A week and a half ago, I published a post featuring 11 experts taking a crowbar to the calories-in-calories-out (CICO) model of obesity. You know — the one that says people get fat because they’re sinners (they “eat too much” and “don’t exercise enough”) and that their only hope is to repent and “eat less and move more.”
That post went somewhat viral (3,700 FB likes and 30K+ pageviews), but many critics were STILL not convinced. So it’s time to bring out more big guns to blow CICO away.
1. Zoe Harcombe — “I would like [calories-in-calories-out] to be banished from all dietary advice worldwide.”
One of the U.K.’s leading lights in the world of diet science, Zoe is a Cambridge University educated nutritionist with diplomas in Diet & Nutrition and Clinical Weight Management. She’s the author of multiple bestselling books, including “Stop Counting Calories and Start Losing Weight” and “Why Do You Overeat?” She’s also the best kind of sleuth/gadfly — relentless pressing institutions like the British Dietetic Association (BDA) and the National Health Service (NHS) to explain inconsistencies in their dietary dogma. Here’s an excerpt from a particularly entertaining back and forth she had with several leading UK health agencies: “The Calorie Theory: Use It or Lose It”
“I have a simple and reasonable request. I would like proof of this [calories-in-calories-out] formula – that it holds exactly every single time – or I would like it to be banished from all dietary advice worldwide.
Any proof needs to source the origin of the formula. Then the proof needs to hold in all cases. There needs to be overwhelming, irrefutable and consistent evidence that each and every time a deficit of 3,500 calories is created, one pound of fat is lost.
Since, we already have overwhelming evidence that such proof cannot be provided, it is not enough that we quietly stop using this formula – it is too widely assumed to be true for us to just sweep it under the carpet. We need to issue a public statement saying that it does not hold and should not be used again. We need to tell people that they will not lose one pound of fat for every deficit of 3,500 calories that they create. We need to tell people that there is no formula when it comes to weight loss and we have been wrong in giving people the hope that starvation will lead to the loss of 104 pounds each and every year, in fat alone.”
2. Gustav von Bergmann — “What the body… needs to become fat, even it it’s ten times as much, the body will save for itself from the annual balance.”
A German internist and founder of psychosomatic medicine, Gustav von Bergmann was one of the most widely respected medical specialists of the early 20th century. Europeans still revere von Bergmann and his contributions: the German Society of Internal Medicine’s highest honor is called the Gustav-von-Bergmann-Medaille.
Way, way, WAY back — in 1908!! — von Bergmann wrote about how ridiculous it was to think about obesity as a problem of “eating too much.”‘
Here’s a telling quote from Gary Taubes’ Good Calories Bad Calories (p 360):
“Bergmann considered the energy-balance hypothesis of obesity to be nonsensical: ‘It seems just as illogical,’ he wrote, ‘to say: Child, you shoot up in height because you eat too much or exercise too little–or you have remained short because you play sports too much. What the body needs to grow, it always finds, and what it needs to become fat, even it it’s ten times as much, the body will save for itself from the annual balance.'”
3. Dr. Robert Lustig — “Physicians and politicians who cling to the dogma that ‘all calories should be treated equally’ imperil our country’s health care system, food supply and standing in the world for the next hundred years. “
Bestselling author and childhood obesity expert, Dr. Robert Lustig, managed to do something that very few people in the history of media have ever done: give a detailed biochemistry lecture that went viral in a huge way. Dr. Lustig’s now-famous presentation: “Sugar: The Bitter Truth” has been viewed over 4.8 MILLION times. (With only 100 times that many views, he can surpass the number of people who have watched Rihanna’s “Diamonds” )
Dr. Lustig, whom I had the cool opportunity to meet a few years ago, has almost single-handedly turned public opinion in this country and the rest of the world against sugar. His crusade against the sweet white stuff has motivated powerful policy changes and inspired mainstream support (See: Katie Couric’s new documentary, “Fed Up”).
I love the gusto and fury with which Dr. Lustig strikes at the CICO nonsense. He’s a cutting passage from a Huffington Post piece he wrote, “Still Believe ‘A Calorie Is a Calorie’?”
“Physicians and politicians who cling to the dogma that “all calories should be treated equally” imperil our country’s health care system, food supply and standing in the world for the next hundred years.
A calorie is a measurement of energy (a matter of physics), not a value judgment on where that energy goes (a matter of biochemistry). As my book Fat Chance explains, you get sick from inappropriate energy storage (in your liver and muscle), not defective energy balance (bigger love handles). Nonetheless, “a calorie is a calorie” continues to be promulgated by the food industry as their defense against their culpability for the current epidemic of obesity and chronic metabolic disease. But it is as dishonest as a three-dollar bill… Sugar in excess is a toxin, unrelated to its calories. The dose determines the poison. Like alcohol, a little sugar is fine, but a lot is not. And the food industry has put us way over our limit.”
4. Julius Bauer — “A sort of anarchy exists; the adipose tissue lives for itself and does not fit into the precisely regulated management of the whole organism.”
A University of Vienna endocrinologist and geneticist who rose to prominence in the medical community in pre-World War II Germany — the New York Times once called him the “noted Vienna authority on internal diseases” — Bauer is in many ways the father of the notion that “a calorie is NOT a calorie.” In other words, calorie skeptics like me, Dr. Lustig, Gary Taubes and others ultimately owe a big debt to Bauer (and also to Gustav von Bergmann).
Way back in 1929 (!!!), Bauer wrote the following powerful observations:
“The genes responsible for obesity act upon the local tendency of the adipose [fat] tissue to accumulate fat as well as upon the endocrine glands and those nervous centers which regulate [this process] and dominate metabolic functions and the general feelings ruling the intake of food and the expenditure of energy. Only a broader conception such as this can satisfactorily explain the facts…
Like a malignant tumor of like the fetus, the uterus or the breasts of a pregnant woman, the abnormal [fat-hungry fat] tissue seizes on foodstuffs, even in the case of undernutrition… it maintains its stock, and may increase it independent of the requirements of the organism. A sort of anarchy exists; the adipose tissue lives for itself and does not fit into the precisely regulated management of the whole organism.”
Dr. Peter Attia, who recently co-founded the Nutrition Science Initiative (NuSI) with science writer, Gary Taubes, to fund better science in the realm of nutrition, is one of the most erudite, whip-smart thinkers in the nutrition/obesity space. Disclosure: I’m a fan/supporter of NuSI and its mission (to do nutrition science RIGHT) as well as an avid reader of Peter’s posts at his Eating Academy blog.
For one of the best technical treatises you’ll find on the web (or anywhere) about what ACTUALLY makes people fat and what we actually should be counting, please point your browser to Peter’s post “How to make a fat cell less not thin: the lessons of fat flux.”
Peter’s mathematic reckoning with this topic — he uses the equation DNL + RE >=< L — cuts to the quick. What makes fat cells fat, biochemically? What allows fat cells to release excess fat to be burned/excreted? These are the questions obesity researchers should have been asking for the past 60+ years! After all, the fat in our bodies is just the sum of all the fat we store in our fat cells.
Here’s Peter bashing CICO:
“Let’s explain what’s going on [in a crowded] room in terms of thermodynamics. The First Law would say something like this: The change in the number of people in the room must be equal to the difference between the number of people entering the room and the number of people leaving the room. For example, if the room “gains” 10 people, we can safely conclude that 10 more people entered the room than left it (e.g,. 15 versus 5, or 197 versus 187).
So here’s the million dollar question: Why is the room packed? Let me be more specific, why are there 78 people in the room? The “calories-in-minus-calories-out-model” says, “because 78 more people entered the room than left the room.” I say, sure, that’s true, but it doesn’t tell me WHY? I want to know WHY there are 78 people in the room (or, more specifically, WHY did 78 more people enter the room than leave the room)? Was it because there was a very compelling speaker in the room? Was it because they were giving away free food in room? Was it because it was raining outside and folks wanted to stay dry?
If my goal is to keep people out of the proverbial room, I’d better understand what brought them into the room. I need to know what is causing the room to accumulate people. Restating the First Law offers me nothing beyond the obvious. Of course more people entered the room than exited the room. How does that help me get people out?
Similarly, when someone tells me so-and-so is obese because he eats more than he expends, I say, “of course he does…you’re just re-stating the First Law.” What I want to know is, WHY did he eat more calories than he burned? If we don’t understand this point, how can we treat this condition?”
Dr. Jason Fung of the Institute of Kidney Lifescience Technologies burst onto the nutrition blogosphere less than a year ago and has consistently turned out some of the most insightful, detailed, elegantly written and withering assaults on the sacred cows of modern nutrition, including the nutty idea that obesity is only about calories. It’s on my personal to-do list to read his entire, 20 part series on the hormonal perspective on obesity (and take copious notes).
“How do we gain weight? This is the single most important question in obesity. It is impossible to adequately treat any disease without having some understanding of the cause (the aetiology). For instance, if you understand the cause of infections to be bacteria, then you can target bacteria in its treatment. This leads to hand-washing as opposed to, say, leeching. So, how do we gain weight – or more scientifically- what is the aetiology of obesity? That is the question we should be asking.
However, very little time is spent considering this all-important question because we feel that we already know the answer. It is a matter of calories in versus calories out, we say. Eating too much and exercising too little causes obesity, we say. We hold these truths to be so self-evident that we do not even for a minute question their veracity (whether it is true)….
I call this the Caloric Reduction as Primary (CRaP) hypothesis. This means that the primary (but not the only) factor in obesity is calories and reducing calories is the mainstay of treatment. Furthermore, the reason behind eating too much is not hormonal, not hunger, but personal choice. It can also be called the “Calories in, Calories out” model (CICO), and is often depicted as a scale. Calories not used in exercise will be deposited as fat.
Calories In, Calories Out
It is the imbalance of calories that lead over time to the accumulation of fat. It is often called the ‘First Law of Thermodynamics‘ – energy can neither be created or destroyed in an isolated system. This make things sound very science-y and evokes thought of Einstein but thermodynamics has approximately zero to do with human biology. The human body is not an isolated system. Energy comes in and goes out all the time. It is an open system so therefore thermodynamics does not apply in any manner.
Neither the Second nor Third Law of Thermodynamics applies to human beings or other living creatures either, so why should the First Law apply? The answer is that it does not, and people only use the First Law of Thermodynamics in discussion to make themselves feel smart. They also use it to make it seem that their theory of obesity has scientific credibility.
I mean, I don’t apply Heisenberg’s Uncertainty Principle to my breakfast cereal do I? So why should the First Law of Thermodynamics apply to obesity? It doesn’t. But the mere application of this “Law” gives the Calories In, Calories Out folk a sheen of respectability that is not deserved.”
A doctor who spent three decades treating hormone disorders in the mid-20th century, Dr. Astwood was one of the most famous and well regarded endocrinologists of his time. The New England Journal of Medicine heralded his experiments on hyperthyroidism “brilliant,” for instance, and his obituary in the journal Endocrinology sung his praises, calling his record “perhaps unequaled in medicine.”
In 1962, Dr. Astwood gave a landmark lecture, “The Heritage of Corpulence,” which should have (but, sadly, did not) sparked the medical community to abandon the calories-in-calories-out mentality in a New York minute:
“Suppose that the release of fat or its combustion was somewhat impeded, or that the deposition or synthesis of fat was promoted; what would happen? Lack of food is the cause of hunger and, to most of the body, [fat] is the food; it is easy to imagine that a minor derangement could be responsible for a voracious appetite. It seems likely to me that hunger in the obese might be so ravaging and ravenous that skinny physicians do not understand it.
There is no reason to suppose that only one of these mechanisms ever goes wrong… there are so many possibilities here that I am willing to give odds that obesity is caused by a metabolic defect. I would not want to wager about how many enzymes determine the shape of voluminous pulchritude.
This theory would explain why dieting is so seldom effective and why most fat people are miserable when they fast. It would also take care of our friends, the psychiatrists, who find all kinds of preoccupation with food, which pervades dreams among patients who are obese. Which of us would not be preoccupied with thoughts of food if we were suffering from internal starvation? Hunger is such an awful thing that it is classically cited with pestilence and war as one of our three worst burdens. Add to the physical discomfort the emotional discomfort of being fat, the taunts and teasing from the thin, the constant criticism, the accusations of gluttony and lack of ‘will power,’ and the constant guilt feelings, and we have reasons enough for the emotional disturbances which preoccupy the psychiatrists.”
8. Dr. Andreas Eenfeldt — “Here’s what’s wrong with calorie obsession: It’s absolutely meaningless.”
Dr. Eenfeldt is a Swedish medical doctor specializing in family medicine who runs the most popular health blog in Sweden (50,000+ visitors a day). In addition to having a gift for explaining complex nutrition and obesity research in plain language — I had the pleasure of watching him give a stirring presentation on these topics a few years ago — Dr. Eenfeldt has had a powerful impact on the dietary habits of his fellow Swedes, who have begun adopting a Low Carb High Fat (LCHF) diet en masse.
Here’s a beautiful, simple, devastating post he wrote last year about the meaninglessness of focusing on calories:
“We’ve all been brainwashed about calories. A few years ago I believed it myself. Losing weight was exclusively about “consuming less calories than you expend”. The mantra was: “eat less, run more”.
Fat people’s problems – I believed – came from them eating more calories than they expended. They were gluttonous and slothful; they lacked strength of character, which meant that thin people like me had such strength of character. This was uplifting news to me, if a bit prejudiced. This way of looking at things seemed so obvious and simple. Today however, more and more people realizing how inane it is. Soon we’ll look back and laugh at the silliness.
The following explanation may be difficult to understand if you’ve been brainwashed with the “calorie in, calorie out” logic. It takes time to digest the concept (it did for me, too). Here’s what’s wrong with calorie obsession: It’s absolutely meaningless. It may seem logical and smart, but in fact it says naught, zip and nothing.
A typical example:
“Excess calories are the cause of obesity.” This sounds plausible, sure. But what does it really tell us? The fact that an excess of calories will cause weight gain is obvious. Really, it’s obvious to the point of the two things actually being one and the same. An excess of calories is simply the same thing as weight gain. When you realise this, you realise how the statement loses all substance:
Excess calories are Weight gain is the cause of obesity.”
This is plainly meaningless. It may be true, sure, but it’s devoid of any valuable information. It doesn’t say anything about the real causes of obesity.
Other generic statements from calorie fundamentalists include: “The only way to get thin is to burn more calories than you consume.”
As a calorie deficit is equivalent to weight loss, we can expose this flawed proposition as well:
“The only way to get thin is to
burn more calories than you consume lose weight.”
Again: a statement so obvious it becomes useless.”
9. Kris Gunnars — “It is true that all “calories” have the same amount of energy… But when it comes to your body, things are not that simple.”
Medical student and personal trainer, Kris Gunnars, has written many deeply researched, explosively popular blog posts on nutrition and health topics over the past year. Kris has a knack for boiling down complex topics for lay readers without oversimplifying the research or the underlying insights. Some his best work, which you should check out, includes:
Here’s an excerpt from a post he wrote last December: “6 Reasons Why a Calorie is NOT a Calorie.” He examines, among other things, the difference between fructose and glucose, the thermic effect of food, the satiating effects of protein, and the appetite suppressing effects of low carb diets:
“A calorie is a calorie IS a calorie,” they say… that it doesn’t matter whether you eat a 100 calories of candy or broccoli, they will have the same effect on your weight. It is true that all “calories” have the same amount of energy. One dietary Calorie contains 4184 Joules of energy. In that respect, a calorie IS a calorie.
But when it comes to your body, things are not that simple.
The human body is a highly complex biochemical system with elaborate processes that regulate energy balance. Different foods go through different biochemical pathways, some of which are inefficient and cause energy (calories) to be lost as heat. Even more important is the fact that different foods and macronutrients have a major effect on the hormones and brain centers that control hunger and eating behavior. The foods we eat can have a huge impact on the biological processes that govern when, what and how much we eat.”