In Obesity Epidemic, What’s One Cookie?

Stuart Bradford

The basic formula for gaining and losing weight is well known: a pound of fat equals 3,500 calories.

That simple equation has fueled the widely accepted notion that weight loss does not require daunting lifestyle changes but “small changes that add up,” as the first lady, Michelle Obama, put it last month in announcing a national plan to counter childhood obesity.

In this view, cutting out or burning just 100 extra calories a day — by replacing soda with water, say, or walking to school — can lead to significant weight loss over time: a pound every 35 days, or more than 10 pounds a year.

While it’s certainly a hopeful message, it’s also misleading. Numerous scientific studies show that small caloric changes have almost no long-term effect on weight. When we skip a cookie or exercise a little more, the body’s biological and behavioral adaptations kick in, significantly reducing the caloric benefits of our effort.

But can small changes in diet and exercise at least keep children from gaining weight? While some obesity experts think so, mathematical models suggest otherwise.

The first lady, Michelle Obama, spoke last month at the White House about her “Let’s Move” initiative, which aims to change the way children eat and play. Saul Loeb/Agence France-Presse — Getty Images The first lady, Michelle Obama, spoke last month at the White House about her “Let’s Move” initiative, which aims to change the way children eat and play.

As a recent commentary in The Journal of the American Medical Association noted, the “small changes” theory fails to take the body’s adaptive mechanisms into account. The rise in children’s obesity over the past few decades can’t be explained by an extra 100-calorie soda each day, or fewer physical education classes. Skipping a cookie or walking to school would barely make a dent in a calorie imbalance that goes “far beyond the ability of most individuals to address on a personal level,” the authors wrote — on the order of walking 5 to 10 miles a day for 10 years.

This doesn’t mean small improvements are futile — far from it. But people need to take a realistic view of what they can accomplish.

“As clinicians, we celebrate small changes because they often lead to big changes,” said Dr. David Ludwig, director of the Optimal Weight for Life program at Children’s Hospital Boston and a co-author of the JAMA commentary. “An obese adolescent who cuts back TV viewing from six to five hours each day may then go on to decrease viewing much more. However, it would be entirely unrealistic to think that these changes alone would produce substantial weight loss.”

Why wouldn’t they? The answer lies in biology. A person’s weight remains stable as long as the number of calories consumed doesn’t exceed the amount of calories the body spends, both on exercise and to maintain basic body functions. As the balance between calories going in and calories going out changes, we gain or lose weight.

But bodies don’t gain or lose weight indefinitely. Eventually, a cascade of biological changes kicks in to help the body maintain a new weight. As the JAMA article explains, a person who eats an extra cookie a day will gain some weight, but over time, an increasing proportion of the cookie’s calories also goes to taking care of the extra body weight. Eventually, the body adjusts and stops gaining weight, even if the person continues to eat the cookie.

Similar factors come into play when we skip the extra cookie. We may lose a little weight at first, but soon the body adjusts to the new weight and requires fewer calories.

Regrettably, however, the body is more resistant to weight loss than weight gain. Hormones and brain chemicals that regulate your unconscious drive to eat and how your body responds to exercise can make it even more difficult to lose the weight. You may skip the cookie but unknowingly compensate by eating a bagel later on or an extra serving of pasta at dinner.

“There is a much bigger picture than parsing out the cookie a day or the Coke a day,” said Dr. Jeffrey M. Friedman, head of Rockefeller University’s molecular genetics lab, which first identified leptin, a hormonal signal made by the body’s fat cells that regulates food intake and energy expenditure. “If you ask anyone on the street, ‘Why is someone obese?,’ they’ll say, ‘They eat too much.’ ”

“That is undoubtedly true,” he continued, “but the deeper question is why do they eat too much? It’s clear now that there are many important drivers to eat and that it is not purely a conscious or higher cognitive decision.”

This is not to say that the push for small daily changes in eating and exercise is misguided. James O. Hill, director of the Center for Human Nutrition at the University of Colorado Denver, says that while weight loss requires significant lifestyle changes, taking away extra calories through small steps can help slow and prevent weight gain.

In a study of 200 families, half were asked to replace 100 calories of sugar with a noncaloric sweetener and walk an extra 2,000 steps a day. The other families were asked to use pedometers to record their exercise but were not asked to make diet changes.

During the six-month study, both groups of children showed small but statistically significant drops in body mass index; the group that also cut 100 calories had more children who maintained or reduced body mass and fewer children who gained excess weight.

The study, published in 2007 in Pediatrics, didn’t look at long-term benefits. But Dr. Hill says it suggests that small changes can keep overweight kids from gaining even more excess weight.

“Once you’re trying for weight loss, you’re out of the small-change realm,” he said. “But the small-steps approach can stop weight gain.”

While small steps are unlikely to solve the nation’s obesity crisis, doctors say losing a little weight, eating more heart-healthy foods and increasing exercise can make a meaningful difference in overall health and risks for heart disease and diabetes.

“I’m not saying throw up your hands and forget about it,” Dr. Friedman said. “Instead of focusing on weight or appearance, focus on people’s health. There are things people can do to improve their health significantly that don’t require normalizing your weight.”

Dr. Ludwig still encourages individuals to make small changes, like watching less television or eating a few extra vegetables, because those shifts can be a prelude to even bigger lifestyle changes that may ultimately lead to weight loss. But he and others say that reversing obesity will require larger shifts — like regulating food advertising to children and eliminating government subsidies that make junk food cheap and profitable.

“We need to know what we’re up against in terms of the basic biological challenges, and then design a campaign that will truly address the problem in its full magnitude,” Dr. Ludwig said. “If we just expect that inner-city child to exercise self-control and walk a little bit more, then I think we’re in for a big disappointment.”

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Obesity is 100% an epidemic…. The american lifestyle is one of tv watching, fast food eating, low activity….. Americans need to adopt a more active lifestyle and they need to do it fast… 25lbs overweight is considered normal in America…. that is scary… Hit the gym

-Ron
//www.HypoRelief.com

Childhood obesity is out-of-control. How many children today get dinner in a paper bag from a drive-though, rather than from a sit-down meal. As a retired school psychologist, I’ve also witnesses most of the free-breakfast meals served to ADC children to be high in sugar and something many families wouldn’t serve their own children. I care about the American family, and its plight, and created the FAMILY JOURNAL WebBlog. I hope its free articles, videos and daily updated newspaper articles about dozens of family issues offers readers hope.
//familyjournal1.blogspot.com/

I differ with the experts. I love cookies. I love sugar in my tea and coffee. But over the past 2 years I have cut out all of the above. It is a sad state of affairs, but it was necessary, and effective. First I stopped gaining weight, then I started to lose weight, almost at the same rate I gained it, a very little every month, but over the years, it adds up. A cookie a day with sweetened coffee and tea may only be a few ounces a week, but the end of the year it makes a few pounds, and after a decade, well… We have begun to be so baffled and confused by the ‘food experts’ that we have lost track of common sense. Furthermore, with the vast amounts of money to be made in ‘value added’ food products, as opposed to unprocessed food, much of the research and the results on weight and nutrition is in some way funded by these special interests. To counter the logic that every little thing that goes into our mouths has the potential to eventually end up on our hips, further serves to undermine the individual’s ability to in charge and ultimately responsible for their own health.

Among other reasons, people feel hungry when their blood sugar drops. Their blood sugar drops because they haven’t eaten for a while, or more likely, they ate something with a high glycemic (sugar) index about an hour ago, and the resulting insulin spike dropped their blood sugar level.

Thus, when your blood sugar level drops & you feel hungry, you have two choices: eat something which you didn’t really need, or do some exercise (walk around the block, etc.). When you get moving, your liver will kick in & raise your blood sugar level so you no longer feel hungry.

Reducing the amounts of high glycemic index foods — e.g., high fructose corn syrup-laced soft drinks, sugar donuts, etc. — wins two ways: you avoid the initial calories, and you avoid the inevitable “sugar blues” that follow & lead to additional food consumption.

What’s one cookie? The article only seems to be analyzing this from a cliche-ridden perspective. Why does there have to be one action that solves the entire obesity problem?

No child eats just one cookie, or just one less cookie, let along one less can of soda. What it really amounts to is having 3-5 sodas per day, plus 10 cookies per day, etc. Don’t ask the kid to have one less cookie per day — you should be asking the kid to only HAVE one cookie per day, or only one soda per day. Or how about NONE at all?!?!

Take all the junk food out of the equation, and the body will adjust to that, too, and in a good way.

Progressive Gadfly March 1, 2010 · 5:47 pm

When our bodies developed as necessary to keep us alive long enough to grow up and to raise children, food was not abundant but was often hard to obtain. The result is that our bodies are extremely efficient at doing a lot with not a lot of calories and automatically take every opportunity not to waste any calories we ingest, storing them as fat if we cannot use them up immediately. These were essential to our survival as individuals in a harsh environment. Now we have the ability to live our lives without ever being really hungary and we have machines that can move us over great distances without requiring a lot of walking or running. This is the source of our basic imbalance of calories in to calories out.

But we have learned a lot more about how our way of life makes all of this worse. If we don’t get enough sleep or we are under sustained distressful conditions without the ability to move much for extended periods we will eat too much and much more of that food will become stored as fat.

We need to change the way we live, to relieve our bodies of the effects of prolonged stress, to afford nutritious foods that contain what we need in the optimal quantities, and to want to do things that provide us exercise and the kinds of absorbed focus that keep us busy and not interested in feeding our faces beyond what we really need.

I find it frustrating when people suggest small changes, but know that these changes aren’t expected to actually do anything.

I think there should be much clearer directions on how to lose, gain, or maintain weight. If cutting out a cookie isn’t actually going to lead to weight loss of 1-2 lb/week, please outline what exactly is going to lead to that. I had good success with Atkins, and many in my family had good success with a variety of other methods (Overeaters Anonymous, Weight Watchers, etc.) but all of us had major lifestyle changes that went above and beyond cutting out cookies. And no one was losing more than 1-2 lb/week.

We had many conversations about what was and was not healthy, with contradictory information coming from all sides. In the end, all the methods worked, but we really could have used some clear guidance on what was going on.

One giant step the government could take to fix healthcare costs is to provide clear, accurate instructions on how to eat well (that’s the title — Eat Well). The guidelines are currently so narrow-minded and corrupted by food companies (Food Politics by Marion Nestle is a great read) that they are useless. People have forgotten how to eat and the government is supposed to help, but the agencies are so poorly funded that health suggestions are driven by food corporations.

You had me until the end…

Why “innercity child”?

If small changes don’t make difference, then how did we get here in the first place? What changed to make obesity such a problem, and why can’t we undo that?

OMG, it’s all true! In fact, eating *three* cookies requires the equivalent of walking 500,000 miles, or a trip to the moon and back!

Better to stay on the couch and order another pizza.

I wonder if the article doesn’t miss out on suggesting some synergy, though. Sure, if I cut 100 calories out of my day, my body’s going to adapt. But what if I cut out 100 calories, AND increase my fruits and vegetables, AND add some habits like taking the stairs instead of the elevator, or walking to the corner store instead of driving to the supermarket?

Because I read about this, and I get a little discouraged about all the small changes I’ve made in my diet in the last year and a half or so, and I wonder if they’re all for nothing. I’ve switched a lot of my sweets out for fruit (not much change in calories but a decrease in processed foods), I’ve made sure to include a fresh vegetable of some sort in every lunch or dinner, I’ve gone from working out three or four times a month to four or five, I take the stairs instead of the elevator, I drink water instead of tea or soda in restaurants, and I get a consistent amount of calories roughly equivalent to what my body needs each day.

Then I think about the fact that since making those changes and no other changes, I’m currently around 60 pounds lighter than I was, and have gone from a size 18 to a size 12.

In an obesity epidemic, one cookie is, you’re correct, not very much. But rather than massive, invasive lifestyle change like switching to artificial sweeteners or working out nine times a week or (gods forbid) the Atkins Diet, most of us really can benefit from a simple, mindful program of small, healthy, incremental choices. Those choices, over time, become healthy, sensible habits. They become a tendency to reach, when snacking, for the apple first and the apple pie second. And in pulling them apart to force them to each stand on their own as a life-changing event, you kind of overlook the merits of, well, life changing.

Eat less exercise more loss weight, be healthier.
No medical magic it works doctors can you hear me ?

” The answer lies in biology. A person’s weight remains stable as long as the number of calories consumed doesn’t exceed the amount of calories the body spends, both on exercise and to maintain basic body functions. As the balance between calories going in and calories going out changes, we gain or lose weight.” (Tara Parker-Pope)

This statement is not accurate; in fact, it’s worse than inaccurate. The obesity epidemic that the United States is facing today has its genesis in precisely this kind of unscientific and uncorroborated thinking.

Study after study demonstrates that one calorie is not the same as another calorie; the source of those calories is highly relevant to whether weight is gained or lost.

And virtually every well executed experimental trial demonstrates that exercise is largely irrelevant to weight loss.

The obestity epidemic has proven intractable. Given the rampant increase in Type II diabetes and metabolic syndrome and given the implications that those two disorders have on other disease states ranging from cancer to coronary artery disease to Alzheimer;s disease, the need to find a genuine solution to weight gain is extraordinarily important. It is hard to imagine a bigger failure by the biomedical research and public health communities than their failure to come up with realistic solutions to the obesity epidemic.

Until those communities rid themselves of their lipid phobia, there won’t be any improvement and the next generation of children will be as fat and unhealthy as the current generation.

One cookie is more. More is the problem.

Did you ever notice how only overweight people overeat? It’s one of those paradoxes of obesity “research”.

The irony of the whole weight debate is that although it really is, in the end, about calories in vs calories out, counting calories is not the best way to achieve that. We’re just not built for it, it’s a miserable way to live, and it only works for short periods of time, or for people who are counting as a means to another ends, such as making a particular weight class for a fight, etc. Counting calories just for the sake of losing weight is too much like old religious injunctions against masturbation, etc. It’s simply too repressive.

It’s far easier to limit merely one or two aspects. I told myself that for six months I’d avoid carbs, and do intermittent fasting (only eat between 2PM and 10PM every day), but have complete freedom to eat as much as I wanted otherwise. I lost 60 pounds in the process. This was a year ago, and I’ve kept it off. And most importantly, I’ve done it without having to think about food on a constant basis.

This is not meant as an argument for a low carb diet — though carbs are the only thing that are not “essential” in the scientific meaning of the word, in that the body can create anything in a carb from other material, but it can’t create essential amino acids or essential fats. It’s merely an argument about the psychology of weight loss. If it’s positive — achieving a fighting weight, freedom to eat as much as you want at least within some parameters, etc. — it’s much more likely to work than if it’s negative and repressive.

//www.boldizar.com

Long Island Lawyer March 1, 2010 · 7:01 pm

I agree with the suggestion to TAX junk food (and subsidize healthier food), We must “require” manufacturers, stores and fast food outlets to promote and subsidize healthier choices recognizing the financial costs of the junk food to society in later years. Right now they profit from and cause addiction to the junk food while healthier choices are more expensive and harder to find.

Is it really a problem of quantity, per se, or is the problem truly quality? American’s eat enormous amounts of junk, empty calories, processed “food.” But I would suggest eating such food actually leaves one “hungry” for the nutrients the body actually needs to function well. Substituting real food for junk food makes the quantity issue disappear. Its hard to eat too much fruit, vegetables, whole grains, legumes, and the like. Michael Pollan said it best – “Eat food, mostly vegetables…” Just for emphasis I would insert the word “real” after “eat.” I don’t believe for a second that eating one less cookie or one less bottle of soda will work as long as the rest of the diet is full of junk.

It may be wrong to focus on weight, rather than diet. We all know that a muscular person may be heavy, but is likely to be healthy. Weight is only an indicator of diet.

If you have a healthy diet (that means healthy ingredients, not a calorie count), your weight will take care of itself. That means no simple carbohydrates (not one less cookie, but none at all), and no saturated or trans fat. Low-carbohydrate, high fat and protein diets produce weight loss and better blood lipid profiles, although the complex carbohydrates (fruit and vegetables) excluded by these diets are probably beneficial.

Tara: You say that: ” regrettably”, the body is more resistant to weight loss than to weight gain. This may be the perspective of one who is overweight, or worse. This is not the sentiment of one who is, as a purely hypothetical example, 6’1” and 144 lbs.

Sick and Tired of being sick and Tired March 1, 2010 · 7:28 pm

The obesity epidemic in America is not due to a lack of information or education or more strategies for sticking to your eating plan. When the doctors and experts start sincerely addressing the emotional, psychological and addictive behavior around eating (denial, anyone?) then we will start to see some progress, but forever repeating the refrain and variations on “calories in and calories out” is insanity. People eat to restore to themselves a sense of well being, including that one cookie. We are never going to put down that cookie unless we address the tremendous emotional drive beneath it. Our fast paced, plugged in, socially connected and yet mindless and alienated lifestyle doesn’t help much. Check out a meeting.

//www.oa.org/

Putting on weight just snacks up on you.

remember that commercial “bet you can’t eat just one”? it applies to cookies also

I was borderline obese when I graduated college 20 years ago, and now my BMI is below 20. What worked for me is changing to low calorie-density foods and drinks. It was tough at first giving up soda pop, but I think it was well worth it. I lost 1/3 of my weight yet eat more pounds per day than ever. So why not start every meal with a large soup and salad like I do? It may not work for you but I think it’s worth a try.

In the waiting room of the medical group where I get my primary care they installed a vending machine that dispenses junk food and soda.
Trying to increase business ? :-)