Tuesday, June 5, 2012

Calories Still Matter

The Centers for Disease Control's NHANES surveys documented a massive increase in obesity in the United States between the 1960-62 and 2007-2008 survey periods (1).  In 1960, 13 percent of US adults were obese, while in 2008 that number had risen to 34 percent.  The prevalence of extreme obesity increased from 0.9 to 6.0 percent over the same time period!

Something has changed, but what?  Well, the most parsimonious explanation is that we're simply eating more.  Here is a graph I created of our calorie intake (green) overlaid on a graph of obesity prevalence (blue) between 1970 and 2008:



As you can see, the fit is extraordinary.  For those who may note that calorie intake appears to increase after obesity, I have to point out that the calorie intake graph has a point for each year, while the obesity graph has no points between 1978 and 1991.  Therefore, all we know is that obesity began to climb at some point between the 1976-1980 and 1988-1994 survey periods.  This is consistent with obesity being a result of increased calorie intake. 

The careful work of Dr. Eric Ravussin and colleagues, based on what we know about the relationship between calorie intake and body fat, has shown that the increase in calorie intake over the last 40 years can single-handedly explain the increase in obesity in this country (2, 3)*.  This is something I discussed in my Boing Boing feature piece "Seduced by Food: Obesity and the Human Brain". 

The question remains, why are we eating more calories today than we used to?  The answer is related to increased availability and consumption of energy-dense, seductive and palatable foods, including sweetened beverages, and advertising that makes us crave them (4).  However, nothing about human physiology or behavior is simple, and as always there's more to the story.

In future posts, I'll explore in more detail why we eat.  From this position of knowledge, based on the work of many outstanding researchers, I think it will be fairly clear why we eat more today than we used to. 


94 comments:

Ross said...

The Secretary of Agriculture said,
"Get big or get out". Americans took him seriously.

Keep up the good work.

Blissful Writer said...

There are some elderly thin people that seem to getting thinner each year. They attempt to gain weight by increasing calories, but have just as difficult time gaining weight as the obese in loosing weight. What do you think is going on there?

Chris Kresser said...

I love that you used the word "parsimonious".

Tom A said...

I agree, parsnips are poisonous.

Unknown said...
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Unknown said...
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Unknown said...

@Blissful Writer, and potential others I suppose: I think that Stephan is being careful to walk the middle path here, as he always is. Overeating can indeed lead to weight gain, but that doesn't mean that there aren't people out there who are trying to gain weight and can't, and that also doesn't mean that your weight will increase by exactly the number of pounds you get when you divide excess calories by 3500 or whatever, and that also doesn't mean -- this is the big one of course -- that *everyone* in *every* situation can guarantee weight loss by consciously reducing calorie intake constant and keeping activity constant (up to a limit of course). The reason why all these things are true is because your body does things (perfectly consistent with the laws of physics) that are outside of your conscious control. There is room for "both" perspectives -- the word "both" in quotes because my perspective is really a synthesis.

I am guessing Stephan would agree with all of this. This will be my last comment on this thread.

psychic24 said...

what's a not/less wasteful explanation? It doesn't seem to make sense..

Bixy said...
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Rajat Gaur said...

Yeah! that's perhaps the reason why Disney has decided to do away with junk food ads on kids' TV channels and websites...

LeonRover said...

"Parsimonious" - Yeah, I agree.

The obese just did not use "Occam's Razor" on their food food portions.

Jane said...

When calorie restriction was introduced in the lab, it meant restriction of calories without restriction of micronutrients. The ratio of micro- to macronutrients was raised, with remarkable results.

Later, calorie restriction turned into food restriction, in which the animals were fed the same food as before but every other day. This version appears to work by stimulating autophagy.

The first kind was the equivalent in humans of eliminating micronutrient-depleted food (refined carbs) from the diet. The second kind was the equivalent of starving yourself. This second kind will never work in humans, obviously. So it seems to me that we need to try the first kind.

Perhaps food manufacturers could be persuaded to make a second version of their hyperpalatable treats, using only unrefined ingredients. If this version had the same appearance/taste/mouthfeel etc as the standard version, perhaps obese people would eat it.

Gretchen said...
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Rok Osterman said...

Palatability may not matter that much. Raw cream from cow's milk for example tastes so good and yet it can't be eaten forever. You have it enough quite soon. When I say enough I don't mean tension-in-the-tummy full (i.e. until you feel discomfort) like from those depleted modern foods. The need to eat it just goes away.

Perhaps increased obesity is a result of reduced concentration of minerals & vitamins in the food (depleted soil etc)? Our body demands more of X mineral/vitamin but can get it only together with so many calories and because majority of those calories come from things that leach minerals the short-circuit is closed.

HoneyRazwell said...

I know that it is extremely - difficult - exceeedingly difficult to fatten a naturally thin person.

"Why Thin People Are Not Fat" on YouTube featuring Dr Rudolph Leibel

The increase in obesity has been dramatically overstated. It is a problem but not nearly an epidemic as the media pronounces. Since 2000 it has leveled off.

Defining a continuous trait such as body weight using a fixed threshold such as BMI is a HUGE problem of why it SEEMS there is an "epidemic."

The diagnostic criteria is terrible. I propose DEXA scans for everybody to turly know who is obese.

Obesity has always been around it but people are SO more sensitized to it now and notice it more as Dr Friedman commented.

There is "normal weight obesity" also , which is something the caloric hypothesis cannot even begin to explain.

LeonRover said...
This comment has been removed by the author.
LeonRover said...

Hey Honey

"normal weight obesity" merely means that BMI can be a deeply flawed measure.

When other anthro measures, fat%, weight/height etc. are used, then the oxy-moronic term "normal weight obesity" is obviated.

David said...

As I have perused the USDA food loss database there appears to be a shift towards higher sugar/carbohydrate consumption during the same period??

LPJohnson said...

Is there any data about the percentage of food we eat that is shelf stable vs. readily decomposable and the shift away from fresh food towards boxed dry items? When did Hamburger Helper start being dinner, Cheerios become breakfast, and Townhouse crackers and Cheez-whiz become a snack? Is it cool to feed your kid like this as long as you use 100 calorie packs so they don't get fat? Sorry, I think calories should be thrown out the window.

Elliot said...

All theories of obesity that I'm aware of agree that putting on weight always coincides with (putting matters of causality aside) a net calorie intake.

Given this, how can the fact that an increase in net calorie intake coincided with an increase in weight be evidence for only one of those views? It seems to me that it provides no new evidence to decide between views at all.

steven said...

It's interesting that around 2001 it appears that something changed that was driving the increase in calorie consumption... I wonder if this was awareness of how overweight the population was becoming? Or something else?

Mario Vachon said...

It would be very difficult to get the data, but I would bet there is a high correlation between obesity and the intake of "manufactured" or processed food. Its hard to overeat on meat, vegetables, fruits, tubers, nuts etc... More often than not, you just have had enough after a while and don't "binge" on real food.

A bag of "Oreo" cookies on the other hand..... or chips, pizza, fries, slurpees...... all very easy to overeat and with huge calorie counts.

I suspect that companies like Kraft, Nabisco etc.. and fast food chains that serve highly calorically dense foods with dubious nutritional qualities are probably as much of a reason for obesity as anything else.

David said...

I have to agree with people positing that it's not just about calories, but the quality of the food. As a personal trainer, I've had success getting people to eat whole, real food, like meat, cheese, and fish, rather than processed foods. After meticulous data collecting (I made them write daily food journals, taught them how to cook, etc.), they ended up eating about the same amount. Surprisingly, my overweight clients did not eat that much to begin with--just junk took priority over real food and meal timing was erratic.

Marie Everington said...

It's been my experience that whole foods are nutritionally dense and somewhat lower in calories than comparable processed foods, which are calorically dense and nutritionally lacking.

Thus just switching to mostly whole foods would drop the effective calorie count even if the amounts were the same. Shelf-stable foods are most calorically accurate, and most fresh whole foods don't fit that bill.

HoneyRazwell said...

Hey Leon

No, that is not what the expression means. ( Although there are muscled poeple who weigh a lot- and the BMI is generally junk)

Normal weight obesity is a REAL medical condition that the Mayo Clinic recognizes where a person who APPEARS thin actually is carrying A LOT of body fat.

THAT is what it means.

See here:

http://www.mayoclinic.com/health/normal-weight-obesity/AN02007

http://www.sciencedaily.com/releases/2008/080327172025.htm


Sincerely,
Raz

Stephan Guyenet said...

Hi LPJohnson,

There has been a massive shift from home-cooked food to processed food in this country over the last half century. Please see my talk "The American Diet: a Historical Perspective" (YouTube) for more details.

Hi Elliott,

Not all hypotheses say that fat gain coincides with increased calorie intake. GCBC attempted to make the argument that obese people don't eat more than lean people. I think he has backed away from that argument though.

I agree that seeing a correlation between calorie intake and obesity in and of itself does not prove that #1 caused #2 and not the reverse, but in the context of the rest of the evidence, it is by far the most plausible explanation. Again, I have yet to see any evidence that fat tissue expansion causes increased food intake in humans.

There is evidence that alterations to homeostatic circuits in the brain lead to both increased food intake and body fat accumulation, but this is not an example of fat tissue expansion itself driving increased food intake.

Teech said...

New name for this theory - Low satiating food theory. This would end the confusion over foods that are highly palatable and highly satiating.

Stephan Guyenet said...

Hi Teech,

Thank you for the thought, however satiety and hunger are only two of the reasons why we eat, and they are not sufficient to encapsulate the effects of reward/palatability on calorie intake and fat mass. Hunger/satiety are obviously important, but they aren't the whole picture. I'll explain this more in upcoming posts.

Unknown said...

Paper that appears to be looking at the alternative hypothesis http://www.ncbi.nlm.nih.gov/pubmed/21772313

LeonRover said...

Raz Honey

Here is quote:

"The researchers defined "normal weight" by body mass index (BMI).


"Using the term 'normal weight obesity' is really a way of being more precise about the changing conceptualization of obesity, because the real definition of obesity is excess body fat," says Francisco Lopez-Jimenez, M.D., a cardiologist on the Mayo research team."

Well, I am more picky about definitions.

"normal BMI obesity" not weight.

It is about fat%.

So what's new Pussycat

Murph said...

Why is it that some people accumulate more fat around their belly button area? What is going on there?

Dave said...

Since energy expenditure increases with increased body mass, is it reasonable to say that in order to continue growing obese, the person's ingestion of calories must also gradually increase over time to keep on pace with the increased fat accumulation and energy expenditure? If so, how can you say that fat growth doesn't lead to further ingestion of more calories?

How does FR cause someone to eat more and more over time to sustain their positive calorie balance?

Stephan Guyenet said...

Hi Unknown,

Yes, I've seen that paper. The authors did not provide any evidence that fat mass expansion drives increased food intake in humans. They only speculated that it might be the case, which I find a bit too ad hoc for my tastes considering the complete lack of evidence.

The article is basically a Taubes/Lustig lovefest (GCBC is cited 15 times!!!), and just like the obesity section of GCBC and WWGF it's a lot of speculation and not much substance. Suffice it to say it hasn't exactly rocked the research world.

I'm not sure why this fructose-obesity idea continues to persist in the face of abundant evidence that sugar and fructose are no more fattening than other equally palatable calorie sources.

wholehealthsource.blogspot.com/2012/02/is-sugar-fattening.html

elliebelly said...

What about all the studies that Jenny Rhul discusses that show how all the toxins we are exposed to have damaged our metabolisms? One of them, Atrozine, an herbicide sprayed on most corn, shows up in almost all fast foods. It has been shown to cause insulin resistance. As bad as these foods are per se, it seems they would not be able to cause such huge weight gain in such a large swath of the population without this secret ingredient. Then there are the organochlorines, the plastics, etc, not to even mention the synergies amongst them. The increased prevalence of all these substances would, I suspect, fit neatly into your graph.

P2ZR said...

Stephan,

I wish you wouldn't use terms like 'seductive' for foodstuffs. Longtime readers know what you mean, but that just feeds into the misapprehension that acknowledging food reward = calling the obese gluttons. You know how eager holders of that belief are to pounce.

Razwell said...

Leon

You are still misunderstanding. A person can fit perfectly into the BMI category and carry too much fat.

It is the perfect "appearance" of thin , or even normal size ( leaning on kind of thin) but actually carrying a startling amount of body fat.

People who look average to thinner can have a startling percentage of body fat .

It's not BMI. Although, I agree that BMI is junk. It is also useless for NBA and NFL. Those guys have super genetics and are very muscular.THis is a separe thing from my orginal point, as these guys do not fit into the BMI noraml weight category.

I hope this helps.

Robb Wolf said...

Looking forward to the series and have really been enjoying the recent posts. It seems like some integration of systemic inflammation and the neuroregulation of appetite is where the money is.

George Henderson said...

There's a graph (HNAMES I think)somewhere on RD Feinmans blog showing that calories consumed by women have increased in recent decades whereas those consumed by men have stayed more stable.
And the big change in diet composition in the women's graph is increased % of PUFAs.
There is no comparable change in the men's graph.

However, all this is looking at whole populations rather than individuals.
Some people are getting fat, others are getting skinny against the background you describe.
What is the role of calories there?

If certain macronutrient and other food choices promote overeating, leading to obesity, then calories matter, but they also don't matter at all, because the same calories from healthy choices in the first instance might not have led to any overeating or obesity. Or have led to greater energy expenditure.
All more or less spontaneous consequences. And not dependent on calories but choices within calories.

George Henderson said...

Can I just point out to some commenters here that calories can only come from nutrients.
Calorie-dense foods are ipso facto nutrient-dense foods.
Starvation, for example, is caused by deficiency of the calorie-supplying nutrients.
"Energy-dense, nutrient-poor" is an oxymoron.

Stephan Guyenet said...

Thanks Robb, glad you found it useful.

James Kimbell said...

George,

Surely "nutrient" in these types of discussion is shorthand for "micronutrient." This is a common way of describing the issue - I've seen everyone from WAPF to Joel Furhman talk about "nutrient density" meaning the ratio of micronutrients to macro - and it's a useful one, too.

Unknown said...

I think the fructose (or the CIH) hypothesis of obesity hangs on because it is easier for folks to have a clear villain.

Taubes made a very compelling case to the non-specialist, and the message was heartily received. In a way, it's analogous to the "cholesterol skeptics" who very convincingly argue that blood lipids have nothing to do with atherosclerosis and heart disease (where the truth is rather more subtle indeed).

People today want simple one-liners with which to justify their beliefs and behaviors, not complicated (empirical/scientific) explanations with conditionals and context.

It has to be simple, short, and encapsulated with some unambiguous prescriptions: low-carb, low-fat, whole plant foods, yadayadayada...

By and large, people bring the same attitude to their internet-based "keyboard jousting".

Also, there's a certain thrill in discovering something that "the experts" have all got wrong!


Chris

Galina L. said...

Cervantes in his Don Quixote said that a “Hunger is the best sauce”. How true! Hunger makes food very rewarding to a degree food manufactures can only dream about , hunger promotes over-eating and consumption of excessive calories. I used to straggle with keeping my weight in a reasonable range because I had to eat less than my body demanded, and fighting own physiology is hard. Some lucky people have a weight-stable body from the beginning, I suspect they don't know how it feels to live in a hungry body which wants to get heavy. My fight is over now, I am almost like them in my attitude around food because the best sauce in the world is removed from my menu together with grains of any type and sugars, I am weight-stable now . Luck of hunger rubs food out of rewarding qualities to great degree. Just for records - I have been eating real food all my life prepared by me from a scratch. It is laughable how some people rave about such crap as pizza, Oreo cookies and chips, they just don't know how to cook.

Sanjeev said...

Hi Stephan,
Just wondering if you've had any more thoughts on the theory

"deficiencies force people to remedy the deficiency by eating more"

I did a survey of what I could find on deficiencies and while I found a lot of

"xxx deficiency leads to loss of appetite"

I found not one source claiming "xxx deficiency causes excessive hunger or food-seeking-and-consuming behaviour"

a summary is here or to ensure work safety copy and paste:

http://carbsanity.blogspot.ca/2011/12/best-diet-fitness-regime-for-health.html?showComment=1336338877370#c3370334761307419487

I'm wondering, based on your older post about magnesium deficiency causing insulin resistance, if this insulin resistance is one of the mechanisms (at least for magnesium) that the body makes itself lose appetite.

Another small thought occurred to me: if the environment has proven to the organism (via deficiency) that the environment can't provide some nutrient or other, should the organism consume more of what's been proven deficient, or should it take steps to conserve the nutrients that do come in ... reduce energy intake to reduce the need for the nutrients that process energy.

thoughts? Critiques?

Sanjeev said...

> one of the mechanisms (at least for magnesium) that the body makes itself lose appetite
______
rephrase:
that the body uses to rid itself of appetite

> should the organism consume more
> of what's been proven deficient,
_________
and almost guarantee worse micronutrient ratios - for example, if magnesium is deficient in the environment but copper's excessive, what will eating more of the skewed ratio actually do?

The body does have control over various buffers and some control over excretion of excesses, conservation of what's deficient and so on.

But the individual being deficient argues that most of these mechanisms have been used and have been insufficient for the challenge.

ivat said...

Clearly, we are eating more. But more calories or more food?

In eating increased amounts of calorie-dense food, we might actually be eating less food, as measured in grams. Or the same amount of food, with more calories per gram. It's hard for me to believe that people have been progressively eating greater stacks of food over the past few decades.

marchwinds said...

With regard to increasing consumption of calories: this is shockingly easy to do. If you eat a bagel at Tim Hortons, that bagel has 310 calories without any toppings. I once has a veggie sandwich at Quizno's and it had over 700 calories (400 from the bread alone). The amounts of food were not excessive, but the calories were pretty high. You can't tell how much energy you are consuming when you eat and your body does not somehow feel more full because a sandwich has 700 calories as opposed to 400. It is almost fair to say that we are not eating more on the surface of things, but the foods themselves are just hypercaloric. Apart from never eating out, I don't think there is any way to avoid high calories in this food world.

HoneyRazwell said...

Obesity truly is a phenomenon. In obesity, we know *something* went wrong. I have witnessed , in several people I know, setpoints rise out of nowhere ( 20 pounds heavier). My friends had the same healthful behaviors they always had, but their weight and body fat became greater.

Obese people are defending their weight in the same way, and with the same voracity as a normal weight or naturally thin person even.


Obesity is not really a problem of weight regulation, it is more a problem of the setpoint becoming enormously great. Now , the body views the obese state as the correct weight and level of body fat for this particular individual.

Once this happens we get screwed.


As scientists know ,the system is designed to defend the weight your body considers as normal extremely voraciously- like imminent death is approaching
( As Dr. Michael Rosenbaum as commented).

It is truly depressing news to find out from Dr. Leibel's most current research that the body fights back SO intensively that:

You now burn 20 to 25 % less calories when exercising

What used to be normal easting nopw represents 20 to 25 % overeating. There is a SIGNIFICANT energy expenditure drop - more so that what would be expected from your new reduced weight

The body never adjusts to this new dieted down weight and the brain absolutely hates it

You get cold and very hungry

Muscle movements even become extremely efficient

The situation looks bleak and hopless. But, WITHOUT this new insight it would be. With this insight new intervention can EVENTUALLY be devised but nowhere in the very near future.




I think the most KEY questions about obesity are :

*What makes the setpoint rise?


*Why does the body view an obese individuals' weight and body fat level as the correct weight for them?

*How do we lower the setpoint?



Healthful behaviors are important to maintain well being. But, in a healthy functioning body, not eating well and not doing movement would only account for about 5 to 10 pounds heavier or so- not obesity. (Dr. Friedman blames his lazy ,carefree attitude as the reason for his extra 5 pounds he now carries etc). Unless, of course ,the person is naturally super lean where it is unbelievable difficult to fatten them.

So, the key questions about obesity seem to revolve around the setpoint and why the body views morbid obesity as the perfectly correct state for the body. In other words- BIOLOGY.

Gadfly said...

The most parsimonious explanation for the Sun rising in the East and setting in the West is that the Sun revolves around the Earth.

Dave said...

"You can't tell how much energy you are consuming when you eat and your body does not somehow feel more full because a sandwich has 700 calories as opposed to 400. It is almost fair to say that we are not eating more on the surface of things, but the foods themselves are just hypercaloric"

I completely disagree with this. This goes against the idea that body fat is regulated and instead implies its determined by ad libitum eating behaviors. I know that when I overeat one day by a massive amount of calories (no matter what the food content is), I am always less hungry the next day. Is it coincidence or a compensatory response to overeating calories? Well there is quite the body of evidence showing body fat is regulated in both directions. This is why naturally skinny people cannot gain weight, because their body will not allow them to sustain a caloric surplus for very long.

Also I tend to load up on healthy non-starchy veggies with soy sauce, garlic, and whatever other flavors I can find to make them taste good. Yet because of the deficiency in calories, I can eat tons and tons of them and I'm never full, probably because my body doesn't like dropping too low from my set point.

When I eat unprocessed foods with more micro-nutrients, I tend to hover at a lower weight than when I eat micro-nutrient devoid refined foods. I don't think its ad libitum calories, but the deficiency in micro-nutrients that allows me to eat more. There is always a ceiling as to how much junk refined foods I can eat before my body decides to cut me off. Everyone's ceiling is different, but its there.

The more I look at the scientific literature, the more I think the CIH is wrong, and its really just a coincidence in that because the most refined, micro-nutrient devoid foods tend to be very high in carbohydrates. So instead of blaming the lack of micro-nutrients, the LC community blames the carb content. It could also be the added chemicals that are the real culprit as well.

I think "eat less, move more" is nonsense because it implies you can eat whatever you want without regards to macros, micros, and appetite management, but I think that phrase just sets you up for failure. Instead people should not focus as much on weight, and should focus on fitness and eating cleaner foods, and weight should hopefully improve as a side effect.

P2ZR said...

Gadfly: Clearly you are trying to live up to your username. The geocentric model of the universe was inconsistent with observations of retrograde motion, causing the ancient Greeks to add epicycles to planetary orbits, and then epicycles upon those epicycles, in an almost fractal manner--'refinements' which did NOT lead to a parsimonious explanation cf. the heliocentric model.

Dave: 'I think "eat less, move more" is nonsense because it implies you can eat whatever you want without regards to macros, micros, and appetite management, but I think that phrase just sets you up for failure.'

It is not nonsense just because it is is difficult to accomplish without regard to macros/micros/appetite management. Obviously, you will be swimming upstream if you are trying to ELMM via the Twinkies diet because the macros are terrible, vitamins and minerals are almost nonexistent, and appetite regulation will be hopeless. We can and should recognize that ELMM works; the sensible next step is to figure out what eating behaviors are conducive to it: i.e., what foods/timing of food consumption promote satiety and give us the energy for physical activity?

Razwell said...

P2ZR

"Eat less, move more "HAS been discredited completely in the scientific literature.I encourage you to read it. My blog has links to this research and the top scientists behind it.

Dave is RIGHT. He is a smart guy.

Anybody who keeps up on the current, extremely detailed research of Dr. Michael Rosenbaum and Dr. Rudolph Leibel ( top scientists in this field-cream of the crop )knows this. Their research thoroughly contradicts "willpower" and the like.

ONLY Internet gurus who have fat loss books to SELL peddle the discredited "eat less, move more" nonsense.

Genuine obesity scientists laugh off that childish nostrum. Internet guru salesmen have a kindergarten model view of obesity science.

As my friend Urgelt has said, it is OVER for the commercial weight loss industry. Consumers are realizing they are the victims of FRAUD. It is not a question "if" , but rather, when. The truth has come out.

Pretty soon the commercial weight loss industry is going to have to find another way to scam desperate obese people.

Ness Paterson said...

My doctor friend laughed at me when I said that I thought the obesity epidemic was caused by too much yummy food that was at hands reach all of the time.
It may be simplistic but I have very much based successful weight loss, for 10 years, around this theory and the fact it really is just calories. Just because I believe calories underpin it all, does not mean I think it is a good working theory to decrease weight by just trying to reduce calories. Being mother of my household, I do get to dictate my environment and keep highly palatable foods out, which is an advantage that not everyone has.
Some people are more influenced by environment or reward of food than others. My husband is very slim and always has but he can sit right in front of a bowl of lollies and not touch one. For hours. Food simply isn't as rewarding to him as it is for others.
I also think there is a difference between palatable and "more-ish" foods. Low sodium bread with no salt or sugar added to me is palatable, but it isn't more-ish.
And as for the hunter gatherers, even if their food they ate was 1oo% high reward food, they still had to get up and go get it. I allow myself to walk down and get chocolate from the shop whenever I want to. I hardly ever do because it is two kilometres away.
So yes I believe calories matter. How rewarding the calories are (and this takes in individual factors into account) and how easy it is to get them are important factors for influencing total intake.
I have only found this blog today. Love it.

Bill said...

@ Stephen,
That’s a very compelling graph, but at the end of the day, are we going with “parsimonious,” or “there’s more to the story?”

@ Jane, I totally agree! Empty calories are the devil.

marchwinds said...

@ Dave: You may completely disagree with what I said, but that is my experience. Of course fat mass is regulated, but unfortunately, I am not less hungry the next day because I ate more calories the day before, and I don't eat less the next day. Everyone is different, I guess. I am also not more hungry if I exercise a lot - actually I tend to eat less. There might be biochemical reasons for it, I don't know. Sorry I don't conform with your theories of fat regulation. :-)

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Jane said...

Hi Bill
I see on your profile that you're a scientist. You must have thought about this problem of empty calories. Do you have any ideas about how it has happened that it's socially acceptable and legal to remove micronutrients from food and feed it to small children?

Galina L. said...

Mine fat mass is self-regulated when I eat food low in carbohydrates. I noticed, however, that I eat less now
(after a weight loss on a LC diet) than naturally thin people I personally know, but I eat according to mine appetite. Doing exercise doesn't cause an appetite increase now, but it was the case before.

frank r said...

@Razwell: I believe there are various ways to reset the setpoint downwards. No I don't have any scientific studies and I'm skeptical that there ever will be studies of any validity, since the conscious mind DOES have a role in the setpoint.

Kruse suggests that prolonged cold showers or ice baths can reset the setpoint downwards. I've been taking cold showers myself for many years, but not prolonged ones. After reading "Becoming the Ice Man", about a young man's experiences learning from Wim Hof, I began taking prolonged cold showers this past winter, and noticed an immediate reduction in appetite, in addition to better cold tolerance. The reduction in appetite was not something I was looking for at the time, and I paid it no heed until reading Kruse's website recently. I gave up the prolong cold shower experiment after a while and never tried the cold baths.

Prolonged fasting may also reset the setpoint. I've never fasted more than a week, and that was long ago, so I don't recall the effects on my weight setpoint. I wasn't fat back then in any case. As with most people who fast, my physiological appetite went away completely after about two days of fasting, though I continued to think about food and became sort of gloomy. I also had a lot of extra time on my hands, since I couldn't go out with friends, since most of my activities with friends at the time involved eating or drinking alcohol. Supposedly, appetite returns with a vengeance after a couple of weeks, at least for people who didn't start out with much extra body fat, but I didn't continue the fast for that long. There are scientific reports of a very obese man fasting for a year, with little loss of muscle and apparently little problems with appetite. Presumably, he obtained glucose for the brain from the glycerol in the fat that was being burned off while fasting. So maybe appetite doesn't always return after two weeks like the reports I read said. Those reports were from yogis, who tend to be lean to begin with.

After many years of being lean, I had some problems with weight gain about a year ago, and gained 20 pounds more than old weight very rapidly (in less than a month) after returning from a long hiking trip. This is what got me interested in this obesity issue. After trying low-carb, low-fat and various other diets, I eventually discovered that that intermittent fasting (eating once a day, high-fiber and low-fat, plus one candy bar snack a few hours after this single meal) allowed me to lose weight slowly but surely, with no appetite problems. Kruse also discusses intermittent fasting in his leptin reset protocol and many other people endorse it as a way to reduce the setpoint. It is still possible to overeat when eating once a day, even if eating high-fiber and low-fat (whole-grains, beans, vegetables) and there will still be some cravings a few hours after this single meal, but if you can resist those cravings, they will soon go away and won't return. Or such is my experience.

The guy who wrote that Shangri-La book observed that his appetite disappeared when he travelled to Paris for a few weeks. But I don't think he drew the right conclusions. His conclusion was that subtle changes in tastes confuse the brain. My hypothesis is that radical changes in lifestyle in general will cause all sorts of setpoints, includingn the leptin/appetite setpoints, to be reset, and that is precisely what happens when we travel to another country in a much different timezone.

There will probably be some chemical methods of lowering the setpoint in the future.

frank r said...

(continued)
Right now, if someone really wanted to lower their setpoint, here's what I would advise. Travel to Nepal (other side of the world, huge time zone change, radically different culture). Water fast during the airline flight and for the first 3 days after arrival. Afterwards, eat only local foods and eat only once a day. Pick one of low-carb or low-fat, though I think high-fiber low-fat is better in the long run (rice and lentils plus boiled vegetables, eaten to satiety). Take ice cold showers whenever possible. Keep on the move, so you never feel quite settled down, until you've lost as much weight as you want and you've gotten comfortable with the new weight.

Reducing setpoint is not a panacea, because physiological hunger is only part of the problem. There is also psychological hunger: eating for pleasure, eating to please other people, eating to reduce stress, eating to fill the time. The only way to cut psychological hunger is willpower, and therein is a problem, because most fat people lack willpower where food is concerned. That is, no matter how mature they may be in most areas of life, when it comes to food, they are stuck at the infantile oral stage of development: baby cries, give baby something to eat. This stimulus-response conditioning was setup for them by their parents starting at any early age, and is extremely hard to break. Though like all habits, it CAN eventually be broken.

There is no easy way to get inside a person's head to distinguish physiological from psychological hunger, though maybe there are some chemicals (ghrelin, leptin, etc) that could be measured in the blood. Really, you have to use introspection to understand what is going on. Which means it is difficult doing research studies about reducing setpoint that hold up to scrutiny.

Galina L. said...

@frank r,
"most fat people lack willpower where food is concerned. That is, no matter how mature they may be in most areas of life, when it comes to food, they are stuck at the infantile oral stage of development: baby cries, give baby something to eat. "
It is exactly the sort of remark that makes me feel infuriated. Fat people are deserved to be looked down because they are inferior. According to my own experience, when a body in a fat-storing mood, the sense of hunger is unbelievably strong, it just doesn't go away. There is no way to explain it to other people how overpowering you hunger is, for them you are a crying baby who stack in some wrong stage of development. I am not cry for food any longer,fasting is not a problem for me now, but I remember well enough how it feels. Due to mine experience I know how it feels to live in a body which wants to grow fat.

frank r said...

@galina: you're discussing physiological hunger and I am well aware of what it is. That's how I gained those 20 pounds in less than a month. My body would simply not leave me alone until I ate. In other words, something happened to raise my setpoint by 20 pounds. Eventually I figured out how to lower my setpoint. I discussed my methods, but they may not work for other people.

Also, there is a limit to how far down a person can push the setpoint, especially middle-aged women, who tend to naturally put on weight on the hips. Such a pear-shaped body has never been shown to be unhealthy and it is quite possible it is impossible to reduce the setpoint to restore a slender teenage body to these women. If this describes you, then my remarks have nothing to do with you.

The apple-shaped body, with visceral fat, is another story. Here is a good website by a man who had such a body and eventually saw the light and accepted that his problems were in his mind more than in his body (the photos in the My Story'My Life and Transformation are quite a story indeed):

http://www.foodisforfuel.com/

Margaretrc said...

I think your characterization of the "alternate hypothesis" as saying that increasing fat drives increased calorie consumption is incorrect. That is not how I understand it at all as put forth in GCBC and WWGF and many other sources. The way I understand the hypothesis is that the same thing--hyperinsulinemia--drives both fat accumulation and hunger/increased consumption.

Galina L. said...

I am a pear-shaped female, my body-type is the same, but on a limited-carbohydrate diet I don't experience excessive physiological hunger, I used to straggle with since I remember myself. My health markers have been good all the time. My mom who is 75 years old now,is similar to me in appearance, also likes being physically active, she never experienced high blood pressure till the ripe age of 65. Health is important, I never looked ugly, but being hungry almost all the time in order not to reach BMI=30 is really tiring. I am glad to be free from it now. I am passing all sort of cakes, cookies, candies, breads without even the slight effort.

G said...

Stephan,

I was reading this talk from Richard hamming "You And Your Research" and I thought of you. I think you may enjoy it:

http://www.paulgraham.com/hamming.html

Bill said...

Hi Jane-
I’m a scientist, not a politician! freedom and big food companies?

Bill

John and Melissa said...

@ gadfly: in addition to what P27R said (which is absolutely correct). A later theory which combated Copernicus' theory (heliocentric theory) placed the earth in the center with the sun rotating around the earth, but all of the planets rotated around the sun. Now, since there is no "Privileged perspective". We can't actually say that this theory is wrong. We can just as easily say that the earth rotates around the sun, as to say that the sun rotates around the earth. The point is that just because you don't like an answer doesn't make it wrong. It all depends on how you look at things.
Certainly, there is no study that I am aware of that has had the result of weight loss (short term or long term) that did not somehow get the participants to reduce calories (either as part of the design, or by putting them on a diet that causes them to spontaneously reduce calories). There are obviously a lot of factors as to why a person gains weight, and what causes changes in metabolic rate. But ultimately, whether because of a decrease in metabolic rate, or in increase in calorie consumption, weight gain is ALWAYS caused by excess calories. That doesn't mean that the cure is necessarily active calorie restriction (after all, if the metabolism slowed down for some reason, reversing that process to speed it up, would seem a better option).
@margaretrc: Stephan posted links to references showing that hyperinsulinemia doesn't cause weight gain. Insulin resistance, on the other hand (which can correspond to hyperinsulinemia), does tend to make people more hungry, and does tend to make people eat more. So, it's not hyperinsulinemia, per se, but insulin resistance. Obviously insulin resistance only accounts for some people, not everyone.

Morten G said...

That graph....

On the left the scales for obesity are limited between 0 and 100 (proportion of the population) and one right it's between 0 and infinite.
Also, it's a line graph despite a limited number of data points. It should always include the scatter/xy in cases like this - you can include lines to guide the eye but not to represent data.

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Jane said...

@Bill
You think it's a political problem? To do with freedom? The UK Department of Health once told me it allows people to eat empty calories because they must have 'choice'. I was astonished, because obviously, feeding this stuff to small children removes their choices. Their bodies change in such a way that they can't get 'reward' from anything except eating, and they don't even really enjoy it.

I don't think the food companies are to blame. They get a lot of abuse for causing the obesity epidemic, but they have yet to be told by scientists that the problem is micronutrient depeletion. I know the chairman of the UK Food Standards Agency scientific advisory committee. I have tried to tell him about this problem without success.

Razwell said...

Thanks for the information, frank.


For everybody in general :

Here is a podcast from Dr. Linda Bacon Ph.D.

She discusses how EVEN when people MAINTAIN their healthful behaviors, the overwhelming majority STILL regain weight . Thgey also did detailed studies on exercise and knew exactly how much energy the subjects expended, measured by a laboratory ( so it was not self reported etc.)

The result? The SAME thing - WEIGHT REGAIN.

The body kicks in and tries to maintain homeostasis with immemsely powerful INVOLUNTARY mechanisms to counter weight loss attempts.

Short term there is success very frequently. BUT, over the long term, the body wins. This is bad news, but reality. This is the genuine science of obesity. But there is a vast ocean left to learn.

Obese people have very few options.

The HAES approach is very good. It's been put to the test in clinical trials over traditional dieting and won in spades.Subjects health numers and well being was a lot better using HAES. Neither group lost that much weight.

THis is a fabulous podcast.What we currently know about this phenomenon of obesity is about about a glass of water compared to a vast ocean


Here is the podcast:

http://www.youtube.com/watch?v=A-uiUNim__g

You could always type not YouTube "On Hold Dr. LInda Bacon" if the above link does not work.

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Jon said...

I noticed that people consume more also because of the increased sugar in our diets. (Filling up on sugar, blood-glucose spike, blood-glucose sudden drop, then immediate hunger again.)

Bill said...

@ Jane, I don’t know!!!! Who or what do YOU think is to blame? Me, for not convincing Big Brother or Coca-Cola that “micronutrient depletion” is the culprit? Coca-Cola tried a vitamin-fortified product but nobody bought it.

sandycai said...

On each of our initial sleepover,Came rested well ergo baby as part of his baby room room inside my parents' ergo baby carrier property. He has a new child's crib and Ergo Baby Organic goes to sleep quickly in there. The room I rested well throughout had been baby rucksack proper beside their. At night time, he automobile as soon as and the weep shocked me personally.

Jane said...

@Bill
Interesting question, isn't it. I don't see how anything can change, and yet it's clear things have to change because we can't afford the healthcare.

Tony Blair used to say biotechnology and genetics were going to cure half our diseases and prevent the other half. We would get rich selling our cures abroad. None of this has happened, of course, and I would LOVE to be able to blame Tony Blair. But in the meantime scientists have done a lot of work that was badly needed. I expect you have done some of it yourself. Who would have funded this work if it was known that the problem was micronutrient deficiencies?

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engineering-health.org said...

Based on responses over at Hyperlipid, I suggest that this post is misleading people about the nature of food reward, and lipostasis- it's reinforcing the confusion that they're the same as the "sloth/gluttony" idea.

Your ideas are fundamentally based on control theory and the notion of feedback, which I think it's being understood by much of your audience which aren't engineers, and aren't accustomed to this idea.

Maybe you should do a post on the basics of control theory, and why it's useful and scientifically rigorous to apply to to biological systems.

engineering-health.org said...

There's a typo in the above comment, "it's being understood" should have been "are being misunderstood."

Stephan Guyenet said...

Hi engineering-health,

People with an agenda will always find ways to discredit opposing views, no matter how well founded they are. This idea that I'm blaming fat people, calling them lazy or gluttons, is just another example of this. These folks are being deliberately dense about my writing so that they can discredit it.

There's a small group of rabble rousers that have a chip on their shoulders about my ideas (these are different from the people who politely disagree). There aren't many of them but this is the Internet so they're fairly visible. There is nothing I can do to change this while staying true to the science. If everyone liked me, I probably wouldn't be doing anything important.

George Henderson said...

This is probably a wasted effort, but does anyone know what Gary Taube's position on this is?
I found this at http://www.awlr.org/1/category/gary%20taubes/1.html
from 9 May 2012
- where he says

"Most researchers now would say that calories are probably the most important factor, calories and weight, so you're still left with: What is it that makes you eat more calories?"


"The underlying philosophy is this kind of Paleolithic diet theory. It's what we ate during the 2 million years that we were hunter-gatherers on this planet. The fact that we were hunter-gatherers for 2 million years suggests it was an extraordinarily successful evolutionary adaptation. The question is: What did we eat during these 2 million [years] when we left the jungle, the trees, went down into savanna and started surviving on whatever we could hunt or gather? That's the philosophy. The answer is, probably considerable meat, very low glycemic index, hard-to-digest roots and starches, and fruits and berries that look nothing at all like the beautiful Fuji applies you can buy at your local market now. Some carbohydrates, but whatever it was, it wasn't refined. It wasn't sugar. It wasn't flour. It wasn't easy to digest. That's my going theory."

There's an interesting detail where he's allergic to HCFS, which made him pay attention to Lustig initially. This intrigues me, because there can be an immunological component to weight gain; as Richard Mackarness pointed out long ago, foods that people are allergic (or "allergic") to can also be obstacles to weight-loss beyond their caloric content; metabolism and immunology connect at many points (e.g., probiotics, or the "diabetes vaccine").

Rick said...

Stephan
Is there anything worth discussing in the idea that the amount of food energy absorbed by an individual may be different than what's been estimated for the foods on the shelf? Or are the estimates we all use in discussing "calories in" reasonably accurate?
Thanks

George Henderson said...
This comment has been removed by the author.
George Henderson said...

I've read this Rick; that, for example, long-chain fatty triglycerides (e.g. PUFAs) are more calorie-dense than shorter FAs (such as most SFAs) because the glycerol makes up proportionately less of them; 9 kilocalories per gram being the average of free fatty acids, but glycerol being closer to 4.
While starches are digested to a somewhat larger mass of sugars by the addition of water, increasing the kC per gram.
There are a number of errors like this that creep in. Some would caancel each other out on a mixed diet, perhaps, but the difference between fats and carbs - as eaten - may not be as great as the 9:4 ratio commonly given.
And different amino acids have different nitrogen ratios, meaning this can also supply different calories per gram (as nitrogen is inert in metabolism).
So that legume protein may give different calories per gram than grain protein, for example...

Sanjeev said...

> absorbed by an individual may be different than what's been estimated for the foods on the shelf
__
sure, lots of disease states and simple diarrhea can do that.

I would expect less of a mismatch with industrial foods (uniformity being a requirement for material to make it through the extruders, heaters, cesspits, pressure cookers and so on). And the standardized end-product packaging adds another layer of reducing variability.

and would expect much more variation in natural food.

That said, the errors should even out in the end. For a month your steaks might tend to be fattier than what's reported, for the next month leaner.

And taken as a whole, if making a good faith effort, under-estimation of one food's calories should even out in the long run with over-estimation of another food's calories.

Jane said...

@George
So that's what Taubes believes about our ancestors. Of course, he eats meat three times a day himself. And I think avoids grains and legumes?

The interesting thing about this supposedly ancestral diet is that in theory at least, it should cause iron overload. For some reason, our ancestors never acquired the means to excrete excess iron. Why not, one might ask. Is it that difficult? Other metals get excreted with no problem.

Taubes is in danger of getting iron overload in his brain, which he would not know about. The people who work on Alzheimer's say it starts decades before symptoms arise.

Now as it happens, eating your meat together with grains or legumes is an excellent way to avoid iron overload. I think we have to wonder whether this is what our ancestors did.

Jane said...

I just looked up what Taubes eats.

'I do indeed eat three eggs with cheese, bacon and sausage for breakfast every morning, typically a couple of cheeseburgers (no bun) or a roast chicken for lunch, and more often than not, a rib eye or New York steak (grass fed) for dinner, usually in the neighborhood of a pound of meat. I cook with butter and, occasionally, olive oil (the sausages). My snacks run to cheese and almonds. So lots of fat and saturated fat and very little carbohydrates.'

There is a second problem here besides the vast quantities of meat. Iron absorption can be increased by saturated fat, which probably explains why it has been found to make red meat toxic. http://www.meandmydiabetes.com/2012/04/17/ron-krauss-saturated-fat-red-meat-it-depends/

Stephan, sorry I've gone off topic.

George Henderson said...

However iron regulation is sensitive to insulin (which promotes ferritin synthesis) and inflammation. A healthy liver, low inflammation state, and normal insulin should see iron levels controlled.
Iron is too important not to be well-regulated by a healthy metabolism.

http://gut.bmj.com/content/early/2011/10/19/gut.2010.214312.abstract

Major pathways of iron utilisation and production of iron-containing proteins include iron sulphur cluster biosynthesis, haem synthesis and storage within ferritin. The main site of iron absorption is the small intestine, but most iron is recycled by the monocyte–macrophage system via phagocytosis of senescent erythrocytes. Hepcidin, the key iron-regulating peptide binds to the iron exporter ferroportin and leads to its degradation, thereby inhibiting intestinal iron absorption and cellular export. Hepcidin levels are regulated on a transcriptional level by various stimuli, including transferrin saturation, erythropoietic activity, hypoxia and inflammation. Iron deficiency evokes adaptive responses resulting in alteration of cellular metabolism, changes in gene expression, activation of signalling pathways, cell cycle regulation, differentiation and cell death. Such responses are mediated by a number of iron-sensitive signalling pathways, including the IRE/IRP system, HIF and haem signalling.

George Henderson said...

This just in; Chris Kresser talks to Mat Lalonde about paleo and they touch on iron:
http://chriskresser.com/rhr-what-science-really-says-about-the-paleo-diet-with-mat-lalonde

Mat Lalonde: However, if you were to supplement with too much iron, the mechanism for absorption is very well controlled if you do not have primary hemochromatosis.

Chris Kresser: That’s true.

Mat Lalonde: So the iron excess is just gonna be excreted, but that’s why a lot of these iron supplements constipate people.

Chris Kresser: Yeah, but the problem is that hemochromatosis is the most common genetic mutation in people of northern European descent, so it’s between 1 in 200 and 1 in 300, and that’s for people who are homozygous for the mutation. And then you have heterozygous or carriers, and there’s a lot of recent evidence that suggests that people who are carriers have a mildly increased risk of iron overload, not as significant, of course, as people with primary hereditary hemochromatosis who are homozygous for the mutation, but I see a lot of people in my practice who are just carriers for the mutation, and they still have ferritin levels in the 400s, 500s, 600s, 700s, iron saturation as high as 70%, and these are folks that have adopted a paleo diet, which is, of course, beneficial in many ways, but it’s very iron-rich, and so all of a sudden you start to see their ferritin and iron saturation go through the roof.

********************************
however, you don't need an especially iron-rich diet to get high ferritin if you have hemochromatosis, or indeed anaemia of chronic disease (inflammation derived, high-iron anaemia).

Jane said...

@George
Yes, iron is too important not to be well regulated. But the review you linked does not discuss copper, which is arguably the most important of the iron regulators. The paper is extremely long, and covers every aspect of iron regulation I have ever heard of, with the exception of copper. It does say ceruloplasmin is a copper protein, but that's it.

Very interesting what Chris Kresser is saying. I suspect the paleo diet increases the need for copper, because of its high iron content, but may not supply it.

Yes iron transporters get down regulated to avoid absorbing too much iron. But they are also used by manganese, which is anyway very low in meat. This may not be a problem in the short term, because if you absorb less Mn you will excrete less, but in the long term it might be.

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michael said...

The trick is to put less on your plate, its quite simple really.

Jonckel said...

I was under the impression that high reward foods stimulate the hypothalamus which in turn governs the fat signaling mechanism.(1) This weight gaining process would be agnostic in terms of number of calories. Either the food you are eating is signaling the fat accumulation switch or it is not.(2) I could agree that this chart might jive with the increase and prevalence of hyper-palatable foods over the time period. I cannot agree that it is calories which has driven this.(3)

To make this statement,

"......that the increase in calorie intake over the last 40 years can single-handedly explain the increase in obesity in this country (2, 3)*."

contradicts the hypothalamus fat signaling. This current discussion indicates any excessive calories will make you fat. Is it calories or is it high-reward, hyper-palatable foods signaling the hypothalamus that is the cause of obesity increase in this country? It is easy to say that the rise of fast foods and national restaurant chains equally corresponds with this table as well. Additionally more people eat out now than they did decades ago.


(1)"The paper is a nice overview of the evidence linking dopamine signaling with body fatness via its effects on the hypothalamus,"
(WHS Blog entry 6/18/11)

(2)"Together, this supports a hypothesis that I've scarcely seen in the scientific literature: that reward centers, and probably food reward itself, can directly influence body fatness and metabolism."
WHS Blog entry 6/18/11)

(3)"Putting it All Together
I believe the evidence as a whole shows that chronic consumption of foods with an excessive reward value causes abnormalities in parts of the brain that regulate body fatness, metabolism and reward/motivation. This can lead to weight gain and metabolic problems, and favor addictive and compulsive relationships to food and other things. The combination of readily accessible, cheap, high-reward food, and stressful lifestyles that drive us to eat it, is probably a major contributor to overweight, obesity, diabetes and perhaps other health problems in affluent nations."
http://wholehealthsource.blogspot.com/2011/06/food-reward-dominant-factor-in-obesity_18.html