We have known as far back as 1982 that tracking calories, food logging is inaccurate & doesn’t predict weight loss
10.1093/ajcn/35.4.727.
2/n
Meta-analysis in 2008 by Harnack and French, then follow-up in 2014 from Eblel, Kiszko reviews and assesses the evidence on the effectiveness of calorie labeling at the point of purchase
"Concerns on the effectiveness of calorie labeling policies"
10.1007/s10900-014-9876-0
3/n
Less than 0.1% of people getting fast food actually care about calories...
10.2105/AJPH.2008.136457
4/n
Men actually INCREASE intake with calorie information
10.1186/1479-5868-5-63
5/n
nutritional labeling in a college setting caused some people to eat more....
10.1016/0271-5317(95)02001-C
6/n
dietitians miscalculate calories by 10-20%, lay people around 20-30% and some patients with obesity up to 50%
10.1016/s0002-8223(02)90316-0
7/n
Head to head, calorie counting performs worse than EVEN the low fat diet (the diet that failed the last half century)
10.1136/bmj.314.7073.29
8/n
There are millions of people with access to calorie information with no END in sight to the obesity pandemic
9/n
Many patients actually DONT like tracking or counting calories
10.1016/j.invent.2016.12.003
10/n
There's more
11/n
SUMMARY:
Calorie estimation for both intake & expenditure are inaccurate, even for orthorexic dietitians/trainers
Several real-world examples from NYC, college cafeterias, menus etc have shown that calorie information has no clear positive impact on food intake
11/n
Educating patients on calories has been an overall disastrous experiment with no signs of real world improvement
Calorie counting and point tracking diets HAVE never been shown to be superior to ANY approach
Consider stopping the bullshit & actually helping people instead
/end
If you want to hear me lecture on this join me this Saturday for a Grand Rounds for @TheSMHP@DougieReynolds
We will discuss why calories NEVER mattered and the history & importance of glycemic variability...
I love the curious & creative thinkers, the patients who question everything, b/c answering these questions makes me a better educator & confirms my commitment to lifelong learning & shared decision-making
1/10
I don't “kick patients out” for presenting difficult questions… a cruel, yet common, practice among paternalistic/authoritarian doctors... I instead embrace the questions
I use them as an opportunity to dig deeper, understand more and understand better.
2/10
I’ve had many of the same questions that my patients have had, why should I or why would I patronize a patient for thinking logically and asking questions?
In any case, these question have led me to the primary literature...
Many patients ask me about exercise for weight loss, and getting toned.
We are often advised to exercise, however, if we are severely overweight this can be quite challenging.
I typically advise patients to focus on fixing the diet first and forgo exercise for the first 6-8 weeks of any weight loss plan. if your diet isn’t in order & your appetite isn’t controlled, exercise will increase appetite and likely stall weight loss.
While it is true that over a long enough time, patients may experience changes in body composition (ie getting toned) they won’t see the scale move and the process will be slow and this can be discouraging to patients.
After helping thousands of patients lose weight, here’s my advice for those looking for lifelong, sustainable life changes. These are the “5 MUSTS” anyone trying to lose weight lifelong NEEDS to do.
🧵/Thread
Before you understand my “5 musts”, simply ask yourself -what are the side effects of your prior weight loss attempts- NOT your reasons, NOT what you want to happen, what went wrong, what made you stop?
The 5 Musts: #1 HUNGER
Most people quit diets because they feel low energy, tired & hungry. Your weight loss attempt will need to manage HUNGER. Are food choices making you full, or are they leaving you craving more a couple of hours later? Stick to:: 🐠🥩🍳🍗🍖🍤🫑🥑🥬🥦
Everything you need to know about gallstones as it relates to diet and dietary composition.
👇🏻👇🏻👇🏻👇🏻👇🏻
In the obese during rapid weight loss from a very low-calorie diet, a relatively high fat intake could prevent gallstone formation, probably by maintaining an adequate gallbladder emptying, which could counterbalance lithogenic mechanisms
On the basis of a meta-analysis of randomized controlled trials, during weight loss, UDCA and/or higher dietary fat content appear to prevent the formation of gallstones.
🔔 10 woke takes from the world of Modern Medicine in 2024 🔔
1) climate change is more important than human nutrition 2) obesity is genetic disease that requires drugs 3) obesity is healthy & should be embraced 4) diets don’t work, carbs are good, meat is bad 5) masking kids prevents death & causes no harm 6) any living thing needs 9-10 COVID shots, especially pregnant women & young children 7) COVID shots prevent long COVID & myocarditis 8) DNA & chromosomes don’t mean much, they are fluid, so is biology 9) the AMA covering the ethics of banning meat & NEJM covering climate change is more important than the diabesity epidemic 9) take drugs for every chronic disease 10) luck charms is healthier than eggs
People wanted context - lie 1
1) “Meat is unhealthy”
Meanwhile it’s associated with improved mental health, improved bone and muscle health and newer studies like that from PURE show that excluding it is bad for mortality
Lie 2
“Obesity is racist and it’s actually healthy”
Doctors, in an effort to be “inclusive” are ignoring the health impacts of excess adiposity