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How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative.

Abstract

Prevailing thinking about obesity and related diseases holds that quantifying calories should be a principal concern and target for intervention. Part of this thinking is that consumed calories - regardless of their sources - are equivalent; i.e. 'a calorie is a calorie'. The present commentary discusses various problems with the idea that 'a calorie is a calorie' and with a primarily quantitative focus on food calories. Instead, the authors argue for a greater qualitative focus on the sources of calories consumed (i.e. a greater focus on types of foods) and on the metabolic changes that result from consuming foods of different types. In particular, the authors consider how calorie-focused thinking is inherently biased against high-fat foods, many of which may be protective against obesity and related diseases, and supportive of starchy and sugary replacements, which are likely detrimental. Shifting the focus to qualitative food distinctions, a central argument of the paper is that obesity and related diseases are problems due largely to food-induced physiology (e.g. neurohormonal pathways) not addressable through arithmetic dieting (i.e. calorie counting). The paper considers potential harms of public health initiatives framed around calorie balance sheets - targeting 'calories in' and/or 'calories out' - that reinforce messages of overeating and inactivity as underlying causes, rather than intermediate effects, of obesity. Finally, the paper concludes that public health should work primarily to support the consumption of whole foods that help protect against obesity-promoting energy imbalance and metabolic dysfunction and not continue to promote calorie-directed messages that may create and blame victims and possibly exacerbate epidemics of obesity and related diseases.

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  • Authors+Show Affiliations

    ,

    1Department of Family and Social Medicine,Albert Einstein College of Medicine/Montefiore Medical Center,1300 Morris Park Avenue,Block Building,Room 410,Bronx,NY 10461,USA.

    2Department of Preventive Cardiology,Mid America Heart Institute at Saint Luke's Hospital,Kansas City,MO,USA.

    Source

    Public health nutrition 18:4 2015 Mar pg 571-81

    MeSH

    Energy Intake
    Food
    Humans
    Nutritive Value
    Obesity
    Public Health

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    25416919

    Citation

    Lucan, Sean C., and James J. DiNicolantonio. "How Calorie-focused Thinking About Obesity and Related Diseases May Mislead and Harm Public Health. an Alternative." Public Health Nutrition, vol. 18, no. 4, 2015, pp. 571-81.
    Lucan SC, DiNicolantonio JJ. How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative. Public Health Nutr. 2015;18(4):571-81.
    Lucan, S. C., & DiNicolantonio, J. J. (2015). How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative. Public Health Nutrition, 18(4), pp. 571-81. doi:10.1017/S1368980014002559.
    Lucan SC, DiNicolantonio JJ. How Calorie-focused Thinking About Obesity and Related Diseases May Mislead and Harm Public Health. an Alternative. Public Health Nutr. 2015;18(4):571-81. PubMed PMID: 25416919.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative. AU - Lucan,Sean C, AU - DiNicolantonio,James J, Y1 - 2014/11/24/ PY - 2014/11/24/entrez PY - 2014/11/25/pubmed PY - 2015/10/21/medline KW - Chronic disease SP - 571 EP - 81 JF - Public health nutrition JO - Public Health Nutr VL - 18 IS - 4 N2 - Prevailing thinking about obesity and related diseases holds that quantifying calories should be a principal concern and target for intervention. Part of this thinking is that consumed calories - regardless of their sources - are equivalent; i.e. 'a calorie is a calorie'. The present commentary discusses various problems with the idea that 'a calorie is a calorie' and with a primarily quantitative focus on food calories. Instead, the authors argue for a greater qualitative focus on the sources of calories consumed (i.e. a greater focus on types of foods) and on the metabolic changes that result from consuming foods of different types. In particular, the authors consider how calorie-focused thinking is inherently biased against high-fat foods, many of which may be protective against obesity and related diseases, and supportive of starchy and sugary replacements, which are likely detrimental. Shifting the focus to qualitative food distinctions, a central argument of the paper is that obesity and related diseases are problems due largely to food-induced physiology (e.g. neurohormonal pathways) not addressable through arithmetic dieting (i.e. calorie counting). The paper considers potential harms of public health initiatives framed around calorie balance sheets - targeting 'calories in' and/or 'calories out' - that reinforce messages of overeating and inactivity as underlying causes, rather than intermediate effects, of obesity. Finally, the paper concludes that public health should work primarily to support the consumption of whole foods that help protect against obesity-promoting energy imbalance and metabolic dysfunction and not continue to promote calorie-directed messages that may create and blame victims and possibly exacerbate epidemics of obesity and related diseases. SN - 1475-2727 UR - https://www.unboundmedicine.com/medline/citation/25416919/full_citation L2 - https://www.cambridge.org/core/product/identifier/S1368980014002559/type/journal_article DB - PRIME DP - Unbound Medicine ER -