You can't manage what you don't measure, whether it's the money you earn and spend, or the calories you eat and burn. Nevertheless, most quick-fix solutions promise results without calorie counting. No wonder they fail so often. As advertising campaigns for quick-fix solutions rage within the media, and as people debate which unbalanced and restricted diet is best to follow for losing weight (high-protein, low-carb, low-fat, etc.), or which type of exercise machine is best, or which pill or surgical procedure is the most popular, science has already provided us with the answer to effective weight management, but unfortunately, hardly anyone is listening. 

Scientific Evidence

Hundreds of scientific studies on weight control have been conducted over the past 35 years, but, according to Baker and Kirschenbaum (1998), only a few have focused on the most promising of all behavioral techniques that has been scientifically shown to be successful in weight management: self-monitoring one's calorie intake. Self-monitoring the amount of food one eats has been shown by researchers to be related to weight change in experimental subjects, while not monitoring at all was unrelated to weight change in subjects.

Self-monitoring devices described by researchers include paper-and-pencil methods, such as keeping a Food and Activity Journal to record entries of calories consumed and burned each day. Electronic devices such as organizers and calculators may also by used. 

Monitoring the calories consumed in one’s diet and burned in activity is one of the "3 M’s" of a weight management solution that this article’s author has developed as a professional

fitness trainer and author of a best-selling book on weight management, The Body Fat Guide (Brown, 1999). The 3 M’s of weight management are: 

1. Measure changes in body composition. 
2. Monitor diet and activity. 
3. Modify energy balance—the balance between calorie intake and calorie expenditures. 

These three components form an interactive relationship to create a total solution, as illustrated in the author’s Weight Management Triangle.  As this article points out, scientific research supports the principles of self-monitoring employed in this weight management solution.

A study published in the November 2005 issue of the New England Journal of Medicine (Berkowitz et al, 2005) found that participants in one group who consistently monitored what they ate lost more than twice as much weight as those in the group who only kept track occasionally, even though all participants in the group took an appetite suppressant and received group therapy in behavior modification. 

Self monitoring weight is just as important as monitoring calorie intake. At the 2007 conference of the Obesity Society held in New Orleans, a Duke University research study was presented which indicated that people who lose a large amount of weight track their weight and diet (Los Angeles Times, 2007). Another 2007 study at Brown University Medical School/The Miriam Hospital (Wing et al, 2007) showed that daily weighing increased dietary restraint in subjects.

More recently, the world's largest controlled study of weight-loss methods, published in The New England Journal of Medicine (Sacks et al, 2009), reported that the type of diet a person chooses to lose weight was found not to be as important as simply cutting calories.

Calorie Counting Basics

Calorie counting is the reality check most people need to take effective control of their weight. If people could ignore calorie counting and manage their weight by feel alone, they wouldn't have a weight problem in the first place. Relying on restricted and unbalanced diets instead of calorie counting is a dead end because a restricted or unbalanced diet cannot be maintained for long periods of time. Most of these diets are followed by immediate rebounds in weight.

So what, exactly, is it about self-monitoring through calorie counting that makes it so effective? Experience shows it is difficult for a dieter to judge precisely when they have reached their calorie intake allowance just by guessing. However, if the dieter receives a clear signal that they have reached their calorie intake allowance, it is relatively easier for them to stop eating. On the other hand, without that information, it is just as easy for them to continue eating right past their allowance! 

There is a right way and a wrong way to employ calorie counting as an effective self-monitoring technique in weight management. Korotitsch and Nelson-Gray (1999) emphasize that proper training of the subject in monitoring the target behavior improves self-monitoring. In weight management, the subject must be trained to refer to calorie tables of foods eaten, and the subject must also make reasonably accurate estimates of portion sizes. Measuring cups and food scales are employed when possible, and the subject is instructed in how to read food labels listing nutritional information. A technique often used by dieticians to assist subjects in estimating portion sizes is to have subjects compare a portion of food to a deck of playing cards or to a tennis ball (Brown, 1999).

The accuracy of data collected by self-monitoring may be judged by several criteria (Korotitsch & Nelson-Gray, 1999). One criteria is a comparison of the subject’s data to a mechanical measuring device. For example, the subject’s estimate of calories burned at a comfortable walking speed outdoors may be compared to the calorie amount electronically displayed while walking on a treadmill.

Another judging criteria is a comparison of the subject’s data to some other behavioral byproduct. For example, if the subject’s estimated net calorie loss over a period of time is accurate, a corresponding decrease in body fat should be measured. Each net loss of 3,500 calories should result in a loss of one pound of body fat. Therefore, if a subject claims to have self-recorded a net loss of 3,500 calories, but a loss of only half a pound of body fat is measured, this may indicate that the subject needs to improve the accuracy of their self-monitored calorie estimates. Additionally, should the subject’s calorie estimates prove accurate, attention must be paid to possible confounds that could distort the corresponding weight measurement, such as variable amounts of gastrointestinal contents, water retention and skeletal muscle loss (Brown, 1999).

Calorie Blunters

There is another reason why subjects’ self-monitored estimates may not appear accurate: noncompliance with consistent self-monitoring. For example, Wilson and Vitousek (1999) describe how so-called "diet-resistant" obese patients, who reported far lower calorie intake estimates than could be verified by the amount of weight they lost, were discovered to have reported only 50% of their actual calorie intake. This trend to underreport eating was seen even in non-obese subjects.

Kirchenbaum and Baker (1993) label people who have traits that lead to inconsistent self-monitoring as "blunters." Blunters avoid threatening information under stressful conditions. Therefore, blunters are likely to fail to record an excessive amount of ingested calories if it jeopardizes their weight-loss goals. On the other hand, people who utilize this same sort of threatening information in an effective coping style are labeled by these researchers as "monitors." Monitors might record the excess of ingested calories and adjust their eating plan to make up for this excess by reducing the amount of calories eaten at subsequent meals (See: How to Rescue a Blown Diet).

As effective as self-monitoring has been show by research to be for losing weight, maintaining one’s weight loss presents a completely different challenge that is not as well researched. When one’s goal is simply to lose weight, accuracy of self-monitored estimates is not always crucial (Kirchenbaum & Baker, 1993). As long as one correctly guesses that one is eating fewer calories than are burned each day, bodyweight is bound to be lost. 

However, the situation is more exacting when one’s goal is to maintain weight loss. The number of calories one eats must exactly match the number of calories one burns, else excess calorie intake will be stored as body fat and increase one’s bodyweight (Brown, 1999). How can such a precise balance of calories be ensured by self-monitoring?

One answer would be to employ a criteria for self-monitoring accuracy previously mentioned. That is, one must consistently employ daily weighing, or even better, body composition analysis, to indicate changes in body fat and lean body mass levels associated with self-monitored data. The association between monitored diet and exercise behavior with one’s body composition analysis is found in the Weight Management Triangle. By examining this association, the self-monitor can properly modify calorie intake and calorie expenditures in order to stabilize weight. The modification of one’s calorie intake and expenditures in this manner determines one’s energy balance, the third part of the Weight Management Triangle.

All this weighing, measuring and self-monitoring on a daily basis has been criticized by some as promoting obsessive preoccupation with food and bodyweight (Kirchenbaum & Baker, 1993), and of encouraging the development of eating disorders. Yet, a classic study of behavior modification in the treatment of anorexia nervosa (Agras, Barlow, Chapin, Abel & Leitenberg, 1974) notes that overweight people eat less food if they receive precise caloric feedback, while anorexic patients in treatment eat more food if given precise caloric feedback. Feedback of this nature tended to cause both types of disturbed eating behaviors to normalize. This may explain why restaurants do not prominently display calories in their menus—it may make customers less inclined to overeat, which would reduce sales' revenue. On the other hand, if customers demanded to know the calories, the restaurant owners would probably be more than happy to comply.

In conclusion, self-monitoring holds much promise for providing solutions to our society’s weight management problems. The population needs to be educated in techniques of self-monitoring such as calorie counting. More importantly, the population needs to free itself from the grasp of the quick-fix diet industry so that people can stop wasting time and money on ineffective solutions that fail to provide long-term benefits to their health.

References

Agras, W. S., Barlow, D. H., Chapin, H. N., Abel, G. G., & Leitenberg, H. (1974). Behavior modification of anorexia nervosa. Arch Gen Psychiatry, 30, 279-286.

Baker, R. C., & Kirschenbaum, D. S. (1993). Self-monitoring may be necessary for successful weight control. Behavior Therapy, 24, 377-394.

Baker, R. C., & Kirschenbaum, D. S. (1998). Weight control during the holidays: Highly consistent self-monitoring as a potentially useful coping mechanism. Health Psychology, 17, 367-370.

Berkowitz, R. I., Cato, R. K., Hesson, L. A., Kaplan, R., Osei, S. Y., Phelan, S., Sarwer, D. B., Stunkard, A. J., Wadden, T. A., & Womble, L. G. (2005). Randomized trial of lifestyle modification and pharmacotherapy for obesity. New England Journal of Medicine, 353, 2111-2120.

Brown, R. (1999). The body fat guide (2nd ed.). Kitchener, ON, Canada: HealthStyle

 

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