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Perspective: Public Health Nutrition Policies Should Focus on Healthy Eating, Not on Calorie Counting, Even to Decrease Obesity

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Perspective: Public Health Nutrition Policies Should Focus on Healthy Eating, Not on Calorie Counting, Even to Decrease Obesity PERSPECTIVE Downloaded from https://academic.oup.com/advances/advance-article-abstract/doi/10.1093/advances/nmz025/5479414 by Universidade Federal de Santa Catarina user on 06 May 2019 Perspective: Public Health Nutrition Policies Should Focus on Healthy Eating, Not on Calorie Counting, Even to Decrease Obesity Ana C Fernandes,1,2 Débora K Rieger,1 and Rossana PC Proença1,2 1Nutrition Postgraduate Program (Programa de Pós-graduação em Nutrição); and 2Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de Nutrição em Produção de Refeições, NUPPRE), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil ABSTRACT Calorie-focused policies, such as calorie menu labeling, seem to result in minor shifts toward healthier choices and public health improvement. This paper discusses the (lack of) relations between energy intake and healthy eating and the rationale for shifting the focus of public health nutrition policies to healthier foods and meals. We argue that the benefits of reducing caloric intake from low-quality foods might not result from the calorie reduction but rather from the reduced consumption of low-quality foods. It is better to consume a given number of calories from high-quality foods than a smaller number of calories from low-quality foods. It is not possible to choose a healthy diet solely based on the caloric value of foods because calories are not equal; they differ in nutritional quality according to their source. Foods are more than just a collection of calories and nutrients, and nutrients interact differently when presented as foods. Different subtypes of a macronutrient, although they have the same caloric value, are metabolized and influence health in different ways. For instance, industrial trans fats increase lipogenesis and the risk of heart diseases, whereas monounsaturated fats have the opposite effect. Food processing and cooking methods also influence the nutritional value of foods. Thus, public health nutrition policies should stop encouraging people to focus mainly on calorie counting to fight noncommunicable diseases. Instead, policies should focus on ingredients, dietary sources, and food processing and cooking methods. Adv Nutr 2019;0:1–8. Keywords: calories, energy, joules, processed food, food quality, healthy food, obesity, chronic diseases, menu labeling, food guidelines Introduction that menu calorie labeling has little or no effect on the Calorie-focused policies, such as calorie labeling, and dietary consumer’s choice of dish (3–7). A study (8) exploring guidelines that emphasize calorie counting might not be demographic patterns on the use of calorie information enough to improve public health, such as to prevent obesity in restaurants in the United States showed that only 53% and related diseases (1, 2). For instance, studies have shown of consumers notice calorie information, and less than half of these use the information. Calorie labeling was Perspective articles allow authors to take a position on a topic of current major importance or associated with binge eating, increase in weight-related controversy in the field of nutrition. As such, these articles could include statements basedon concerns, dieting, and unhealthy weight-control practices author opinions or point of view. Opinions expressed in Perspective articles are those of the author and are not attributable to the funder(s) or the sponsor(s) or the publisher, Editor, or (8). Thus, highlighting calorie information on food labels or Editorial Board of Advances in Nutrition. Individuals with different positions on the topic ofa disclosing only this information on menus can complicate Perspective are invited to submit their comments in the form of a Perspectives article or in a eating disorders. Letter to the Editor. This paper was based on discussions from a PhD thesis that was supported by a scholarship Public nutrition policies are not based solely on caloric and funding from the Brazilian National Council for Scientific and Technological Development, consumption, but they emphasize it as the main problem CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico) (grant number 485004/2012-7), and by scholarships from the Brazilian Federal Agency for Support and and solution for obesity and other chronic diseases. Although Evaluation of Graduate Education, CAPES (Coordenação de Aperfeiçoamento de Pessoal de some actions might promote a reduction in caloric intake, Nível Superior). it is relevant to debate whether calorie reduction is able Author disclosures: ACF, DKR, and RPCP,no conflicts of interest. Address correspondence to ACF (e-mail: [email protected]). to improve health simply because it can result in weight Abbreviations used: CAPES, Brazilian Federal Agency for Support and Evaluation of Graduate loss. The relation between calorie reduction and health Education; CNCDs, chronic noncommunicable diseases; CNPq, Brazilian National Council for improvement has been contested by other authors (2, 9)and Scientific and Technological Development; NUPPRE, Nutrition in Foodservice Research Centre; UFSC, Federal University of Santa Catarina. is discussed in this study with the aim of answering the fol- Copyright C American Society for Nutrition 2019. All rights reserved. Adv Nutr 2019;0:1–8; doi: https://doi.org/10.1093/advances/nmz025. 1 lowing question: Should public health policies focus mainly Calorie counting and obesity on calories rather than on the quality and composition of Dietary guidelines recommend healthy eating as a means to Downloaded from https://academic.oup.com/advances/advance-article-abstract/doi/10.1093/advances/nmz025/5479414 by Universidade Federal de Santa Catarina user on 06 May 2019 foods? promote health and prevent diseases, but when it comes to Some studies claim that nutrition information policies obesity, the premise is that imbalance of energy is the main that stress the importance of a food’s caloric value stimulate cause of the condition (16, 19). the reformulation of foods and culinary preparations (10, According to the WHO (22), “overweight and obesity 11). However, we question whether reformulations are are defined as the abnormal or excessive accumulation of directed to healthier options. A study analyzed 11,737 fat that may impair health.” Still according to WHO (22), menu items in 37 fast-food restaurants in the USA and the fundamental cause of overweight and obesity is the observed a mean reduction of 22 kcal in food items from imbalance between calories consumed and expended as 2012 to 2014. However, the macronutrient composition aresultofincreasedingestionofhigh-energyfoodsthat of the new items did not shift toward a healthier profile are rich in fat and reduced physical activity. Furthermore, (12). they explain that changes in food patterns and physical In light of these considerations on calorie-focused poli- activity are often the result of environmental and social cies,weaimtodiscusstherelationbetweencaloriesand changes associated with the lack of supportive policies in healthy eating, and propose a shift in the main focus of public health, agriculture, transport, urban planning, environment, policies from calorie counting toward healthier foods and food processing, distribution, marketing, and education (22). meals. However, the WHO bulletin (22) does not specify foods or food patterns that might be involved in the causes of obesity. In the document, the WHO (22) does not present other Current status of knowledge causes of obesity, yet, contradictorily, it proposes dietary recommendations to reduce overweight and obesity, for Concept of calorie and its use in the field of nutrition instance, through a reduction in fats, sugar, and sodium. We begin by discussing the transposition of a term used in In addition, the consumption of oilseeds (rich in fats and physics to the field of nutrition. Calorie is a unit of energy, calories) and of foods rich in fibers and minerals are also used to express the energy value of foods. The first recommended. definition of Calorie (capitalized, referring to kilocalorie or When the imbalance between caloric intake and ex- kcal) entered the English language through translation of a penditure is considered to be the fundamental cause of French text, which defined Calorie as “the heat needed to obesity, it is assumed that a decrease in caloric intake ◦ raise the temperature of 1 kg of water from 0 to 1 C,” that reduces the energy imbalance and might automatically is equivalent to 4,186 kJ (13). In this paper, the term calorie revert obesity. Even though high caloric intake might (lowercase) is used as a synonym for Calorie to refer to the be associated with a high BMI, calorie reduction should concept of a food’s energy value. be associated with an improvement in the nutritional In 1887, Atwater (14) defined calorie as “the amount of quality of the diet for long-term weight-loss maintenance heat which would raise the temperature of 1 kg of water (23–26). ◦ 1 C,” and according to Hargrove (13), in 1896, a scientific According to the 2013 American Heart committee proposed that a temperature range between 0 and Association/American College of Cardiology Task Force ◦ 20 C should be chosen. on Practice Guideline for the Management of Overweight The concept of food calorie as originated from ther- and Obesity in Adults (27), an energy deficit is required to modynamics was not adequate to transfer to the human achieve weight loss. However, energy deficit is a consequence condition because the human body is not a 100% efficient
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