Why ‘calories in, calories out’ is oversimplified

calories in calories out

How energy balance is oversimplified and what to consider instead.

 

The ‘calories in, calories out’ model suggests that the number of calories consumed must equal the calories expended to maintain a stable weight and have good health. You have likely heard this before, and perhaps it even unknowingly has made you feel guilty for consuming a large meal or not feeling up for a workout. 

However, there are many points we want to highlight that make this statement grossly inaccurate and oversimplified. This infamous statement is so popularised by the pesky perils of diet culture, making it easy to forget all of the other factors that play a role in our health and wellbeing. 

You may have read our previous blogs on why calorie counting doesn’t serve you and how to stop calorie counting. Here are three reasons why there is MUCH more to the ‘calories in, calories out’ equation, and what you can think about instead:

 

Nutrients, not numbers 

Food is much more nuanced than we think. First, it’s important to remember that all food has some nutrition, and no food has zero nutritional value. So yes, a cookie may not seem like the ‘healthiest’ option out there – but it probably is packed full of satisfying carbohydrates, energy-boosting sugars, iron and B vitamins in the flour. 

When we break it down, a calorie is a universal unit of energy across all food and drink.

However, this doesn’t mean that calories from one food will give us the same amount of nutrition as it may from another – it’s important to consider the nutritional profile of the food too.

To offer an example, glucose and fructose are both sugars with similar calorific quantities but are metabolised and work in very different ways. They may have quite distinct effects on our blood sugar levels, insulin resistance, and cholesterol levels. (1)

Calories of differing sources may also affect our appetite differently. Consuming 200 calories worth of sweets may not fill us up as much as consuming 200 calories of lentils, for example. Simplifying foods to their calorific quantities denies the variation and diversity of foods and the importance of balance in one’s diet. (2)

 

Food is pleasurable, too

The ‘calories in, calories out’ agenda fails to acknowledge the fact that foods can and should be enjoyed for pleasure. Historically, and still to this day, food holds substantial cultural, social and emotional value. Eating can often be the theme of elaborate celebrations and festivities, and there are many celebrations each year where food is made and consumed in pretty large quantities. 

Thankfully (and conveniently,) the ‘calories in, calories out’ approach tends to be forgotten in these cases – and diet culture messages may take a break, kicking in in the media following a season change or New Year period.  

But perhaps taking this approach to everyday life may hold more value – why should we wait until a particular day of the year to eat freely and enjoy food? Food can be a crutch to people in a challenging time or life event. A specific flavour or dish may bring back memories of childhood, a vacation or a particular experience. And all of this deserves to be recognised and accepted!

 

Individual differences 

Another major point to remember is that as individuals, food and movement affects us all in different ways. According to the set point hypothesis, we all have an individual weight range and body type. With hunger and fullness hormones, ghrelin and leptin, working to maintain this, comparing ourselves to others may not be helpful. (3)

Energy balance is an equation that considers basic metabolism, digestion, thermogenesis and physical activity, however it fails to consider genetics, environmental factors among others. There are so many other fundamental components of this equation that we shouldn’t ignore.

Additionally, the potentially disempowering use of fitness tracking apps and devices such as a Fitbit or using MyFitnessPal to log our food intake also isn’t entirely accurate.

Fitness trackers often work with general averages and ask for little details about your health upon sign-up. Even food intakes measured by diet professionals themselves have been shown to be significantly inaccurate. (4)

Calorific differences can present according to variations in where food is grown, how it is processed, and the ways in which it is prepared and eaten – so again, they are averages. They don’t include every dish or ingredient on the planet, which can lead to a lot of guesswork and uncertainty.

So the next time diet culture tells you to ‘balance’ your calorie intake, remind yourself of all the reasons why this statement is too general and potentially damaging.

You’re doing an amazing job wherever you are on your journey, so please take this as a reminder to keep choosing recovery and shower yourself with some self-care and compassion today and every day!

 

Priya Chotai, BSc ANutr

EHL Team x 

 

References:

  1. Lustig RH. Fructose: metabolic, hedonic, and societal parallels with ethanol. J Am Diet Assoc. 2010 Sep;110(9):1307-21. doi: 10.1016/j.jada.2010.06.008. PMID: 20800122.
  2. Stanhope KL, Schwarz JM, Keim NL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009;119(5):1322-1334. doi:10.1172/JCI37385
  3. Soares M, Cummings N, Ping-Delfos W. Energy metabolism and the metabolic syndrome: Does a lower basal metabolic rate signal recovery following weight loss?. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2011;5(2):98-101.
  4. Champagne CM, Bray GA, Kurtz AA, Monteiro JB, Tucker E, Volaufova J, Delany JP. Energy intake and energy expenditure: a controlled study comparing dietitians and non-dietitians. J Am Diet Assoc. 2002 Oct;102(10):1428-32. doi: 10.1016/s0002-8223(02)90316-0. PMID: 12396160.

Three reasons you’re secret eating

secret eating solution

As the name suggests, secret eating is a disordered eating behaviour that involves eating at times, in locations or in ways where you won’t be seen, with the intention of hiding what or how much you’re eating from other people…

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Three steps to challenging your food rules

anti diet food rules challenge recovery

How to move away from the shackles of diet culture by challenging your food rules 

 

If you’ve ever felt guilty or anxious around food and eating, you’re probably be influenced by your food rules.

Food rules are beliefs about foods that are collected over time and form the basis of our food choices when we are not eating intuitively. They dictate things like the types of food you’re allowed to have, how much you should eat, and the timing of your meals and snacks. You may not even realise how many food rules you have until you start your journey towards intuitive eating and begin to question the reasoning behind your eating habits!

This article will give you three simple steps to help you get to the bottom of your food rules and overcome them, in order to learn to eat based on your internal body cues.

 

ONE: Renourish your brain

In order to do the difficult work of changing your thinking patterns and belief systems, you must first ensure that your brain is functioning to the best of its ability. We know that the brain needs a tonne of energy to do its job properly; this means that getting adequate nutrition is one of the most important steps you can take if you want to change your cognitions.

One of the most well-known studies showing the effects of inadequate nutrition on the brain is the Minnesota Starvation Study. Amongst other ground-breaking discoveries, the study found that the restriction of calories causes impaired concentration, reduced alertness, poor comprehension and problem solving, and reduced motivation. Learn more about the effects of starvation on the brain and body here.

Ensuring you are eating regularly and adequately to give your brain the fuel it needs will make the next two steps that much easier.

 

TWO: Unpack the rule

It can be helpful to understand the origin of your food rules and what exactly they mean to you. This can allow you to develop a deeper understanding of you thought processes, making it easier to challenge them.

Some questions you can ask yourself to begin this process are:

  • Where did this rule come from?
  • When did I first begin following this rule? What triggered this?
  • What do I believe this rule will achieve? Is this belief logical?
  • What are my specific fears around breaking this rule?
  • How is my life affected by this rule?

 

THREE: Conduct an experiment

The most effective strategy for breaking down food rules is experimentation. Put your scientific hat on and approach your beliefs with curiosity and a methodical mindset.

The first step of this is to select a rule to challenge. Begin with the more flexible and less fear-inducing rules – there’s no need to throw yourself in the deep end!

Next, form a hypothesis about what you think (or what you fear) might happen. This might be structured like “If I do X, then Y will occur”.

Here comes the scary part – testing your hypothesis out. You might like to ask a friend or family member to support you through this if you’re expecting it to be particularly difficult. Keep in mind that you may need to test your hypothesis several times in order to come to a conclusion.

The last step is to evaluate the results. What actually happened? How did this compare to what you expected to happen? If it was different, can you come up with an alternative belief that might be more accurate?

Continue to repeat this process with all your food rules, gradually progressing to the more challenging ones. With patience and practice, you’ll be eating according to your body cues in no time!

If you believe you would benefit from individual support with your journey towards intuitive eating, our expert dietitians are here to help! Get in touch at hello@embodyhealthlondon.com to learn more about how we can work with you to achieve your goals.

 

Karli Battaglia, APD

EHL Team x

 

What happens within the body during eating disorder recovery?

eating disorder recovery refeeding syndrome

What you need to know as you embark on your recovery journey

 

If you’re in recovery from an eating disorder, we want to start by saying that we truly believe recovery is possible for every person! However, we also know that the early stages of recovery can be particularly scary as you face a tonne of new sensations and experiences. In this article, we’ll walk you through just some of what is going on inside your body during the refeeding phase so that you know what to expect during this period.

 

What will happen to my metabolism during recovery?

In a period of malnutrition like what is typically seen in those with eating disorders, the body slows the metabolism to preserve what little energy it is getting. However, as nutritional rehabilitation begins, the body becomes hypermetabolic.

This means that your body kicks into high gear and begins to utilise the fuel it was previously lacking, initially going towards repairing the vital organs and processes needed for survival.

Metabolism can remain heightened for several months. Until nutritional rehabilitation is complete, a person in eating disorder recovery will need more nutrition than someone of the same weight, height and age who has never had an eating disorder.1

Attempting to maintain one’s weight during recovery through the partial restriction of food can cause the proper functioning of systems like digestion and reproduction to be sacrificed for more life-sustaining processes. This is why it’s SO important to get adequate nutrition, no matter what that looks like for you

 

What will happen to my weight during recovery?

Changes in weight are extremely common at the beginning of the refeeding process, but not for the reasons you might think!

The first cause is the body stabilising, moving from a catabolic state to an anabolic state – in other words, the body shifts from a state of decomposition to a state of repair. This can actually cause some initial weight loss in the first week of refeeding, but this will neutralise.

The second cause is the body becoming appropriately hydrated. People with eating disorders can become extremely dehydrated from behaviours such as laxative or diuretic use, purging, excess caffeine consumption or refusal to drink water. They may also be over-hydrated if they are consuming excessive amounts of fluid. As hydration levels balance out, shifts in weight should be expected.

Over time, weight will gradually increase as lean mass and fat mass are formed. Lean mass is usually created first, to rebuild the skeletal muscles (ie. those used for movement) and to repair damaged organ tissue.2 Fat mass typically comes later in recovery, and is often first seen around the abdomen to protect your vital organs.

It’s important to remember that reaching weight restoration is not the end of your journey, and that it is the thoughts, beliefs and behaviours that truly determine recovery.

 

What will happen to my digestion during recovery?

During a prolonged period of starvation, such as that seen in eating disorders, energy that would normally go towards maintaining the structure and function of gut is sacrificed for more imperative survival processes. This causes issues with digestion such as gastroparesis (slowed gastric emptying), reduced gastric capacity, tissue wastage within the gastrointestinal tract and slowed colonic motility.3 This is all just to say that the gut stops working how it should.

Thankfully, this is reversible with good nutrition! However, it takes time during the refeeding phase to repair the gut and restore its function. This means that in the beginning of recovery, it’s unfortunately common to experience discomfort or pain, nausea, constipation, bloating or distention, and premature fullness.

As you give your gut (and the other systems in your body!) the nutrition it needs to repair, you can expect it to return to its fully-functioning self.

Remember that eating disorder recovery is a long game, and it can take up to 12 months to fully restore from a state of malnutrition. It’s incredibly important to have a great support team around you to guide you through it – and that’s where we come in!

Reach out to us at hello@embodyhealthlondon.com to find out how we can help you on your journey towards recovery.

 

Karli Battaglia, APD

EHL Team x

 

References

  1. Marzola E, Nasser J, Hashim S, Shih P, Kaye W. Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment. BMC Psychiatry. 2013;13(1).
  2. Golden N, Meyer W. Nutritional rehabilitation of anorexia nervosa. Goals and dangers. International Journal of Adolescent Medicine and Health. 2004;16(2).
  3. Georg S. Gut Function in Anorexia Nervosa and Bulimia Nervosa. Scandinavian Journal of Gastroenterology. 2003;38(6):573-587.

Why your body weight does not determine your health

healthy lifestyle weight

Four reasons why your body weight is overrated

 

Weight has been considered to be a key indicator of health for as long as we have known. It continues to be a fundamental factor that is looked at in research surrounding health and lifestyle. But how accurate is it actually at determining our health at an individual and population level?  

You may have read our previous blog post where we picked apart the reliability of BMI. In this article, we will dig deeper into the literature surrounding weight science and what the implications really are when it comes to our health. 

 

What is weight science?

Weight science refers to the research on body weight, which includes and is not limited to:

  • The regulation of body weight (weight loss or gain)
  •  Internal and external factors influencing weight change or maintenance
  •  Intentional or non-intentional weight loss or gain
  • The relationship between weight and health

A lot of weight science research takes into account health outcomes concerning weight or BMI. This might be because the assumption that BMI is a useful indicator of health is still held by many scientists and health researchers. The general consensus is that:

  • Achieving a BMI in the normal range of 18.5-25 will improve health.
  • Dieting and exercise should be encouraged in those lying outside this range to ensure they work towards achieving a ‘healthier’ BMI and are no longer considered ‘obese’ or ‘overweight.’

Read on to explore four reasons why we believe weight can sometimes be overestimated as an indicator of health.

 

ONE: Weight is more often than not, an inaccurate predictor of health.

When we dig deeper into the research, we realise that and social determinants of health play a much greater view than we think. Social determinants of health (SDoH) are the conditions in which we are born, live, work and age. 

SDoH can be thought of as the ’causes of the causes’ as they often shape how we may receive or learn about health and the conditions that may promote good health or disease risk and are the biggest single cause of health inequality. (1)

We also know that being in a larger body may actually be protective, particularly in old age and may have more favourable outcomes. 

A 2011 review showed that those with particular health conditions such as cardiovascular disease survive longer and have a lower mortality rate than those considered a ‘normal’ weight. (2)

Research also found that any effects related to obesity were counteracted when fitness was incorporated, suggesting that low fitness and activity levels may be more damaging to health than being at a higher BMI or weight. (2)

 

TWO: Weight loss is not associated with improved health.

A 2013 review by Tomiyama et al. (3) looked at the changes in cholesterol, triglycerides, systolic/diastolic blood pressure, and fasting blood glucose and weight loss. 

The findings showed minimal improvements in these biochemical markers after weight loss interventions. However, there was no correlation between the actual amount of weight change and the improvement of these factors. 

The review also showed that some confounding variables in the interventions, such as diet and exercise change, might have had an impact. These and engaging actively with your healthcare system are perhaps more beneficial than weight loss. (3)

Other studies have shown that weight cycling (repeated periods of losing and regaining weight) can actually be detrimental to health, increasing mortality risk. (4)

Park et al. showed that weight cycling increased risks of developing type 2 diabetes and can be considered an independent risk factor for the condition. (5) In addition, Welti et al. found that some cancer incidences increased (including a 38% increased risk of endometrial cancer) with weight cycling. (6)

Byun et al. similarly discovered that weight cycling led to poorer heart health, particularly in premenopausal women and women with no history of pregnancy – so we can see a trend here with the negative consequences weight cycling may have on our bodies. (7)

 

THREE: Dieting can lead to poorer mental and physical health.

For those of us who have tried dieting, we know that it quickly loses the fun and excitement that it may have initially started with. Research shows that diets are a cause of stress, creating hypervigilance around food and weight.

This increased thinking and anxiety around food can make us more restrictive when it comes to our diet and may potentially develop into disordered eating or even an eating disorder. 

In a study by Bombak et al., it was shown that dieting is also associated with a loss of bone and lean mass and poorer immunity and skeletal integrity. (8)

This is significant, as we believe our bones reach their peak mass around the ages of 25-30, and any bone mass loss after this age can be irreversible. This increases our chances of developing osteopenia or osteoporosis and being more prone to fractures and serious injury. (8)

 

FOUR: Weight loss is not often achieved and maintained in the long term.

Countless studies have shown that weight loss is uncommon initially, but lasting weight loss is even more rare to accomplish. In fact, some research even shows that more weight is sometimes gained than what was lost in the first place. (9)

A further review by Ayyad and Anderson found that the median success rate of a diet program is around 15%. We believe that this is due to the physiological and psychological effects of dieting, as mentioned in the previous point. (10)

Improvements to health can be obtained without a focus on weight, and non-diet approaches have sparked interest in recent years to improve body image, self-esteem, depressive and disordered eating behaviours. (11)

Non-diet interventions also have displayed improvements in diet quality and diversity of foods, including a higher fruit and vegetable intake and less restriction and stress around food. (12, 13) They have also shown to improve physical activity participation, blood lipid and glucose levels, and total cholesterol and blood pressure. (12, 14)

By reading this, remind yourself that you are already embarking upon an incredible healing journey and have come so far to begin to break away from what may be a period of disordered eating.

We hope this article helped to outline some of the research surrounding why weight loss may not always be as great as diet culture often makes it seem. Until next time, keep your head up and rise above restriction!

 

Priya Chotai, BSc ANutr

EHL Team x

 

References:

1. Irwin A, Valentine N, Brown C, Loewenson R, Solar O, Brown H, Koller T, Vega J. The commission on social determinants of health: tackling the social roots of health inequities. PLoS Med. 2006 May;3(6):e106. doi: 10.1371/journal.pmed.0030106. PMID: 16681414; PMCID: PMC1459479.

2. McAuley PA, Blair SN. Obesity paradoxes. J Sports Sci. 2011 May;29(8):773-82. doi: 10.1080/02640414.2011.553965. PMID: 21416445.

3. Tomiyama AJ, Ahlstrom B, Mann T. Long-term effects of dieting: Is weight loss related to health? Social and Personality Psychology Compass 2013; 7(12): 861-877.

4. Tae Jung Oh, Jae Hoon Moon, Sung Hee Choi, Soo Lim, Kyong Soo Park, Nam H Cho, Hak Chul Jang, Body-Weight Fluctuation and Incident Diabetes Mellitus, Cardiovascular Disease, and Mortality: A 16-Year Prospective Cohort Study, The Journal of Clinical Endocrinology & Metabolism, Volume 104, Issue 3, March 2019, Pages 639–646, https://doi.org/10.1210/jc.2018-01239

5. Park KY, Hwang HS, Cho KH, Han K, Nam GE, Kim YH, Kwon Y, Park YG. Body Weight Fluctuation as a Risk Factor for Type 2 Diabetes: Results from a Nationwide Cohort Study. J Clin Med. 2019 Jun 30;8(7):950. doi: 10.3390/jcm8070950. PMID: 31261984; PMCID: PMC6678837.

6. Welti LM, Beavers DP, Caan BJ, Sangi-Haghpeykar H, Vitolins MZ, Beavers KM. Weight Fluctuation and Cancer Risk in Postmenopausal Women: The Women’s Health Initiative. Cancer Epidemiol Biomarkers Prev. 2017 May;26(5):779-786. doi: 10.1158/1055-9965.EPI-16-0611. Epub 2017 Jan 9. PMID: 28069684; PMCID: PMC5413381.

7. Byun SS, Bello NA, Liao M, Makarem N, Aggarwal B. Associations of weight cycling with cardiovascular health using American Heart Association’s Life’s Simple 7 in a diverse sample of women. Prev Med Rep. 2019 Nov 2;16:100991. doi: 10.1016/j.pmedr.2019.100991. Erratum in: Prev Med Rep. 2020 Oct 29;20:101236. PMID: 31750075; PMCID: PMC6849443.

8. Bombak A, Monaghan LF, Rich E. Dietary approaches to weight-loss, Health At Every Size® and beyond: rethinking the war on obesity. Social Theory and Health. 2019 Mar 1;17(1):89-108. https://doi.org/10.1057/s41285-018-0070-9

9. Bravata DM, Sanders L, Huang J, et al. Efficacy and safety of low-carbohydrate diets: a systematic review. 2003. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK69697/

10. Ayyad C, Andersen T. Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999. Obes Rev. 2000 Oct;1(2):113-9. doi: 10.1046/j.1467-789x.2000.00019.x. PMID: 12119984.

11. Clifford D, Ozier A, Bundros J, Moore J, Kreiser A, Morris MN. Impact of non-diet approaches on attitudes, behaviors, and health outcomes: a systematic review. J Nutr Educ Behav. 2015 Mar-Apr;47(2):143-55.e1. doi: 10.1016/j.jneb.2014.12.002. PMID: 25754299.

12. Carroll S, Borkoles E, Polman R. Short-term effects of a non-dieting lifestyle intervention program on weight management, fitness, metabolic risk, and psychological well-being in obese premenopausal females with the metabolic syndrome. Appl Physiol Nutr Metab. 2007 Feb;32(1):125-42. doi: 10.1139/h06-093. PMID: 17332789.

13. Greene GW, White AA, Hoerr SL, Lohse B, Schembre SM, Riebe D, Patterson J, Kattelmann KK, Shoff S, Horacek T, Blissmer B, Phillips BW. Impact of an online healthful eating and physical activity program for college students. Am J Health Promot. 2012 Nov-Dec;27(2):e47-58. doi: 10.4278/ajhp.110606-QUAN-239. PMID: 23113786.

14. Ciliska D. Evaluation of two non-dieting interventions for obese women. West J Nurs Res. 1998 Feb;20(1):119-35. doi: 10.1177/019394599802000108. PMID: 9473971.