically
- Less added sugar
- Less refined grains

Unfortunately, as I have described here, whole foods has no meaning and is another misused term. What we want is intact and/or minimally processed foods. More vegetables is good as is less sugar and less refined grains. But is leaves off other calorie dense foods including the most calorie dense refined food of all, oil. So, if we were to improve these we would say...

- Increase intact and minimally processed foods
- Make 50% of your plate non-starchy vegetables
- Minimize added sugar (and salt, and oil)
- Minimize refined grains.

Let's compare that to my 5 Pillars of Healthy Eating

1) Plant-Centered - Center your plate and your diet predominately around plant foods (fruits, vegetables, starchy vegetables, roots/tubers, intact whole grains, and legumes (beans, peas & lentils).

2) Minimally Processed - Enjoy foods as close to "as grown in nature" with minimal processing that does not detract from the nutritional value &/or add in any harmful components.

3) Calorie Dilute - Follow the principles of calorie density choosing foods that are calorie adequate, satiating and nutrient sufficient.

4) Low S-O-S - Avoid/minimize the use of added Salts/sodium, Oils/Fats and Sugars/sweeteners

5) Variety - Consume a variety of foods in each of the recommended food groups

:)

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Jeff

JAMA
Original Investigation
February 20, 2018
Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion
The DIETFITS Randomized Clinical Trial
JAMA. 2018;319(7):667-679. doi:10.1001/jama.2018.0245

https://jamanetwork.com/journals/jama/a ... ct/2673150

Key Points
Question
What is the effect of a healthy low-fat (HLF) diet vs a healthy low-carbohydrate (HLC) diet on weight change at 12 months and are these effects related to genotype pattern or insulin secretion?

Findings
In this randomized clinical trial among 609 overweight adults, weight change over 12 months was not significantly different for participants in the HLF diet group (−5.3 kg) vs the HLC diet group (−6.0 kg), and there was no significant diet-genotype interaction or diet-insulin interaction with 12-month weight loss.

Meaning
There was no significant difference in 12-month weight loss between the HLF and HLC diets, and neither genotype pattern nor baseline insulin secretion was associated with the dietary effects on weight loss.

Abstract

Importance
Dietary modification remains key to successful weight loss. Yet, no one dietary strategy is consistently superior to others for the general population. Previous research suggests genotype or insulin-glucose dynamics may modify the effects of diets.

Objective
To determine the effect of a healthy low-fat (HLF) diet vs a healthy low-carbohydrate (HLC) diet on weight change and if genotype pattern or insulin secretion are related to the dietary effects on weight loss.

Design, Setting, and Participants
The Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) randomized clinical trial included 609 adults aged 18 to 50 years without diabetes with a body mass index between 28 and 40. The trial enrollment was from January 29, 2013, through April 14, 2015; the date of final follow-up was May 16, 2016. Participants were randomized to the 12-month HLF or HLC diet. The study also tested whether 3 single-nucleotide polymorphism multilocus genotype responsiveness patterns or insulin secretion (INS-30; blood concentration of insulin 30 minutes after a glucose challenge) were associated with weight loss.

Interventions
Health educators delivered the behavior modification intervention to HLF (n = 305) and HLC (n = 304) participants via 22 diet-specific small group sessions administered over 12 months. The sessions focused on ways to achieve the lowest fat or carbohydrate intake that could be maintained long-term and emphasized diet quality.

Main Outcomes and Measures
Primary outcome was 12-month weight change and determination of whether there were significant interactions among diet type and genotype pattern, diet and insulin secretion, and diet and weight loss.

Results
Among 609 participants randomized (mean age, 40 [SD, 7] years; 57% women; mean body mass index, 33 [SD, 3]; 244 [40%] had a low-fat genotype; 180 [30%] had a low-carbohydrate genotype; mean baseline INS-30, 93 μIU/mL), 481 (79%) completed the trial. In the HLF vs HLC diets, respectively, the mean 12-month macronutrient distributions were 48% vs 30% for carbohydrates, 29% vs 45% for fat, and 21% vs 23% for protein. Weight change at 12 months was −5.3 kg for the HLF diet vs −6.0 kg for the HLC diet (mean between-group difference, 0.7 kg [95% CI, −0.2 to 1.6 kg]). There was no significant diet-genotype pattern interaction (P = .20) or diet-insulin secretion (INS-30) interaction (P = .47) with 12-month weight loss. There were 18 adverse events or serious adverse events that were evenly distributed across the 2 diet groups.

Conclusions and Relevance
In this 12-month weight loss diet study, there was no significant difference in weight change between a healthy low-fat diet vs a healthy low-carbohydrate diet, and neither genotype pattern nor baseline insulin secretion was associated with the dietary effects on weight loss. In the context of these 2 common weight loss diet approaches, neither of the 2 hypothesized predisposing factors was helpful in identifying which diet was better for whom.

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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby JeffN » Wed Feb 21, 2018 6:48 am

NY Times article on the study with an interview with the lead author


The Key to Weight Loss Is Diet Quality, Not Quantity, a New Study Finds
https://nyti.ms/2BDBijA
NY Times
By Anahad O’Connor
Feb. 20, 2018

“In a new study, people who ate lots of vegetables and whole foods rather than processed ones lost weight without worrying about calories or portion size.”

“The bottom line: Diet quality is important for both weight control and long-term well-being,” he said.

Dr. Gardner said it is not that calories don’t matter. After all, both groups ultimately ended up consuming fewer calories on average by the end of the study, even though they were not conscious of it. The point is that they did this by focusing on nutritious whole foods that satisfied their hunger.

“I think one place we go wrong is telling people to figure out how many calories they eat and then telling them to cut back on 500 calories, which makes them miserable,” he said. “We really need to focus on that foundational diet, which is more vegetables, more whole foods, less added sugar and less refined grains.”


And

"The research lends strong support to the notion that diet quality, not quantity, is what helps people lose and manage their weight most easily in the long run. It also suggests that health authorities should shift away from telling the public to obsess over calories and instead encourage Americans to avoid processed foods that are made with refined starches and added sugar, like bagels, white bread, refined flour and sugary snacks and beverages, said Dr. Dariush Mozaffarian, a cardiologist and dean of the Friedman School of Nutrition Science and Policy at Tufts University.

“This is the road map to reducing the obesity epidemic in the United States,” said Dr. Mozaffarian, who was not involved in the new study. “It’s time for U.S. and other national policies to stop focusing on calories and calorie counting.”


As we know, implementing the principles of calorie density is the best way to do this.

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Re: Math, Obesity & You: Is a Calorie Still a Calorie?

Postby JeffN » Mon Jul 23, 2018 7:14 pm

Kevin Hall’s 2018 Nutrition talk entitled "Diets Differing in Macronutrient Composition for Weight Loss and Maintenance of Lost Weight" has been posted on ASN and is available free of charge

http://ondemand.nutrition.org/console/p ... lideVideo&

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