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Why Calories Count

From Science to Politics

Marion Nestle (Author), Malden Nesheim (Author)


Calories—too few or too many—are the source of health problems affecting billions of people in today’s globalized world. Although calories are essential to human health and survival, they cannot be seen, smelled, or tasted. They are also hard to understand. In Why Calories Count, Marion Nestle and Malden Nesheim explain in clear and accessible language what calories are and how they work, both biologically and politically. As they take readers through the issues that are fundamental to our understanding of diet and food, weight gain, loss, and obesity, Nestle and Nesheim sort through a great deal of the misinformation put forth by food manufacturers and diet program promoters. They elucidate the political stakes and show how federal and corporate policies have come together to create an “eat more” environment. Finally, having armed readers with the necessary information to interpret food labels, evaluate diet claims, and understand evidence as presented in popular media, the authors offer some candid advice: Get organized. Eat less. Eat better. Move more. Get political.

Part One. Understanding Calories: It All Starts with the Science
1. What Is a Calorie?
2. The History: From Ancient Greece to Modern Calorie Science
3. Food: How Scientists Count the Calories
4. Bodies: How Scientists Measure the Use of Calories

Part Two. Why We Need Calories: Survival, Warmth, and Work
5. Metabolism: How the Body Turns Food into Energy
6. The First Use of Calories: Basic Life Functions
7. The Second Use: Heat Losses while Metabolizing Food
8. The Third Use: Physical Activity

Part Three. Calorie Intake and Its Regulation
9. How Many Calories Do You Need?
10. Calorie Confusion: The Struggle to Estimate Intake
11. Secret Calories: Alcohol
12. Calorie Regulation: The Body’s Complex Weight-Management System

Part Four. Too Few Calories
13. Starvation and Its Effects on the Body
14. Individuals, Communities, Nations: Calories and Global Hunger
15. Could Restricting Calories Prolong Human Life?

Part Five. Too Many Calories
16. An Introduction to Obesity
17. Calories and Weight Gain: Another Complex Relationship
18. Do Excess Calories Make Some People Gain Weight Faster than Others?
19. Are All Calories Created Equal?
20. Do Some Kinds of Diets Work Better than Others?

Part Six. The Politics of Calories: A Closer Look
21. Today’s “Eat-More” Environment: The Role of the Food Industry
22. More Calorie Confusion: Portion Distortion, Health Halos, and Wishful Thinking
23. Calorie Labeling: Science and Politics
24. Alcohol Labels: Industry vs. Consumers
25. Will Calorie Labels Help Fight Obesity?

Conclusion: How to Cope with the Calorie Environment

Appendix One. Selected Events in the History of Calories, 1614–1919
Appendix Two. The Respiratory Quotient (RQ)
Appendix Three. Frequently Asked Questions

List of Tables
List of Figures
Marion Nestle is Paulette Goddard Professor in the Department of Nutrition, Food Studies, and Public Health and Professor of Sociology at New York University. She is the author of What to Eat and, from UC Press, Food Politics: How the Food Industry Influences Nutrition and Health; Safe Food: The Politics of Food Safety; and Pet Food Politics: The Chihuahua in the Coal Mine. Malden Nesheim is Professor Emeritus of Nutritional Sciences at Cornell University. He is coauthor (with Marion Nestle) of Feed Your Pet Right: The Authoritative Guide to Feeding Your Dog and Cat and (with Ann L. Yaktine) of the Institute of Medicine report Seafood Choices: Balancing Benefits and Risks.
“Obesity has gone global — as has misinformation about nutrition and food. Nutrition scientists Marion Nestle and Malden Nesheim unscramble the confusion with a serving of science. They reveal how calories — those potent but ill-understood measures of heat energy — are really counted, why we need them, how we use them, how many we actually need and why it all sometimes goes so wrong. From 'secret' calories to food politics, malnourishment and calorie restriction for health, this is a feast for the mind.”—Nature
“A diner’s elemental guide to eating. . . . Why Calories Count weaves scientific and social tales into a rich portrait of the American diet and the laws that have shaped it. . . . Sounds like the most succinct diet book ever written.”—The Scientist
“Along with offering a fascinating history, they show how an understanding of calorie needs saved lives in the global fight against hunger - and can save more from obesity.”—Emily Kaiser Thelin The Wall Street Journal
“People should read this book. They should read it if they are obsessive weight-watchers or serial dieters, or just concerned about what their children eat. They should read it if they work in public health, the food industry, catering, or education.”—Times Higher Education
“If the ‘dummy’ catch-phrase wasn't already such a going enterprise, the new book from Marion Nestle and Malden Nesheim might easily have been called ‘Calories for Dummies.’ As it is, their ‘Why Calories Count’ takes the science of calories and breaks it down for the rest of us.”—San Francisco Chronicle
“This book will help dispel many of the commonly held myths we have about eating. An informative and interesting read for those who want to know the science behind calories, food and weight.”—Huffington Post Books
“Both you and your students should read this book. . . . There is great breadth and the style is stimulating and provocative.”—Amer Journal Clinical Nutrition
“Nestle and Nesheim are eminent scientists and excellent communicators. . . . What clearly differentiates this book from all others of its kind is the additional admonition for everyone to help ‘politicize’ calories, thereby making all people winners in the war against the obesity epidemic and its debilitating afflictions.”—Choice
“Dr. Marion Nestle and Dr. Malden Nesheim’s Why Calories Count: From Science to Politics, is not a diet book selling you on the newest trend nor does it encourage you to count calories. Instead it does the seemingly impossible: it takes calories from the abstract to the concrete. Nestle and Nesheim explain the significance of the calorie not only in understandable scientific terms, but also in social terms with the explicit aim of helping their reader navigate the convoluted world of food labels and diet fads.”—Civil Eats
“Why Calories Count: From Science to Politics is far from a diet book. Authors Marion Nestle and Malden Nesheim do an outstanding job of evaluating how a simple unit of energy becomes a confusing mess in the hands of diet purveyors, food manufacturers and unrealistic consumers.”—Ft. Worth Star Telegram
“Meticulous scholarship and a rare ability to make complicated biological processes understandable to nonscientists. . . . A plate of fresh insights into the expanding American waistline, and policy’s proper role in shrinking it.”—Health Affairs
“An encouraging and fascinating story about the mighty yet invisible calorie. . . . Particularly helpful is the section on various fad dieting strategies. And particularly encouraging is the flexible, understanding tone throughout the book. Nestle and Nesheim love to eat, and want you to enjoy the pleasures of good food too. . . . If you feel overwhelmed by conflicting diet claims or just want to be a better grocery shopper, Why Calories Count is for you.”—Linda Watson, Founder, Cook For Good Huffington Post/Healthy Living
“I like that Nestle empowers readers to understand larger social forces behind the food they’re eating, and then get right in and try to change them.”—Hyphen
“A strong, rigorous overview of the calorie, its regulation and the politics behind food labeling and marketing.”—Kirkus Reviews
“Neither a diet nor a weight-loss book, this scholarly, seriously researched work assists readers in evaluating diet claims, formulating strategies to lose, gain, or maintain weight, and learning how to make healthy food choices. Nestle and Nesheim focus on the history of the calorie and its relationship to body weight, the science behind metabolism, how to estimate calories in a given portion, and—what will probably be of most interest to the general reader—the role of big business in creating calorie-laden food and why it's less politically controversial to recommend exercising than cutting back on calories.”—Library Journal
1. Start — as many of those involved in the food movement did — with Marion Nestle, the nutrition and policy guru and an all-around heroine. (Her daily blog, Food Politics, is always worth a look.) Put simply: eat per Marion’s advice and you’ll be eating better. (You’ll probably live longer, too, but as Marion might say, ‘the studies are incomplete.’)”—Mark Bittman New York Times
“With its careful research, lighthearted tone, and eye-opening research, this book certainly lived up to my expectations.”—Serious Eats
“In their new book, Ms. Nestle and Malden Nesheim, both esteemed nutritionists, argue for the importance of calories. Along with offering a fascinating history, they show how an understanding of calorie needs saved lives in the global fight against hunger—and can save more from obesity.”—Wall Street Journal/Bookshelf
"Whether you're interested in the twin public health crises of obesity and malnutrition, curious about the process of digestion, or just looking for a scientifically supported path to a beach body, you should find Why Calories Count an enlightening read."—Science
"Interesting questions are posed."—Taste For Life
"If you want to understand what's wrong with our eating habits, you must understand the central role that calories play. Nestle and Nesheim are two of America's finest nutritionists–and this book explains, clearly and succinctly, why calories count. It is essential reading not only for people interested in food policy, but for everyone who wants to eat well and be well." –Eric Schlosser, author of Fast Food Nation: The Dark Side of the All-American Meal

"This superbly well-researched and scientifically sound book makes it clear how today’s food environment often overrides physiological regulatory controls of body weight. Why Calories Count is essential reading for anyone who wants to understand why so much about food choice lies in the hands of food marketers whose goal is to sell more products, not necessarily in the interests of public health." –Dr. David Kessler, author of The End of Overeating: Taking Control of the Insatiable American Appetite

“We need to understand what ‘empty calories’ are, so that we can feed our children food that is truly nourishing. On this topic, there is no better teacher than Marion Nestle, who writes with meticulousness, clarity and grace.” –Alice Waters, author of The Art of Simple Food: Notes, Lessons, and Recipes from a Delicious Revolution

"Thank god authorities like Nestle and Nesheim have teamed up to give us an epic view of a calorie: what it is, where it came from, what it means, how and why we count them. Thank god they’ve managed to decode nutritional science into a commonsense language we can all understand. And thank god they’ve put calories in their place in a wider cultural and political context to help us think meaningfully about the food our lives depend upon. I’m grateful." –Betty Fussell, author of Raising Steaks: The Life & Times of American Beef

“Calories. We all talk about them—many are even obsessed with them—but what do we really know about them? Not much. Marion Nestle and Malden Nesheim’s latest book changes all that, pulling back the curtain on calories and helping us understand them in a whole new light. You’ll never look at a 100-calorie pack of corporate cookies the same way again.” –Anna Lappé, author of Diet for a Hot Planet: The Climate Crisis at the End of Your Fork and What You Can Do About It

Finalist for IACP Cookbook Award in Food Matters category, International Association of Culinary Professionals

Chapter 22

More Calorie Confusion

Portion Distortion, Health Halos, and Wishful Thinking

For many years Dr. Lisa Young, an expert on portion size and author of The Portion Teller (Crown, 2005), has taught an introductory nutrition class at New York University. As a favor to us, she agreed to devote some time on the first day of class to asking students about their basic understanding of food calories. Among her questions were these: How many calories are in an 8-ounce soda? How many calories are in a 64-ounce Double Gulp soda?

We did not expect beginning students to know the number of calories in an 8-ounce soft drink, and most did not. An 8-ounce soft drink contains about 100 calories. A drink 8 times larger should contain 8 times as many calories-800. Although this is not higher mathematics, only about a quarter of the class correctly multiplied the number they guessed for the size of the smaller drink by 8.

Instead, a large majority of students-nearly 70 percent-underestimated the calories in the larger drink. The underestimaters typically multiplied the calories in the 8-ounce drink by an average of 3, not 8. How could this be? We asked Dr. Young to try to find out from her students why their estimates were so far off. Their answer: 800 calories in a soda is impossible. They simply did not believe the math. Soda package labels, the students pointed out, never say "800 calories"; they say "100 calories per serving." Besides, drinking sodas doesn't make them feel full.

We should not have been surprised. In lectures, we often show a photograph of Dr. Young posed behind soft drink containers ranging from 8 to 64 ounces. When we tell audiences that a 64-ounce soda has 800 calories, we are met with gasps of disbelief-even from trained nutritionists. As we keep pointing out, calories are invisible and devoid of taste. You cannot tell how many are in a food just by looking at it or even tasting it. If you eat anything other than packaged foods with Nutrition Facts labels or anyplace other than fast-food restaurants that post calories on menu boards, you can only guess the number of calories in your foods. If you want to know how many calories you are eating, you have to weigh every ingredient in everything you eat and drink and look up the calories in food composition tables. Even so, these will only be estimates that depend on the accuracy of your weighing. Restaurant calories are particularly difficult because customers have no idea (and are not supposed to know) how the foods were prepared.

This is not because people are ignorant. Even professional nutritionists cannot estimate calories accurately. In the mid-1990s Marion Nestle and Lisa Young demonstrated this embarrassing fact when they were invited by New York Times reporter Marian Burros to lunch at a fine Italian restaurant in company with some other nutrition educators. Burros ordered two of everything on the menu. She asked the nutritionists to guess the calories in one set of meals and sent the matching meals off to a laboratory to be analyzed. Not one of the nutritionists came close to guessing that the small, lunch-size portion of risotto, for example. contained nearly 1,300 calories. These professional nutritionists underestimated the calories in those meals by about 30 percent. Errors of that size are typical.

In another such experiment, Lisa Young asked dietitians attending an annual meeting of the American Dietetic Association to estimate the number of calories in samples of several fast-food meals. The dietitians accurately guessed the calories in a glass of whole milk but underestimated those in the mixed meals by the usual 30 percent or so. For example, when shown a typical chain-restaurant hamburger and onion rings, they guessed 865 calories on average, whereas the meal actually contained 1,550.

Calorie estimations are especially inaccurate when the food portions are large and when the foods appear to be healthy, as researchers have repeatedly demonstrated.

The Portion Size Effect

Even students trained to know that portion size influences calorie estimations get fooled by large portions. Cornell professor Brian Wansink demonstrated this phenomenon in his famous Super Bowl experiment. He invited students to his home to watch a Super Bowl game. He put half of them in one room with 2-quart bowls of snacks and the other half in another room with 4-quart bowls. The students who were served snacks from the larger bowls consumed about 50 percent more calories than those served from the smaller bowls. Both groups underestimated the calories they had eaten, but those served the larger portions underestimated by a much larger proportion.

These students should have known better. Even though they had heard lectures from Professor Wansink about the influence of large portions on the amount of food people consume, they ate more from the larger bowls anyway. And so does almost everyone else when confronted with large food portions.

The "Health Halo" Effect

People tend to underestimate the calories in foods that they perceive as healthy. This has led researchers to suggest that health claims cause a systematic bias in calorie perception. Brian Wansink and his colleagues call this the health halo effect. We think of all such marketing methods as calorie distracters. Whatever you want to call the phenomenon, much evidence indicates that marketing a product as healthy makes people think it has fewer calories:

• When fast-food restaurants position themselves as healthy, customers tend to underestimate the calories in main dishes and choose higher-calorie side dishes, drinks, or desserts.

• When portions are labeled small, people believe they are eating fewer calories regardless of the number of calories the foods contain or their actual size.

• When Oreo cookies are labeled as organic, people perceive them as having fewer calories than conventional Oreos. This happens even when the study subjects have been shown package labels indicating that calories are equal in both kinds of cookies.

Studies suggest that any health label on a food product-"no trans fat," "vitamins added," "contains antioxidants," "contains probiotics"-will encourage customers to believe that the calories don't count, or don't count nearly as much.

The Dieting Effect

Some research has suggested that overweight people tend to underestimate the number of calories they eat to a greater extent than do people of normal weight. It also suggests that the degree of underreporting increases with increasing overweight. But as Brian Wansink and his colleagues point out, underreporting is more likely to be due to the effect of the size of the meal than to weight itself. People who are overweight eat larger meals and, therefore, underestimate calories by a larger fraction. Although some studies suggest that people who are dieting deliberately underreport calorie intake, most research finds that nearly everyone underestimates calorie intake regardless of their body weights or dieting status.

The "Negative Calorie" (or Wishful Thinking) Effect

We have argued throughout this book that calories do count, so we are especially amused by the claims of some diet books that certain foods use up more calories in digestion, absorption, and metabolism than they contained in the first place-that their thermic effects are greater than their calorie values. This, of course, is physiologically impossible. The maximum thermic effect of food, as we discussed in previous chapters, is 20 to 30 percent (for protein), which still leaves plenty of calories left over. The only example of negative calories that we can think of is what happens when you drink ice-cold water. Water has no calories, but it takes some heat-about 100 calories per quart-to warm it to body temperature. A quart is quite a lot of water, and ice-cold water is not always comfortable to drink. We do not view this method as a convenient way to waste calories.

But we enjoy negative-calorie studies, and here is a favorite. The investigator came up with the idea that "people intuitively believe that eating healthy foods in addition to unhealthy ones can decrease a meal's calorie count." To test this idea, he showed bowls of chili with and without a side salad to volunteers. On average, the study subjects guessed that the chili alone contained about 700 calories. But when they saw the chili along with a green salad, they thought the meal provided only 655 calories, 45 fewer than the chili alone-as if, as the investigator put it, the salad had negative calories. People who said they were dieting were twice as likely as nondieters to make this error.

And then there are the claims of the Negative Calorie Diet, ostensibly "based on more than 100 negative calorie foods requiring your body to BURN more calories than the actual calorie content of the food itself!" On this diet you are supposed to be able to eat all you want of more than a hundred negative-calorie foods, lose weight, and not feel hungry. What are these magic foods? Just the low-calorie, high-nutrient-density fruits and vegetables that you might expect to be recommended to someone who is dieting: celery, grapefruit, lemon, lime, apple, lettuce, broccoli, cabbage, and other such items.

In practice, the negative-calorie idea sounds much like the well-researched volumetric approach developed by Professor Barbara Rolls at Pennsylvania State University. Eating low-calorie fruits and vegetables helps with weight loss because they fill the stomach and make you feel satisfied. As Julie Upton explains in an article on myths about metabolism, "A medium-size rib of celery has only about 6 calories; its [thermic effect] is approximately half a calorie. In reality, 'negative calorie foods' are nothing more than wishful thinking."

The "Calorie Oblivion" Effect

Overall, surveys and research studies consistently report widespread public misunderstanding of calories not only in food but also in the body. In May 2011, for example, the International Food Information Council, an educational arm of the food industry, published the results of its sixth annual survey of consumer attitudes toward food safety, nutrition, and health. The survey asked about perceptions of caloric intake and expenditure. Here are some of its findings:

• Only 9 percent of respondents came close to estimating the correct number of calories they might need each day.

• One-quarter thought they required 1,000 calories a day or less.

• Sixty percent said they had no idea how many calories they needed to eat.

These results were similar to those obtained a year earlier, when USA Today quoted the nutritionist Dawn Jackson Blatner: "Nobody knows how many calories they should be eating, nobody knows how many they are eating, and nobody knows how many calories are in foods. ... I would say it's beyond calorie-confused. It's calorie-oblivious."

Given widespread calorie oblivion, and short of doubly labeled water experiments, how are you supposed to know whether your calories are in balance? We know only one way: weigh yourself on a scale at regular intervals. If your calorie intake pretty much equals your expenditure, your weight should stay about the same over time, within a range of a couple of pounds. And your belt should not require adjustment.

But it is worth knowing about calorie oblivion for one other reason. The inability to judge calories with reasonable accuracy is reason enough to support better public education about calories in food and the number required to maintain body weight. And that brings us to recent efforts to improve calorie information on food labels and restaurant menus.

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