This article was written by our regular contributor; dietitian – Maeve Hanan.
Calorie counting and Intuitive Eating are different approaches in nutrition which are often hotly debated. This article will explore the benefits of moving from calorie counting to Intuitive Eating.
What is Calorie Counting?
Calorie counting involves counting the amount of calories consumed each day, in order to stick to your estimated requirements. This often involves using calorie tracking apps.
A calorie is a way of measuring the energy that the body uses to function. In technical terms, this is the amount of energy required to raise the temperature of 1 g of water by 1 degree celsius (1). When we talk about calorie counting, what we are usually referring to is actually kilocalories (kcals) which are a thousand calories. For example, the average daily calorie requirements often used for women is 2000 kcals, and for men this is usually 2500 kcals (2).
Calories can also be expressed in metric form as kilojoules (kJ), where one kcal equals 4.18 kJ (3). In the UK, kcals are used more often than kJs.
However, calorie requirements are estimated based on a variety of factors such as:
- Height and body composition (i.e. the amount of bone, fat, water and muscle)
- Sex and hormal differences
- Physical activity
- Health status
Calorie Counting and Weight Loss
The aim of calorie counting is usually to create a calorie deficit in order to lose weight. Although a calorie deficit plays a role in losing weight, there are a complex web of factors involved when it comes to body size and losing weight, much of which is beyond our individual control such as genetics, the environment we live in and other socio-economic factors (4).
Studies have found that including calorie reduction as part of interventions that involve physical activity and behavioural support, promotes weight loss over 6 months (5, 6). Whereas rigid control of eating and thinking in a ‘black and white’ way about food is associated with regaining weight (7). An example of blcack and white thinking in terms of calorie counting would be believing that low-kcal foods are ‘good’ and high kcal foods are ‘bad’ .
Current data also indicates that a high amount of those that lose weight regain this within 2-5 years (8, 9, 10). The results of weight loss studies can also be impacted by the effect of healthy changes made by participants, regardless of what happens to their weight. Similarly, some studies investigating the impact of having a higher weight may not account for the effect of the weight stigma; and weight stigma in itself has been linked with worsened health outcomes (10). High dropout rates of more than 40% within the first 12 months (which can be as high as 80%) have been found in weight loss studies, which raises the question about how realistic weight loss diets are to follow (11). Characteristics of more successful weight loss interventions include: focusing on health behaviours and behaviour change, face to face input and frequent, longer-term follow-up (12, 13).
In addition, losing weight does not automatically mean improved health. In fact, unexplained weight loss is a red flag for numerous medical issues, including cancer (9). Although losing weight can improve health outcomes in certain circumstances (such as reducing insulin resistance for those who carry more weight around their middle), many health improvements can occur independent of weight loss. For example, focusing on health behaviours such as increased physical activity, quitting smoking, improving sleep, reducing stress levels and consuming a nutritious diet improve health regardless of weight changes (9, 10).
Other concerns related to promoting weight loss include (10):
- Ongoing cycles of losing and regaining weight – which is linked with increased inflammation and worsened health outcomes.
- Contributing to poor mental health, body image and relationship with food – including the risk of developing an eating disorder.
- Contributing to descrimination, weight stigma and fatphobia – which have a big impact on health and wellbeing.
- Reduction in health behaviours as a result of reduced self-esteem and weight stigma.
Calorie Counting and Health
Nutrition is very individual, so some people find that calorie counting or having some awareness of calories helps them to pay attention to eating well.
But some of the calorie recommendations from calorie counting programmes and apps can be worryingly low, sometimes as low as 1200 kcals for an adult which is closer to the nutrition requirements of a toddler.
Risks related to consuming too few calories include (14):
- Nutritional deficiencies
- Fatigue, worsened mood and concentration
- Loss of muscle and bone mass
- Fertility issues
- Digestive issues
- Increased stress and inflammation
- Worsened heart and metabolic health
- Reduced sports performance and recovery
Women are particularly at risk of the side-effects of under-fuelling (14).
Closely monitoring and restricting calorie intake can also contribute to an obsessive or disordered relation with food (15, 16, 17). Giving too much power to ‘calories in vs. calories out’ often sets up a very black and white way of thinking, which can lead to feeling the need to ‘earn food’ or to compensate for food with exercise. Whereas, it’s normal to eat more on some days as compared with others, rather than having to hit a rigid daily calorie goal – afterall how would our ancestors have survived without tracking apps if we didn’t naturally have some wiggle room with this!
One of the reasons for obsessive calorie counting can be due to the misconception that this is highly accurate. A number of factors impact the accuracy of the kcal amounts and requirements in apps, food databases and on food labels. For example, the type of equation used to estimate calorie requirements, hormonal factors, the nutrition database used, and the impact of nutritional composition and digestion on the amount of calories available to the body (18, 19, 20).
Importantly, calories are not the full picture when it comes to nutrition. We need to consume a variety of nutrients in order to have a balanced and nourishing diet, so there is much more to eating well than simply focusing on calories. Counting calories can actually take us away from the most nutritious choice at times by limiting foods that are seen as high calorie, such as avocados, nuts or olive oil. Calorie counting can also get in the way of other healthy behaviours, such as socialising and enjoying food without the added stress or guilt about calorie intake.
What is Intuitive Eating?
Intuitive Eating is an approach that was created in 1995 by two dietitians, Evelyn Tribole and Elyse Resch, described as “a personal process of honouring health by listening and responding to the direct messages of the body in order to meet your physical and psychological needs” (21).
IE is based on the following 10 principles (22):
- Reject the diet mentality
- Honour your hunger
- Make peace with food
- Challenge the food police
- Discover the satisfaction factor
- Feel your fullness
- Cope with your emotions with kindness
- Respect your body
- Movement — feel the difference
- Honour your health with gentle nutrition
As Intuitive Eating is an anti-diet approach, it does not involve counting calories, focusing on losing weight, restricting or micromanaging food intake or labelling foods as ‘good or bad’.
Intuitive Eating and Health
Intuitive Eating is still a relatively new model, but there is some exciting research emerging related to this.
Intuitive Eating has been associated with (23, 24, 25, 26, 27, 28):
- Reduced disordered eating and binge eating
- Higher body satisfaction
- Greater emotional functioning, psychological flexibility and improved mental health
- Better interoceptive awareness – the ability to identify internal bodily signals
- Improved blood pressure and cholesterol
- A more varied diet
- Improved blood sugar control in those with diabetes
Although changes to weight or BMI is not the intended outcome of Intuitive Eating, a number of studies have found that weight maintenance or a reduction in weight or BMI is associated with higher Intuitive Eating scores (24, 29, 30, 31). Whereas, the intentional goal of losing weight has been seen to reduce Intuitive Eating scores and increase binge eating (32).
A lot of the current research related to Intuitive Eating is cross sectional, which looks at behaviours and outcomes at one specific time, rather than observing these over time. However, a recent study did explore the link between Intuitive
Eating and weight-related behaviours over 5 years (33). This study found that Intuitive Eating was associated with lower risk of dieting, binge eating, unhealthy weight control behaviours and having a higher weight (33).
Many studies related to Intuitive Eating have also been conducted in women and some of them have been quite small, so ongoing high-quality research in a variety of populations is needed.
Take Home Message
Calorie counting may work for some people as a weight-loss method. But there are many factors involved in losing weight, and current data suggests that only the minority of people maintain weight loss in the long term. Health also encompasses so much more than weight alone. Similarly, there is so much more to food than just calories, in terms of both nutrition and quality of life.
Intuitive Eating is an anti-diet approach that focuses on honouring internal signals in order to meet our needs; including paying attention to hunger and fullness levels rather than external factors like calorie-counting apps. This is a relatively recent approach, so ongoing research is needed. But the available evidence related to Intuitive Eating is very promising in terms of a number of markers of psychological and physical health.
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