NPR

Counting Calories Is A Tricky Business

Many health-conscious Americans are obsessed with one thing: calories. The nation's new health care law will soon require chain restaurants to display calorie information on menus. But many of those counts are off by hundreds of calories. And even accurate counts rarely change the way we eat.

Transcript

TONY COX, host: This is TALK OF THE NATION. I'm Tony Cox in Washington. Neal Conan is away. When it comes to watching your weight, many Americans are obsessed with one thing: calories. We count them, we track them on smartphones, and we feel guilty when we ignore them and dig into that plate of hot wings - or maybe not.

Regardless, the information is now there. As just one example, if you're trying to do the right thing, I'm sorry to report that a bleu cheese salad at Outback Steakhouse can set you back more than 1,000 calories. A grand peppermint mocha at Starbucks weighs in at over 300 calories.

The nation's new health care law will eventually require large chain restaurants to display calorie information on their menus, and some cities around the country already do. But how accurate are those calorie counts? And does labeling help people make healthier choices?

Furthermore, is tracking calorie intake the best way to lose weight to begin with? There is evidence that already provides some of the answers. We'd like to hear from you. Are you a calorie counter? How do you do it, and how does it affect the way you eat?

Give us a call. Our number here is 800-989-8255. The email address is talk@npr.org. And you can join the conversation at our website. Go to npr.org, and click on TALK OF THE NATION.

Later in the program, does crime go up when the mercury rises? But first calories. With us now to tell us more about the accuracy of calorie labeling is NPR health policy correspondent Patti Neighmond. She joins us from Los Angeles. Patti, thank you for coming on the show.

PATTI NEIGHMOND: My pleasure, Tony.

COX: More and more, chain restaurants, Patti, are adding calorie counts to their menus. A recent study at Tufts University examined some of those counts. What did they find, and can we trust what these counts say?

NEIGHMOND: Well, we can pretty much trust them in that they were about 10 calories up or down. Of the 269 foods these researchers chose, they went to all kinds of chain restaurants, including Pizza Hut and Boston Market, Olive Garden and Outback Steakhouse.

And they found about half of them, if not more, had fewer calories than stated on the menu, which is something of a surprise. For example, Au Bon Pain's orange scone had 16 less calories than the 470 listed. But the real story, I think, is when they were off, they were really, really off.

For example, one in five of those foods ended up containing 100 or more calories. And that salad you mentioned, that was one of the big culprits, 1,000 more calories than expected, as was a couple of chips and salsas. So when they were off, they were really off.

COX: Who does the counting?

NEIGHMOND: Well, in this case, the researchers ordered the foods. They ordered anything from appetizers to desserts, main courses and sides. They packed them up, and they shipped them to an independent lab. And scientists there tested the foods for carbohydrates, protein, fat and fiber, and then compared the calorie counts that they analyzed and assessed to the counts that were written on the menu.

COX: So my question, though, was who does the counting for the restaurants? Do they do their own? Does the municipality or a governing body in the area determine what the counts are?

NEIGHMOND: Oh, that's a really good question, Tony. I don't know who does the counting. I think they probably do the counting their own, and they come up with an assessment of what they think the food is worth in terms of calories. And some restaurants have fat and protein content, as well.

But I think part of what the health reform bill included last year when it was passed by Congress is a mandate for the FDA, the Food and Drug Administration, to come up with some very clear guidelines about how calories are counted, how they can be as accurate as possible and how they should be presented to consumers.

One thing I just want to add is that interestingly, the sit-down chain restaurants, sort of like I guess Applebee's and Outback, were the ones that had the biggest discrepancies between what the calories were listed on the menu versus what the analysts found when they looked at them closer.

And a lot of the reason for that probably has to do with portion size. You know, fast food like McDonald's and Burger King, Pizza Hut, they're automated. Everyone gets the same size. When you sit down at a restaurant, there's a chef there who gives you more or less, and more means, of course, more calories.

COX: Here's one last question for you. You mentioned some of the foods that were off in terms of their calorie count. Is there a way to determine right now which foods are more likely to be off than others?

NEIGHMOND: Well perhaps not surprisingly, desserts were typically off, you know, muffins, ice cream. Carvel's Butterfinger ice cream, chocolate chip cookies, a lot of these calories were underestimated. And then so of course were some of the expected low-calorie items like salads.

So really the best thing if you're watching your calories you might want to do, which is advice we've all heard before, anything with sauces and salad dressings, order the dressing and the sauce on the side and of course try to focus more on lean meats, fruits and vegetables.

COX: NPR health correspondent Patti Neighmond joined us from Los Angeles. Patti, thank you very much.

NEIGHMOND: Thank you, Tony.

COX: Some restaurants may need to work on their calorie count accuracy, as we have just heard, but even when we have that information, do people use it to make healthier choices?

New York City has required calorie labeling for restaurant chains since 2008. The effect of that law on people's behavior is the subject of a new study published in the British Journal of Medicine. Dr. Lynn Silver is one of the co-authors of that study. She is director of the office of science and policy at the New York City Department of Health and Mental Hygiene. And she joins us today from her office in New York. Dr. Silver, nice to have you.

Dr. LYNN SILVER: Good afternoon, Tony, thank you for having me.

COX: The goal of the New York City law was to help people make better choices, obviously, about what they eat. Did your research find that, in fact, that's what people are doing?

SILVER: It does suggest that that's the case. About one in five people who came out of a fast food restaurant on a given visit said that they had used the information, and those people bought 106 fewer calories, on average.

And when we polled New Yorkers - actually, Quinnipiac University polled New Yorkers, 84 percent of New Yorkers said that they found the calorie postings useful.

COX: One of the questions that I just put to our health correspondent, Patti, a moment ago was who does the counting. So in New York City, who does the counting for the restaurants?

SILVER: The restaurants are responsible for the accuracy of their calorie counts. They may do it through laboratory analyses, but they can also do it through other mechanisms, such as using computer programs that work from recipes.

COX: And you find that people actually are paying attention, consumers are paying attention to what these calorie counts are suggesting?

SILVER: Well, when we passed this law, we thought it could work a couple of different ways. One of the most important ways was through informing consumers and helping them make informed choices.

The other way, which is probably equally important, is to provide a strong incentive for the restaurant industry to start giving people food that looks more like what a human being's body needs and cutting down those calories.

And we think that we're starting to see signs of both of those mechanisms happening in the marketplace.

COX: We're beginning to get some callers who want to share their stories or to ask questions about this. The first one let's take, this is Jenny(ph) from Kansas City, who is a frequent traveler. Hello, Jenny, welcome to TALK OF THE NATION.

JENNY: Hi, I'm so excited about this program.

(SOUNDBITE OF LAUGHTER)

JENNY: Yeah, I have been traveling every week for work, roughly for about the last 10 years. Because I eat out constantly and sit down an awful lot, over the last 10 years, I managed to gain about 40, 50 pounds. I noticed as I was traveling to the West Coast a few years ago that they were having the calorie counts on the menu.

I notice now that Panera does, Ruby Tuesdays do. Not only does it affect the choices I make when I'm ordering in the moment, but it also affects where I actually go. If I'm in the middle of Weight Watchers, or I'm in the middle of trying to lose weight, I'm going to choose a place, or I'm going to try to choose a place, where I know I can stay on track versus going somewhere where I'm not going to have any idea, I could get fooled and just be completely knocked out of the park.

And just with the ever-increasing drumbeat against, you know, us fatties here in this society is the society at large wants us to be less fat, they'd better help us out with some tools to do it.

COX: Jenny, thank you very much for the call. Are you finding, Dr. Silver, that in New York City, with regard to the program there, that the restaurants were compliant without being forced? Are they doing any of this voluntarily? Are they, now that they are into it, saying oh, this is a great idea, it's bringing new people in? What's the circumstance?

SILVER: Well, initially they weren't doing it voluntarily. A couple of restaurants had displayed some calorie information voluntarily, but when we first implemented this law, we were sued by the restaurant industry to block its implementation.

We had to reissue the law and eventually won the second lawsuit, and they only really became fully compliant when fines went into effect in July of 2008. However, as these laws spread across the country, the restaurant industry basically reversed its position and finally supported the proposal in the health care reform discussion to make calorie labeling national.

COX: Is there any way to track how the public is responding to this from the Restaurant Owners Association? And before you answer, let me just say to Lisa(ph), who is in Jackson to hold on, I'm going to get to you in just a moment. Are people responding favorably by going into restaurants, and are restaurants saying, you know, this isn't so bad for business after all?

SILVER: Well, there was a great study from Starbucks on more than 100 million Starbucks transactions before and after the law, and what Starbucks found was that there was no change in their revenues - so presumably people are still coming in and buying their food - but that there was a six percent drop in the calories of those purchases.

So as far as we're aware, we don't have evidence that this hurt business in any way.

COX: Is this primarily an urban phenomenon, or are restaurants all over the state of New York beginning to do this kind of thing?

SILVER: Well, our law applied to New York City. It was passed by New York City government. But several other counties in the states have implemented similar legislation.

But next year, this will be across the United States. We think that's very important because the chain restaurants that are affected will now really have a strong incentive to start putting healthier stuff on their dollar menu, which is where it needs to be, and to have more offerings that have lower calories and to shave some calories off just their regular old offerings, too.

COX: I want you to think about this question, and I'll get your answer when we come back from the break. What about this program surprised you once it went into effect? We're talking about the calorie counts, whether or not they change people's habits, eating habits, of course, and whether counting calories is enough to ensure a healthy diet.

We'd like to hear from you. Are you a calorie counter? How do you do it, and how does it affect the way that you eat or where you decide to go eat? Give us a call. Our number here is 800-989-8255. The email address is talk@npr.org. I'm Tony Cox. This is TALK OF THE NATION from NPR News.

(SOUNDBITE OF MUSIC)

COX: This is TALK OF THE NATION from NPR News. I'm Tony Cox. We're talking calories today. They're almost an obsession for many people, especially dieters. But is counting calories the best way to make sure that you are eating a healthy diet?

We'd like to hear from you. Are you a calorie counter? How do you do it? Does it affect the way you eat? How so? Give us a call. Our number here, 800-989-8255. The email address is talk@npr.org, and you can join the conversation at our website. Just go to npr.org, and click on TALK OF THE NATION.

Our guest is Dr. Lynn Silver, director of the Office of Science and Policy at the New York City Department of Health and Mental Hygiene. She co-authored New York City's recent study of the effectiveness of New York's calorie labeling law, which was published in the British Journal of Medicine.

We have links to a number of the studies that we have mentioned today, and you can find those at npr.org. Just click on TALK OF THE NATION. Before I get to Lisa, who is waiting on the line, Doctor, let me ask you about the question that I put to you before we went to the break, which is now that you are into this, did anything surprise you? Have you learned anything that you had not anticipated?

SILVER: We learned that consumers often don't look - there aren't that many consumers who are chart-carrying calorie counters. But often the most important thing is simply to compare - you can see when you get to the cash register, more is more, and less is less.

So you don't need to be an obsessive-compulsive calorie counter to be able to use calorie labeling in very simple ways, to pick the sandwich that has fewer calories or to go from the 300-calorie beverage to a zero-calorie beverage. Those are simple steps that consumers are taking to make use of this information, and I think that's part of what we learned.

COX: That's a perfect segue for Lisa, who is joining us now. Lisa, thanks for your patience. I understand that your husband really does count calories.

LISA: Yeah, he has an application on his smartphone, and he started this about a week and a half ago, and he's really into it. We like to eat out a lot, so we try to choose places and choose meals that are within his calorie level for the day, and it's kind of - you know, you feel really betrayed that you're trying to do something good for your body, good for yourself, and, you know, they're not meeting you with the battle. They don't care.

COX: Well, Lisa, here's a question for you. Is it working? Or should I say how is it working for your husband?

LISA: He really has gotten better about his portions. He's more conscious about what he eats. He started exercising more. And it's only been, you know, a short while. But he's set reasonable goals, like a pound a week, and he's very excited about it. So I like his attitude.

But this is a little disheartening, you know, that you're trying so hard.

COX: Lisa, thank you for that. Doctor, should people have a target, a calorie number target that they work for and fit their eating habits and meal selections into that limitation?

SILVER: I mean, it's always important for people to have an idea of how many calories they need because a middle-aged woman may need 1,500, 1,600. A 20-year-old basketball player can need well over 2,000 calories a day. So for example I could reach my whole day's caloric need easily sometimes with a single dish in some of these restaurants.

So for you to understand the context of what you're eating, it's important for you to know your calorie needs. Most people probably don't need more than, you know, 600, 700 calories in a meal.

COX: We have a number of emails. I want to read them, a couple of them right now. The first is from Danielle(ph) in Landon, Wyoming: I was obsessed with calories and portion control in high school. My friend got obsessed with me, and later it triggered an eating disorder for her. I realize that it is much more important to have moderation in foods that we choose. I have maintained a health weight five years out of college by working out regularly and eating healthy - most of the time she adds on in parentheses.

This is from Danessa(ph). She says: I used calorie counting to take off about 125 pounds. It was a lot of work, but I tracked every meal, every day, every bite. If we wanted to go out with family or friends, I had to know in advance so I could research the menu and all the items on it to find the best option for myself. This was made easier if nutritional values were made available.

I feel very strongly that nutritional information should always - always in caps - be available. People need to be aware what is going on into their bodies.

One more, this is from April(ph): Information is essential to making an informed choice. However, I'm hoping that calories won't be the only thing listed. As a diabetic, I'm much more interested in carbohydrate content than raw calories. That's because it is the carbohydrates that affect my blood sugar levels, determine how much insulin I'm going to need and whether I'm going to be, quote, off for the rest of the day.

High or low sugars can be equally problematic. Knowing how many carbs I've eaten is my only weapon in the daily battle for sugar control.

Now, many eaters think a lot about how many calories they're taking in each day, as we have been talking all day today, and while there are all kinds of diets out there, most nutritionists say the key to losing weight is simply to eat fewer calories.

But when it comes to losing or maintaining our weight, are all calories created equal? Joining us now in the conversation is Dr. Dariush Mozaffarian. He is a professor of medicine at Brigham and Women's Hospital at Harvard Medical School in Boston, and he studies how our diets and lifestyle affect our heart risk and other diseases. He recently led a study that examined different types of food and weight gain, published in the New England Journal of Medicine. Welcome.

Dr. DARIUSH MOZAFFARIAN: Thank you very much.

COX: You've heard what some of the people have said about counting calories, and, you know, the conventional wisdom says everything should be eaten in moderation, just eat fewer calories, and you will lose weight. Does your research bear that out?

MOZAFFARIAN: Well, so I think there's two separate issues. So one issue is of course weight loss. That's someone who's overweight and trying to lose 100 pounds over a few years. That's a very different scenario than long-term, gradual weight gain.

And so what our research looked at was the latter, the long-term weight gain over many years. And that's a very slow, gradual, subtle process, about a pound a year on average. And that pound-a-year creep is what leads to 10, 20 pounds of weight gain over 10 to 20 years, and that's what's causing the obesity epidemic.

And so when we looked at that very slow weight gain, we found that, you know, a calorie is not a calorie, that it actually makes a big different what types of foods you eat. And that's because, you know, 100 calories of nuts will have a very different effect on your fullness and your satisfaction and how much you'll eat in the whole day compared to 100 calories of a sugar-sweetened beverage.

So just counting calories alone to prevent long-term weight gain I think could be very misleading.

COX: That's a very interesting concept, and let me go to Ken(ph) from Walnut Creek, California, whose comment I think fits right in with what we are talking about. Ken, welcome to TALK OF THE NATION.

KEN: Hi, thank you. Yeah, I completely agree with the comments that have been said. I have gained a pound a year probably for 25 years, and, you know, probably more like 40 pounds is what I put on. And it wasn't until I finally gave up really paying attention to calories and even fat content and even my weight and started focusing on some of the things that reflect more on my heart risk like fasting glucose or insulin level and changed...

I didn't think of myself as going on a diet anymore. I just thought of myself as changing my eating habits. And what I mean by that, two really big changes for me were to simply cut out the big, starchy things: bread, cereal, pasta. And then the other one being sweets.

I know that sounds sort of crazy, but I found for me, the perfect abstinence was a whole lot easier than the imperfect moderation. So even when I slip, I find each time it's easier not to slip the next time because I just remember how I felt.

And sure enough, you know, all of those numbers that I mentioned started to come in line, and the ones I wasn't paying attention to but that everybody else could see, like my weight, they all started falling in line, and I feel a lot healthier.

COX: Good for you. Ken, thank you very much for that. I want to come to you, Dr. Silver, to ask this question: Because how far should restaurants and even the government go in terms of trying to make sure, for lack of a better word, that people are offered the kinds of healthy choices? And how much of this is the responsibility of the person who is eating to do this on their own?

We've already heard that a calorie can mean one thing depending upon what kind of food you are eating and mean something completely different if you're eating a different type of food.

SILVER: Well, you know, when you only ate out at restaurants at Christmastime, it wasn't that important. But today, half of U.S. food dollars are going to the away-from-home environment, and people are getting about a third of their calories from eating at restaurants. So what they do is very important, and it's been a real contributor to this incredible epidemic of obesity and diabetes.

So as far as we're concerned, both restaurants and government have a responsibility to make sure that the restaurant environment is not - or reduces the harm that it's currently causing to people's health. So restaurants should take responsibility for offering people reasonable human-sized portions, not giant-sized portions, and foods that are healthy, the types of vegetables and fruits that people need and reducing the amounts of the - precisely the items that Dr. Mozaffarian is pointing out as these leading contributors to the obesity epidemic and to that weight creep that's affecting so many Americans.

When government sees tens of thousands of people being affected by rates of diabetes that we never had before and suffering the consequences, then it became time for government to take some action.

COX: Let's take a couple of calls. The first one, this is...

SILVER: There's not an easy solution.

COX: This is Alexander, I believe, in Jacksonville, North Carolina. Alexander, welcome.

ALEXANDRA: Hi. Thanks for having me.

COX: Oh, Alexandra. The A just...

(SOUNDBITE OF LAUGHTER)

ALEXANDRA: Yes, Alexandra.

COX: The A got cut off. Welcome to TALK OF THE NATION.

ALEXANDRA: Thank you.

COX: Did you have a comment?

ALEXANDRA: Oh, yes. I just - I wanted to point out that when I changed my diet - because I always focused on calories and not exactly what I was eating, but the amount of calories that were in it, and I was always so hungry all the time. But when I changed my food to clean, whole foods, I found that I could eat almost as much as I wanted, and I would just - the weight just dropped off because instead of eating this high sodium, low calorie frozen meals, I was eating whole foods that just had so much more nutritional value to them, and the weight just came right off. And it tastes better, so it's just awesome to finally figure that out. Just clicked.

COX: Oh, great. Thank you for the call. Let me read an email. We'll take another call right after that. This comes from Matthew. Matthew says, I'm all in favor of mandating calorie counts on menus. It makes a difference in the way I order my food. I think mandate should be even more strict by requiring sodium, sugar and saturated fat content information as well.

Here's another one. This comes from Ventura, California, from Sheryl. Although I do not count calories every day, but when I place an order at a restaurant, I do look at the calories and I do make change - I may change my choice to make a selection with less calories and no longer order dessert unless I'm sharing it. I was really unaware of the amount of calories in the meals that I ordered.

Let's go to Anne who is calling us from Jackson, Ohio. Anne, welcome to TALK OF THE NATION.

ANNE: Yeah. Hi. I want to point out - I wanted to ask both the doctors - I believe they're both doctors - whether females are more - concerned about calorie counting versus males. And I want to point out that you guys - your screener has just let seven female questions through last hour. The male screener only allowed one female in during a foreign policy issue. So I hope your producers and Neal Conan look at that issue of male-female callers versus who gets through and who doesn't.

But again I want to ask your doctors, are - do you find women more concerned about calorie counting than men? And, again, I'm the eighth woman who's gotten through on this issue.

COX: I'm going to try to have the doctors respond to that. And our decisions are not made by who's screening as they're made by who is calling. I just wanted to set the record straight on that. Dr. Mozaffarian, would you like to answer her?

MOZAFFARIAN: Well, I think that, you know, many studies have shown that both and men and women are very concerned about their weights. You know, I don't know of as much information on who's actually counting calories. Anecdotally, I would think that women maybe do that more than men. But, certainly, both men and women are very concerned about their weights. Two-thirds of Americans are overweight or obese, and a large number, even at their normal weight, are close to overweight. So it's certainly a global problem across the U.S. and the world.

I think that the main point that Alexandra mentioned in her call is really what our research found, is that instead of counting calories, you know, focusing on the healthy foods that you eat - eating fruits, vegetables, whole grains, nuts and eating less of starches, white rice, white bread, sugars, and processed meats - I think that's really probably the most effective way to keep the weight off. And wonderfully, fortunately, that recipe coincides perfectly with lowering risk of diabetes, of heart disease and of several common cancers, independently of the benefits for weight. So it really, I think, gives us a set of targets that the government should be targeting.

And I just - one last point. I think that just going on nutrients alone, just thinking only about saturated fat or only about calories, or even only about salt - although salts, we should definitely reduce. I think we should stop thinking and breaking down food into these, you know, micro parts and think about the food itself. Is the food good for me? Is the food not good for me? And if we do that and think of the overall food rather than these subcomponents, I think we'll go a long way towards setting the right targets for Dr. Silver and others' policies.

COX: We're talking about calorie and calorie counting. You're listening to TALK OF THE NATION from NPR News.

Dr. Silver, do you want to offer comment about...

SILVER: Yes, Alexandra. In our research, what we found, as you suspected, women are more likely to use calorie information. It was 18 versus - percent of women versus 13 percent of men. Where ever - when people used it, whether it was a man or a woman, they've reduced their calories purchased by similar amounts.

But I did want to just add that I don't think that Dr. Mozaffarian's approach and calorie labeling are contradictory. It's very important for people to think: I need to buy healthy foods, I need to take smaller portions. The calorie information can help steer you to those smaller portions. They often coincide, but these are not contradictory approaches. I think they can be complementary.

There's no question that you need to worry - not worry, but that you need to try and eat healthy in simple ways, and those are very successful strategies. But people differ and different things work for different people.

COX: Rachel, I'm going to have you come on. This is Rachel from Canton, South Dakota. You'll be our last caller if you promise to be really brief.

RACHEL: Yes. I'll try to. I am a single mom of three adolescent girls. I have a 12-year-old who's a vegetarian. I have a 15-year-old who's almost 5'10" and a basketball player. And I have an 18-year-old who's about the same height with this gorgeous, voluptuous body. And so all three have different outlooks on what they should be eating or how they should be eating.

Obviously, when you were saying earlier, the basketball player needs more calories. She's in a extreme fitness training program, right now, where they had them keep track of all of their food, though, and they got marked off for things like eating - putting cream cheese on your bagel. And the last thing I want this girl, who's tall and slender and gorgeous, to worry about is that she has cream cheese on her bagel.

COX: Rachelle, unfortunately, the story is a good one and I'd like to hear the rest of it, but we just don't have time because our - the clock has said we have to go. And I need to say thank you to Dr. Lynn Silver, director of the Office of Science and Policy at the New York City Department of Health and Mental Hygiene, also to Dr. Dariush Mozaffarian, who is a professor of medicine at Brigham and Women's Hospital and Harvard Medical School in Boston. Thank you both for joining the conversation today. We had a number of calls and a number of emails. Unfortunately, we just could not get to each one of them.

Up next, the heat still won't let up in many parts of the country. But do higher temperatures bring higher crime rates? We'll check the science. And if you work in law enforcement, what do you see when the temperatures rise? 800-989-8255 is the number. The email address is talk@npr.org. I'm Tony Cox. It is TALK OF THE NATION from NPR News. Transcript provided by NPR, Copyright NPR.

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