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How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative

  • Sean C Lucan (a1) and James J DiNicolantonio (a2)

Prevailing thinking about obesity and related diseases holds that quantifying calories should be a principal concern and target for intervention. Part of this thinking is that consumed calories – regardless of their sources – are equivalent; i.e. ‘a calorie is a calorie’. The present commentary discusses various problems with the idea that ‘a calorie is a calorie’ and with a primarily quantitative focus on food calories. Instead, the authors argue for a greater qualitative focus on the sources of calories consumed (i.e. a greater focus on types of foods) and on the metabolic changes that result from consuming foods of different types. In particular, the authors consider how calorie-focused thinking is inherently biased against high-fat foods, many of which may be protective against obesity and related diseases, and supportive of starchy and sugary replacements, which are likely detrimental. Shifting the focus to qualitative food distinctions, a central argument of the paper is that obesity and related diseases are problems due largely to food-induced physiology (e.g. neurohormonal pathways) not addressable through arithmetic dieting (i.e. calorie counting). The paper considers potential harms of public health initiatives framed around calorie balance sheets – targeting ‘calories in’ and/or ‘calories out’ – that reinforce messages of overeating and inactivity as underlying causes, rather than intermediate effects, of obesity. Finally, the paper concludes that public health should work primarily to support the consumption of whole foods that help protect against obesity-promoting energy imbalance and metabolic dysfunction and not continue to promote calorie-directed messages that may create and blame victims and possibly exacerbate epidemics of obesity and related diseases.

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1. Huffman, DM & Barzilai, N (2010) Contribution of adipose tissue to health span and longevity. Interdiscip Top Gerontol 37, 119.
2. Neeland, IJ, Ayers, CR, Rohatgi, AK et al. (2013) Associations of visceral and abdominal subcutaneous adipose tissue with markers of cardiac and metabolic risk in obese adults. Obesity (Silver Spring) 21, E439E447.
3. Oliveros, E, Somers, VK, Sochor, O et al. (2014) The concept of normal weight obesity. Prog Cardiovasc Dis 56, 426433.
4. Thomas, JE (1957) Mechanics and regulation of gastric emptying. Physiol Rev 37, 453474.
5. Benedini, S, Codella, R, Caumo, A et al. (2011) Different circulating ghrelin responses to isoglucidic snack food in healthy individuals. Horm Metab Res 43, 135140.
6. Raben, A, Agerholm-Larsen, L, Flint, A et al. (2003) Meals with similar energy densities but rich in protein, fat, carbohydrate, or alcohol have different effects on energy expenditure and substrate metabolism but not on appetite and energy intake. Am J Clin Nutr 77, 91100.
7. Lomenick, JP, Melguizo, MS, Mitchell, SL et al. (2009) Effects of meals high in carbohydrate, protein, and fat on ghrelin and peptide YY secretion in prepubertal children. J Clin Endocrinol Metab 94, 44634471.
8. Riera-Crichton, D & Tefft, N (2014) Macronutrients and obesity: revisiting the calories in, calories out framework. Econ Hum Biol 14, 3349.
9. Kekwick, A & Pawan, GL (1956) Calorie intake in relation to body-weight changes in the obese. Lancet 271, 155161.
10. Ebbeling, CB, Swain, JF, Feldman, HA et al. (2012) Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA 307, 26272634.
11. Gerstein, DE, Woodward-Lopez, G, Evans, AE et al. (2004) Clarifying concepts about macronutrients’ effects on satiation and satiety. J Am Diet Assoc 104, 11511153.
12. Feinman, RD & Fine, EJ (2004) ‘A calorie is a calorie’ violates the second law of thermodynamics. Nutr J 3, 9.
13. Shook, RP, Hand, GA & Blair, SN (2014) Top 10 research questions related to energy balance. Res Q Exerc Sport 85, 4958.
14. Westerterp, KR, Wilson, SA & Rolland, V (1999) Diet induced thermogenesis measured over 24h in a respiration chamber: effect of diet composition. Int J Obes Relat Metab Disord 23, 287292.
15. Guth, E (2014) JAMA patient page. Healthy weight loss. JAMA 312, 974.
16. Baer, DJ, Gebauer, SK & Novotny, JA (2012) Measured energy value of pistachios in the human diet. Br J Nutr 107, 120125.
17. Urban, LE, Dallal, GE, Robinson, LM et al. (2010) The accuracy of stated energy contents of reduced-energy, commercially prepared foods. J Am Diet Assoc 110, 116123.
18. Hall, KD, Heymsfield, SB, Kemnitz, JW et al. (2012) Energy balance and its components: implications for body weight regulation. Am J Clin Nutr 95, 989994.
19. Novotny, JA, Gebauer, SK & Baer, DJ (2012) Discrepancy between the Atwater factor predicted and empirically measured energy values of almonds in human diets. Am J Clin Nutr 96, 296301.
20. Lee, JM, Kim, Y & Welk, GJ (2014) Validity of consumer-based physical activity monitors. Med Sci Sports Exerc 46, 18401848.
21. Jakubowicz, D, Barnea, M, Wainstein, J et al. (2013) High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obesity (Silver Spring) 21, 25042512.
22. Leibel, RL, Rosenbaum, M & Hirsch, J (1995) Changes in energy expenditure resulting from altered body weight. N Engl J Med 332, 621628.
23. Harris, RB (1990) Role of set-point theory in regulation of body weight. FASEB J 4, 33103318.
24. St Clair Gibson, A, Goedecke, JH, Harley, YX et al. (2005) Metabolic setpoint control mechanisms in different physiological systems at rest and during exercise. J Theor Biol 236, 6072.
25. Sumithran, P & Proietto, J (2013) The defence of body weight: a physiological basis for weight regain after weight loss. Clin Sci (Lond) 124, 231241.
26. Ochner, CN, Barrios, DM, Lee, CD et al. (2013) Biological mechanisms that promote weight regain following weight loss in obese humans. Physiol Behav 120, 106113.
27. Lustig, RH (2006) The ‘skinny’ on childhood obesity: how our western environment starves kids’ brains. Pediatr Ann 35, 898902.
28. Heymsfield, SB, Harp, JB, Reitman, ML et al. (2007) Why do obese patients not lose more weight when treated with low-calorie diets? A mechanistic perspective. Am J Clin Nutr 85, 346354.
29. Speakman, JR, Levitsky, DA, Allison, DB et al. (2011) Set points, settling points and some alternative models: theoretical options to understand how genes and environments combine to regulate body adiposity. Dis Model Mech 4, 733745.
30. Ludwig, DS & Friedman, MI (2014) Increasing adiposity: consequence or cause of overeating? JAMA 311, 21672168.
31. Hall, KD, Hammond, RA & Rahmandad, H (2014) Dynamic interplay among homeostatic, hedonic, and cognitive feedback circuits regulating body weight. Am J Public Health 104, 11691175.
32. Nackers, LM, Middleton, KR, Dubyak, PJ et al. (2013) Effects of prescribing 1,000 versus 1,500 kilocalories per day in the behavioral treatment of obesity: a randomized trial. Obesity (Silver Spring) 21, 24812487.
33. Maclean, PS, Bergouignan, A, Cornier, MA et al. (2011) Biology’s response to dieting: the impetus for weight regain. Am J Physiol Regul Integr Comp Physiol 301, R581R600.
34. Hall, KD, Sacks, G, Chandramohan, D et al. (2011) Quantification of the effect of energy imbalance on bodyweight. Lancet 378, 826837.
35. Hall, KD, Butte, NF, Swinburn, BA et al. (2013) Dynamics of childhood growth and obesity: development and validation of a quantitative mathematical model. Lancet Diabetes Endocrinol 1, 97105.
36. Shah, NR & Braverman, ER (2012) Measuring adiposity in patients: the utility of body mass index (BMI), percent body fat, and leptin. PLoS One 7, e33308.
37. Wildman, RP, Muntner, P, Reynolds, K et al. (2008) The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999–2004). Arch Intern Med 168, 16171624.
38. Coutinho, T, Goel, K, Correa de Sa, D et al. (2013) Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: role of ‘normal weight central obesity’. J Am Coll Cardiol 61, 553560.
39. Song, Y, Manson, JE, Meigs, JB et al. (2007) Comparison of usefulness of body mass index versus metabolic risk factors in predicting 10-year risk of cardiovascular events in women. Am J Cardiol 100, 16541658.
40. Hamer, M & Stamatakis, E (2012) Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab 97, 24822488.
41. Kramer, CK, Zinman, B & Retnakaran, R (2013) Are metabolically healthy overweight and obesity benign conditions? A systematic review and meta-analysis. Ann Intern Med 159, 758769.
42. Gannon, MC & Nuttall, FQ (2006) Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition. Nutr Metab (Lond) 3, 16.
43. Look AHEAD Research Group, Wing RR & Bolin P (2013) Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 369, 145154.
44. Richmond, RC, Davey Smith, G, Ness, AR et al. (2014) Assessing causality in the association between child adiposity and physical activity levels: a Mendelian randomization analysis. PLoS Med 11, e1001618.
45. Mann, J (2007) Dietary carbohydrate: relationship to cardiovascular disease and disorders of carbohydrate metabolism. Eur J Clin Nutr 61, Suppl. 1, S100S111.
46. Jenkins, DJ, Wolever, TM, Taylor, RH et al. (1981) Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr 34, 362366.
47. Foster-Powell, K, Holt, SH & Brand-Miller, JC (2002) International table of glycemic index and glycemic load values. Am J Clin Nutr 76, 556.
48. Ludwig, DS (2002) The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA 287, 24142423.
49. Spreadbury, I (2012) Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity. Diabetes Metab Syndr Obes 5, 175189.
50. Taubes, G (2012) Treat obesity as physiology, not physics. Nature 492, 155.
51. Nicklas, T, Kleinman, RE & O’Neil, CE (2012) Taking into account scientific evidence showing the benefits of 100% fruit juice. Am J Public Health 102, e4.
52. Wojcicki, JM & Heyman, MB (2012) Reducing childhood obesity by eliminating 100% fruit juice. Am J Public Health 102, 16301633.
53. Atwater, WO (1899) Experiments on the Metabolism of Matter and Energy in the Human Body. Washington, DC: Government Printing Office.
54. Wansink, B, Shimizu, M & Brumberg, A (2013) Association of nutrient-dense snack combinations with calories and vegetable intake. Pediatrics 131, 2229.
55. Marmonier, C, Chapelot, D & Louis-Sylvestre, J (2000) Effects of macronutrient content and energy density of snacks consumed in a satiety state on the onset of the next meal. Appetite 34, 161168.
56. Vozzo, R, Wittert, G, Cocchiaro, C et al. (2003) Similar effects of foods high in protein, carbohydrate and fat on subsequent spontaneous food intake in healthy individuals. Appetite 40, 101107.
57. Rouhani, MH, Salehi-Abargouei, A & Azadbakht, L (2013) Effect of glycemic index and glycemic load on energy intake in children. Nutrition 29, 11001105.
58. Ludwig, DS (2000) Dietary glycemic index and obesity. J Nutr 130, 2S Suppl., 280S283S.
59. Powell, LM & Nguyen, BT (2013) Fast-food and full-service restaurant consumption among children and adolescents: effect on energy, beverage, and nutrient intake. Arch Pediatr Adolesc Med 167, 1420.
60. Ebbeling, CB, Sinclair, KB, Pereira, MA et al. (2004) Compensation for energy intake from fast food among overweight and lean adolescents. JAMA 291, 28282833.
61. Mozaffarian, D, Hao, T, Rimm, EB et al. (2011) Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 364, 23922404.
62. Hu, EA, Pan, A, Malik, V et al. (2012) White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ 344, e1454.
63. Qi, Q, Chu, AY, Kang, JH et al. (2012) Sugar-sweetened beverages and genetic risk of obesity. N Engl J Med 367, 13871396.
64. Faith, MS, Dennison, BA, Edmunds, LS et al. (2006) Fruit juice intake predicts increased adiposity gain in children from low-income families: weight status-by-environment interaction. Pediatrics 118, 20662075.
65. Malik, VS, Schulze, MB & Hu, FB (2006) Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 84, 274288.
66. Bes-Rastrollo, M, Schulze, MB, Ruiz-Canela, M et al. (2013) Financial conflicts of interest and reporting bias regarding the association between sugar-sweetened beverages and weight gain: a systematic review of systematic reviews. PLoS Med 10, e1001578.
67. Tan, SY & Mattes, RD (2013) Appetitive, dietary and health effects of almonds consumed with meals or as snacks: a randomized, controlled trial. Eur J Clin Nutr 67, 12051214.
68. Tey, SL, Brown, R, Gray, A et al. (2011) Nuts improve diet quality compared to other energy-dense snacks while maintaining body weight. J Nutr Metab 2011, 357350.
69. Estruch, R, Ros, E, Salas-Salvado, J et al. (2013) Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 368, 12791290.
70. Guasch-Ferre, M, Bullo, M, Martinez-Gonzalez, MA et al. (2013) Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial. BMC Med 11, 164.
71. Bao, Y, Han, J, Hu, FB et al. (2013) Association of nut consumption with total and cause-specific mortality. N Engl J Med 369, 20012011.
72. Ma, Y, Njike, VY, Millet, J et al. (2010) Effects of walnut consumption on endothelial function in type 2 diabetic subjects: a randomized controlled crossover trial. Diabetes Care 33, 227232.
73. Tan, SY, Dhillon, J & Mattes, RD (2014) A review of the effects of nuts on appetite, food intake, metabolism, and body weight. Am J Clin Nutr 100, Suppl. 1, 412S422S.
74. Viguiliouk, E, Kendall, CW, Blanco Mejia, S et al. (2014) Effect of tree nuts on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled dietary trials. PLoS One 9, e103376.
75. Thorsdottir, I, Tomasson, H, Gunnarsdottir, I et al. (2007) Randomized trial of weight-loss-diets for young adults varying in fish and fish oil content. Int J Obes (Lond) 31, 15601566.
76. Perez-Martinez, P, Garcia-Rios, A, Delgado-Lista, J et al. (2011) Mediterranean diet rich in olive oil and obesity, metabolic syndrome and diabetes mellitus. Curr Pharm Des 17, 769777.
77. Salas-Salvado, J, Bullo, M, Estruch, R et al. (2014) Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Ann Intern Med 160, 110.
78. Siri-Tarino, PW, Sun, Q, Hu, FB et al. (2010) Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr 91, 535546.
79. Chowdhury, R, Warnakula, S, Kunutsor, S et al. (2014) Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med 160, 398406.
80. Scharf, RJ, Demmer, RT & Deboer, MD (2013) Longitudinal evaluation of milk type consumed and weight status in preschoolers. Arch Dis Child 98, 335340.
81. Rice, BH, Quann, EE & Miller, GD (2013) Meeting and exceeding dairy recommendations: effects of dairy consumption on nutrient intakes and risk of chronic disease. Nutr Rev 71, 209223.
82. O’Sullivan, TA, Hafekost, K, Mitrou, F et al. (2013) Food sources of saturated fat and the association with mortality: a meta-analysis. Am J Public Health 103, e31e42.
83. de Oliveira Otto, MC, Mozaffarian, D, Kromhout, D et al. (2012) Dietary intake of saturated fat by food source and incident cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr 96, 397404.
84. Aune, D, Norat, T, Romundstad, P et al. (2013) Dairy products and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Am J Clin Nutr 98, 10661083.
85. Holmberg, S & Thelin, A (2013) High dairy fat intake related to less central obesity: a male cohort study with 12 years’ follow-up. Scand J Prim Health Care 31, 8994.
86. Kratz, M, Baars, T & Guyenet, S (2013) The relationship between high-fat dairy consumption and obesity, cardiovascular, and metabolic disease. Eur J Nutr 52, 124.
87. Li, S, Field, A, Rimm, E et al. (2014) Dairy consumption with onset of overweight and obesity among US adolescents. FASEB J 28, 1 Suppl., abstr. 370.7.
88. Martinez-Gonzalez, MA, Sayon-Orea, C, Ruiz-Canela, M et al. (2014) Yogurt consumption, weight change and risk of overweight/obesity: the SUN cohort study. Nutr Metab Cardiovasc Dis (Epublication ahead of print version).
89. Hession, M, Rolland, C, Kulkarni, U et al. (2009) Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev 10, 3650.
90. Spieth, LE, Harnish, JD, Lenders, CM et al. (2000) A low-glycemic index diet in the treatment of pediatric obesity. Arch Pediatr Adolesc Med 154, 947951.
91. Hu, T, Mills, KT, Yao, L et al. (2012) Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol 176, Suppl. 7, S44S54.
92. Yancy, WS Jr, Olsen, MK, Guyton, JR et al. (2004) A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med 140, 769777.
93. Volek, JS, Phinney, SD, Forsythe, CE et al. (2009) Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids 44, 297309.
94. Westman, EC, Yancy, WS Jr, Mavropoulos, JC et al. (2008) The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond) 5, 36.
95. Tobias, DK, Chen, M, Willett, W et al. (2014) Randomized trials of low-fat vs. other diet interventions on weight loss: a meta-analysis. Circulation 129, Suppl. 1, abstr. MP63.
96. Dutton, GR, Laitner, MH & Perri, MG (2014) Lifestyle interventions for cardiovascular disease risk reduction: a systematic review of the effects of diet composition, food provision, and treatment modality on weight loss. Curr Atheroscler Rep 16, 442.
97. Johnston, BC, Kanters, S, Bandayrel, K et al. (2014) Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA 312, 923933.
98. Gow, ML, Ho, M, Burrows, TL et al. (2014) Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obese children and adolescents: a systematic review. Nutr Rev 72, 453470.
99. Ebbeling, CB, Leidig, MM, Feldman, HA et al. (2007) Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial. JAMA 297, 20922102.
100. Mensink, RP & Katan, MB (1992) Effect of dietary fatty acids on serum lipids and lipoproteins. A meta-analysis of 27 trials. Arterioscler Thromb 12, 911919.
101. Richard, C, Couture, P, Desroches, S et al. (2013) Effect of the Mediterranean diet with and without weight loss on markers of inflammation in men with metabolic syndrome. Obesity (Silver Spring) 21, 5157.
102. Corella, D, Carrasco, P, Sorli, JV et al. (2013) Mediterranean diet reduces the adverse effect of the TCF7L2-rs7903146 polymorphism on cardiovascular risk factors and stroke incidence: a randomized controlled trial in a high-cardiovascular-risk population. Diabetes Care 36, 38033811.
103. Foster, GD, Wyatt, HR, Hill, JO et al. (2010) Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med 153, 147157.
104. Shai, I, Spence, JD, Schwarzfuchs, D et al. (2010) Dietary intervention to reverse carotid atherosclerosis. Circulation 121, 12001208.
105. Mobbs, CV, Mastaitis, J, Isoda, F et al. (2013) Treatment of diabetes and diabetic complications with a ketogenic diet. J Child Neurol 28, 10091014.
106. Schwingshackl, L & Hoffmann, G (2013) Comparison of effects of long-term low-fat vs high-fat diets on blood lipid levels in overweight or obese patients: a systematic review and meta-analysis. J Acad Nutr Diet 113, 16401661.
107. Meckling, KA, O’Sullivan, C & Saari, D (2004) Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women. J Clin Endocrinol Metab 89, 27172723.
108. Gogebakan, O, Kohl, A, Osterhoff, MA et al. (2011) Effects of weight loss and long-term weight maintenance with diets varying in protein and glycemic index on cardiovascular risk factors: the diet, obesity, and genes (DiOGenes) study: a randomized, controlled trial. Circulation 124, 28292838.
109. Bazzano, LA, Hu, T, Reynolds, K et al. (2014) Effects of low-carbohydrate and low-fat diets: a randomized trial. Ann Intern Med 161, 309318.
110. Fung, TT, Rexrode, KM, Mantzoros, CS et al. (2009) Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation 119, 10931100.
111. Sofi, F, Macchi, C, Abbate, R et al. (2014) Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr 17, 27692782.
112. Knoops, KT, de Groot, LC, Kromhout, D et al. (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292, 14331439.
113. Trichopoulou, A, Orfanos, P, Norat, T et al. (2005) Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330, 991.
114. Marantz, PR, Bird, ED & Alderman, MH (2008) A call for higher standards of evidence for dietary guidelines. Am J Prev Med 34, 234240.
115. National Center for Health Statistics, Centers for Disease Control and Prevention (2005) Health, United States, 2005 with Chartbook on Trends in the Health of Americans. (accessed April 2013).
116. Centers for Disease Control and Prevention (2012) Increasing prevalence of diagnosed diabetes – United States and Puerto Rico, 1995–2010. MMWR Morb Mortal Wkly Rep 61, 918921.
117. Centers for Disease Control and Prevention (2013) Number (in Millions) of Civilian, Noninstitutionalized Persons with Diagnosed Diabetes, United States, 1980–2011. (accessed June 2013).
118. Hodge, JG Jr & White, LC (2012) Supplementing national menu labeling. Am J Public Health 102, e11e13.
119. US Food and Drug Administration (2011) FDA Issues Two Proposed Rules on Food Labeling: Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments; and Calorie Labeling of Articles of Food in Vending Machines. (accessed April 2013).
120. Block, JP & Roberto, CA (2014) Potential benefits of calorie labeling in restaurants. JAMA 312, 887888.
121. Swartz, JJ, Braxton, D & Viera, AJ (2011) Calorie menu labeling on quick-service restaurant menus: an updated systematic review of the literature. Int J Behav Nutr Phys Act 8, 135.
122. Elbel, B, Mijanovich, T, Dixon, LB et al. (2013) Calorie labeling, fast food purchasing and restaurant visits. Obesity (Silver Spring) 21, 21722179.
123. Kiszko, KM, Martinez, OD, Abrams, C et al. (2014) The influence of calorie labeling on food orders and consumption: a review of the literature. J Community Health (Epublication ahead of print version).
124. Sinclair, SE, Cooper, M & Mansfield, ED (2014) The influence of menu labeling on calories selected or consumed: a systematic review and meta-Analysis. J Acad Nutr Diet 114, 13751388.
125. Downs, JS, Wisdom, J, Wansink, B et al. (2013) Supplementing menu labeling with calorie recommendations to test for facilitation effects. Am J Public Health 103, 16041609.
126. Brownell, KD & Frieden, TR (2009) Ounces of prevention – the public policy case for taxes on sugared beverages. N Engl J Med 360, 18051808.
127. Brownell, KD, Farley, T, Willett, WC et al. (2009) The public health and economic benefits of taxing sugar-sweetened beverages. N Engl J Med 361, 15991605.
128. Wilson J & Christensen J for CNN (2014) Nutrition labels getting a makeover. (accessed February 2014).
129. Schwingshackl, L & Hoffmann, G (2013) Long-term effects of low glycemic index/load vs. high glycemic index/load diets on parameters of obesity and obesity-associated risks: a systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 23, 699706.
130. Te Morenga, LA, Howatson, AJ, Jones, RM et al. (2014) Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am J Clin Nutr 100, 6579.
131. Turnbaugh, PJ, Ridaura, VK, Faith, JJ et al. (2009) The effect of diet on the human gut microbiome: a metagenomic analysis in humanized gnotobiotic mice. Sci Transl Med 1, 6ra14.
132. Sorensen, LB, Raben, A, Stender, S et al. (2005) Effect of sucrose on inflammatory markers in overweight humans. Am J Clin Nutr 82, 421427.
133. Te Morenga, L, Mallard, S & Mann, J (2012) Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ 346, e7492.
134. Basu, S, Yoffe, P, Hills, N et al. (2013) The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data. PLoS One 8, e57873.
135. Tavani, A, Giordano, L, Gallus, S et al. (2006) Consumption of sweet foods and breast cancer risk in Italy. Ann Oncol 17, 341345.
136. Schernhammer, ES, Hu, FB, Giovannucci, E et al. (2005) Sugar-sweetened soft drink consumption and risk of pancreatic cancer in two prospective cohorts. Cancer Epidemiol Biomarkers Prev 14, 20982105.
137. Yang, Q, Zhang, Z, Gregg, EW et al. (2014) Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med 174, 516524.
138. Fineberg, HV (2013) Public health in a time of government austerity. Am J Public Health 103, 4749.
139. Ramos Salas, X, Forhan, M & Sharma, AM (2014) Diffusing obesity myths. Clin Obes 4, 189196.
140. Mozaffarian, D, Rogoff, KS & Ludwig, DS (2014) The real cost of food: can taxes and subsidies improve public health? JAMA 312, 889890.
141. Katz, DL & Meller, S (2014) Can we say what diet is best for health? Annu Rev Public Health 35, 83103.
142. Robert Wood Johnson Foundation (2014) Major Food, Beverage Companies Remove 6.4 Trillion Calories from US Marketplace. (accessed March 2014).
143. World Helath Organization (2014) WHO opens public consultation on draft sugars guideline. (accessed March 2014).
144. BBC News (2014) Sugar tax may be necessary, England’s chief medical officer says. (accessed March 2014).
145. Calefati, J (2014) Health warning labels proposed for sodas, other sugary drinks sold in California. San Jose Mercury News, 13 February; available at
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  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
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