The Calories In, Calories Out Fallacy
Helping patients lose weight has become one of my most rewarding experiences in practicing medicine. At the same time, it can be overwhelmingly frustrating. I chose nutrition in my undergraduate studies because I believed it would make a solid foundation for medical treatment, as I had always been interested in health and medicine. Little did I know at the time we were being taught by the flawed guidance of the USDA Food Pyramid, and that most conventional medicine is often based on treating symptoms and not focusing on metabolic causes. Appointments also rarely leave time for anything other than the basic advice of “eat less, move more”. Even the primary takeaway from my initial nutritional studies was to eat in “variety and moderation.” How does a patient even apply that to their life?
It's complicated.
If you attend a conference on obesity medicine, as I did just a few weeks ago, you will hear impassioned physician lectures on every diet imaginable. All of them will cite research on why their plan works best. Many of them will even have written books or started podcasts on the wonders of their advice. All of them will also have happy patients with success stories on that plan. Dr. Neal Barnard promotes a vegan, plant-based diet. Dr. Jason Fung promotes intermittent fasting and a low-carb diet or ketogenic diet. Dr. Valter Longo (PhD) promotes the longevity diet and fasting-mimicking program. Dr. Gabrielle Lyon promotes muscle-centric medicine with a focus on strength training with high protein diet. The list goes on.
How can they all be right? Do all roads lead to Rome? Indeed, all plans do have success stories, but they do not work for everyone. There is a gap between research and clinical application.
Do you feel that you have tried everything and still cannot keep the weight off? You are not alone. And it is not about will power. Weight loss is more complicated than “eat less and move more”. Everyone is unique in their wellness journey. Your age, gender, other comorbidities and medications, exercise and muscle mass, food quality, eating times, microbiome, stress, unhealthy relationships with food, sleep quantity and quality, and genetics all play a role.
So where do you start? What do most plans agree upon?
Generally, more plants are probably a good thing, and eat whole foods. Minimize, eliminate where possible, energy-dense foods such as sugar-sweetened beverages and juices. Minimize, or eliminate, ultra-processed foods of minimum nutritional value such as refined grains (white flour), “sweets” (cookies, cakes, candies), “junk foods” (chips, etc) and ultra-processed meats (bacon, sausage, hot dogs, lunch meat). Minimize, or eliminate, trans fats and excessive sodium.
According to the Obesity Medicine Association, ‘health outcomes are most improved with nutrition therapy when the dietary interventions are evidence-based, quantitative, qualitative, and facilitate patient engagement and adherence.” This is why I support unique plans for each patient. There is no secret that will suddenly make this effortless, and beware of anyone who advertises such promises. There are also no “bad” or “forbidden” foods, just mindfulness of your relationship with food and the recommendation to minimize foods, or food-like substances, that do not fit into your wellness journey.