Thursday, January 08, 2009

Renowned Dietitian Leslie Beck Calorically Confused?

What is it about calories that makes health professionals not want to talk about them?

Some say that teaching people about calories will lead to increased incidences of eating disorders - yet there's never been any evidence published to suggest that would be true.

And really it's more about how you talk and teach about calories.

At my offices we teach people to be non-judgmental about calories. They're not by definition, "bad", it's just that we have to pick and choose when they're worth it.

It's a money type analogy - before you buy anything it's probably a good idea not only to look at the price tag, but also to know how much you've got in your bank account and how much you make a month. We all buy things we don't need, but we of course don't buy every last thing we want - some things just aren't worth their price tags and frankly some foods just aren't worth their calories.

The other thing we teach about calories is that rather than worrying about maximums, worry about minimums - eating too few of them at any given meal or snack and you're asking to get hungry and as anyone who's ever gone to the supermarket hungry knows, hunger influences our choices.

Of course there's much more to successfully losing weight than simply keeping track of calories. Elements such as the timing of meals and snacks, macronutrient distributions, protein consumption, learning how to cook, finding time, planning and meal preparation, shopping skills, media awareness and so on.

Which brings me to Leslie Beck. She's a very prominent Toronto based dietitian and I often quite like what she's got to say. Yesterday though wasn't one of those times.

Yesterday she wrote an article for the Globe and Mail that told readers that the key to weight loss was simply portion control and explicitly discouraged them from looking at calories.

Why is her assertion ridiculous and upsetting?

Well it's upsetting because she knows better. It's upsetting because there's this non-complicated factor of which she's well aware called energy density. What energy density refers to is the fact that gram per gram some foods have more calories than others. What that means is that even eating small portions of highly energy dense foods can lead to the consumption of large numbers of calories. By not including this concept in her article and by simply telling people to eat less, she's doing a disservice both to the public and to the privilege she enjoys of being able to reach huge numbers of people.

It's a ridiculous assertion because basically Leslie is telling her readers that in order to lose weight you simply have to eat less. While ultimately that's true it's about as useful a piece of advice as someone telling you that to get rich all you need to do is, "buy low and sell high" in the stock market. In Leslie's case the analogy would be to an actual stockbroker giving you that sage advice.

If it were that easy Leslie, everybody'd be skinny.

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10 comments:

  1. Anonymous7:30 am

    Dieticians don't know anything about diet. They are by and large the most humorless, banal individuals. They are completely disconnected from what people face in the real world. Everyone of them who writes for the popular press offers up watered down, party line drivel. Good for you for taking her to task. More should be.

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  2. Unrelated (or maybe related?), I recently saw this commercial about high fructose corn syrup that Ilan and thought was hilarious: http://www.youtube.com/watch?v=KVsgXPt564Q

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  3. Andrew11:17 am

    Anonymous - it is quite ingenious of you to anonymously state that dietitians "know nothing about diet" but maybe you should refrain from making such broad, sweeping, useless statements. Since my doctor referred me to a dietitian, I have lost 65 pounds and my medical status has improved in all areas (blood pressure, cholesterol, blood sugar). I am off all medication that I used to take. Referring me to her was the best decision my doctor has ever made and, frankly, she has done more to help me than he ever has. The only thing he ever managed to do was put me on pills. Not once did he offer helpful advice about changing my lifestyle. I feel better than I have felt in 15 years and will continue to see my dietitian for information and support. So in conclusion, Anonymous, your comments are unfounded and baseless.

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  4. Anonymous11:27 am

    While you have a point with her comments on calories, if you read further down in the column, she refers directly to energy density:

    "BULK UP YOUR MEALS

    Foods such as fruit, vegetables, whole grains, broth-based soups, low-fat milk, legumes, poultry breast and white fish are called low-energy-density foods. They provide a larger portion size for fewer calories, thanks to their water and fibre content.

    Desserts, processed foods, crackers, chips and oils have a high energy density - a small portion has a large number of calories. Medium-energy-density foods include cheese, salad dressing, meats and breads.

    Research shows that eating larger quantities of low-energy-density foods and smaller portions of foods with high and medium energy density increases satisfaction and reduces caloric intake more effectively than drinking water with a meal."

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  5. It's a fair point Anonymous (the one talking about energy density).

    Of course a discussion on energy density is moot if you've explicitly told people not to keep track of calories and unfortunately that's just what Leslie did in her opening line, "If you've resolved to shed those extra pounds this year, forget about counting grams of fat, carbohydrate blocks or even calories". The problem herein is that energy density is not always intuitive and if you're not looking for calories, you can't always guess it right.

    If the "eat smarter" diet worked, I'd be working in an emergency room instead of helping people lose weight.

    While I'm posting - I need to disagree with an earlier anonymous poster. Dietitians, including Leslie who I agree with most of the time (and you know what, we're allowed to disagree and it doesn't mean I'm right and she's wrong, just that we disagree), are a great resource. While it's true there are some who might not be terrifically helpful or skilled, that's true for any and every profession.

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  6. Anonymous2:19 pm

    Thank you for this post, Yoni. I am not usually confused after reading Ms. Beck's column; however, this time I was wondering if I had gotten something wrong.

    And to the first Anonymous poster: please do not paint all dietitians with one brush. My dietitian, BMI's Shawna Hunt, is the antithesis of humourless/banal/disconnected from the real world. Her knowledge -- and her empathy -- have been, and continue to be, invaluable to me and many others. VP

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  7. Michelle4:09 pm

    Yoni, I have to disagree with you on this one. Anonymous #2 is correct – Leslie does very clearly address the issue of energy density in this article.

    I think her article is for those folks who have NO INTEREST at all in counting calories or in knowing the calorie counts of foods. There are MANY people out there who are like this. You talk to them about calories and their eyes gloss over, they think “diet” and they are automatically resistant. There is something to be said for intuitive eating principles (“mindful” rather than “mindless” eating) which can be learned, over time, through portion control and paying very close attention to hunger cues. It is not *necessary* to calorie count in order to lose weight.

    What Leslie IS doing is letting people know that they CAN lose weight without having to count calories but following two main steps:
    1) Reducing portion sizes.
    2) Eating larger quantities of low-energy-density foods and smaller portions of foods with high and medium energy density

    Guess what? By following these main steps, one's calories will, by default, be reduced. And they didn’t even have to be counted.

    In addition, her article DOES address factors other than ‘simply having to eat less’, including managing hunger: “Before you start controlling portion size, you may need to rein in your appetite. In order to feel satisfied with less food at meals, you need to eat three small meals plus two healthy snacks throughout the day."

    She also talks about eating slower and portioning out food, both of which are strategies that have been shown to reduce mindless eating and direct attention to hunger cues.

    She clearly does not say that losing weight is just a matter of reducing portions as you imply. Her article address multiple factors and considerations. I think your blog post was unfairly critical.

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  8. Christina7:25 pm

    I am a dietitian and would like to comment that as a profession we are conscious of making suggestions that are sustainable and practical lifestyle changes, not a diet that you are on or off (such as high protein, very low calorie, etc). Eating smaller portions of the foods you usually eat is one of the most straightforward and practical ideas for weight management.

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  9. Michelle and Christina,

    Perhaps I was too critical of the tenor of the piece.

    That said, I don't think it's useful, and in fact think it's downright counterproductive, for health professionals providing advice about weight management to specifically recommend not looking at calories.

    Those folks who want to lose weight but have no interest in understanding/looking into calories are in most cases unlikely to be successful in the longterm.

    Calories are not intuitive.

    Leslie knows that better than most (feel free to google her post on the hidden calories in restaurant meals) and while it may not be what people want to hear, and while it may be a pain in the butt, the likelihood of a longterm success without the inclusion of calorie awareness is low.

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  10. I don't count calories, I eat smaller portions of some things, bigger of others. Obviously, I'm not totally ignorant of calories, but I pay much more attention to food density, which I can feel sometimes by how tired and sluggish I feel after eating something. I've lost 25 pounds so far, 25 or so left to go.

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