Category Archives: health

2010 Year in Review, Part II: The Non-Recipes

2010 nonrecipes collage

A Record of Sticking Places

In September, Lauren Berlant wrote the following description of writing on her blog, Supervalent Thought

Most of the writing we do is actually a performance of stuckness.  It is a record of where we got stuck on a question for long enough to do some research and write out the whole knot until the original passion and curiosity that made us want to try to say something about something got so detailed, buried, encrypted, and diluted that the energetic and risk-taking impulse became sealed and delivered in the form of a defense against thinking any more about it. Along the way, something might have happened to the scene the question stood for:  or not.

At first, I thought of that as something that applied only to “serious” writing—to articles or book chapters that unfold over months or years. But in retrospect, I think it’s actually one of the reasons I started this blog: to have a place to delve (even if only shallowly) into the kinds of questions that were distracting me from writing my dissertation and then seal them up so they’d stop cluttering my thought process. At some point in the process of writing most of the longer, essayish posts, I get sick of the topic and just want to be done with it. So I finish it, and even if I haven’t entirely resolved the question I started with, I feel released from thinking about it at least for a while.

However, the blog hasn’t quite had the intended effect of freeing me up to write the dissertation because, unsurprisingly, getting mentally “free” takes up a lot of the time and energy I ought to be spending on that other, more important “performance of stuckness.” And the whole idea of having a mentally “clean slate” before I deal with my dissertation was probably always a hopeless ambition.

So this part of the retrospective on the year is also a sort of penitent offering to anyone who’s come to appreciate or even maybe expect this kind of content. In the next six months, I need to finish and defend and submit my dissertation. Also, I’m getting married. Between the two, I’m probably not going to have the time to do a lot of longer posts on culture/history/politics. I’m toying with the idea of taking excerpts from the dissertation and editing them into blog-friendly essays on the weekends. But in case I don’t end up having the time to post much of anything substantial for at least the first half of 2011 and that makes you sad, maybe there will be something here that you missed or might be interested in revisiting.

Special Series

Image from Look at this Fucking HipsterHipsters on Food StampsA three-part look at the bogus “trend” piece published last March in Salon about college-educated people using food stamps to buy organic, ethnic, and otherwise non-subsistence-diet foods and what it says about food & social class in America:

Part I: The New Generation of Welfare Queens—A critique of the article that places it in the longer history of concern about how the poor eat

Part II: Who Deserves Public Assistance?—An analysis of the comments and some of the myths about social class and poverty in America they reflect

Part III: Damned If You Do-ritos and Damned If You Don’t—An attempt to explain the contradictory trends of patronizing vs. romanticizing the poor and how they eat and what kinds of contemporary anxieties the bogus trend of hipsters on food stamps might be a response to

Responses to Food, Inc.—Posts related to the film (and the broader agendas it gave voice to) and how they distort the picture of the American food system and confused their audience.

I never got around to going through the list of suggestions at the end of the film. Perhaps I'll get to it in 2011.Part I: No Bones in the Supermarket—An interrogation of the film’s premise that “looking” at the food system will lead everyone to the same conclusion

Part II: Is the Food More Dangerous?—The film suggests that industrial animal agriculture is responsible for the deadly strain of e coli that killed at least one innocent child, but it turns out that’s not true. Grass-fed cattle have less generic, harmless e coli but the same prevalence of 0157:H7.

Price, Sacrifice, and the Food Movement’s “Virtue” Problem—Why a food “movement” predicated on spending more or making sacrifices is necessarily limited to the privileged few.

The Myth of the Grass-Fed Pig—Why not every farm animal can or should be “grass fed,” and the ecological argument for vegetarianism.

The Myth of the Grass-Fed Pig, Part II: Cornphobia—On the epidemic of irrational fears about corn inspired by Michael Pollan’s books and the documentaries he has appeared in.

Don’t Drink the Agave-Sweetened Kool-AidWhy agave nectar Greenwashing alert.isn’t “natural,” healthy, or (probably) more delicious than other sweeteners.

Part I: Natural, My Foot—Agave nectar isn’t an “ancient sweetener” used by Native Americans, it was invented in the 1990s and involves a process almost identical to the one used to make High Fructose Corn Syrup.

Part II: What’s Wrong With Any High-Fructose Sweetener—Why agave nectar, with up to 90% fructose, isn’t a healthier substitute for sugar.

Part III: The Mint Julep Taste Test and Calorie Comparison—The results of a comparison between agave and simple syrup-sweetened mint juleps and some number crunching that shows you could theoretically cut a small number of calories by substituting agave for sugar, but not if you use the recommended amount, which is calorically identical.

Why Posting Calorie Counts Won’t WorkCalorie counts are already appearing on menus across the country, and will soon be required for most chains. This series explores why they won’t make Americans thinner or healthier. 

Another thing I didn't mention--many of the calorie counts are being posted as "ranges" that take into account all the forms of customization, which makes the numbers even less useful. What are you supposed to do with the knowledge that a burrito has somewhere between 400-1400 calories?Introduction—A brief run-down of the reasons I don’t think the policy will work as intended.

Part I: The Number Posted is Often Wrong—What you see on the label is not always what you get, and the difference isn’t entirely random. 

Part II: Most People Don’t Know How Many Calories They Burn—The problem of calorie ignorance isn’t one that can be fixed with an educational campaign—people don’t know how many calories they burn because they can’t know, because it changes, especially if they change their diets.

Part III: Calorie-restriction Dieting Doesn’t Work Long Term—A meta-literature review of three decades of research on calorie-restriction weight loss that shows again and again that by far the most common result of dieting is weight loss followed by regain. And an explanation of why the National Weight Loss Control Registry isn’t a representative sample.


Health

Probably my favorite post because writing it helped me get over/through that rough patch.When What I Want Isn’t What I Want: Temptation and Disordered Thinking/Eating—Not about nutrition, but about mental health and how easy it is to fall into into negative thought patterns about food and body image, even if you think you’re “beyond” all that

Salt Headlines That Make the Vein in My Forehead Throb—Irresponsible news media reporting about public health research, and especially comparisons between the relative merits of cutting salt  and quitting smoking, may be hazardous to my health

Stop Serving Assemblyman Felix Ortiz Salt in Any Form—A plea to the restaurateurs of New York to teach Mr. Ortiz a lesson handed down from fairytales about what it would be like to eat food without salt.Unless you are a rabbit or a chicken, cholesterol in your food does not automatically translate to cholesterol in your veins.

Things that Won’t Kill You Volume IV: Saturated Fat, Part II: Cholesterol Myths—No one, not even Ancel Keys, ever thought you should avoid dietary cholesterol. Volumes I: High Fructose Corn Syrup, II: Fruit Juice, III: MSG, and IV: Saturated Fat Part I went up in 2009.

Things That Might Kill You Volume I : Trans-fats—Why you might want to avoid trans fats, including things with “0 grams of trans fats per serving,” which still contain potentially non-trivial amounts.

HFCS Follow-up: What the Rats at Princeton Can and Can’t Tell US—A review of the study claiming rats consuming HFCS gained more weight than rats consuming table sugar

Food Policy & Politics

I'm still sometimes uneasy trying to choose between better-for-the-environment and better-for-animals and often end up buying Omega-3 enriched eggs because so far at least it seems like those eggs might be measurably different and healthier.You’re All Good Eggs: New research shows that specialty eggs aren’t any better for the environment or  more delicious—A review of the evidence for and against specialty eggs, concluding that they might be marginally more humane but come at an environmental cost.

Good Egg Update: Someone’s Keeping Score—Explaining the Cornucopia Institute’s guide to specialty eggs

A Food Policy & Politics Christmas Wish List—Seven things that might improve the U.S. food system

Robots

Who Says Robots Can’t Taste? On Cooking Robots and Electronic Noses—A survey of cooking robots and  anxieties about electronic incursions on the acts of cooking and eating

Ingredient Spotlight

The first three listed below were stand-alone posts without recipes. The others were also collected in the 2010 recipe retrospective, but I thought they might merit inclusion here, too, because they involved some research beyond just looking at a few recipes and cooking something.

I'm still not totally satisfied by what I was able to find--the active chemicals have been identified, but it's still a bit of a mystery how they work the way they do. The Sweet Science of Artichokes—Why they make things taste sweet after you eat them

Morel Time in Michigan—How to identify morels and tell them apart from vague look-a-likes.

Meet the Paw-Paw, aka the Michigan Banana—A tropical fruit for the American midwest, with its very own Johnny Appleseed. 

Two on the Tomato: The Official Verdict in the Fruit v. Vegetable Debate and The Case For Tomatoes as Dessert—On the Supreme Court case that ruled tomatoes a “vegetable,” and why there’s still a debate about them even though there are lots of other “vegetables” that are botanically fruits. And how to use them to substitute for sweeter fruits in dessert recipes.

Cheddar-Garlic Biscuits: In Defense of Garlic Powder—Why garlic powder is so maligned, and a culinary defense.

The saffron crocus--each bloom produces 3 pistils, which must be harvested by hand during the brief window when they bloom, before sunrise because the flowers wilt in the sun. Jonathan Franzen and Joël Robuchon-inpspired Rutabaga Purée—On the root vegetable’s biggest fans (some of whom use it as a curling rock), its many detractors, and its supporting role in Jonathan Franzen’s novel The Corrections.

Now in Season: Sour Cherry Pie—What makes sour cherries different from normal pie cherries, and the science of flaky pie crusts.

Deviled Eggs with Saffron Aioli—On the history of deviled eggs and why saffron is so expensive.

Pork Chops with Cider Reduction and Greens—A review of several theories on why pork is so often prepared or paired with apples.

Recipes with History

These were all in the recipe round-up, but again, they have something to offer aside from cooking instruction. New annotations to explain what else you might learn there.

Benedictines and Pimento Cheese Sandwiches for Derby Day—On Miss Jennie Carter Benedict of Louisville,  Kentucky and the shaping of an “American” cuisine for the emerging middle classI'm still tickled by the idea that a reality television show can have a soul.

Jook (Chicken and Rice Porridge)—On the cross-cultural phenomenon of prescribing bone broths and particularly chicken broth-based soups as a healing or restorative food.

Lemon and Herb Chicken Drumsticks—On the history of Labor Day and the relationship between food and holidays

Sourdough-risen Whole Wheat Bagels and the Sweetness of the Old World—On the fetishization of a humble roll with a hole, its origins in the Jewish diaspora and why you don’t have to use “malt extract” to make it authentic (but why some people think you do).

Introducing Ezekiel and How and Why to Make a Sourdough Starter—A brief history of sourdough starters and why so many of them are named “Herman.”

Buckeyes, Shmuckeyes, or if you prefer, Peanut Butter Bon-Bons—How buckeyes became Ohioan and Not, I suspect, bluffin' with her muffin. Ohioans became buckeyes, starring General Ebenzer Sproat and President William Henry Harrison.

Sourdough English Muffins: Of nooks and crannies and double-entendres—Muffin nationalism explained, and also how muffin became a slang term for women and various parts of their anatomy.

American Pumpernickel—Devil’s Fart Bread! The history of Old World and New World rye breads.

Baguettes, regular or whole wheat—On the history and Frenchification of long, skinny, crusty loaves of bread.

A Sourdough-risen Challah Trinity: Braid, Loaf, Knot—The history of challah from tithing to the temple to European decorative braided breads. 

Homemade Peeps and Chocolate-covered Marshmallow Eggs—On this history of the candy, from the therapeutic uses of the mallow flower to the contemporary, mallow-less confection.

A Food Policy & Politics Christmas Wish List

Santa baby, just slip sustainable aquaculture
under the tree, for me.
Been an awful good girl, Santa baby,
So hurry down the chimney tonight.

I wonder if she's asking for a garbage-fed pig, too. Also, I love that it looks like she's saying, "Santa, how could you? Why, I've never heard of such a thing!"From flickr user duluoz cats

Dear Santa,

I know I can be a bit of a “negative Nancy.” I spend a lot more time criticizing existing policy and reform efforts than offering alternatives or solutions. Of course, that’s partially due to the fact that not all policies need alternatives—the flip side of a lot of my apparent negativity is that I have a much sunnier outlook on the U.S. food system than many self-identified foodies and people associated with the “food revolution.”

For example, I’m down on most anti-obesity initiatives because I don’t think obesity causes serious diseases or death. I’m open to evidence to the contrary, but in all the epidemiological studies I’ve seen (including the ones cited by the WHO and NIH when they redefined “obesity” to a lower BMI range) BMI isn’t even significantly correlated with an increased risk of mortality until you get into the territory of severe or morbid obesity (BMI 35+). The number of Americans in that category has been growing since 1980, but it still amounts to less than 5% of the U.S. population, far less than the 30-60% of overweight or obese Americans usually cited as the evidence that we’re in the midst of an obesity “epidemic.” Americans on average aren’t much fatter than they were 50 or 100 years ago. The “typical American diet” high in refined grains and sugar probably isn’t optimal for human health (for reasons other than that it makes most people fatter), but it nonetheless enables many people to live long, relatively healthy lives.

What with the kids in laps and such, I'd think Santa might be more concerned about keeping his Ginger *down*, but what do I know?From Found in Mom’s Basement.

I think we’re doing somewhere between okay and great on several other fronts, too. Although imperfect in many ways, the industrial food production and distribution systems are sometimes more efficient in terms of total inputs and carbon emissions per calorie or pound than small, local farms—environmentalists should celebrate the spread of no-till farming and possibility of safe GMO crops that increase yields with reduced water, nitrogen, or phosphorus needs. Illnesses caused by food-borne pathogens are probably less common now than at any point in our country’s history (and new estimates about the incidence of food-borne illness are even lower). For anyone who’s interested in novel foods, there’s probably never been a better time or place to be an eater. The ever-increasing flows of people, goods, and information around the world have made everything from far-flung regional specialties to ancient recipes to innovative taste experiences more available to more consumers than ever.

Of course, that doesn’t mean things couldn’t be better. So here’s a list of seven changes I would like to see in how people produce, consume, regulate, and talk about food in the U.S. It’s a bit of a motley assortment—if there’s one thing people in the “food movement” seem to agree on it’s that food is implicated in our lives in a myriad of interconnected ways. I think there’s room for improvement in multiple realms. 

Is it just me or does this look like 1950s-era photoshopping? I'm skeptical that that dude's cheeks were actually that rosy, and wonder if maybe he wasn't really wearing that hat or holidng that magic kit. From flickr user HA! Designs

1. More Garbage-fed Pigs. This might be impractical, or ultimately less efficient than just feeding them  corn, but it certainly seems like it would make sense to feed more restaurant and/or home kitchen waste food to pigs. That might require revisiting some recent changes in state and local laws—according to the Institute of Food and Agricultural Sciences at the University of Florida, the practice of feeding pigs garbage in the U.S. has “declined in recent years because of stricter federal, state, and local laws regulating animal health, transportation, and the feed usage of food waste.”

1940s wartime poster from the UK, from the Mary Evans Picture Library, which will sell it to you as a mousepad or jigsaw puzzle. Click.According to George Monbiot, similar changes in the UK have caused the percentage of edible grain in pig feed to double from 33% in the early 1990s to over 60% today, replacing crop residues and food waste. He claims that was largely an overreaction to fears about mad cow disease, even though there’s no danger in letting pigs eat meat and bone meal. Given that it’s now apparently against English law to feed kitchen scraps—even vegetable matter—to pet pigs, I’m inclined to believe him.

I’m all for food safety, but perhaps we could re-examine whether recent laws about the feed usage of food waste are really protecting pigs and people from disease, or just preventing us from making good use of garbage. Anyone who’s ever worked in a restaurant knows how much food gets thrown out. Legal or not, I’ve heard about some people buying kitchen slops from restaurants to feed their pigs, and that sounds like a win-win: the restaurant profits from their garbage, and the hobby farmer gets cheap, high-quality pig food. I’m imagining something like that, but on a grander scale. Could we increase the amount of food waste in pig feed to 60-70% nationwide? Get on it, Santa.

2. More funding for food stamps. Not only do they prevent poor people from having to choose between buying food and paying the rent, they also provide the best stimulus “bang for the buck.” The biggest disappointment of the new school lunch bill is that it’s partially funded by cuts in federal funding for SNAP. If you’re the type to get your panties in a bunch over the possibility that a handful of underemployed college graduates might use them at Whole Foods, just remember 1) that’s probably not hurting anyone and 2) it’s not how the vast majority of food stamps get used. From Economix, click for link

3. More sustainable aquaculture. I love fish, but it’s getting hard to keep track of what kinds are safe and ethical and I’m worried about declining ocean stocks and the ecological impact of farmed salmon. Some promising developments I’ve heard about in the last year are aquaponics and farmed barramundi. More please?

4. Living wages for farm and food industry workers. Congrats to the Coalition of Immokalee Workers, who finally won the $0.01/lb raise they’ve been fighting for since 2001, which may raise their average annual income from $10,000 to $17,000. But that’s still pretty terrible. The low cost of fast food that people like Pollan complain about is almost certainly due more to the declining cost of labor in the last three decades than to farm subsidies. Thirty years ago, most meatpacking jobs were unionized and paid decent wages. I want that back.

Of course, it’s possible that if that happened, everyone else ( at least in the bottom 80% of income earners) would need help paying for the increased cost of food. So I guess this is a two-part request, and it’s probably the “big ticket” item on the list: I want more equitable income distribution. As Ezra Klein argued on the Washington Post site recently, there’s no reason to take our current rates of income inequality for granted.

In 1969, for instance, the average CEO made 26 times what the average worker made. Today, it’s closer to 500 times.

Not so in Japan, where “it’s indecent for rich people to make too much money because, after all, these are collaborative endeavors.” I’m not saying everyone needs to take home an identical paycheck, but I have a hard time believing the work and expertise of the average CEO is worth 500 times the work and expertise of their average employee. Or that the bankers who made deals with Magnetar deserve exponentially greater compensation than the people who spend all day every day picking vegetables or disemboweling beef carcasses. If that’s too much to ask, how about this for starters: everyone who works full time should be paid enough that they don’t qualify for food stamps.

5. Less “local,” more “low-impact.” I think the locavore movement has good intentions, but proximity is a poor proxy for things like the carbon footprint of food, largely because transportation only accounts for approximately 11% of the energy used in the food system—most of the rest is used up in water delivery, fertilizer production and application, harvesting, processing, packaging, heated barns and refrigeration, and the gas or electricity you use in your own kitchen.

Photo by Carbon Trust, featured in G-Online, click for storyJames Williams suggests that watchdog groups should calculate “life cycle carbon counts,” and the European Union has introduced “carbon labels.” I’m in favor of that, even though I’m not sure how practical it is. Perhaps some of your local farmers drive their produce to a single market in a new, energy-efficient vehicle while others drive old trucks, half-full, to a dozen markets every week. Despite the complications, someone might be able to come up with some ballpark regionally-specific estimates for commonly-purchased produce, and develop a “rating” system similar to the Seafood Watch guides you can print or download.

More broadly, I’d like to see the popular discourse shift away from the obsessive focus on locality, which corporations have already successfully co-opted. Are farmers in California or sub-Saharan Africa really any less deserving of your support than some guy who happens to live 50 miles away, especially if the former can get you a greener product? Sometimes thinking “global” may require buying “global,” not local.

6. Less condescension, more compassion. No more telling people they should be buying local, organic  heirloom beets instead of sneakers and cell phones. No more sneering at people who shop at “Whole Paycheck.” For the rich and the poor and everyone in between, I just want a cease-fire. I’m tired of people scolding other people or claiming the moral high ground because of where they shop, what they buy, how they cook, or what they feed their kids. This cuts both ways—it’s as annoying when people berate vegetarians for being stupid hypocrites or sneer at insufficiently-adventurous eaters as it is when people criticize fast food eaters and get smug about having a CSA share (or even having a particular CSA—I’m looking at you, Tantre shareholders).

No more of this passive-aggressive crap either. No one lectures people about how they ought to make their own clothes, but surely most of the same arguments people make about homemade food apply. Homemade clothes would probably be better-quality (at least once the maker has some practice and skill). They could be made with local, organic textiles free from chemical dyes and designed to suit individual tastes and needs instead of being made in factories and shipped halfway around the world. Wearing them instead of ready-made clothes would reduce your dependence on and support for unethical labor conditions and the culture of cheap, disposable wearables. And yet people are much more willing to accept that some people just don’t have the time to make their own clothes.

I’ve heard people say things to the effect of “it’s about priorities” in response to those who claim that some people don’t have time to cook. Well, duh, it’s about priorities. What is “I don’t have time,” if not a different way of saying, “It is less important to me than the other things I have to do”? No one saying “I don’t have time” is claiming they’ve got fewer hours in a day than anyone else, just that more important things are occupying those hours. What “it’s about priorities” doesn’t explain is why anyone thinks they should be the one to tell someone else what their priorities should be. If you have time to cook, or make your own clothes, bully for you. What I’m asking for is that people stop assuming the same is true of anyone else. Better to assume that most people are doing the best they can with what they’ve got. The fact that someone else’s life looks different than yours doesn’t make theirs inferior—nor does it make yours inferior, which is the fear that I suspect drives most of that kind of condescension anyway.

TeacherPatti wrote about a similar issue last week in the fabulous post titled “A Different Life.”

7. “Public health” policy that focuses on health instead of thinness. Thinness is a really poor proxy for health, for reasons I’ve already mentioned above. Policies that focus on calories, BMI, and weight-loss are all designed to make people thinner—not that they’re likely to succeed at that either. If we really wanted to make people healthier, we’d stop advocating calorie-restriction dieting, which is more likely to make people fatter and less healthy in the long-term. Instead, we could devote resources to encouraging physical activity and decreasing sugar consumption. And maybe in the process we could start promoting acceptance of a wider range of body shapes and sizes, which might in turn help people develop healthier relationships with food. More on this topic before and I’m sure, again in the New Year.

I know that’’s a lot to ask for, Santa, and I know you’re a busy guy. I don’t actually expect to get any of these things, and perhaps it’s better that way—as multiple fairy tales and clichés warn us, wishes can be dangerous, volatile things, prone to tragic backfiring. In the realm of food, that seems especially true. Policies that might be better for the environment often seem to be worse for animal welfare or human health; reforms that might be better for nutrition might be bad for the environment or leave some people hungry. The food system and its effects are so far-reaching and complicated that change is never going to be simple. I’m prepared to be happy with whatever you can swing this year.

Best regards to you and Mrs. Claus,

Margot

p.s. Happy Holidays.

nomnomnomFrom Roar of the Tigers

A Cure for Whatever Ails You: Chicken and Rice Porridge (aka Congee, aka Jook)

This is not really a traditional congee, which wouldn't have a mirepoix base. It's more like a cross between congee and a Euro-American chicken soup.

And Tom brought him chicken soup until he wanted to kill him.
The lore has not died out of the world, and you will
still find people who believe that soup will cure any hurt or illness 
and is no bad thing to have for the funeral either.
                              —East of Eden, John Steinbeck

Grandmothers of the World Unite

I’ve always been intrigued by parallels in culinary traditions from far-removed places. For example, almost every cuisine seems to include some kind of dough filled with seasoned meat or vegetables—gyoza, pierogi, samosas, wontons, empanadas, bao, knishes, ravioli, pasties, shishbarak, and manti are all just variations on the same basic theme. Ditto for griddled batter-based breads, i.e. pancakes—there are Euro-American flapjacks, French crepes, Italian farinata, Indian dosas, Eastern European blintzes, Ethiopian injera, Chinese moo shu wrappers, Korean jeon, etc. Commonalities like those seem to point to universal imperatives or desires that form a sort of core or essence of the uniquely human act of cooking, like, for instance, the reliance of large, settled populations on grains and starchy vegetables as their dietary staples.

this soup wants you to feel betterChicken broth-based soup is another one of those near-universal foods, and what makes it unique is that not only is the soup itself basically the same wherever you go, but its use as a folk remedy is also seemingly universal. All over the world, whenever people are feeling under the weather, tradition dictates that the best thing to feed them is rice or pasta or potato simmered until very soft in a broth made from chicken bones, often flavored with some kind of alliums and aromatic herbs.

In Greece, it goes by the name avgolemno, for the egg and lemon that are traditionally included, and it’s prescribed as a remedy for colds and hangovers. In Korea, a chicken broth soup including ginger, ginseng, and rice called samgyetang is not just supposed to cure minor illnesses, but also to prevent them—a bit like the American “apple a day.” Chicken soup, often prepared with matzoh balls, is so often prescribed as a cure in Jewish families that it’s been referred to as “the Jewish penicillin.”

And soup’s reputation for healing and restorative powers may be best represented by its metaphorical invocation in the title of the bestselling series of collected “inspirational” writings whose many iterations also serve as a catalog of demographics that marketers see as “easy prey”:

1) Women

  there is no "grandpa's" version nor is there a new dad's version no love for christian menI wholly expected this to be targeted at black women, but the cover definitely suggests otherwiseNourish your "soul" while you starve your body!

2) People who identify as “animal lovers”:

it occurs to me that there may be an entire small industry devoted to feline glamour shotsI have never seen a dog wearing clothes look this happy IRL  Way to improve all of these titles #1: replace any of the nouns with "FERRETS!" i.e. "101 stories about life, love, and FERRETS!"   Way to improve all of these titles #2: add "(not like that, you pervert)" wherever "love" or "loving" appears, i.e. "Loving Our Dogs (not like that, you pervert)" FERRET! Soup for the Horse Lover's Soul (not like that, you pervert): Inspirational Stories About Horses and the People Who Love Them (not like that, you pervert).

3) People who are especially enthused about capitalism & mass entertainment, or captive audiences:

Chicken soup for those who have no souls? This confuses me a little, because isn't shopping the chicken soup for the FERRET!...shopper's soul? I think this makes the same fundamental error as the BWW commericals based on the idea that someone might just be a fan of sports, rather than the fan of a particular team, and thus have a very specific rooting interest that has nothing to do with the game going into overtime just so they can stay at BWW longer and everything to do with their team winning the damn game. I hope this has an excerpt by William Hung. Hell, I hope the whole thing is by William HungAccording to Amazon, this is the 5th most popular title in the series and #13,101 for all books

I think animal lovers win the “Biggest Sucker” prize because of the amazing co-branding that brings us Chicken Soup for the Cat Lover’s Soul Cat Food and Chicken Soup for the Dog Lover’s Soul Dog Food. 

I don't know if this makes me feel cynical or delighted ...or if my delight is inherently cynical anyway.

Chicken Soup Science

However, as the global omnipresence of the chicken soup-as-remedy suggests, it’s not just an old wives’ tale co-opted by the self-help industry. Clear broths may actually be one of the best ways to get water and nutrients into a sick body, and bone broths seem to be especially stomach-soothing and nutrient-rich because of their gelatin, collagen, and mineral content. Adding some kind of acid like wine, lemon, or vinegar to the water as the broth cooks, as many traditional home recipes do, increases the mineral content of the final product even more. Many of the classic starches, especially rice and potatoes, are generally tolerated well by distressed gastrointestinal systems that might struggle with or reject meat, beans, corn or dairy fat. And most versions of the soup are enhanced by other nutrient-rich foods like onions and garlic and carrots and ginger and mushrooms, which are all also generally easy to digest once they’ve been cooked thoroughly, .

In 2000, some researchers at the University of Nebraska set out to test whether or not chicken soup could actually alleviate symptoms associated with the common cold and flu—particularly those in the respiratory tract—or if the oft-touted restorative effects were just the result of hydration and placebo. They studied the effects of one kind of homemade chicken soup, using a recipe from the lead researcher’s Lithuanian grandmother, and 13 commercial brands on neutrophil chemotaxis, which is probably one of the main causes of the inflammatory response that causes sputum production and coughing. They found that chicken soup inhibited neutrophil chemotaxis, and that it did so in a concentration-dependent manner, i.e. the more watered down the soup, the less of an effect it had. The commercial soups varied in their effectiveness—some showed no effect on the neutrophils at all, and others out-performed grandma’s, although they don’t say what the distinguishing feature might have been.

More chemotaxis = more inflammation, sputum, coughing. the homemade soup is the BOR They weren’t testing the soup on human subjects, but the in vitro effects at least suggest a mechanism by which chicken soup might actually make cold sufferers feel better (full published study available here).

Chicken Soup for the Congested, Nauseous, Aching, Hungover, Chronically Fatigued, Demoralized, Where Did September Go and Why Is It All So Hard Soul

Congee can be as simple as plain rice simmered in lots of water (usually at a 1:8 or 1:10 ratio of uncooked rice : water) until it’s basically the consistency of oatmeal. Like most grain porridges the world over, it’s typically flavored with either savory or sweet toppings and eaten for breakfast. However, the version made with chicken broth is nearly as common as the plain version, and is vastly more substantial and comforting. The rice is cooked until the grains begin to break down and release a lot of their starch, which makes the broth thick and creamy, almost like a loose risotto but without all the butter and cheese. If you’re ever in too bad a shape to do anything else, but you can manage to throw a half a cup of rice in a pot with 6-8 cups of broth and stir it from time to time, a couple of hours later, it’ll be a meal fit for an invalid. If you have a fuzzy logic-enabled rice cooker, it’s even easier—just put the rice and broth in the bowl and select the “porridge” option and then you don’t even have to stir.

I decided I wanted to make the most spectacularly healing soup I could possibly concoct, so I started with a basic mirepoix with some garlic and ginger, which also helps soothe nausea. If I’d been nursing a head cold I probably would have added a hot pepper, too. Once the onions were translucent, I added a splash of rice wine and then a big handful of finely diced shitake mushrooms. Then I added the rice—about 2 cups of leftover cooked short-grain rice that was 1/2 brown and 1/2 white—and 6 cups of chicken broth that had been hanging out in the freezer from the last time I had chicken bones. And then I threw in about 2 dozen knots of dried seaweed, which is also mineral-rich and supposedly helps boost immunity, and a bunch of chopped green onion to layer a brighter onion flavor on top of the cooked-onion base.

A couple of hours later, it was as thick as a cream soup and all the vegetables were completely soft. The mushrooms and seaweed make it richly umami and the ginger+garlic combination is as delicious as it is therapeutic. This is not some bland, insipid noodle broth, and really the only way to describe it is nourishing. Not a bad thing to have in your arsenal as the seasons change and winter approaches.

Recipe: Chicken and Rice Porridge drumstick bones and aromatic vegetables, the base of a stock; adding a little wine and/or vinegear will increase the calcium content of the broth

  • 1-2 T. cooking oil
  • 1 medium to large onion (or 2-3 leeks, white parts only, or 2 shallots)
  • 2 large carrots
  • 2 large celery ribs
  • 1 thumb-sized piece of fresh ginger
  • 2 cloves garlic
  • 4 oz. fresh mushrooms (or dried mushrooms soaked in hot water for 15+ minutes)
  • 2-3 T. rice wine or dry sherry
  • 2 cups leftover steamed rice or 1/2 cup uncooked rice, white or brown)
  • 6 cups chicken broth (or substitute any kind of broth)
  • 1/2 cup dried seaweed (or substitute any other cooking greens)
  • 3-4 green onions
  • salt and pepper to taste
  • 1-2 cups shredded cooked chicken (optional)
  • fresh cilantro or basil (optional)
  • chopped peanuts (optional)

mirepoix + ginger and garlicall the aromatics minced and sweating

1. Dice the onion, carrots, and celery ribs, mince the garlic cloves, and peel the ginger and cut it into 5-6 coin-shaped slices.

2. Heat the oil in a large pot until it shimmers, and sweat the vegetables until the onion is translucent (8-10 minutes). Meanwhile, mince the mushrooms.

3. Add a generous glug of the rice wine or sherry and let it cook off for 2-3 minutes, or until the liquid is reduced by half. Add the mushrooms and cook for another minute or two. I used about 2 cups of cooked brown and white short-grain ricegreen onions go in raw to add a brighter, grassier onion flavor on top of the sauteed onion

4. Add the rice, broth, seaweed, and green onions. If using leftover cooked rice, take a minute to break up any large clumps before adding the broth.

5. Bring to a simmer and cook for 1 1/2-2 hours, stirring occasionally, until it’s the consistency of a thin oatmeal or porridge. You don’t need to stir much in the first hour, but as the rice begins to release it’s starch, you should give it a good stir it every 10-15 minutes to prevent it from adhering to the bottom of the pan and burning. You can add more water or broth or cover the pot if it starts to get too thick or stick to the bottom too much.

6. Season with salt and pepper to taste. Add the chicken, if using, and cook just until heated through. Garnish with cilantro or basil and chopped peanuts, if desired.

at first, it will be brothy, much like chicken noodle soup after a couple of hours, thickened with starch and reduced liquid

Why Posting Calorie Counts Will Fail, Part III: Calorie-restriction dieting doesn’t work long-term for most people

Previously in this series: Intro, Part I, and Part II.

The article on "Making Weight Loss Stick" is by Bob Greene, the personal trainer and "fitness guru" Oprah first started consulting with in 1996. Sadly, I don't think that's *meant* to be ironic. Oprah 2005/2009

To test whether turning [fat people] into thin people actually improves their health, or is instead the equivalent of giving bald men hair implants, it would be necessary to take a statistically significant group of fat people, make them thin, and then keep them thin for long enough to see whether or not their overall health then mirrored that of people who were physiologically inclined to be thin. No one has ever successfully conducted such a study, for a very simple reason: No one knows how to turn fat people into thin people.
Paul Campos, The Obesity Myth (2004)

Diets do cause weight loss…in the short term

People who think calorie restriction dieting “works” haven’t necessarily been duped by the diet industry or seduced by the prevailing nutritional “common sense” that weight loss and gain are a simple matter of calories in vs. calories out. Many of them believe it because their personal experience seems to confirm it, often repeatedly. Of course, “repeatedly” is part of the problem. Weight cycling—losing and re-gaining 5% or more of one’s total body weight—isn’t what dieters or public health policy makers are shooting for. Even people dieting with a specific occasion in mind, like a wedding or a high school reunion, would generally prefer to achieve permanent weight-loss.

But almost a century of research has shown that dieting—which usually involves calorie restriction—is not the way to do that. Studies repeatedly find that while eating less causes weight-loss in the short term, a majority of participants in weight-loss interventions focused on diet gain most of the weight back within 1 year and the vast majority (90-95%) gain all of it back within 3-5 years. Approximately 30% gain back more than they initially lost, and there’s some evidence that people who’ve lost and regained weight have more health problems than people who weigh the same, but have never lost and regained a significant amount of weight.

This is not controversial. Virtually every study of weight-loss dieting that has followed participants for longer than 6 months has found that the majority of dieters regain all the weight they lose initially, if not more. In other words, Oprah’s high-profile weight fluctuations are not the unfortunate exception to most dieters’ experience, they are the rule. A gallery of pictures of Oprah through the years illustrates the most frequent and reliable outcome of dieting:

Oprah in The Color Purple Screen shot of the infamous "fat wagon" episode first aired in the fall of 1988, when Oprah strode on set in what she proudly declared were size 10 Calvin Klein jeans after an Optifast diet, wheeling a Red Flyer wagon full of lard representing how much weight she'd lost  At the Emmy Awards, holding her third for "Outstanding Talk/Service Show Host"  Holding yet another Emmy at the end of that impressively-muscled arm, shaped with the help of trainer Bob Greene

             1985                           1988                             1992                             1996

 At the party celebrating the first anniversary of O Magazine  At the Academy Awards, wearing Vera Wang Presenting at the Emmy Awards presenting at the 2010 Oscars, possibly on the way back down again?

              2001                            2005                          2008                            2010        

I am not concerned (in this entry) with why calorie restriction diets fail—there are competing theories and perhaps I’ll try to tackle them some other time. However, when it comes to evaluating public health policies aimed at the general population, like posting calorie counts on menus, it doesn’t really matter why the kind of behavior it’s designed to encourage fails, especially when it fails so spectacularly. Whether the problem is that 90-95% of people don’t have the willpower to stick to calorie-restricted diets or that most peoples’ metabolic rates eventually adjust or both or something else entirely, continuing to prescribe calorie restriction to individuals seeking to lose weight is futile at best. Given the health problems associated with weight cycling and psychological distress caused by diet “failure,” it’s probably also dangerous and cruel. More on that another day, too.

The goal of this entry is to provide a condensed-but-comprehensive overview of the evidence that convinced me that weight-loss dieting—and particularly calorie-restriction dieting or eating less—does not “work” for most people. By “work” I mean lead to significant weight loss—at least 10% of starting body weight—that lasts for more than 3 years (in keeping with the clinical definition of “weight loss success” proposed by the 1998 National Heart, Lung, and Blood Institute [NHLBI] Obesity Education Initiative Expert Panel proposed). I honestly tried to keep this as short as possible and bolded the “highlights” if you want to skim. However, if brevity is what you’re looking for, see this 2007 Slate article.


A Meta-Review of the Literature

Of course, I’m not the first person to try to figure out what kind of picture decades of weight-loss research was painting. I found 14 reviews of weight-loss research in peer-reviewed journals (Mann et al 2007, Jeffrey et al 2000, Perri & Fuller 1995, Garner & Wooley 1991, Jeffrey 1987, Bennett 1986, Brownell & Wadden 1986, Brownell 1982, Foreyt et al 1981, Wilson & Brownell 1980, Stunkard & Penick 1979, Wooley et al 1979, Foreyt 1977, Stunkard & Mahoney 1976). And they all say basically the same thing: calorie-restriction diets don’t work long-term. Here’s how three of the most recent ones came to that conclusion, and one meta-analysis that claims to challenge the consensus, although it turns out that all they’ve really done is redefine “success.” 

Diets Don’t Work—Mann et al 2007 (free full text): This review of 31 weight-loss studies by a team of UCLA researchers was aimed at developing recommendations for Medicare regarding obesity prevention and treatment. They were only able to find 7 studies of weight-loss dieting that randomly assigned participants to diet or control groups and followed them for at least two years (the “gold standard” required to make causal claims about the effects of dieting). And the “gold standard” studies did not support the claim that dieting promotes significant or long-term weight loss:

Across these studies, there is not strong evidence for the efficacy of diets in leading to long-term weight loss. In two of the studies, there was not a significant difference between the amount of weight loss maintained by participants assigned to the diet conditions and those assigned to the control conditions. In the three studies that did find significant differences, the differences were quite small. The amount of weight loss maintained in the diet conditions of these studies averaged 1.1 kg (2.4 lb), ranging from a 4.7-kg (10.4-lb) loss to a 1.6-kg (3.5-lb) gain. (223)

They also examined 14 studies with long-term follow-ups that didn’t involve control groups. The average initial weight loss in those studies was 14 kg (30.8 lb), but in the long-term follow-ups, participants typically gained back all but 3 kg (6.6 lb). Of the eight studies that tracked how many participants weighed more at the follow-up than before they went on the diet, the average was 41% with a range of 29%-64%, and in every case was higher than the percentage of participants who maintained weight loss. In other words, participants were more likely to regain more weight than they initially lost than they were to maintain their initial weight loss. Although Mann et al note several problems with these studies, like low participation rates in the long-term follow-ups, heavy reliance on self-reporting as the primary or only measure of weight, and failure to control for the likelihood that some of participants were already dieting again at the follow-up, those factors should have biased the results in the direction of showing greater weight-loss and better long-term maintenance, not less.

Finally, they looked at 10 long-term studies that didn’t assign participants to “diet” or “non diet” conditions randomly. In general, these were observational studies that assessed dieting behavior and weight at a baseline time and then followed up with participants to measure changes in behavior and weight over time. Of those studies, only 1 found that that dieting at the baseline led to weight loss over time, 2 showed no relationship between dieting at the baseline and weight gain, and 7 showed that dieting at the baseline led to weight gain.

Their recommendation to Medicare:

In the studies reviewed here, dieters were not able to maintain their weight losses in the long term, and there was not consistent evidence that the diets resulted in significant improvements in their health. In the few cases in which health benefits were shown, it could not be demonstrated that they resulted from dieting, rather than exercise, medication use, or other lifestyle changes. It appears that dieters who manage to sustain a weight loss are the rare exception, rather than the rule. Dieters who gain back more weight than they lost may very well be the norm, rather than an unlucky minority. If Medicare is to fund an obesity treatment, it must lead to sustained improvements in weight and health for the majority of individuals. It seems clear to us that dieting does not. (230)

Long-term Maintenance of Weight Loss: Current Status—Jeffrey et al 2000 (free abstract or full text with umich login): A review of 20 years of long-term weight loss studies that describes the weight loss and regain among patients who participate in behavioral treatments for obesity as “remarkably consistent” (7) which is visually represented by lots of graphs of different studies on the long-term results of weight loss studies that all pretty much look the same:

Very low calorie diets vs. Low calorie diets (Wadden et al 1993)  Fat restriction vs. calorie restriction (Jeffrey et al 1995)

Diet only vs. Diet + exercise (Sikand et al 1988) People who were paid $25/wk for successful weight loss vs. people who weren't paid (Jeffrey et al 1993)

Basically no matter what researchers do, most dieters achieve their maximum weight loss at 6 months and then gradually regain all or almost all of the initial weight lost within 3-5 years, if not faster. They conclude:

The experience of people trying to control their weight is a continuing source of fascination and frustration for behavioral researchers. Overweight people readily initiate weight control efforts and, with professional assistance, are quite
able to persist, and lose weight, for several months. They also experience positive outcomes in medical, psychological, and social domains (NHLBI Obesity Education Initiative Expert Panel, 1998). Nevertheless, they almost always fail to maintain the behavior changes that brought them these positive results. Moreover, as we hope we have shown, efforts to date to change this weight loss-regain scenario have not been very successful.

Confronting the Failure of Behavioral and Dietary Treatments for Obesity—Garner and Wooley 1991 (free abstract or full text with umich login): Like Mann et al, Garner and Wooley were seeking to translate the available evidence about weight-loss dieting into recommendations for treatment—in this case, best practices for mental health practitioners seeking to counsel and treat overweight and obese patients. They note that short-term behavioral studies consistently show that modifications in eating and exercise behaviors lead to weight-loss, but that as the duration of studies increases, “over and over again the initial encouraging findings are eroded with time” (734).

The authors are particularly perturbed that poor results are often presented by study authors as positive. For example, an 1981 study comparing standard behavioral therapy with a weight-loss drug, or the therapy and drug combined found that all of the treatment groups lost a significant amount of weight in the first 6 months, and then all of the treatment groups showed significant re-gain by the end of the 18 month follow-up.the consistency in the curves is really eerie after a while...the 6 month nadir, the gradual incline; also, it is completely baffling to me how someone could look at this graph and think the most notable part is the gap between the three treatments at 18 months

Instead of concluding that all of the treatments had failed to produce lasting weight loss, the authors conclude that these results provide hope for behavioral therapy, because that group showed the slowest rate of weight re-gain:

This most recent study provides grounds for optimism as to the future of behavioral treatment of obesity . over the long run, behavior therapy clearly outperformed the most potent alternative treatment with which it has yet been compared. (734 in Garner and Wooley, 135 in the original)

This pattern is nearly as consistent as the finding that weight is gradually regained and many individuals eventually weigh more than they did at the start of the treatment. After four years, nearly all participants in nearly all studies gain back nearly all the weight they initially lost: Adams, Grady, Lund, Mukaida, & Wolk, 1983; Dubbert & Wilson,1984; Kirschenbaum, Stalonas, Zastowny, & Tomarken, 1985; Murphy, Bruce, & Williamson, 1985; Rosenthal, Allen, & Winter, 1980, Bjorvell & Rossner, 1985; Graham, Taylor, Hovell, & Siegel, 1983; Jordan, Canavan, & Steer, 1985; Kramer, Jeffery, Forster, & Snell, 1989; Murphy et al. 1985; Stalonas, Perri, & Kerzner, 1984; Stunkard & Penick, 1979. And yet, the authors of those studies insist that the diet interventions are “effective,” sometimes claiming that if the subjects had not dieted they would weigh even more. They almost never admit that the treatments completely failed to do what they set out to do, which is produce a clinically significant weight loss that can be maintained long-term. When they do admit that the results are “disappointing,” they frequently call for more “aggressive” treatments like very low calorie diets (VLCD or <800 kcal/day) or supervised fasting (which is no longer approved because of the risk of mortality).

Garner and Wooley also evaluate studies that used VLCD, some of which involved Optifast, the protein shake that Oprah used to achieve her 67 lb weight loss in 1988. Just like with other calorie-restriction diets, people on VLCD generally lose weight initially, although drop-out rates are much higher than in other weight loss studies (50% or more). Participants who stick to the diet typically maintain the weight loss for about a year, but regain most if not all of the weight they lost within three years and many gain more than they initially lost (Swanson and Dinello, 1970, Sohar and Sneh, 1973, Stunkard and Penick, 1979, Johnson and Drenick 1977, Drenick SC Johnson, 1980, Wadden et al., 1983, Wadden, Stunkard, & Liebschutz 1988, Hovel et al., 1988). Based on all of those studies, they conclude:

Although the rate and magnitude of weight loss have been the basis for recommending the VLCD, its most remarkable feature is the speed of weight regain following treatment. (740)

Garner and Wooley found only two studies of weight-loss dieting that reported better long-term results, and both had extremely low rates of participation in the follow-up and relied on self-reported weights. For example, Grinker et al (1985) reported that 55% of the participants in a residential treatment program had maintained a 5-kg weight loss based on the responses of only 38% of the original participants. They suggest that it seems far more likely that the low participation in the follow-up biased the results than that those studies are right and all the other ones or wrong and conclude:

It is only the rate of weight regain, not the fact of weight regain, that appears open to debate. While this may be discouraging to the individual intent on weight loss, it should also provide some solace to the many individuals who have failed at dieting and have attributed the failure to a personal lack of will power. (740)

It is difficult to find any scientific justification for the continued use of dietary treatments of obesity. Regardless of the specific techniques used, most participants regain the weight lost. (767)

They make the following recommendation to mental health practitioners:

We suggest that at the least, if weight loss is offered, it should be done with full disclosure of the lack of long-term efficacy and of the possible health risks [which, as they explain, include physical and psychological risks correlated with weight fluctuation]. It is further recommended that alternative nondieting approaches aimed at improving the physical and psychological well-being of the obese individual be given priority over dietary treatments as a subject of research and that such treatments be offered on an experimental basis. (767)

Long-term weight-loss maintenance: a meta-analysis of US studies—Anderson et al 2001 (free full text): As the title suggests, this is a meta-analysis rather than a review article, meaning rather than summarizing and evaluating what other studies found, they lumped together the data from 29 different studies. 13 of the studies involved “very low energy diets” (VELDs), 14 involved “hypoenergetic balanced diets” (HBDs) and 2 involved both—in other words, they were all calorie-restriction diets, and about half of them required participants to eat less than 800 kcal/day. The authors claim that no long-term randomized, controlled studies were available, and it’s unclear why they didn’t think studies like Jeffrey and Wing 1995 (discussed below) should count.

They don’t provide details for any of the studies individually, but do disclose that the number of participants ranged from 6 to 504, the length of treatment ranged from 8 to 30 weeks, average initial weight loss ranged from 3.5 to 37.9 kg for women and 6.2 to 44.2 kg for men, and follow-up participation rates ranged from 50% to 100% with a median of 82%. In other words, these were very different studies. Here are the results of their aggregation of the data:

again, what they're focusing on is the relatively small loss maintained by year 5 rather than, say, the precipitous drop from year 1 to year 2

The average weight loss at 5 years for both VELDs and HBDs was 3.0 kg, or ~3.2% of the participants’ starting weight and 23.4% of their initial weight loss. Anderson et al conclude:

These average values are higher than those reported in earlier studies and indicate that most individuals who participate in structured weight-loss programs in the United States of the type reported in the literature do not regain all of the weight lost at 5 y. of follow-up.

Sure, not all of the weight, only 76.6% of it. It still seems to me like a perversion of the idea of “success” to claim that these results show that calorie-restriction diets are “effective.” The average initial weight loss was 14 kg. If you lost almost 31 lbs and then regained 25 lbs, would you consider your diet a long-term success? Mann et al wouldn’t. In the 14 long-term studies without control groups that Mann et al evaluated, they also note an average maintenance of ~3 kg. They just don’t think that’s very impressive:

It is hard to call these obesity treatments effective when participants maintain such a small weight loss. Clearly, these participants remain obese. (Mann et al 223)

Interpretation/equivocation aside, there’s still some discrepancies between their analysis and the consensus in the other reviews which I wish I could explain. It’s not like this was a study of a new treatment—they relied exclusively on existing studies, at least some of which were also included in the reviews of the literature discussed above. However, some of the studies they included must have reported (possibly significantly) better results to bring up the average. Since they didn’t evaluate the studies individually, it’s impossible to tell from their write-up whether those studies involved some sort of strategy that made calorie restriction dieting “work” (and somehow didn’t attract widespread attention) or whether the results in those studies were biased by low participation rates in follow-ups, self-reporting, or some other factor(s).

A Closer Look at the Studies Themselves

I have not read every single study referenced in the review articles, although I have at least glanced at many of them. The ones I chose to explore in further depth here either 1) meet the “gold standard” of randomized assignment to diet/non-diet conditions and at least 2 years of follow-up or 2) are too recent to be included in the review articles.

Long-term Effects of Interventions for Weight Loss—Jeffrey and Wing 1995 (free abstract or full text with umich login): This is one of the seven studies included in the first part of the Mann review. 202 participants between the ages of 25 and 45 who were between 14-32 kg above the MetLife standards for the “ideal weight” for their height were randomly assigned to one of five experimental groups:

  • a control group which received no intervention
  • a standard behavioral therapy group (SBT) that received instruction on diet (including advice on how to follow a 1000-1500 calorie/day diet), exercise (including the recommendation to walk or bike 5 days/wk with an initial goal of burning 250 kcal/wk and gradually increasing that to 1000 kcal/wk), and behavior modification (including keeping food and exercise diaries. This advice was given in weekly counseling sessions for the first 20 weeks and monthly sessions thereafter for a period of 18 months.
  • a SBT + food group, which received the same counseling along with premeasured and prepackaged breakfasts and dinners for 5 days/week for 18 months
  • a SBT + $ incentive group, which received the same counseling along with up to $25/week  for achieving and maintaining weight loss
  • a SBT + food + $ incentive group, which got the counseling, meals, and money

In addition to the 18 months of the study, the participants were contacted at 30 months (a full year after the study ended) for an additional follow-up, which was completed by 177 (88%) of the original participants. Here are the results:

 is this shape getting familiar? 

All the treatment groups lost weight during the intervention, achieving their maximum results at 6 months. However, by 12 months—even though they were all still receiving the treatment, they were beginning to regain weight. By 30 months, there was no significant difference between any of the treatment groups and the control group. The authors wheedle a bit, claiming the difference “approaches levels of statistical significance” (.08), but are honest enough to admit in the end:

The overall results of this evaluation reemphasize the important point that maintaining weight loss in obese patients is a difficult and persistent problem.

Preventing Weight Gain in Adults: The Pound of Prevention Study—Jeffrey & French 1999 (free full text): This more of a “failure of low-cost educational interventions designed to encourage weight loss” than a failure of weight loss dieting per se, but it’s still relevant because 1) the experimental group “got the message” communicated in the educational intervention but gained the same amount of weight over 3 years as the control group and 2) calorie labeling is essentially a large-scale, low-cost educational intervention. The idea that education will make people thinner relies on the assumption that people would not be (as) obese if they only knew they were gaining weight, that they should eat more fruits and vegetables, that they should reduce their consumption of high-fat foods, and/or that they should get more exercise.

But most people do know all those things. In this study, 228 men and 594 women employed by the University of Minnesota and 404 low-income women, all between the ages of 20-45, were recruited to participate in a 3-year study. Half of the participants were assigned randomly to a control group and the other half were assigned to the “intervention” group, which received a 2-4 pg monthly newsletter called Pound of Prevention. The newsletter emphasized five themes:

1) weighing yourself regularly (at least once a week)
2) eating at least 2 servings of fruit per day
3) eating at least 3 servings of vegetables per day
4) reducing the consumption of high-fat foods
5) increasing exercise, especially walking

In other words, “common sense” nutritional advice, although not explicitly calorie reduction. The newsletter included recipes, suggested particular areas/routes in the local areas for walking, and included a return-addressed, stamped postcard asking participants to report their current weight and also answer whether they had walked for 20 minutes or more, eaten 2 servings of fruit, eaten 3 servings of vegetables, or weighed themselves in the last 24 hours. Intervention participants were also invited to take part in a variety of activities during the three years, including 4-session weight control classes, aerobic dance classes, free 1-month memberships to community exercise facilities, walking groups, and a walking competition. Additionally, half of the “intervention” group was assigned randomly to an “incentive” group who were eligible for a monthly $100 lottery drawing for members who returned the postcards.

All participants were evaluated in annual physicals where they were weighed, their height was measured, their dietary intake evaluated using a standard 60-item Food Frequency Questionnaire, and they were asked about behaviors like exercising, eating fruits and vegetables, decreasing fat intake, using “unhealthy diet practices” like laxatives and diet pills or liquid diet supplements, weighing themselves, and smoking. At some point in the study, a questionnaire was administered to test “message recognition.”

Participation in the “intervention” group was high—68% of postcards were returned, 80% of the participants reported having read most or all of the newsletters at their annual visits, and 25% participated in one or more of the extra activities. The “message recognition” test was somewhat successful—the intervention group was significantly more likely to identify the 5 targeted treatment messages as being among the best ways to prevent weight gain; however, even 66% of the control group endorsed the treatment messages. The intervention groups were slightly-but-significantly more likely to weigh themselves and more likely to continue practicing “health weight loss practices” as measured by a 23-item questionnaire. However, changes in BMI, energy intake, percent of calories from fat, and rates of physical activity were not significantly different between the control and intervention groups. All participants gained an average of 3.5 lbs over the course of the 3 years.

In short, the intervention was a failure. The authors conclude:

It is easier to teach people what to do than to persuade them to actually do it…. The overall impact on weight itself…was very weak, indicating that stronger educational strategies are needed or, alternatively education alone is insufficient to deal effectively with this important problem.

Weight Maintenance, Behaviors and Barriers—Befort et al 2007 (free abstract or full text with umich login): Based on the abstract, this study sounds like a success, but under closer examination, not so much. The data was collected at a university weight loss clinic where participants were recruited to follow low-calorie or very low-calorie (500 kcal/day) weight-loss diets followed by a maintenance program. The “weight-loss” phase lasted for 3 months during which participants consumed prepackaged meals and/or shakes. The maintenance programs ranged from 6 to 21 months and consisted of weekly or bi-weekly meetings at the clinic during which participants were counseled to follow a structured diet plan with a daily calorie goal and exercise 150-300 minutes per week. In 3 out of 4 trials, the participants were also encouraged to continue consuming the shakes/prepackaged meals.

Out of 461 participants who started treatment, 44 dropped out during the 3-month weight loss phase and 211 dropped out during the maintenance phase. They sent follow-up surveys to everyone who completed the 3-month weight loss phase (n=417), and got 179 back (46.6.%). The more recently participants had been part of one of the studies, the more likely they were to respond to the follow-up survey. Responders had only been out of treatment for an average of 14 months.

Their claim that a “majority” of the participants maintained their initial weight loss is based on them lumping together respondents who had only been out of treatment for 6 months with people who had been out of treatment for 24 months or more, despite the fact that—just like in every other study of calorie-restriction weight loss—the results showed that most participants gradually regain weight. As they admit:

Compared to participants who were out from treatment for 24 months or longer, those who were out for less than 6 months (P<0.05) or for 6–12 months (P<0.01) had significantly greater weight loss maintenance, both in terms of kg and percent of baseline weight.

What they don’t say is that the percentage of respondents who report maintaining their initial weight loss drops off precipitously after 24 months.

no graph; perhaps it would have been too damning?

Of the 31 respondents who’d been out of treatment for 24+ months, only 25.8% had maintained a weight loss of 10% of their body weight or more and 48.4% had maintained a weight loss of 5% or more. That means out of the original pool of 417 who completed the 3-month diet, only 8 had proven capable of maintaining weight loss equal to 10% of their body weight for more than 2 years and only 15 had proven capable of maintaining a weight loss equal to 5% of their body weight. Other participants might be able to maintain their initial weight loss—that data isn’t available, but the trajectory certainly doesn’t look good. And that’s based on the half of the participants who participated in the follow-up—as Garner and Wooley note, the higher the rate of participation and the longer the follow up, the less weight loss on average is maintained.

What About the National Weight Loss Control Registry?

Several of the studies and at least one person who commented on one of the earlier posts in this series mentioned the National Weight Loss Control Registry (NWCR) as evidence that people can indeed lose weight and keep it off. I’ve never disputed that. Even in the studies that show the least hope for long-term maintenance, there are exceptions to the general trend. But that’s what they are: exceptions.

According to the NWCR website, they have over 5,000 members, all of whom have lost at least 30 lbs and kept it off for at least 1 year; however, most of them have done far better—registry members have lost an average of 66 lbs and kept it off for an average of 5.5 years. As the research above suggests, that’s not remotely “representative” of people who attempt to lose weight. On the contrary, the entire raison d’être of the registry is to figure out what’s different about the 5-10% of dieters who lose significant amounts of weight and keep it off. The goal is to identify strategies that might help other dieters, but as the researchers who run the registry admitted in a 2005 article (free abstract):

Because this is not a random sample of those who attempt weight loss, the results have limited generalizability to the entire population of overweight and obese individuals.

Indeed, the kinds of things the registry members do are generally the same things the participants in most weight loss studies are counseled to do (or, in clinical settings, forced to do): most of them follow a low calorie, low fat diet, eat breakfast every day, weigh themselves at least once a week, watch less than 10 hrs of TV per week, and engage in very high levels of activity—420 minutes per week on average. The NWCR has yet to figure out what makes those things work for them and/or makes them capable of sustaining those behaviors when for most people, they don’t/can’t.

Collecting 5,000 success stories does not prove that dieting “works” for most people let alone that it’s the norm. Somewhere between 45 million and 90 million Americans diet to lose weight every year, most of them by attempting to reduce their caloric intake. According to a survey conducted in April 2010 by a private consumer research firm on behalf of Nutrisystem, 30% of Americans have dieted repeatedly—an average of 20 times. Unsurprisingly, weight loss attempts are more common among overweight and obese people. If calorie-restriction dieting “worked,” America would be a nation of thin people.

Conclusion: Putting the burden of proof back where it belongs

Traditionally, researchers assume that a treatment is not effective until they have evidence that proves otherwise. The reverse is true in regard to weight-loss dieting: most people assume dieting is effective for long-term weight loss and challenge anyone who believes otherwise to prove that it doesn’t—not that that’s difficult, given the consistent failure of most weight-loss interventions to produce lasting results. I have not been able to find one long-term, randomized, controlled study that shows that dieting works (i.e. a statistically significant group of people following a calorie-reduction diet losing a clinically significant amount of weight and keeping it off for more than 3 years). Instead, what all the research to date shows is that the most reliable outcome of calorie-restriction dieting is short-term weight loss followed by weight regain.

I suspect the stubborn persistence in prescribing calorie-restriction dieting as a weight loss strategy in spite of the available evidence probably has a lot to do with dominant and deeply-engrained attitudes about fatness, meritocracy, virtue, and effort. People exhibit remarkable cognitive dissonance when it comes to the research on weight loss—they hold up exceptions as the rule and claim that the 90-95% of people for whom calorie restriction dieting does not produce weight loss must simply not be trying hard enough. 

Imagine this scenario playing out with any other condition—imagine that instead of weight, we were talking about some kind of rash that was widely considered unattractive and thought to be correlated with a variety of other health problems. There’s a treatment that showed promise in short-term trials. In virtually every study, most of the people who get the treatment experience significant improvement in their symptoms, with peak results around six months. However, in longer-term studies, there’s a reversal. Just as consistently, the vast majority of sufferers—at least 75% and usually closer to 90 or 95%—experience a gradual return of their symptoms. For approximately 30-40% of participants, their symptoms actually get worse than before they started the treatment. Only 5-10% show lasting improvement. Of course you would want to do more research to figure out why the treatment works for that 5-10%, but in the meantime, would you keep prescribing it to everyone with the same skin condition?

Even if the problem is that only 5-10% of them fail to use the treatment as instructed—say, it’s a topical cream that only works if you apply it every hour on the hour and people get fatigued, especially by trying to wake up at night to put it on. If 90% of the affected population can’t use the treatment effectively, the results are the same as if the treatment never worked in the first place. Well, except for that part where 30-40% of them end up worse off than before they started the treatment…

So even if the calorie counts on menus were accurate, and people could accurately and reliably estimate how many calories they burn, and they did choose lower-calorie options at least some of the time, and they didn’t compensate by eating more on other occasions…in other words, even if the calorie counts worked the way they were intended to, the best you could hope for would be short-term weight loss. There’s no reason to believe the policy—even under ideal conditions—would have a lasting effect on most Americans’ weight or health.

Why Posting Calorie Counts Will Fail, Part II: Most People Don’t Know How Many Calories They Burn

Introduction and Part I of this series.

click for USA Today article

Few stories that begin, “Many Americans clueless…” can really be called “news.” Nonetheless, a recent study made headlines earlier this month by confirming what research has shown time and again: most people don’t know how many calories they supposedly burn. The 2010 Food & Health Survey by Cogent Research asked respondents (1,024 adults “nationally representative of the US population based on the Census”) to estimate how many calories someone of their age, height, weight, and activity levels “should consume” per day. Only 12% got within 100 calories +/- their Estimated Energy Requirement (or EER, the formula currently used by the USDA) and 25% wouldn’t even venture a guess. The remaining 63% were just wrong. This seems to pose a problem for the claim that publishing calorie counts on menus will improve public health. Logically, if people don’t know if they burn 10 or 10,000 calories in a day, which is the range of estimates collected in another survey, conducted in 2006 at the University of Vermont (full text with UMich login), knowing how many calories a particular menu item contains probably isn’t going to do them much good. The campaign is called "Read 'em before you eat 'em" (the slogan in the little purple circle. Image from nyc.gov

The new calorie publishing policy actually includes a provision to help address this problem—in addition to the calorie counts of all menu items, menus will also have to publish the average daily calorie requirement for adults (2,000 Kcal). New York City also attempted to address the problem of calorie ignorance when it instituted its calorie count requirement by launching an ad campaign aimed at drilling the 2000/day calorie requirement into people’s heads.

But that’s not the kind of calorie ignorance I’m concerned about. For one, I don’t think the success of calorie counts in reducing obesity or improving public health depends on people keeping strict caloric budgets. Enough people have internalized the belief they ought to eat fewer calories that the numbers could be useful as a point of comparison regardless of how many people can accurately estimate how many calories they supposedly burn based on their age, height, weight, and activity level. Even if you’re under the mistaken impression that you’re Michael Phelps, if your goal is to consume less energy, choosing between the 250-calorie sandwich and the 350-calorie one is a simple matter of figuring out which number is smaller. IF calorie counts were accurate, and they inspired at least some people to consistently chose lower-calorie items, and at least some of those people didn’t compensate for those choices by eating more later or being less active, and some of them continued to burn the same number of calories despite eating fewer of them, then the counts would actually have the intended effect. The magnitude of the effect might be small, but it would be in the right direction.

Of course, that’s a big “if.” I already addressed the first condition (calorie counts are often wrong), and will be looking at the next two (people don’t order fewer calories but if they think they have they are likely to compensate later) in more detail in later entries. The problem of most people not knowing how many calories they burn is related to the third condition—the mistaken assumption that people will continue to burn the same number of calories even if they reduce the number of calories they eat.

In other words, the problem isn’t that too few people know that the average adult probably burns something in the vicinity of 2000 calories per day. The problem is that metabolism varies. It doesn’t stick to the formula based on height, weight, age, and activity levels. Most people don’t know how many calories they burn because they can’t know, because it’s dependent on lots of factors that formulas don’t and can’t account for. And one of the things that usually causes people to burn fewer calories per day is eating fewer of them. This starts to get at one of the other reasons I don’t think posting calorie counts will have the desired effect: it’s true that eating fewer calories often leads to short-term weight loss, but the vast majority of people either get hungry and can’t sustain the energy deficit or their bodies adjust to burning fewer calories and erases the deficit. Either way, almost all of them regain all of the weight they lost, and often more.

The Rise, Fall and Return of the Calories-in/Calories-out Myth

The idea that weight gain and loss is simple matter of calories in versus calories out also dates back to William Atwater (the turn of the 20th C. USDA scientist who was into burning food and excrement). Before Atwater, most people believed that the major nutrients in food were used in entirely different ways—proteins were thought to be “plastic” and used exclusively for tissue repair and growth, like little band-aids that the body could extract from food and simply insert where necessary; fats were similarly thought to be extracted from food and stored basically intact; only carbohydrates were thought to be transformed by digestion as they were burned for fuel. The discoveries that protein could be converted to glucose by the liver and that carbohydrates could be transformed into body fat were both seen as wildly counterintuitive and controversial. Some physicians continued to give advice based on the earlier principles as late as 1910. RMR = resting metabolism, which should probably be shaped more like a big empty question mark

However, in the last few decades of the 20th C., Atwater and others managed to convince an increasing number of people that a calorie was a calorie was a calorie—that all of the major nutrients could be burned for fuel and that any fuel not immediately consumed in heat or motion would be stored as fat. The idea of seeking an equilibrium between calories ingested and calories used was first advocated by Irving Fischer, a Yale economist who drew a parallel between Atwater’s new measure of food energy and the laws of thermodynamic equilibrium and market equilibrium. This theory had widespread appeal in the age of Taylorism and scientific management, which coincided with the first major national trend of weight-loss dieting and the aesthetic ideal of thinness represented by the Gibson Girl and the flapper.* Caloric equilibrium was a way to apply the same universal, rational logic thought to govern the laws of chemistry and the market to the body. From the 1890s through the 1920s, the calorie reigned supreme. As historian Hillel Schwartz says:

The calorie promised precision and essence in the same breath. It should have been as easy to put the body in order as it was to put the books in order for a factory” (Never Satisfied: A Cultural History of Diets, Fantasies, and Fat 1986, 135).

That human bodies don’t reliably obey this logic in practice didn’t matter then any more than it seems to matter to most contemporary advocates of caloric algebra. Skeptics noted, even then, that many fat people seemed to eat much smaller meals than thin people, and that some people could reduce their intake to practically nothing without losing weight while others seemed to eat constantly without gaining weight. But the theory of caloric equilibrium is powerfully seductive, not just because of its simple, elegant logic, but also because it seems to “work,” at least in the short term. People who reduce the number of calories they eat do tend to lose weight initially, often at approximately the predicted rate of 1 lb/3500 calories. That offers a kind of intermittent reinforcement. When it doesn’t work or stops working, people scramble to come up with excuses—either the dieter’s estimates of how much they were eating must have been wrong, or they were “cheating” and eating too much (more on this in the entry on why calorie-cutting diets fail).

However, caloric math hasn’t always been the dominant nutritional theory (despite what many people claim). In thefrom Atlas of Men, Sheldon's most popular book 1930s and 1940s, as weight-loss dieting became less popular and feminine ideals got a little plumper again, nutrition science became more concerned with the psychology of appetite—often relying on Freudian-influenced theories about how traumatic childhood experiences and sexual dysfunction might manifest as insatiable hunger—and a new theory of body types.

The theory of somatotypes was initially developed by William Sheldon in the 1940s as part of an attempt to use measurements of the body to predict personality types and behaviors, like criminality. He proposed a sort of three-part continuum between three extremes: the thin ectomorph, the fat endomorph, and the muscular mesomorph, based on the three layers of tissue observed in mammalian embryos. It was similar to the medieval medical theory of different physical constitutions based on the balance of humors (blood, phelgm, bile, etc.) but with a new sciencey gloss and some nationalist overtones—Sheldon noted, for example, that Christ had traditionally been portrayed as an ectomorph (supposed to be cerebral and introspective), and suggested that therefore Christian America would have a military advantage over the mesomorphic Nazis (supposed to be constitutionally bold and arrogant). Somatotypes were later used to customize diet and exercise plans, but at the time, they were primarily embraced as a way to describe and justify the apparent differences in peoples’ ability to be thin. Unlike the algebra of calories in/calories out, somatotyping suggested that no matter what they did, endomorphs could never become ectomorphs. They simply did not burn calories at the same rate, and their bodies would cling stubbornly to fat, especially in the abdominal region.

Sheldon’s theory, like many projects with eugenicist overtones, fell out of favor somewhat after WWII, especially after the embryonic tissue theory was discredited. However, his somatotypes live on, primarily among bodybuilders and competitive weightlifters, perhaps because they still need some way to explain individual differences in outcomes for identical (and rigorously-monitored) inputs. There are also subtler echoes in the idea that people have individual “set points” or genetic predispositions towards certain body types, which isn’t meant to imply that there’s no validity to those theories—I think it seems far more likely that there are genetic components to body size than that all family resemblances are environmental. However, as the new calorie labeling policy exemplifies, the universalizing logic of calories in/calories out is back with a vengeance. Almost every popular diet plan today, with the exception of paleo/low-carb/grain-free diets, is based on creating a calorie deficit (and in practice, many low-carb diets also “work” to the extent that they do at least partially by reducing caloric intake).

The point of this little history lesson is that the extent to which people ascribe to either the theory of calories in/calories out or the theory of intransigent body types seems to have more to do with what they want to believe than the available evidence. Calories-in/calories-out may appeal to Americans today for different reasons than it appealed to the enlightenment rationalist seeking to find and apply universal laws to everything. I suspect that it has a lot to do with normative egalitarianism and faith in meritocracy, e.g. anyone can be thin if they eat right and exercise. The idea of predetermined body types, on the other hand, appealed to mid-century Americans eager to identify and justify differences and hierarchies of difference. But in every case, the evidence is either cherry-picked or gathered specifically to support the theory rather than the theory emerging from the evidence, which is complicated and contradictory.

*Before the 1880s, the  practice of “dieting” and various regimens like Grahmism (inspired by Sylvester Graham), the water cure, and temperance were concerned more with spiritual purity or alleviating the discomforts of indigestion and constipation than achieving a particular body shape or size. Graham’s followers actually weighed themselves to prove that they weren’t losing weight, because thinness was associated with poor health.

So What?

Even if most people can estimate how many calories they burn on an average day now with some degree of accuracy, and the calorie counts help them eat fewer calories than they did before or would have otherwise, there’s no guarantee that they’ll continue burning the same number of calories if they continue to eat fewer calories, which they would have to do for the policy to have long-term effects. In fact, given >6 months of calorie restriction, most people appear to burn fewer calories or start eating more and any weight lost is regained. So either the calorie counts will change nothing about how people order at restaurants and there will be no effect on their weight or health. Or they will have the desired change on how people order… but there still won’t be any effect on their weight or health.

But boy am I glad we have easier access to that critical information.

Why Posting Calorie Counts Will Fail, Part I: The Number Posted is Often Wrong

Introduction to this series here.

image stolen from some article about the new policy that I lost track of because I had 70 tabs open  When you see 450 posted, that might really mean 530. Or more.

Publishing caloric values right on the menu seems straightforward and transparent. The numbers offer what appears to be a simple way to compare items no matter how different they are based on what many people believe is, as Margo Wootan said, the “most critical piece of nutrition information.”  But even setting aside for a moment the issue of whether the number of calories should be the most important factor governing food choices or all calories are equal, there are problems with the numbers themselves.

Give or take 20%…but almost always give

According to a recent study at Tufts where a team of nutrition scientists led by Susan Roberts used a calorimeter to measure the actual caloric value of 39 prepared meals purchased at supermarkets and restaurant chains:

Measured energy values of 29 quick-serve and sit-down restaurant foods averaged 18% more than stated values, and measured energy values of 10 frozen meals purchased from supermarkets averaged 8% more than originally stated. Some individual restaurant items contained up to 200% of stated values and, in addition, free side dishes increased provided energy to an average of 245% of stated values for the entrees they accompanied. (Journal of the American Dietetic Association; full-text is subscription only—here if you have UM library permission)

As Roberts told Time, she decided to do the study because when she was trying to follow the diet advice in her own book, substituting prepared or restaurant meals, “the pounds stopped dropping off. Just as suspiciously, she always felt full” (more on the idea the fullness means a diet must be failing when I get to the issue of why calorie-restriction doesn’t work for long-term weight loss).

It’s worth noting that the results of the study didn’t reach statistical significance “due to considerable variability in the degree of underreporting.” However, they “substantially exceeded laboratory measurement error” and—as noted above—the average discrepancy was 8% or 18% higher, it didn’t even out. However, the average is actually within the Federal regulations—from the same Time article:

Federal regulations are strict about the accuracy of the net weight of a package of prepared food, which must be at least 99% of the advertised weight. When it comes to calories, the count can be a far bigger 20% off. The Federal Government plays no role in checking the calorie claims in restaurants, which means it’s up to the states to handle the job — with the predictable patchwork results.

What Roberts’ research suggests is that calorie counts aren’t just wrong, they’re wrong in one direction. As anyone who’s ever tried to count calories knows, a difference of +18% could be devastating to a diet. Say, for example, you think you burn 2000 calories/day, like the supposed average American adult, and you’re trying to generate a ~250 calorie/day deficit through your diet. Assuming you continue to burn 2000 calories/day, that diet should make you lose about 1/2 lb per week or 26 lbs in a year. However, if you were actually eating 18% more calories than the 1750 you’ve budgeted, or 2065 calories/day, and the caloric algebra worked perfectly, you’d gain 6.8 lbs in a year instead.

Even if you’re being reductive, food is more than the sum of its parts

One factor that may work in the opposite direction: the method used to determine the caloric  content of food may systematically overestimate how much energy most people get from some foods. A quick primer on the calorie (most people who are reading this probably already know this, but since lots of people don’t): a nutritional calorie is a measure of the energy contained in food. The base unit, a gram calorie, is the amount of energy required to heat 1 gram of water 1 degree Celsius. A nutritional calorie is a kilocalorie (kcal) or “large calorie” (C), the amount of energy required to heat a 1 kg water 1 degree.

William Olin Atwater c. 1900 from the USDA via the Wikimedia CommonsHere’s the part a lot of people don’t know: the caloric value on labels is calculated according to the “Atwater system” named after the USDA chemist William Atwater, who spent his career burning food and excrement (cue Bevis & Buthead laughter). Based on the formula Metabolizable Energy = Gross Energy in Food – Energy Lost in Secretions, Atwater came up with average energy values for each macronutrient: 9 Kcal/g for fat, 4 Kcal/g for protein, 4 Kcal/g for carbohydrates, and 7 Kcal/g for alcohol. For the purposes of nutrition labeling, even though fiber is technically a carbohydrate, it’s subtracted from the total carb weight before the calories are calculated since it’s not digested.

However, there appears to be considerable variation within macronutrients. Sucrose burns at a lower temperature than starch and isolated amino acids vary in their heat of combustion. Additionally, the Atwater system doesn’t account for differences in how macronutrients behave in when combined—for example, fiber seems to change the amount of fat and nitrogen that turn up in feces, which suggests that its effect on caloric value might not be entirely accounted for by simply subtracting fiber grams from the total carbohydrates. And, as you might expect, “variations in individuals are seen in all human studies” (Wikipedia).

The differences between estimated calories and the actual caloric value (as measured by a bomb calorimeter like the one Roberts’ team used in their study, which still might not correspond exactly to how food is turned to energy in the human digestive tract–I’m not entirely sure how calorimeters account for fiber given that fiber is combustible even though it isn’t digestible) might not be very large—but perhaps more importantly, the discrepancies probably aren’t consistent. The Atwater system is probably more accurate for some foods than others, and seems especially likely to overestimate the energy value of high-fiber foods and distort the differences between starchy and sugary foods.

That might help to explain the discrepancy seen in studies on nuts: in controlled nut-feeding trials, people eating more calories in the form of nuts don’t gain the weight that they should based on their greater energy intake. Additionally, they excrete more fat in their feces (Sabate 2003, American Journal of Clinical Nutrition). This is similar to another issue I mentioned in the introduction—not all calories are the same—but it’s not actually the same problem. Non-random variance in the reliability of caloric estimation means that even if all calories were the same, the numbers on the menus might not be accurate, i.e. the way we estimate calories might not correspond reliably to the amount of energy people actually derive from the food they eat.

So what?

Well, this means that there are (at least) two possible ways that providing consumers with “more information” in the form of calorie counts might actually lead to worse decision-making:

1) Even if people do base their decisions about what to order on the posted calorie counts, they might end up getting many more calories than they want and eating more than think they are.

2) Certain kinds of foods—including high-fiber foods and nuts, which might be “healthier” than items with lower posted calorie counts according to more holistic metrics—might have misleadingly high calorie counts based on the Atwater system. That could dissuade customers from ordering them or restaurants from offering them in favor of less “healthy” foods that may  have lower counts based on the Atwater system but actually provide more energy.

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Why Posting Calorie Counts Will Fail: Introduction

Calories on menus are already a fact of life in New York City and were set to appear in a handful of states like California and Oregon in 2011. Instead, thanks to a provision in the health care legislation Obama signed in March, they’ll be required nationwide. The policy calls for all restaurant chains with 20 or more locations to publish calorie counts for all items on all menus. The policy also applies to vending machines, buffets, and bars. McDonalds menu with calorie counts from the website for the film Fat Head, click for info. I'm surprised to see that the fries actually aren't the best Kcal/$ bargain--the burgers and even the McChicken give you slightly more bang--or burn--for your buck. The profit margin on fries must be astounding.

The policy’s advocates and authors claim that it will reduce obesity rates and improve public health. In a press release from The Center for Science in the Public Interest, Margo Wootan, a nutritionist who helped write the calorie count part of the bill said:

"Congress is giving Americans easy access to the most critical piece of nutrition information they need when eating out…. It’s just one of dozens of things we will need to do to reduce rates of obesity and diet-related disease in this country…. Menu labeling at restaurants will help make First Lady Michelle Obama’s mission to reduce childhood obesity just a little bit easier.” (CSPI press release)

In an interview with the LA Times, she expanded on the logic of the claim: 

"People will be able to see that the order of chili cheese fries they are considering will be 3,000 calories.”

Well, probably more like 400500. But how could she be expected to know that before the law goes into effect?

Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale told the NYTimes that even if some consumers ignore the information, it will affect enough people to create a public health benefit. However, he also hedged his bet—saying that even if it doesn’t make people eat better, it’s an issue of rights as much as an issue of health:

“You don’t need a study that proves anything,” Mr. Brownell said. “You just have a right to know.”

Proof? Who needs proof? His disclaimer is savvy, because now in 5 or 10 years if obesity rates are still the same* or higher and there’s been no significant decrease in cardiovascular disease, diabetes, cancer, or any of the other conditions correlated (albeit often weakly) with obesity, Brownell can claim we’re still better off knowing than not knowing.

I’m not so sure. While I don’t think posting the number of calories is likely to have a significant, negative impact on public health, nutrition is one realm where more information isn’t always better. The usefulness of information always depends on its reliability, relevance, and people’s ability to place it in meaningful context. Calorie counts fail on all three measures, which is why I suspect the new policy isn’t going to have the desired effect on obesity rates or public health.**

Here are a few of the problems with calorie counts I’ll address in this series:

1) The number posted is often wrong (a problem for reliability)

2) Most people don’t know how many calories they burn (a problem for meaningful context)

3) Even though calorie restriction is a highly effective short-term weight loss strategy, it doesn’t work long-term (at least for 90% of dieters) (a problem for relevance)

4) Not all calories are equal (another problem for relevance)

Furthermore, the limited evidence available so far about how calorie counts on menus affect purchasing decisions based on the New York City law is mixed. That calls into question the mechanism by which the policy is supposed to improve public health. Apparently, knowing the calorie content of menu items doesn’t necessarily reduce the number of calories people purchase. And that’s before even beginning to try to measure whether purchasing fewer calories on single visits to restaurants actually leads to weight loss or if people just compensate by eating more on other occasions or eating more often.

One response might be: well, it can’t hurt. I’m also not so sure about that. While I don’t think it’s likely to make public health worse, by reinforcing the idea that your health (or your weight) is based on the number of calories you eat, it may prevent people from taking steps that would actually improve their health, which the preponderance of evidence suggests that calorie-restriction dieting will not.

Part I in this series, on why the number posted is often wrong, coming later today.

*The rate of increase in obesity has already been slowing down so even if it plateaus, that’s not necessarily evidence this or anything else is “working,” it may simply mean that obesity rates have reached an upper limit.

**Two separate issues which are often unjustly conflated. For more on that, see Paul Campos’ The Obesity Myth, J. Eric Oliver’s Fat Politics, Glen Gaesser’s Big Fat Lies, or Michael Gard and Jan Wright’s The Obesity Epidemic: Science, Morality, and Ideology—if you feel like I’ve said that before, it’s because I have. The reason I bring them up again and again is that they completely changed my thinking about nutrition, fatness, and health. The authors of those books all—independently—examined the evidence for the argument that obesity is dangerous and all reached the same conclusion: it’s not, and the belief that it is is based on some shockingly bad science. They also argue convincingly that the actual increases in Americans’ weight in the last few decades are actually quite modest (it’s the rate of people being defined as obese that’s trumpeted, not the amount of weight people have gained on average and some of the increase is based on changes in the definition of “normal” or “healthy” with no medical justification); that the correlations between obesity and disease or early mortality—many of which are quite weak—can be entirely explained by other factors that also happen to be correlated with BMI like differences in physical activity, income, and insurance status; and that weight-loss dieting, especially low-fat and calorie-restrictive dieting, do more harm than good. You don’t have to take my word for it. Substantial portions of the books are available for free online, as are many of the studies they cite (including the CDC study that revised the widely-cited statistic that overweight and obesity causes 300,000 deaths per year in the U.S. and said, effectively, “Actually make that 26,000 and by causes we mean correlates with.”)

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When What I Want Isn’t What I Want: On Temptation and Disordered Thinking/Eating

Note: I try to avoid writing overly confessional, navel-gazing posts, but I’m making an exception today because I think personal narratives can be useful in attempting to understand the complexities and challenges of trying to eat “well.”  

I have never been diagnosed with an eating disorder, but I think it's hard for most people to reach this state--disordered or not. I thought I had reached it, but now I'm starting to think it's not a destination that I can "arrive" at but something that requires continuous work, like a balancing act or relationship.

All images in this entry from PostSecret 

When I work from home, I almost never eat out. That doesn’t mean I don’t eat prepared or processed foods—the freezer is almost always full of things from Trader Joes and the local Asian market (I know I could make tamales and pot stickers myself, and that that would probably be cheaper and perhaps better-tasting, but at least for now, other priorities win out over eating 100% cooked-from-scratch meals). But even if you don’t count TJ’s prepared foods and the occasional package of instant pho or ramen, I still eat mostly “homemade” food most of the time, even when I’m working under deadline pressure. A lot of that has to do with the fact that it’s usually quicker, easier, and cheaper to cook an egg, cut up some fruit or vegetables, or throw together a salad or sandwich than it is to go somewhere or get delivery.

Having to be at an office everyday, which I’ve been doing for the last six weeks due to a dissertation writing institute, has disrupted my eat-at-home habits. I’ve tried to pack lunches every night and keep “healthy” convenience foods like nuts and apples in my office to minimize the extent to which I end up eating out, but I haven’t been entirely successful. The availability of outside food has basically exposed me to a whole array of temptations that I don’t normally encounter, and I’ve found myself engaging in some of the patterns of impulsive or emotional eating, negative self-talk, and general anxiety about food that I thought I was mostly “over.”

"Disordered" eating (which may be a misnomer that implies there's such a thing as "ordered" eating) can manifest in many ways; starving and purging are only symptoms, the underlying "disorder" may exist or persist without those symptoms.

Bad Day Part 1: Pizza and Self-loathing

Here’s how last Friday went:

While getting ready in the morning in the bathroom, I weigh myself for the first time in about a week. I used to weigh myself multiple times a day, taking perverse pleasure in every decrease, no matter how small, even if it was clearly due to excretion or being dehydrated from drinking too much the night before. Now I’m not nearly as obsessive, but when I see that the number is over 110—the highest it’s been in at least two years—I feel disappointed and ashamed. I tell myself the number doesn’t matter, and even if it did matter, 110.4 is a perfectly acceptable number for my height and build. And even if it wasn’t a totally acceptable number, obsessing about it wouldn’t do any good. But the best I can do is repress the emotions. I can’t un-feel them. 

It's so hard to internalize the fact that restricting food actually represents a *lack* of control or self-restraint. Even when it takes the form of "restraint," it is unrestrained restraint. I mean, obviously, right, someone in control of their restraint doesn't let it kill them.  In the kitchen, I look at the last container of leftover nettle soup in the refrigerator and sigh. The factors in favor of taking it are many and obvious: it is tasty, relatively healthy, easy, and will prevent me from even having to think about leaving the office to get food. There was even a handful of oyster crackers left at my office from the day before, when I had made the “right” choice and taken the soup. But I tell myself I’m “sick” of it, since I had it yesterday. I briefly contemplate grabbing one of the packages of tamales from the freezer, but then I’d have to find something to transport salsa in. Also, I don’t really have the eating implements at the office for that, and it doesn’t even sound that good in the first place. I am conscious of and unhappy about the fact that I’m making excuses. I throw some cherries in a tupperware container to eat for breakfast, feeling like that’s a reasonably healthy “trade-off” for the potentially less-healthy lunch I’m setting myself up for.

It hasn’t been a good week for dissertation writing. I keep revising instead of adding new material—or, worse, writing blog entries and playing games online. I feel lazy and ashamed, and I know that what would make me feel better is to actually do the work. But I just keep not doing it—willpower failing on multiple fronts. However, this particular morning goes pretty well. I spend an hour or so on the egg post, but then I finish revising a section of the chapter that’s been frustrating me for a while. Around noon, when I start to get hungry and distracted, I decide that the best way to keep my momentum going is to take a break and go to lunch to try to circumvent the pit of despair that I seem to slip into around 1pm.

I wander outside contemplating my options and decide to get pizza. I know this is probably among the worst of the options available to me no matter what criteria you’re using—carbs, calories, fat, pizza has it all in abundance. My justification is that I have been vaguely wanting pizza for days, so perhaps if I just have it, I will stop thinking about it and possibly compensating for not having it by “splurging” on other foods.

It tastes good, but as with most foods I have ever craved or idealized, it’s not nearly good enough to warrant either “craving” or feeling guilty about. The idea that it’s a “bad” food only makes me want it more, it doesn’t make it taste better. I probably would have gotten more pleasure from the nettle soup. I make a note of this but endeavor not to mentally castigate myself. working to change my perceptions about what is pretty--on myself and other people--is a related challenge, and also one that takes continuous effort.

Perhaps because I can tell I’m on a sort of dangerous track, while I’m eating the pizza, I start thinking about a moment a few years ago that has become somewhat totemic for me as an example of my “disordered” past tendencies. I was looking at a friend’s stomach—she’s slender, but has a tiny rounded belly—and I thought something along the lines of: ugh, if my stomach ever looked like that, I’d start seriously starving myself. It was less…concrete than that because I didn’t put it into words, but it was something between that kind of thought and more general feeling of disgust and dread that seemed like it was directed outward (towards the friend) but was actually just a projected form of self-hatred. At the time, I took the comparative flatness of my stomach as evidence of my superior self-control. But I wasn’t in control—I was terrified of getting fat and ashamed of my hunger and hypercritical of my body. When I did feel beautiful back then, it was entirely dependent on feeling thin (not being thin, because it was entirely about perception, not reality) and it was a hollow, imperious sort of self-love that required other people to be fat and inferior. And most of the time, I didn’t feel beautiful at all.

Thinking about that moment and how completely insane I had to be to think this woman was fat seems to help. I say to myself: So I had pizza for lunch, so what? Eating two pieces of pizza is not some major “transgression.” It’s not going to make me fat or sick, it doesn’t make me morally weak, and it definitely does not make me less beautiful or deserving of love.

Bad Day Part 2: The Unscratchable Itch

After lunch, still feeling vaguely hungry but suspecting that I’m really just thirsty since I didn’t get a drink with my slices, I stop in a small market/deli and contemplate the bottled drinks. I know VitaminWater is basically just sugar-water—that the antioxidants and “superfruits” advertised on the label are classic appeals to what Michael Pollan calls “nutritionism,” that it is not going to make me healthier, that I won’t even like the taste that much. But for some reason, some part of me wants it—VitaminWater is now the thing I hope will scratch this itch I can’t seem to locate, which is probably the same itch I was trying to scratch with the pizza. Deciding not to agonize over it, I pick up a bottle of XXX vitaminwater ZERO (acai-blueberry-pomegranate flavored), without even checking to see what the “natural” zero-calorie sweetener is (it turns out to be stevia). I also grab an apple in case it turns out that I am actually still hungry or want a snack later that afternoon. And then, remembering that I have a 5 hr drive ahead of me that evening, and in anticipation of that or perhaps to offset the “virtue” of the apple and calorie-free vitamin water, I grab a bag of Werther’s Originals Chewy Caramels. Even though I clearly also have and succumb to cravings, I find myself being snarkily judgemental about people who talk about cravings, which I think results partially from popular representations of women as basically crave-beasts made utterly irrational by things like chocolate and low-fat/low-calorie yogurt.

As I put them on the counter at the register, I feel like this is unlike me. I feel like I ought to be above these things: eating “junk food” for lunch, impulse-buying VitaminWater and candy. I’m not even entirely sure why I’m doing it. It certainly doesn’t make me happy.

Back at the office, I look at the nutritional information for the caramels, even though I don’t want to care. I used to count calories obsessively. I don’t anymore, and not just because caloric algebra is imprecise and restricting calories just prevents you from having enough energy and slows your metabolism. What concerns me more are the psychological effects: it causes me to moralize my hunger and food choices, making calorie-dense foods “bad,” and that causes me to crave them. Even when I resist the cravings, I feel ashamed for having them, and become more inclined to indulge in other self-destructive behaviors, either to “treat” myself for being good (resisting cravings) or to punish myself for my unruly appetite. Basically, it makes me want to eat more and enjoy the food I do eat less. Even people who lose weight the "healthy" way through diet and exercise almost always gain it all back, or more. 60% within a year, 97% within three years. 23% gain back more than they lost. Attaching moral significance to weight is a recipe for self-loathing.

Also, it’s unsustainable. My pattern for years was basically: for 2-6 months, I’d restrict myself to 1100-1700 calories/day (usually trying to alternate low and high days). I’d lose a few pounds, feel superior in a hollow way and make pejorative judgments about the moral character of everyone fatter than me (and given that my BMI was between 17.2-18.0, almost everyone I knew or met was fatter than me). But eventually, I’d run out of steam and I’d start “cheating” more, although most of the “cheating” seems pretty ludicrous now—I remember considering a small skim latte a big indulgence. Eventually, I’d stop weighing everything I ate and looking up nutritional values online and for maybe 6 months, I’d eat basically whatever I wanted (although I was always still following some form of restricted diet that usually had ethical/medical rationalizations, i.e. veganism, but was also at least partially motivated by the desire to stay thin). At some point, I’d notice that I had gained a few lbs, and that would inspire me to start counting/restricting again. Many dieters know this cycle well.  Of course, not all vegans are disordered eaters, but I think part of the gender imbalance in vegetarianism/veganism is related to the same factors that cause the gender imbalance in diagnosed eating disorders. More women than men use/abuse food as a form of self-control. Because I really don't think women are generally more "ethical" than men.

Even though calorie counting or “dieting” is often difficult and unpleasant and takes a lot of mental energy, it’s also incredibly difficult to resist because of the short-term weight loss and the illusion of control. The thing I still can’t seem to shake, no matter how much I try and want to, is the desire to be thin—or at least, to not be fat. Given that I know how to be (temporarily, unhappily) very thin by restricting how many calories I eat, it’s hard not to see calories, especially in sugary or starchy foods, as a measure of how bad the “bad’ things I eat are. The caramels turn out to be approximately 40 calories/caramel bad, which I immediately compare to the 20-calorie sugar-free popsicles in our freezer at home (another sin against the Church of Real Food, like the VitaminWater). Each one of these caramels = two popsicles. I eat three of them and ignore the apple, and then struggle to tell myself that that’s okay and that letting this become a matter of guilt/desire will only make me want more and feel worse, etc.

People also derive a lot of pleasure from monitoring their diet, weight, and body shape, too. But if it causes you more anxiety than pleasure, try stopping for a while. I know that's easier said than done, but deciding you don't want to worry or obsess anymore is the first step.

Saying “Enough!” and Giving Myself Permission to Eat What I Want

The rest of that day was better and this week has been fine. I really can’t emphasize this enough: last Friday was an exception, not the norm. However, that kind of lapse—and I’m referring to the thought patterns I indulged in, not the act of eating the pizza or caramels—has been happening way more frequently since the institute started. It’s been an unpleasant reminder that the balance I thought I had achieved—where I generally don’t make impulsive, emotional decisions about what to eat, don’t count calories, don’t feel bad about what I want, and just plain don’t worry so much about getting fat (and by the way, don’t gain weight: I was stable at ~105 lbs for almost 3 years after breaking the calorie-counting cycle)—is still really fragile.

I try to speak up when people make pejorative comments about fatness, I try not to make or think complimentary things about thinness or congratulate people on weight loss. But the idealization of thinness is pretty pervasive. It's difficult to resist. At first—hell, even when I started writing this entry—I thought the problem was the sudden exposure to all kinds of temptations I normally don’t have to deal with. But that’s not quite right. The kind of food that I want when I’m on campus is not the kind of food I actually find all that desirable. The reason it’s not tempting when I work from home is not just because it’s far away, but because there’s nothing inherently tempting about it. I made it into a temptation by constructing “food from home” as the virtuous alternative, which inevitably made it seem boring and oppressive and made me desire restaurant food as the “bad” other. And then, rather than choosing restaurant food that might have been nutritionally equivalent to something I’d eat at home, I was looking for a “treat” so I chose things that violated my beliefs about what is “healthy”…and still felt dissatisfied. Thus the itch I couldn’t scratch.

What I should have done from the start of the institute, and what I will do if I’m ever in this kind of situation again, is reject the impulse to moralize my lunch. I hereby give myself permission to eat as much restaurant food as I want, from whatever restaurants I want. I will eat pizza every day for a week if I want to. And the funny thing is that already, just by giving myself permission to do it, I find that I don’t want to. I only want it when I think I shouldn’t.

That’s basically the same strategy that a lot of proponents of “intuitive eating” recommend to people who want to break patterns of emotional or compulsive eating. It’s hard to listen to the cues your body supplies about hunger and satiety if the reasons you’re eating have more to do with being sad or angry or feeling deprived or wanting to be comforted or thinking you deserve a “treat” than they do with whether you physically need food. If you reject the idea that some foods are virtuous and others “bad” but therefore very desirable and rewarding, you rob food of the moral and emotional significance it has acquired due largely to contemporary anxieties about fat (which are not medically justified—see Paul Campos The Obesity Myth, J. Eric Oliver Fat Politics, Glen Gaesser Big Fat Lies or Michael Gard and Jan Wright The Obesity Epidemic: Science, Morality, and Ideology).

If you decide that you are going to eat what you want without judging yourself—without feeling shame or guilt or self-hatred or the culturally-constructed fear of fatness—a crazy thing happens: you will probably eat mostly “healthy” things in moderate amounts. I don't think most people do have to pick, but if I ever do, I hope I have the strength to choose fat and then try to learn to be happy.Here’s how another Margot, who writes the blog ReelGirl describes her experience of learning to “eat when you’re hungry, eat whatever you want, stop when you are full” (basically the intuitive eating mantra):

I was ready to stop dieting. I’d had enough. It bored me to tears. I was sick of it and bulimia too and thinking about calories or fat grams. I read a book called Overcoming Overeating and When Women Stop Hating Their Bodies (both by Jane Hirschmann), and I did exactly what the books said. I filled my house with an abundance of every food I wanted, and if I binged, I’d go out the next day and buy lots more. That action helped me like nothing else.

Keeping my house stocked with all the food I loved no matter what showed me that I was sticking with myself no matter what, even if I gained 300 pounds, I didn’t care, dieting was over for me. I didn’t gain much weight, by the way, maybe five pounds– going from extreme dieting, calorie counting, and throwing up to eating whatever I wanted hardly made a physical difference. (from an interview she did with A Weight Lifted)

The hardest part is really convincing yourself it’s okay to eat what you want. I’m actually not sure if she—or I—would stick with it if we did gain weight. Despite the fact that I believe that fatness is not a moral or medical concern, despite the fact that I think the idealization of thinness is destructive—especially to women, who are subject to far more scrutiny of their bodies and food choices and held to a much more restrictive standard—the desire to be thin is hard to shake. And as long as I care about being thin, I will probably still sometimes feel ashamed of my body or my desires or my food choices. I feel better and happier about my body and food choices than I did three years ago, in part because giving myself permission to eat what I want broke the negative thought patterns that used to really dominate how I thought about food. But it’s clearly still—and may always be—a work in progress. 

Most days, I am. All is probably too much to ask for.

You’re All Good Eggs: New research shows that specialty eggs aren’t any better for the environment or more delicious

Next year, I will decorate Easter eggs and they will have faces. See 39 other pictures of egg face dioramas at The Design Inspiration by clicking on image

Two articles about eggs published last week have rocked my commitment to paying the specialty egg surcharge. I’m still tentatively on the organic, cage-free, local egg bandwagon for animal welfare and health concerns, but I have to admit that even those reasons may be a little flimsy. The four main reasons given for the superiority of specialty eggs are:

1. They’re better for the environment
2. They taste better
3. They’re produced in a more humane way
4. They’re healthier

There may also be an argument for supporting local producers who might employ less exploitative or abusive labor practices, although that’s not guaranteed. In order to help offset the increased labor requirements of non-conventional practices, small and local farms often rely on unpaid interns and family members, including children. Not that I think it’s a major ethical abuse to have your kids gather eggs, but I often feel at least a little pang of sympathy for the kids—often Amish, sometimes very young-looking—manning farmer’s market booths alone. So I’m deliberately tabling the labor issue because 1) I suspect that the issue of labor conditions at small, local farms vs. big, industrial ones is, like so many things related to the food industry, complicated and 2) it’s nowhere near the top of the list of most consumers’ concerns about eggs.

1. Green Eggs vs. Ham

On June 1, Slate’s Green Lantern reported that specialty eggs (cage-free, free range, and organic) have a greater environmental impact than conventional based on land use, greenhouse gas emissions, and feed efficiency (measured by kg eggs laid/kg feed). The article also noted that according to life-cycle analysis, a recent review article by two Dutch researchers found no consistent or conclusive difference between the environmental impact of pork, chicken, milk, and eggs. Beef requires more land, water, and feed, but pound for pound (or kilogram for kilogram—most life-cycle analyses are European), the review, “did not show consistent differences in environmental impact per kg protein in milk, pork, chicken and eggs.”

The Lantern didn’t evaluate the transportation costs “since the majority of the impacts associated with chicken-rearing comes from producing their feed.” For local eggs, the reduced transportation costs might help balance out the increased feed requirement, but that’s just speculation. For cage-free, free-range, organic, or vegetarian eggs, transportation costs probably further increase the relative impact because not only do they travel just as far or farther than conventional eggs to get to the market, there are probably costs associated with transporting the additional feed they require.

I don't remember where I first heard the story about the egg yolk-inspired label, but it's documented in multiple places, including Red, White, and Drunk All Over and the biography of The Widow Cliquot by Tilar MazzeoMy initial response was basically:

Well, that’s too bad, but efficiency be damned, if it takes more feed and produces higher ammonia emissions to treat chickens humanely and produce healthy eggs with yolks the vibrant orange-yellow of a Veuve Cliquot label, so be it. I know specialty eggs are better, I can see and taste the difference.

2. Golden Eggs

Not so much, apparently. The very next day, The Washington Post published the results of a blind taste test of “ordinary supermarket-brand eggs, organic supermarket eggs, high-end organic Country Hen brand eggs and [eggs from the author’s own backyard chickens].” Blindfolded and spoon-fed, the tasters—two food professionals and six “avocationally culinary” folks with “highly critical palates”—struggled to find differences between the eggs, which were soft cooked to ensure firm whites and runny yolks.

And apparently, this isn’t a new finding. It replicates the results of years of research by food scientists:

Had Pat Curtis, a poultry scientist at Auburn University, been at the tasting, she wouldn’t have been at all surprised. "People’s perception of egg flavor is mostly psychological," she told me in a phone interview. "If you ask them what tastes best, they’ll choose whatever they grew up with, whatever they buy at the market. When you have them actually taste, there’s not enough difference to tell."

The egg industry has been conducting blind tastings for years. The only difference is that they don’t use dish-towel blindfolds; they have special lights that mask the color of the yolks. "If people can see the difference in the eggs, they also find flavor differences," Curtis says. "But if they have no visual cues, they don’t."

Freshness can affect the moisture content, and thus the performance of eggs for some applications, especially recipes that rely heavily on beaten egg whites like meringues or angel food cake. But probably not enough for most people to notice. The author also tested a simple spice cake with super-fresh eggs from her backyard versus regular supermarket eggs. The batters looked different, but once the cakes were baked and cooled, they were indistinguishable.

3. Do They Suffer?

Given how self-evidently cruel battery cage poultry production seems, I’m not entirely sure that “free-range” is as meaningless as people like Jonathan Safran Foer have argued. Sure, “cage free” chickens might never see daylight, and the range available to “free range” chickens might be a dubious privilege at best—a crowded concrete lot exposed to some minimal sunlight would fulfill the USDA requirements. But I don’t think it’s entirely marketing gimmickry, either. For one thing, if there were really no difference, the specialty eggs wouldn’t have a larger carbon footprint.

The animal welfare argument relies on the assumption that either chickens have a right not to experience pain or discomfort or that humans have a moral obligation not to cause them pain, or at least wanton, unnecessary or excessive pain. The debate about animal rights/humans’ moral obligations to animals is too big and complicated for me to cover in any real depth here, but I tend to believe that we ought to try to minimize the pain and discomfort of anything that seems capable of suffering. I used to draw the line at the limbic system—i.e. fish and invertebrates might respond to pain but don’t process it in a way that rises to the level of suffering, whereas birds and mammals can suffer and it’s often pretty apparent when they do. However, as it turns out, the boundaries of the limbic system are “grounded more in tradition than in facts,” and there are unsettled questions in my mind about what constitutes suffering and how to evaluate it. 

Even renowned animal rights theorist Peter Singer has gone back and forth about oysters over the years. I suspect that David Foster Wallace was right when he concluded that what guides our behavior in these matters has more to do with historically and culturally-variable forms of moral intuition than any objective criterion for “suffering”:

The scientific and philosophical arguments on either side of the animal-suffering issue are involved, abstruse, technical, often informed by self-interest or ideology, and in the end so totally inconclusive that as a practical matter, in the kitchen or restaurant, it all still seems to come down to individual conscience, going with (no pun) your gut” ("Consider the Lobster” footnote 19).

I hate relying on “I know it when I see it” standards, because I suspect we’re all inclined to see what we want to, but I don’t have a better answer. My gut says that chickens can suffer and that being able to flap around a concrete lot is better than never getting to move at all. However, my gut also says that chickens are pretty stupid creatures, and it might be an entirely reasonable thing to care more about the environmental impact of egg production than the happiness and well-being of the chickens.

4. Eggs Good For You This Week

Health is the issue that matters most to most consumers (see: The Jungle), and unfortunately, the available research on conventional vs. specialty eggs is frustratingly inconclusive. The most common assertion re: the health of specialty eggs concerns omega-3 fatty acids. I’ve mentioned this in passing and will try to devote some more time to it soon, but for now, I’m tentatively convinced that omega-3s are healthful and low ratios of omega-6:omega-3 are optimal.

Some studies have suggested that chickens raised on pasture—i.e. who get at least some of their nutrients from plants, especially clover or alfalfa—produce eggs with more omega-3 fatty acids and vitamins A and E (and less cholesterol and saturated fat, not that that probably matters). However, specialty labels like “cage free,” “free range,” and “organic” don’t mean pastured and the results of the nutritional analysis of eggs bearing those labels don’t provide very clear guidelines about what to purchase.

A 2002 comparison between five different kinds of specialty eggs and conventional eggs found differences between them, but none that lead to a simple characterization of specialty eggs as healthier:

From Cherian et al in Poultry Science 81: 30-33 (2002)

The "animal fat free and high in omega-3” eggs (SP1) had the highest percentage of omega-3 fatty acids and lowest ratio of omega 6: omega 3, and the cage-free, unmedicated brown eggs were also significantly better by that measure. However, the Organic-certified free-range (SP2) and cage-free all-vegetarian-feed eggs (SP4) had similar omega-3 content to the regular eggs. While some of the differences might be due to the feed, the authors note that the age, size, and breed of the hen can also affect the composition of fats and nutrients.

The study also showed that the shells of some of the specialty eggs were weaker, which supports other research showing more breakage and leaking in specialty eggs than conventional and my anecdotal experience of typically having to set aside the first few cartons I pick up because they contain cracked eggs.

Additionally, a 2010 USDA survey of traditional, cage-free, free-range, pasteurized, nutritionally enhanced (omega-3), and fertile eggs also concluded that:

Although significant differences were found between white and brown shell eggs and production methods, average values for quality attributes varied without one egg type consistently maintaining the highest or lowest values. (Abstract here, no free full text available)

In sum, if you can get pastured eggs (either from your own backyard or a farmer whose practices you can interrogate or even observe), they might be a little better for you than conventional. But after reading all this, I still found myself thinking: But what about the color difference? Doesn’t a darker yellow yolk mean the egg itself is healthier? Apparently not:

Yolk colour varies. It is almost completely dependent upon the feed the hen eats. Birds that have access to green plants or have yellow corn or alfalfa in their feed tend to produce dark yolks, due to the higher concentration of yellow pigments (mainly carotenoids) in their diet. Since commercial laying hens are confined, lighter and more uniformly coloured yolks are being produced. Yolk colour does not affect nutritive value or cooking characteristics. Egg yolks are a rich source of vitamin A regardless of colour. (from Wageningen University)

The record on other health concerns like salmonella and dioxin and PCB content is mixed:

4A: Can you eat raw cookie dough if it’s organic?

The salmonella thing is reminiscent of the e coli in grass-fed beef thing: some people actually claim organic chickens have no risk of salmonella. One UK study allegedly found salmonella levels over five times higher in conventional caged hens than in birds raised according to Soil Association organic standards (which are comparable to USDA Organic certification). 23.4% of farms with caged hens tested positive for salmonella compared to 4.4% of farms with organic flocks and 6.5% with free-range flocks. The explanation proffered is that the spread of the disease is inversely related to flock size and density. No link or citation for the study itself.

A 2007 UK study that tested 74 flocks (59 caged and 15 free range) from 8 farms, all of which had been vaccinated against salmonella, found a smaller but still significant difference: 19.4% of cage chicken house samples and 10.2% of free-range chicken house samples taken over a 12-month period tested positive for salmonella. However, they also noted a high degree of variation between flocks, and that the longest continuously-occupied houses were typically the most heavily contaminated. It’s possible that some of the results of other studies can be attributed to the fact that free-range or organic hen operations are likely to be newer and differences between them and conventional may diminish as time goes on.

On this side of the Atlantic, the results seem to show the opposite. A 2005 USDA study that tested free-range, all-natural antibiotic-free, and organic chicken meat (and contamination in chickens themselves has been linked to salmonella in eggs) found salmonella in all three groups at higher rates than in past years’ surveys of commercial chicken meat:

A total of 135 processed free-range chickens from four different commercial free-range chicken producers were sampled in 14 different lots for the presence of Salmonella. Overall, 9 (64%) of 14 lots and 42 (31%) of 135 of the carcasses were positive for Salmonella. No Salmonella were detected in 5 of the 14 lots, and in one lot 100% of the chickens were positive for Salmonella. An additional 53 all-natural (no meat or poultry meal or antibiotics in the feed) processed chickens from eight lots were tested; 25% of the individual chickens from 37% of these lots tested positive for Salmonella. Three lots of chickens from a single organic free-range producer were tested, and all three of the lots and 60% of the individual chickens were positive for Salmonella. The U.S. Department of Agriculture Food Safety and Inspection Service reported that commercial chickens processed from 2000 to 2003 had a Salmonella prevalence rate of 9.1 to 12.8%. Consumers should not assume that free-range or organic conditions will have anything to do with the Salmonella status of the chicken.

Additionally, a 2007 analysis of fresh, whole broiler chickens by Consumer Reports found that 83% tested positive for campylobacter or salmonella, and that chickens labeled organic or raised without antibiotics were more likely to harbor salmonella than conventionally-produced broilers:

We tested 525 fresh, whole broilers bought at supermarkets, mass merchandisers, gourmet shops, and ­natural-food stores in 23 states last spring. Represented in our tests were four leading brands (Foster Farms, Perdue, Pilgrim’s Pride, and Tyson) and 10 organic and 12 nonorganic no-antibiotics brands, including three that are “air chilled” in a newer slaughterhouse process designed to re­duce contamination. Among our findings:

  • Campylobacter was present in 81 percent of the chickens, salmonella in 15 percent; both bacteria in 13 percent. Only 17 percent had neither pathogen. That’s the lowest percentage of clean birds in all four of our tests since 1998, and far less than the 51 percent of clean birds we found for our 2003 report.
  • No major brand fared better than others overall. Foster Farms, Pilgrim’s Pride, and Tyson chickens were lower in salmonella incidence than Perdue, but they were higher in campylobacter.

Ultimately, salmonella is a always a risk when dealing with chicken or eggs and it’s not clear that specialty eggs are any better than conventional. If you’re concerned about salmonella, cook your food to 165F or stick to vegan options. You know, like peanut butter.

4B: What’s in the grass?

One final concern: a 2006 Dutch study found that free-range eggs in Europe have increased levels of dioxins and PCBs (which fall under the category of dioxin-like compounds), apparently because they are present in the soil in both residential and agricultural areas. “Dioxins” refer to a wide variety of compounds and they vary in toxicity; the term is basically just shorthand for environmental pollutants. On the one hand, they’re everywhere and we probably can’t avoid them so who cares? On the other, many are fat soluble so eggs are of greater concern than, say, apples.

There’s not really enough research on this to draw any conclusions. Which just pains me to type for what feels like the umpteenth time, because, seriously, is there ever conclusive research? Can we ever really know anything about anything? I like to think we can, but I’ll be damned if I don’t feel like every time I try to find more information about any kind of nutritional claim, the answer turns out to be “well, that’s complicated” or “well, the research on that isn’t conclusive.” Sometimes I really just want to see a chart that says YES! THIS IS THE RIGHT ANSWER! IT IS RELIABLE AND ACCURATE AND CONTROLLED FOR ALL POSSIBLE VARIABLES.

So just in case you might be wondering if I’m trying to be deliberately indecisive or vague in service of whatever ideological position that would even promote: I’m not. When I find conclusive results, I will share them with you in very excited caps lock. 

So Here’s The Deal

If you care more about climate change and efficient resource allocation than chicken welfare, buy conventional eggs; if you care more about chicken welfare, buy cage-free, free-range, Organic, or perhaps ideally, local. Taste and health-wise, there’s no clear difference, although I know that won’t prevent some of you from believing there is (remember the chocolate yogurt with “good strawberry flavor”?) Perhaps the biggest lesson is that, once again, the foods some people think are objectively superior for all kinds of reasons  may not be, and attempting to eat “better” is way more complicated than simply choosing the “green” alternative.

HFCS Follow-up: What the Rats at Princeton Can and Can’t Tell Us

Ed called my attention to last week’s press release about the study at Princeton currently getting some mass media attention. The press release claims:

Rats with access to high-fructose corn syrup gained significantly more weight than those with access to table sugar, even when their overall caloric intake was the same. 

i know it's a squirrel, not a rat. apparently no one's gotten a rat to do this and then circulated it with the right keywords to match my google search. this image likely not original to: http://ybfat101.com/notyourfault.shtmlThat’s pretty surprising, given that other studies have suggested that there is no difference between HFCS and sucrose. The Princeton study doesn’t offer a definitive explanation for the difference they found, but they suggest that it may have something to do with the slightly greater proportion of fructose in the HFCS.

As I noted in the first post on high-fructose corn syrup, HFCS-55, which is the kind used in soft drinks and the Princeton study, has roughly the same proportions of fructose and glucose as table sugar. Table sugar, or sucrose, is composed of fructose bonded to glucose so it’s a perfect 50-50 split. HFCS-55 contains 55% fructose, 42% glucose, and 3% larger sugar molecules. There’s a lot of evidence that fructose is metabolized differently than glucose, and may promote the accumulation of fat, especially in the liver and abdomen. Indeed, that’s why I believe that agave nectar is probably nutritionally worse than table sugar. Still, I’d be pretty shocked if a 5% increase in fructose could produce a statistically significant difference in weight gain, unless the rats were eating nothing but sugar-water. And they weren’t—in both of the experiments reported in the original study, the rats had access to unlimited “standard rat chow,”

Experiment 1: Rats Who Binge?

In the first experiment, 40 male rats were divided into four groups of ten. All of them had 24-hour access to rat chow and water. Group 1 was the control, so they just had chow and water. Group 2 had 24-access to an 8% solution of HFCS (.24 kcal/mL), which the press release claims is “half as concentrated as most sodas”. Group 3 had 12-hr access to the same HFCS solution. And Group 4 had 12-hr access to a 10% solution of sugar dissolved in water (.4 kcal/mL), which the press release claims is “the same as is found in some commercial soft drinks.” The two things of note so far are that none of the rats had 24-hr access to sucrose-sweetened water, and that the concentration of the sucrose was nearly 2x that of the HFCS syrup.*

Why the 24 hr vs 12 hr groups? According to the study:

We selected these schedules to allow comparison of intermittent and continuous access, as our previous publications show limited (12 h) access to sucrose precipitates binge-eating behavior (Avena et al., 2006).

In other words, they fed the sucrose group on a schedule that they already knew would cause binging. And they didn’t include a 24-hr sucrose group to control for that.

That helps to explain the results: the rats that had 24-hr access to HFCS-water gained less weight than either the rats who had 12-hr access to sucrose-water or the rats that had 12-hr access to HFCS-water. So according to the experiment, it’s better to consume some HFCS than it is to binge on sugar (not, obviously, how they chose to frame it in either the formal write-up or the press release).

Princeton rats

The only difference between the four groups in the first experiment that was statistically significant at a p<0.05 was between the rats who got chow only and the rats who got 12-hr HFCS. There was no statistically significant difference between the rats who had 12-hr access to sucrose-water and the rats who had 12-hr access to HFCS-water. There wasn’t even a significant difference between the rats who had 24-hr access to HFCS-water and the chow-only rats. So the only basis for the claim in the press release that HFCS is worse than sucrose is the fact that the rats with 12-hr HFCS got a “significant” amount fatter while the 12-hr sucrose rats didn’t. Even though the 24-hr HFCS rats didn’t either.

I am not the only one who’s picked up on this—both Marion Nestle (a vocal critic of the food industry) and Karen Kaplan (not, as far as I can tell, a shill for the Corn Refiners Association) also dispute the claim that this research demonstrates anything conclusive about HFCS vs. sucrose. The lead researcher replied to Nestle’s post, and rather than addressing the discrepancy between the 12-hr and 24-hr HFCS groups, he merely corrects her assumption that the 24-hr rats should be fatter:

There have been several studies showing that when rats are offered a palatable food on a limited basis, they consume as much or more of it than rats offered the same diet ad libitum, and in some cases this can produce an increase in body weight. So, it is incorrect to expect that just because the rats have a food available ad libitum, they should gain more weight than rats with food available on a limited basis. –Bart Hoebel

Which just makes it all the more baffling why they didn’t include a 24-hr sucrose group. Additionally, according to their results, binging or “consuming more” doesn’t explain the results, because:

There was no overall difference in total caloric intake (sugar plus chow) among the sucrose group and two HFCS groups. Further, no difference was found in HFCS intake and total overall caloric intake in the groups given 12-h access versus 24-h access. Both groups consumed the same amount of HFCS on average (21.3±2.0 kcal HFCS in 12-h versus 20.1±1.6 kcal HFCS in 24 h), even though only the 12-h group showed a significant difference in body weight when compared with the control groups.

The only explanation they offer for these results is the slight difference in the amount of fructose the rats in the HFCS and sucrose groups consumed. But even that relies on the idea that the HFCS rats did not feel as satisfied by their sugar water and compensated by eating more:

…fructose intake might not result in the degree of satiety that would normally ensue with a meal of glucose or sucrose, and this could contribute to increased body weight.

Unless satisfaction itself makes rats thinner.

Experiment 2 (Males): Wait, Where’s the Sucrose?

In the first part of the second experiment, 24 male rats were divided into three groups of eight. Again, all three had unlimited chow and water. Group 1 had 24-hr access to the HFCS-solution, Group 2 had 12-hr access to the HFCS-solution, and Group 3 was the chow-only control. Sucrose, you’ll note, drops out entirely. According to the study:

Since we did not see effects of sucrose on body weight in Experiment 1 with males, we did not include sucrose groups in this long-term analysis in males.

But there were no effects of HFCS on body weight on the 24-hr schedule! The omission of sucrose from this experiment makes as much sense as the omission of a 24-hr sucrose group in the first one. The lead researcher’s reply to Marion Nestle’s criticisms offered no further clarification about this choice. 

We explain in the article that we purposefully did not compare HFCS to sucrose in Experiment 2 in males, because we did not see an effect of sucrose on body weight in males in Experiment 1.

This study went on for 6 months instead of 2 months and, as the table above shows, the groups with both 24-hr and 12-hr access to HFCS-water gained a significantly greater amount of weight than the chow-only rats. This time, the 24-hr HFCS rats gained more weight than the 12-hr HFCS rats.

Experiment 2 (Females): Sucrose is back (still only 12-hr)! But chow is limited.

In order to “determine if the findings applied to both sexes,” they also ran a slightly different version of the second experiment on some female rats (n unknown). The control group, as usual, got unlimited chow and food. Group 1 got 24-hr access to HFCS-water. The remaining two groups got 12-hr access to chow (“to determine if limited access to chow, in the presence of HFCS or sucrose, could affect body weight”) and either 12-hr access to HFCS-water or 12-hr access to sucrose-water. Yeesh. How about testing one thing at a time, guys?**

So this time, only the rats with 24-hr access to HFCS gained a significantly greater amount of weight than the chow-only rats, which flies in the face of the claim that rats with limited access to a palatable food eat more. And the 12-hr sucrose rats actually gained slightly more weight (though not a statistically significant amount) than the 12-hr HFCS rats.

In other words, the findings in the three studies were completely inconsistent. For male rats in the short term, 12-hr access to HFCS induces significant weight gain but 24-hr access to HFCS does not. For male rats in the long term, both 12-hr or 24-hr access to HFCS induces significant weight gain, but they didn’t test sucrose. For female rats in the long term, only 24-hr access to HFCS with unlimited chow induces significant weight gain and limited chow, HFCS, and sucrose do not. And yet, based on this, they claim:

In Experiment 2 (long-term study, 6–7 months), HFCS caused an increase in body weight greater than that of sucrose in both male and female rats. This increase in body weight was accompanied by an increase in fat accrual and circulating levels of TG, shows that this increase in body weight is reflective of obesity.

Despite the fact that Experiment 2 didn’t even test the long-term effects of sucrose consumption on male rats, and 12-hr HFCS (albeit with limited chow) didn’t cause significant weight gain in female rats.

As Usual: Needs More Research

Based on the results of all three experiments, they conclude:

Rats maintained on a diet rich in HFCS for 6 or 7 months show abnormal weight gain, increased circulating TG and augmented fat deposition. All of these factors indicate obesity. Thus, over-consumption of HFCS could very well be a major factor in the
“obesity epidemic,” which correlates with the upsurge in the use of HFCS.

Despite the fact that obesity has also increased in many countries where HFCS is virtually never used, like Australia. According to a 2008 USDA paper:

Australia and the United States have a high and rising prevalence of obesity. They have opposite sugar policies: virtually no distortions affect Australia’s use of sugar, whereas sugar policy in the United States taxes sugar use. Sugar consumption per capita in Australia has been flat from 1980 to 2001, after which it increased by 10%-15%. Sugar is the major sweetener consumed in Australia.

The fact that the experiment doesn’t seem to show that HFCS is necessarily worse than sucrose doesn’t mean the findings aren’t intriguing. I really do want to know, for example, why rats with 12-hr access to HFCS gain more weight in the short term than rats with 24-hr access to HFCS, but the 24-hr HFCS rats gain more in the long term. And if, as they claim, the rats in all the groups consumed the same number of calories—which Nestle doubts because, "measuring the caloric intake of lab rats is notoriously difficult to do (they are messy)”—why were there any differences at all at the end of the trials? If none of the rats are eating more (and indeed, it seems that in some cases the HFCS rats were eating slightly less), what is the mechanism causing them to gain more weight, at least on some feeding schedules?

Does the concentration of the sugar have anything to do with it? In his reply to Nestle, Hoebel says:

Eating sucrose does not necessarily increase body weight in rats, although it has been shown to do so in some studies, usually employing high concentrations of sucrose, such as 32%. Our previously published work, has found no effect of 10% sucrose on mean body weight. At this concentration, rats seem to compensate for the sucrose calories by eating less chow.

I want to know if that’s true for HFCS as well. And did the difference in the concentrations of the HFCS and sucrose drinks have anything to do with the difference in the rats’ weight in this study?

Or does it maybe have something to do with sucrase, the enzyme that splits the fructose and glucose in table sugar? From what I’ve read, sucrase is present in the human digestive tract in sufficient amounts that it doesn’t rate-limit the absorption of those sugars in sucrose compared to the consumption of free fructose and glucose. But is it somehow involved in metabolism or appetite-regulation?

So rather than answering any questions about HFCS vs. table sugar, this really just raises a lot of new ones.

*It’s also not clear why they gave them different concentrations of sweetener. You’d think they would make them both soda-strength, or at least calorically equivalent.

**The failure to control for multiple variables does, in fact, complicate their ability to make any conclusions about gender difference:

In the present study, male rats maintained on 12-h access to HFCS also gained significantly more weight than chow-fed controls, while female rats maintained on 12-h access did not. It is possible that this can be accounted for by the fact that these males had ad libitum chow, while the females had 12-h access to chow. It is possible that the lack of chow for 12 h daily suppressed weight gain and TG levels
that might have otherwise been elevated in the female 12-h HFCS access group. This would indicate an effect of diet rather than a gender difference.