Calorie Counting: Well-Intentioned but Ineffective

For more than 100 years calorie counting has been a mainstay of weight management programs. Its history within the US policy arena is even longer. How did this come about? Is there any scientific evidence that it leads to sustained weight loss?

At the end of the 19th century, calorie counting started as a food-valuing metric to encourage Americans to get the most bang for their buck and live with fewer food dollars. Then in the early 1900s, physician Lulu Peters, who struggled with her own weight issues, adopted the calorie as a way to value food and popularized the idea that constant attention and vigilance to calories was key to weight loss.¹ A century later calorie counting remains at the core of many weight loss programs and apps and is the method chosen by public health advocates to combat the obesity epidemic. This despite the fact there is limited scientific research to support it.

A provision in the 2010 Affordable Care Act, for example, requires that chain restaurants must display the caloric value on all their menu items. While this seems to be a positive step in increasing consumer awareness of healthier food choices, subsequent studies have shown that the overall effects of caloric labeling on food intake and ordering behavior are negligible for most people.A review of 31 studies concluded that although there are some populations that are more likely to use calorie information to make healthier choices—such as women and residents of wealthier neighborhoods—the abundance of evidence suggests that calorie labeling as it is currently being used has no impact on overall food purchases or consumption for the population as a whole.3

Although it may make sense in theory, in practice there are myriad reasons why calorie counting is ineffective. First, all calories are not created equal. Two meals can have the exact number of calories but be processed in your body completely different ways. For example, a 400-calorie nutrient-dense meal of healthy whole foods, will leave you more energized and feeling fuller longer, than a 400-calorie meal consisting of processed foods, trans fats and refined sugar which will lead to lower energy levels and increase the likelihood of weight gain.Calorie counting also changes one’s relationship with food. It puts the focus on numbers and turns eating into a restrictive, often unpleasant and stressful activity. Calorie counting also does not teach what makes a given food healthy or unhealthy. Research has shown a focus on calories is not a sustainable long-term solution. The need for alternative approaches, such as the Traffic Light System, is growing more and more apparent. In contrast to many traditional weight management programs, the Traffic Light Approach has a much lower cognitive load and doesn’t require the participant to purchase special diet meals or give up favorite foods.

To learn more about this exciting new design for weight management programs, please attend our webinar May 11th, 1 pm EST with presenters Kurbo Co-founder Thea Runyan, who has spent 15 years with the Stanford Center For Healthy Weight, and Anne Thorndike, MD, MPH, lead author of a Massachusetts General cafeteria study that examined the impact of traffic light labeling on food choice.

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¹ Levine, D. I. (2017). The Curious History of the Calorie in US Policy. American Journal of Preventive Medicine, 52(1), 125-129.
² Lee, M. S., & Thompson, J. K. (2016). Exploring enhanced menu labels’ influence on fast food selections and exercise-related attitudes, perceptions, and intentions. Appetite105, 416-422.
³ Kiszko, K. M., Martinez, O. D., Abrams, C., & Elbel, B. (2014). The influence of calorie labeling on food orders and consumption: a review of the literature. Journal of community health39(6), 1248-1269.

Why Simple Food Labeling Drives Healthier Choices

Why do so many of our strategies for managing weight and encouraging healthy eating fail to bring about lasting change? Why have so many of us experienced the frustration of short-term weight loss followed by gaining it back and then some? One of the key explanations is that most weight and nutrition strategies are not designed to either change lifelong habits or be sustained over long periods of time. Hence the yo-yoing that results.

Research has shown that to create something that is sustainable over time it has to be simple. And it has to be focused on changing habits for life, not just on short-term gains. Fad diets and programs that require the purchase or preparation of special foods, for example, are rarely sustainable because the minute someone stops limiting their diet, they fail. The underlying “bad” habits were never corrected. And, more importantly, the dieter never developed an understanding of how the foods they are consuming impact their health.

Other strategies that involve a high cognitive load–such as calorie counting or deciphering complex food labels–also tend to lead to limited success. Many diet programs or apps assume that if you can educate someone about how to figure out calorie content, and then allow them to track that data as a cognitive behavior change technique, it will automatically lead to weight loss. But given the data overload we already suffer from in our fast-paced lives, most of us lack the time, motivation or resources to pursue this rational behavior at all, let alone for a sustained period of time. As one 30-something woman Lindsay, recently told us, “Before when I tracked my food, I’d have to track in grams and ounces and hit targets for total carbs, fats, and protein. I was always so stressed out about hitting those targets and I think that prevented my weight loss.”

In addition to the anecdotal evidence, there is also a mounting body of research showing that by simplifying the rules–and reducing the cognitive load–for making healthy food choices, it makes it much easier for people to succeed.

Schulte-Mecklenbeck and colleagues¹, for example, analyzed strategies employed by people while making decisions about their food. They found that decisions are typically made based on a very simplistic process. Most information is ignored. So if people are willing to invest only minimal time and effort, you are better off simplifying how that data is presented, such as using a color-coded Traffic Light food categorization system.  

Another 2015 study published in Obesity reached a similar conclusion that a Traffic Light label is more effective in helping consumers resist high-calorie foods than a purely information-based label. To gather their data, these scientists went so far as to scan the brains of participants as they chose among 100 food products based on either a traditional nutrition label (sugar, fat, salt and calories) or a simplified traffic light label. They were then asked how much they would pay for a product. Participants were willing to pay significantly more money for the same product when it had a “green” traffic light label compared to a standard information-based label. Conversely, when the label was “red,” they were willing to pay less. The researchers concluded that the traffic light label acted as positive reinforcement and was weighted more heavily in the purchase decision.

The results indicated that when we make food decisions we are integrating our taste preferences with how information about the food  is presented. Simple color-coded labels increased the individual’s awareness of the healthy choice and their ability to exhibit self-control over automatic food choices based on taste alone. These findings are in line with previous studies that showed that color-coded labels increase the identification and choice of healthier options.²³45

Over time the traffic light approach starts to shift a person’s relationship with food and they naturally start to categorize foods as red, yellow or green providing them with a simple, yet effective guideline for eating healthier food that is less stressful, less restrictive and requires low cognitive load. Kurbo has integrated this approach into a successful mobile app-based coaching program that has led to weight loss or lowered BMI with 80% of participants who complete it. One woman who lost 11 pounds through the Kurbo Program said what was helpful for her was not to have to give up or  “demonize certain foods. It is more about moderation and balance and saving your red lights for your favorite foods.”  

To learn more about this exciting new design for weight management programs, please attend our webinar May 11th, 1 pm EST with presenters Kurbo Co-founder Thea Runyan, who has spent 15 years with the Stanford Center For Healthy Weight, and Anne Thorndike, MD, MPH, lead author of a Massachusetts General cafeteria study that examined the impact of traffic light labeling on food choice.

Register for Webinar

¹ Schulte-Mecklenbeck, M., Sohn. M., de Bellis, E., Martin, N., Hertwig, R., (2013) A lack of appetite for information and computation. Simple heuristics in food choice. Appetite, 71 (2013), 242–251.

2 Roberto, C. A., Bragg, M. A., Schwartz, M. B., Seamans, M. J., Musicus, A., Novak, N., & Brownell, K. D. (2012). Facts up front versus traffic light food labels: a randomized controlled trial. American Journal of Preventive Medicine, 43(2), 134–141.

3 Borgmeier, I., & Westenhoefer, J. (2009). Impact of different food label formats on healthiness evaluation and food choice of consumers: a randomized-controlled study. BMC Public Health, 9(1), 184

4 Hawley, K. L., Roberto, C. A., Bragg, M. A., Liu, P. J., Schwartz, M. B., & Brownell, K. D. (2013). The science on front-of-package food labels. Public Health Nutrition, 16(3), 430–439.

Hersey, J. C., Wohlgenant, K. C., Arsenault, J. E., Kosa, K.M., & Muth, M. K. (2013). Effects of front-of-package and shelf nutrition labeling systems on consumers. Nutrition Reviews, 71(1), 1–14.

First Designed for Kids & Teens, Traffic Light Food System Proves Great for Adults Too

Thirty years ago Leonard Epstein, PhD, Head of Behavioral Medicine at University of Buffalo developed a food categorization system to help children lose weight based on green for “go,” yellow for “slow”and red for “whoa.”

His system combined data on nutrients and calories and was easy to understand. After all, he was designing for children and their families.  Green light foods are those that are low in sugar, low in fat, low in calorie density and have high nutritional value.  These include most fruits and vegetables. Kids were encouraged to eat these foods freely. Yellow light foods are nutrient-rich, moderate-calorie food–whole grain pasta, rice, and bread as well as lean proteins. With yellow light foods healthy portion control is still key. Finally, red light foods are foods that have little nutritional value and are high in sugar, fat and calories. They should be eaten sparingly and considered a “treat.”  Dr. Epstein’s approach was broadly praised and Stanford’s Center for Healthy Weight, among others, adapted the system for its highly successful family-based program.

What’s interesting is that in recent years, faced with the failure of traditional weight loss approaches, many have started to look to the Traffic Light system to help adults with weight management. In 2010, a team of researchers led by Anne Thorndike, MD, MPH,  from Massachusetts General Hospital conducted a study on the effects of food labeling on food choice. The goal was to provide information about healthy food choices in a simplified manner, one that did not require reading or understanding detailed food labels, and observe purchasing behavior. Using the Traffic Light System, the researchers applied color-coded labels to food in the hospital cafeteria.  The results were exactly what they had hoped for. After two years, overall purchases of green items had increased by 12 percent and red items decreased by 20 percent. In addition, sales of sugary red-light sodas dropped by 39 percent while green light beverages increased 10 percent.  

Adults, like kids, prefer and benefit from simpler solutions. In Thorndike’s study one woman noted that at first she thought the system was simple-minded and patronizing. But increasingly, she found herself considering the “color” of her cravings every time she ordered food.

In another study conducted at the health company Humana, researchers looked at the impact of numeric calorie vs Traffic Light color coding labels on online food purchases.  They found that both types of labels reduced calories by 10%. Traffic light labels achieved the same reduction in calories even in the absence of numeric information, suggesting that consumers benefit from data that identifies healthier choices but rely little on the calorie information.   Other studies have shown that calorie counting involves higher cognitive load and can even lead to increased food decision-making stress.

Having seen this data, pioneering companies are adopting the Traffic Light System in their corporate cafeterias both to promote healthier choices and to reduce stress. Google, for example, uses traffic light food labeling not only in its cafeteria, but for snack items as well. When National Public Radio moved into its new headquarters in 2013, its cafeteria menu included red, yellow, and green dots next to items. Even the Army has a Go for Green initiative that uses the traffic light method at dining facilities.

Outside the US, the shift from calories to color coding has been even more rapid.  A government study in the UK showed that traffic light labeling in combination with standard information about calories, protein , sugar, fat and salt is significantly easier to understand than using text-based information alone.  Today, the Departments of Health in both the UK and Australia have introduced voluntary traffic light food labeling schemes in their supermarkets to simplify healthy food selection.

For its part, Kurbo has licensed the Stanford Traffic Light program, adapted it into a mobile app and virtual coaching program which is used all over the world by kids and adults to develop healthier eating and exercise habits.  Lindsay Lagreid, a young professional woman who recently lost 20 lbs with help from the Kurbo app and coaching program, said she had struggled with weight all her life “and had tried every diet under the sun.”  

“Before, I would avoid tracking my unhealthy meals,” she says.  “But I’ve never felt that way with Kurbo because I know that I can have those red light foods. In addition, though the app was initially designed for kids, I was able to work through issues that adults face with weight loss, like going out to drinks with friends, without ever feeling judged by my coach.”

To learn more about this exciting new design for weight management programs, please attend our webinar May 11th, 1 pm EST with presenters Kurbo Co-founder Thea Runyan, who has spent 15 years with the Stanford Center for Healthy Weight,  and Massachusetts General cafeteria study author Anne Thorndike, MD, MPH.

Register for Webinar

¹ Thorndike, A. N., Riis, J., Sonnenberg, L. M., & Levy, D. E. (2014). Traffic-light labels and choice architecture: promoting healthy food choices. American journal of preventive medicine, 46(2), 143-149.

² http://www.massgeneral.org/News/pressrelease.aspx?id=1660

³ http://civileats.com/2015/01/07/stop-n-go-can-traffic-light-labels-help-us-eat-better/


Meet Allison Falk: former pro-soccer player, Stanford grad, AND Kurbo Coach

27-year-old Allison Falk, raised in Danville, California, started playing soccer when she was 7 years old. After years of training and competing on high-level teams, Allison went on to play on the Women’s Varsity Soccer Team at Stanford University from 2005 to 2008. Despite having to balance her athletics with a very rigorous academic load (as an American Studies Major with a Concentration in Law), Allison believes that the amount that she learned and improved as a soccer player in college was greater than any other period of her career. And it showed.

K2IzlAshbrTLGs3NHN6fY94Hy1d0JsNBo-TLLSYUfT0In her senior year, as Co-Captain of the Stanford team, Allison was drafted into the Women’s Professional Soccer league. She played for the Los Angeles Sol in 2009 and Philadelphia Independence for the two following seasons.

While developing her soccer skill and technique, Allison was simultaneously cultivating a passion for health and wellness.

Allison took nutrition and health classes at Stanford and discovered that what she was learning had an impact on every aspect of her life. Then, during her pro-soccer career, she got involved in the nonprofit space and began working with families to increase health and wellness through various community development programs.

Equipped with this knowledge and experience, Allison became concerned with the staggering growth of childhood obesity.

“Childhood obesity is something that we need to be very aware of and very focused on,” Allison says. “We need to start from the beginning by helping those who are currently struggling with weight, and just as importantly, preventing obesity by encouraging healthy, sustainable lifestyle choices in our communities.”

It was at an obesity prevention conference in the Bay Area where Allison found Kurbo.


Do You Dread Packing School Lunches?












It’s that time of year once again, a time when parents rejoice and kids groan. That’s right – it’s back to school time! But before you breakout the backpacks and the pencils, ask yourself this question: are you setting your children up for success when it comes to their health? Do you dread packing school lunches for your child, even though you know that packing a lunch is healthier than purchasing lunch at school?

In this edition of Kurbo’s ongoing web series, Thea Runyan of Kurbo Health talks about packing a healthy (and delicious) lunch as well as preparing easy afterschool snacks.  

Click here to watch Packing a Healthy Lunch & Easy Afterschool Snacks, presented by Kurbo.

Learn more about managing your family’s health and weight at Kurbo.com. Please contact us at 1-800-444-7158 to speak with an expert behavior coach or email us at info@kurbo.com.

Kurbo provides the first mobile-based health coaching and weight management program for kids, teens, and their families. See whether Kurbo is right for your child, try a Kurbo coaching plan for free today!