Tuesday, March 23, 2010

Calories and the new American health care bill

In a move I strongly support, the new American health care bill includes the provision of chain restaurant calories at point of sale directly on the menu boards. Sure it'll preclude tougher State based laws but all told, this is a huge step forward for calorie awareness and for folks who might be trying to track their caloric intakes.

I've never really understood why it is that so many folks think calorie counting is difficult.

I'd like to make the argument that counting calories is easy, though accuracy can be difficult.

Before I get into the how of counting calories I'd like to talk about the why. As I've said many times before, calories are the currency of weight. If weight's a concern to you, whether the concern's to gain, maintain or lose, caloric intake is certainly the most important factor for you to consider. The problem of course is that calories aren't visible or intuitive and simply looking at a food or a meal doesn't tell you anything about its calories. If you wouldn't consider shopping without looking at pricetags, I'd argue you shouldn't consider eating without looking at calories.

There is some good news. There's more caloric information available now than ever before. Whether it's a calorie counting book, a website, the product's package, the restaurant's nutritional information webpage and thanks to the new US health care reform bill all American chain restaurant menus and apparently even vending machines, it's not tough to find calories. There's also umpteen different means to track. From hardcopy food diaries, to free online services such as Sparkpeople, to iPhone, Android and Blackberry applications, to Twitter as well as cheap recipe analyzing programs such as Mastercook 9.0.

Regardless of the way you go about it, I'd argue on a terrible day tracking calories will take you 20 minutes of effort and that once you're good at it, that effort likely won't exceed 5. Why? People are pretty boring. We eat the same foods over and over again and once you've learned the calories in your foodscape off by heart, tracking will take seconds.

Two things matter in record keeping. Completeness and accuracy and they're different. Completeness means writing foods down as you go along. Studies show that if you wait until the end of the day to recall what you've had you'll forget stuff, and you won't think you did because that's what forgetting is. So I recommend eat something and write it down immediately. However for two reasons I'd recommend not looking the calories up until the very end of the day. Firstly time. It takes virtually no time to write foods down, but it does take time to look them up. I'd rather you wait until the end of the day and set aside 10-20 minutes to look things up rather than get frustrated flipping through a calorie book all day long. Secondly because I don't think calories should be treated as a ceiling. Thinking you've only got a few hundred left for dinner is a diet and while indeed I think it's important to learn from your choices, I don't want you to feel blindly restricted and end of day addition may prevent you from getting too hung up in "what's left". Food diarizing is about guidance, not judgement.

Accuracy's the other thing I mentioned. Scales, spoons, cups - they've all got to be employed, but do remember they're there to tell you how much you had, not how much you're allowed. You're the boss, not a cup.

People seem extremely comfortable with the notion that to lose weight successfully they'd need to spend a bit more time exercising, yet many of those very same people who are willing to find 30 minutes a day to exercise seem to be hesitant to spend 5 minutes a day scribbling in a book. That's a shame because those 5 minutes of scribbling, so long as it was both complete and accurate, would likely have a far greater impact on their ability to manage their weight than the gym would.

It's easier to lose weight with pens in kitchens than in gyms with dumbbells though of course ideally you want to try to do both.

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  1. So, first -- love your blog.

    Second, I'm new to the calorie counting thing (been doing it for about a month, and the results speak for themselves). But I'm trying to figure out how to handle restaurants. If we're going to go out, my fiance and I are more tempted to go to chain restaurants because they have calorie information available. This seems wrong. Do most people just add up the food they eat out and then add a bit because it's a restaurant?


  2. Sadly, before California required calories on the menus, I would have agreed with you on this point (although I don't think it belongs in the healthcare bill but elsewhere), but after seeing it in play in my own state, I can tell you that it doesn't work.

    1.) Fact: State can't enforce it. Some restaurants comply, some don't. Try to report it? Don't bother. Difficult to find any agency who will listen, and then there is no money for them to follow up on it.

    2.) Fact: Calories on menus are frequently incorrect by design. As quoted by a waiter "off the record in secret just to us" at Cheesecake Factory, "We purposely don't put the right calories on the desserts. If we did, nobody would buy them. Everyone wants cheesecake at Cheesecake Factory but a lot change their mind when they find out that one serving is really 2500 calories."

    3.) Fact: Calories for same meal differs from restaurant to restaurant depending on cook and how much oil/butter/dressing he uses. The differences can be quite dramatic, and you wouldn't necessarily know the difference because you're head is believing the menu rather than your taste buds which are screaming "this is way to oily to only have 850 calories."

    4.) DISAPPOINTING FACT: Even amongst my weight loss friends at Richard Simmons, some who are success stories and some who are struggling, whenever we go out to eat together, I am the ONLY one who asks for and considers calories when ordering the meal.

    Everyone else at the table is uncomfortable that I am looking at it when they don't want to. They don't even feel peer pressure to think about it, and if you can't get a group of people dedicated to weight loss to look at it, how many of the general public are going to care?

    Very few are using this information in California - in my opinion - and it is waste of time/money to force restaurants to supply it. For those of us who are interested, we educate ourselves to make good estimates of what we are eating anyway, and for the rest, you cannot legislate cultural norms or denial syndrome out of existence.

    Additionally, as an extremely ill person less than 24 hours out of my last hospital stay and just qualified for an experimental protocol while I was there as a measure of desperation to attempt to give me some relief, I hate that federal money is being spent on "education" when the purpose of this bill was supposed to supply support to sick people who are in desperate need of financial help and affordable health care.

    Calories on a menu are like leading a horse to water. Those of us who want to know what they are eating are going to figure it out anyway; and the rest are not going to drink.

  3. mavis2:11 pm

    With the new law about calories in restaurants taking shape I noticed something fascinating at my local theater. They used to have a board up above registers at the back wall of the food court that listed all the foods and their prices. With the new law requiring them to post calories they knew patrons would not chose as many high calorie options. So they installed huge flat TV screens that flash the foods for only a few seconds with the calories at the end of the line item in smaller text. Then they flash delicious pictures of the foods in between. It was very difficult to focus on trying to learn the calories as I got closer to the cash register. It took me 10 minutes to try to get the information but in the end I found out that the ice cream cone I was considering was 950 calories and opted for a low fat milk instead. It will be hard, it will take time, but Yoni willing, we will have informed consent!

  4. The reports re the calories laws in New York have been mixed. Depends on where you are with the issue as far as whether it appears to be useful or not -- from a behavioral change aspect.

    The one thing that I do think that may prove useful is the extent to which these laws change the behavior of the producers of these foods rather than the consumers.

  5. Sorry it took me so long to respond. Was in Toronto for a meeting.

    First Ben - studies on restaurant calories, even posted calories, reveal that they're inaccurate. Posted calories probably should be inflated by 20% if you're counting. Non posting things get even dicier. Studies suggest that the more outrageously calorific something is, the more we underestimate it. Guess and add 50% is probably undershooting but is what we tend to recommend.

    Laura and Beth - the studies seem fairly clear. Education and an anchoring statement are what's required to utilize the numbers for average folks. I blogged about this a ways back but simply put, the provision of calories without an explanation as to how many a person requires isn't useful and potentially may be detrimental. On the other hand, providing the anchoring statement of how many calories a person generally needs per day helps and I imagine so too would public health campaigns focused on that very fact.

    Furthermore without a doubt this information has a dramatic impact on those folks who are actively trying to lose weight as they obviously are more invested in the numbers.

    Mavis - I look forward to blogging about all sorts of shady things the food industry is bound to do to try to keep the playing field calorically unlevel.

  6. "Studies show that if you wait until the end of the day to recall what you've had you'll forget stuff, and you won't think you did because that's what forgetting is."

    Anything beginning with "Studies show ..." is suspect. ;-) Cite the studies. Grad student in nursing school doing a class assignment?

    Anyway, I really disagree with this statement. Sure, for the first week you forget stuff. But your memory improves very quikly, until it's perfect.

    My experience with this is from three areas: One, I have counted calories. Two, I have logged my expenses. Three, I have given up the use of daily planners and remembered all my appointments.

    In all cases, after a week my memory was perfect. In the case of money it's easiest to prove: You enter it in Quicken at night and then compare the wallet account balance with your actual wallet: If you make a mistake, they don't match.

    What happens is that at night you "relive" your day, and you remember stuff in order. I think this actually may have some beneficial cognitive effects, and older people in particular should do it.

    Another factor is that when you're keeping track of stuff, at the point of decision (eating, spending) after a week you get to the point that you just don't do it because you know you'll have to write it down at night.

  7. Mark VII,

    I'd tweak your skepti-meter a bit. What you need to learn is who to trust and who not to trust.

    Better yet, spend the few seconds necessary yourself to look things up.

    In this particular case I didn't bother with references because it is such an established truth.

    If you'd like to peruse some of the studies yourself, feel free to click here.

    Thank you too for providing the readers with an example of why personal anecdotes aren't a replacement for actual evidence.

    (Oh, and by the way Mark, regarding memory. You'd never know if you forgot anything because that's what forgetting is. The only way you could be sure would be for someone to be following you along and keeping track with you)

  8. > so many folks think calorie counting is difficult

    "more difficult than the alternative" [0]

    eventually gets read as

    "too hard"

    [0] more accurately,
    "more difficult than the ineffective alternatives"

  9. with appointments and money the feedback is near-immediate - one can know what's been forgotten quite quickly and how to adjust

    With forgotten calories it may take months for the extra calories to "show up" - real time feedback is impossible.

  10. Anonymous9:19 pm

    I'd just like to say I stumbled across this blog and I'm actually appalled that you are a doctor.... trying to get people to count calories. I am a long time sufferer of anorexia nervosa and I should sincerely hope you end this campaign to count calories. For the love of god, it's about portion size and portion control and getting the right amount of nutrients and variety in diet. Again, your ignorance is appalling and I sincerely hope I never cross paths with you and I also hope your own little version of what is healthy is not perceived as healthy by the general public, because to put it bluntly, this idea and vision of what healthy eating is, is quite honestly a load of shit.