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Calories in vs. Calories Out--proof?

Anyone read this yet? It appears that calories in/out is THE MOST IMPORTANT factor in weight loss.

This is a work friendly site.)

http://content.nejm.org/cgi/content/full/360/9/859

Thoughts?

Pat

It is an important factor, but it isn't the only factor.

As long as you're getting decent macros and you have decent insulin sensitivity,... then yes, it is probably the most important factor at that point.

This study was far from simply calories in, calories out. Here's why:

Quote:

Weight-Loss Intervention

The nutrient goals for the four diet groups were: 20% fat, 15% protein, and 65% carbohydrates (low-fat, average-protein); 20% fat, 25% protein, and 55% carbohydrates (low-fat, high-protein); 40% fat, 15% protein, and 45% carbohydrates (high-fat, average-protein); and 40% fat, 25% protein, and 35% carbohydrates (high-fat, high-protein). Thus, two diets were low-fat and two were high-fat, and two were average-protein and two were high-protein, constituting a two-by-two factorial design. The four diets also allowed for a dose–response test of carbohydrate intake that ranged from 35 to 65% of energy. Other goals for all groups were that the diets should include 8% or less of saturated fat, at least 20 g of dietary fiber per day, and 150 mg or less of cholesterol per 1000 kcal. Carbohydrate-rich foods with a low glycemic index were recommended in each diet. Each participant's caloric prescription represented a deficit of 750 kcal per day from baseline, as calculated from the person's resting energy expenditure and activity level.

Blinding was maintained by the use of similar foods for each diet. Staff and participants were taught that each diet adhered to principles of a healthful diet29 and that each had been recommended for long-term weight loss, thereby establishing equipoise.1,2,26 Investigators and staff who measured outcomes were unaware of the diet assignment of the participants.

Group sessions were held once a week, 3 of every 4 weeks during the first 6 months and 2 of every 4 weeks from 6 months to 2 years; individual sessions were held every 8 weeks for the entire 2 years. Daily meal plans in 2-week blocks were provided (see the Supplementary Appendix). Participants were instructed to record their food and beverage intake in a daily food diary and in a Web-based self-monitoring tool that provided information on how closely their daily food intake met the goals for macronutrients and energy. Behavioral counseling was integrated into the group and individual sessions to promote adherence to the assigned diets. Contact among the groups was avoided.

The goal for physical activity was 90 minutes of moderate exercise per week. Participation in exercise was monitored by questionnaire30 and by the online self-monitoring tool.

Changing fiber intake, lowering glycemic index, keeping a food diary, and getting dietary counseling. Most of us here would agree that doing any/all of those things would improve general body composition, as they generally improve quality of the diet.

If it was all about calories, the glycemic index should have been avoided, because that in itself is saying that some "calories" have a different impact than others.

As I've said before, the same person could eat chocolate cake for a month straight versus a meat/veggies/good fat diet for a month straight--they would likely feel different and have different body comp at the end of a month due to the effects of different foods on things like hormones. It will never be as simple as only calories.

I didn't go back and check, but I'm assuming that measures of actual body composition were not taken. This was simply measuring weight loss, be it muscle or fat. Not a wise approach, if that's what they did.

While calories is important....people don't know how to count anyways....the beauty of Paleo foods....you just seem to lose weight with no hastle!

A few thoughts:

(1) As Dr. G noted, the study did not look at body composition or any other objective measure of health (or fitness). It only measured weight lost. In my opinion, the goal of the study (or what the study measured) misses the mark.

(2) 25% protein constitutes a "high protein" diet!?! I don't think so.

(3) What MOD said. I do not count calories. It is not in my genetic make up, so any "diet" that requires me to count calories will fail, irrespective of the macronutrient balance.

Not to mention people tend to underestimate their calories by as much as 20% and over estimate their work effort by as much as 30%.

Id have to find the study, but they compared what people considered vigorus exercise versus moderate. For a person who was obese, walking up a flight of stairs was enough to burn em out, while someone who was fit running a mile may be moderate. Not sure if they based their study of exercise like this, or if they calculated actual expenditures.

Though, food log may solve the calorie counting problem.

Quote:

Originally Posted by Mike ODonnell (Post 51668)

the beauty of Paleo foods....you just seem to lose weight with no hastle!

A 5'1 woman with less than 100 lbs of LBM will need to count calories, no matter how philosophically intact her diet is. Even if she is doing WODs.

It kinda bugs me to see this claim posted so often because I think (correct me if I'm wrong) that it mostly applies to people who are very overweight, had a crappy diet before, or have an excellent metabolism - yet that's not even the majority of the people reading it. Then they wonder why they're not getting results. Maybe you could append a disclaimer :)

Quote:

Originally Posted by Gittit Shwartz (Post 51682)

Yes...the majority of people I deal with are usually overweight....so it applies to them. The leaner the people are, the more "tricks" you need to get rid of stubborn BF such as cycling high/low calories and carbs.

Then again....I've learned what people"say" they do...and "actually" do...can vary quite dramatically! My whole life is a disclaimer!

Perhaps an appropriate disclaimer would be that different approaches work for different people--at least when it comes to calorie counting.

Quote:

Originally Posted by Garrett Smith (Post 51662)

I didn't go back and check, but I'm assuming that measures of actual body composition were not taken. This was simply measuring weight loss, be it muscle or fat. Not a wise approach, if that's what they did.

Waist circumference was measured, and didn't show difference between groups.

The only differences between the groups in terms of outcomes were:
1) LDL decreased most for the high carb groups
2) HDL increased most for the high fat group
3) Insulin sensitivity did better in all groups but the highest carb group.

If you think high LDL is the highest risk factor for disease, you'll take away a recommendation for low fat; if you think low HDL and insulin resistance are the biggest risk factors, you'll take away a different recommendation.

A really neat study, all in all.

My takeaway is the same as I've commented multiple times:

There are multiple paths to health, but none of them include refined carbohydrates and processed oils.

I'd also note this isn't the only study in this area, and other studies have shown an advantage to reduced carbohydrate diets. Again, all in all good stuff.