Energy Balance Theory Misleads Economists
Diets usually don't work for long, especially "eat less, exercise more" calorie-counting diets
Arnold Kling cites an Emily Oster ParentData post on Diets and Data and includes this excerpt:
The simplest diet, then, is just … eat less. This is best epitomized by a good book I once read called The Economists’ Diet. The primary message was that to lose weight you need to weigh yourself every day and eat less. And, also, that you’ll be hungry a lot of the time. It was sort of beautiful in its simplicity, but I can see why this hasn’t caught on.
Sounds reasonable. Face reality! Eat less, measure progress, and just deal with being hungry! The Economist's Diet, “by two formerly obese economists” explains their thinking and strategies for losing weight and keeping it off. Much good advice and practical suggestions in the Economists’ Diet. But much also, I would argue, based on a metabolic fallacy. Emily Oster says the best diet is one that works and can be maintained. But even better than the “diet that works” is when not dieting works better. Emily Oster’s Diets and Data post recommends Virginia Sole-Smith and her newsletter Burnt Toast. And Sole-Smith quickly replied to emphasize her opposition to diets:
“I saw that you mentioned my work in the newsletter this morning about diets. I appreciate the link, but just to reiterate: I'm against diets because they perpetuate anti-fat bias, which is harmful to the health of people in larger bodies. Diets also don't work in the long-term—as you noted, even this new evidence review saw the standard drop-off between 6 and 12 months, and didn't follow subjects longer than a year. But it doesn't really matter if they work. Childhood dieting is the top predictor of future eating disorder risk; exposure to parental dieting causes similar harm. And dieting at any age reinforces the oppression of marginalized bodies.”
After sharing this feedback, Emily Oster goes on to address:
…the question of the “best diet,” for the data-driven dieter. I’m motivated by the timing but also by having found this excellent paper on “Optimal Diet Strategies for Weight Loss.” … It starts by noting the key underlying principle of weight loss: energy deficit. You need to burn more calories than you take in to lose weight. Period. As the paper says more formally: The key component of diets for weight loss and weight-loss maintenance is an energy deficit. Under the “calories-in, calories out” model, dietary management has focused on the concept of “eat less, move more.”
The “concept” of “eat less, move more” is the standard energy balance advice offered by most doctors, nutritionists, and public health pronouncements, all following the U.S. federal dietary guidelines. It sounds reasonable, but doesn’t help most people lose weight and keep it off. Explaining its history and failure is The calories in, calories out concept is 'tragically flawed,' new research suggests (Today, September 20, 2021) which reports:
The paper, published in the American Journal of Clinical Nutrition offers an alternative model to the eat-less-move-more message and argues that success in weight loss, as well as weight-loss maintenance, is more about what you eat and less about how much you eat.
Weight loss, the study found, is all about our hormonal response to certain macronutrients. Study authors include several of the most prominent nutrition scientists in the country.
More on the study in STAT News, How a ‘fatally, tragically flawed’ paradigm has derailed the science of obesity:
For nearly a century, obesity research has been predicated on the belief that the cause of the disorder “is an energy imbalance between calories consumed and calories expended,” to quote the World Health Organization. By this ubiquitous thinking, obesity is an energy balance disorder: People get fat because they take in more calories than they expend. They stay lean when they don’t.
My previous Normal Nutrition post Help Americans Get Healthy Again has more on: The carbohydrate-insulin model: a physiological perspective on the obesity pandemic published in The American Journal of Clinical Nutrition (September 13, 2021).
Who is doing the “fat-shaming”? It’s the establishment doctors, nutritionists, and public health officials blaming overweight people for not having the simple discipline to “eat less and exercise more.” Virginia Sole-Smith seems to say overweight people should accept their size and others should accept it too. However, most overweight people are suffering from a hormone imbalance, and gain weight because of it. Insulin resistance and metabolic syndrome generate the inflammation causing, over time, weight gain, cardiovascular disease, obesity, prediabetes, type 2 diabetes, and other chronic conditions. Energy balance driven weight loss advice to eat less and exercise more doesn’t reduce insulin resistance and so doesn’t work for most people.
Science overview: High insulin precedes obesity, a new study suggests (DietDoctor.com March 16, 2021). Here is an article with researchers thinking obesity causes insulin resistance rather than the other way around: What causes the insulin resistance underlying obesity? (Curr Opin Endocrinol Diabetes Obes., 2012).
Moving on from Science to Anecdote
Okay, that’s enough peer-reviewed clinical research for now. Let’s have some anecdotes. Discussing nutrition with my Lyft driver from Ft. Lauderdale airport last month, I learned he had been slender when arriving from Columbia but then had gained a lot of weight on the SAD (Standard American Diet). When the lockdowns hit he started watching nutrition videos on YouTube and changed both what he ate and when he ate. His metabolic health improved and then he began losing weight, some seventy pounds over a year and has kept it off since. Is he eating less and exercising more? Sort of. He’s still an Uber/Lyft driver and not getting much exercise but he is eating less often (twice a day, before and after work). The thing is, he doesn’t count calories or suffer from constant hunger. Why suffer if you don’t have to?
Both “eating less” and “diet” have dual meanings. My Lyft driver eats less often but may or may not consume fewer calories. He stopped snacking and reduced sugar and carbohydrates. Yes, he went Keto… But was this a “Keto Diet”? I’d say no. It was a lifestyle change through learning how his metabolism works from doctors and medical researchers (online). He learned that he had been hungry, sometimes famished, from high carbohydrate meals and snacks. His meals now are more often salmon and other foods high in healthy fats.
On my flight back to Seattle from Florida I sat with two more low-carb or Keto success stories, having lost thirty and seventy pounds (with weight lifting). The lockdown and closed health club led to some weight gain though.
My experience has been much the same. In April 2020 I started watching nutrition and public health videos on YouTube and listening to nutrition podcasts (examples below). My weight dropped twenty pounds in a month and gradually fell another twenty pounds through November. I didn’t count calories or struggle with hunger then (or since).
My online learning started with doctors and nutrition researchers explaining why “eat less and exercise more” is difficult to maintain for most. Those with the discipline to eat less, able to leave meals before feeling full, achieve some success at first. Most can lose five, ten, or more pounds over a month or two. But then one of our two distant “metabolic gifts” kicks in. Our metabolism steps down sensing starvation, and those same smaller meals that led to weight loss last month are now enough to prevent further loss or even add weight. To this frustration our metabolism adds misery; our reduced resting metabolic rate makes most feel cold, fatigued, and soon a little crazy. That’s when these energy balance diets abruptly end, leaving people depressed but still overweight.
Virginia Sole-Smith in Burnt Toast responds to this metabolic reality with what might be called “obesity self-esteem.” Since energy balance diets usually fail, her advice is to avoid the depression, try to eat healthy, and don’t feel bad being heavy. Her Jan. 4 post Will This Diet Be Better Than The Last?, with the brief subtitle “No,” opposes diets and dieting and reviews the usual diet timeline: enthusiasm to brief success to suffering, failure, and feeling depressed.
My two cents: Like a lot of people I’ve never been on a diet though I’ve changed what I eat from time to time. When I learned my father was eating oatmeal and blueberries every morning, I switched to oatmeal and blueberries for breakfast. When I discovered Trader’s Joe’s Mac ‘n Cheese and Farfalle “with 4 Cheeses & Spinach,” I added one or two of each to my shopping cart for years.
But these were dietary changes, not diets. Every time I even thought about dieting, and cut back for a few meals, I got really hungry and quickly perished the thought. I lacked the discipline to launch even a short.-term energy balance diet destined to fail.
Again, Emily Oster recommends The Economists’ Diet:
The simplest diet, then, is just … eat less. This is best epitomized by a good book I once read called The Economists’ Diet. The primary message was that to lose weight you need to weigh yourself every day and eat less. And, also, that you’ll be hungry a lot of the time. It was sort of beautiful in its simplicity, but I can see why this hasn’t caught on.
I’ve now received my copy of The Economists’ Diet after reading the Amazon Look Inside pages. It’s good to read that these economists lost weight and kept it off (and landed a book contract!). But have readers of their book lost weight and kept it off? (We need a data set to work with!) But even if many did, how much suffering was involved (from dieters themselves and those around them)? What if that same weight could have been lost with a lot less struggle with hunger? Let’s search for ways to reduce both suffering and weight.
Plan B could be the Banting Diet. Just reduce carbohydrates as overweight people have since the 1860s. You can read The Banting Diet Pocket Guide (for $4.99 on Kindle) or the William Banting’s original Letter on Corpulence (pdf) and in today’s English from the Noakes Foundation.
Apart from how and why “Banting” works, here is the forgotten history:
Banting was the original diet prescribed by William Harvey MD for his overweight patient, Mr. William Banting, in the 1860s… the diet was then taken to Germany and improved by a German cardiologist, Wilhelm Ebstein… From there the low-carbohydrate high-fat Ebstein/Banting diet travelled to America, finding a home in perhaps the most famous medial textbook of all time, Sir William Osler’s Principles and Practices of Medicine, published in 1892. (The Banting Pocket Guide, 2017, p 3-4).
Still, three cheers for the diets that work! The Simon & Schuster page for The Economists’ Diet says:
Christopher Payne and Rob Barnett are two formerly obese economists who met while working at Bloomberg. They faced the same problems that so many others face today: long hours, frequently eating out for lunch and dinner, and snacking out of boredom. When they finally lost weight by applying what they know best—economics—to their waistlines. By carefully considering economic theories, real-world data, and their own personal experiences, they developed behavioral best practices that helped them control their impulses to overeat and approach food in a healthier way.
I’m all for approaching food “in a healthier way.” But what if just reducing carbohydrates and increasing healthy fat and protein to the percentages of macronutrients common before the 1980s turns out to be an even healthier way to help people lose weight?… and to lose weight with less struggle with cravings.
Every Normal Nutrition post tries to explain how and why. I chose the name Normal Nutrition from a comment by Nutrition Coalition’s Nina Teicholz: what today is labeled the “low-carb diet” is just the normal diet of Americans before government public dietary guidelines started demonizing saturated fat and the food industry jumped in to develop and advertise “heart-healthy” higher-carbohydrate foods.
Critics call “low-carb diets” a fad, maybe a dangerous fad. I put quotes around “low-carb” because it is defined in various ways.
What Is Considered Low-Carb? (MedicineNet.com 9/1/2021) says:
• Very low-carbohydrate diet (less than 10%) or less than 20 to 50 grams per day
•Low-carbohydrate diet (less than 26%) or less than 130 grams per day
• Moderate-carbohydrate diet (26%-44%) per day
• High-carbohydrate diet (45%) per day
The videos and podcasts that launched (and continue) my nutrition research journey: Low Carb Down Under, DietDoctor Podcast, LowCarbUSA, LowCarbMD, Life’s Best Medicine, and Nina Teicholz Big Fat Nutrition Policy.
Here is an overview video of federal dietary guidelines (not so much the energy balance theory) Did the Food Pyramid Make Us Fat? | Freethink Wrong