When it comes to weight loss, it's commonly believed that a calorie is a calorie—and in order to shed a few pounds, you simply need to adhere to the practice of expending more calories than you take in. So then why do some people continue to have trouble losing weight? And why do others lose weight only to gain it all back? The culprit, according to Dr. David S. Ludwig, MD, PhD, is processed carbohydrates. Eating processed carbs—even those marketed as low-calorie—is less conducive to weight loss than eating an equal calorie amount of, say, nuts or dark chocolate.
Meet the Expert
David S. Ludwig, MD, PhD, is a practicing endocrinologist and researcher at Boston Children’s Hospital, professor of pediatrics at Harvard Medical School, and professor of nutrition at Harvard School of Public Health. He is founding director of the Optimal Weight for Life program at Boston Children’s Hospital, and he also also directs the New Balance Foundation Obesity Prevention Center.
In this exclusive excerpt from his best-selling book, Always Hungry?, Dr. Ludwig outlines the key findings from his research on calories—and why we should ditch them. Read on to learn why it's time to rethink calorie consumption, then get ready to dial your favorite take-out spot: We tapped two dietitians to recommend healthy take-out foods and restaurant dishes in cuisines spanning Thai and Japanese to American and Italian. When you’re traveling or too busy to prepare a home-cooked meal, follow their suggestions to help you stay on track.
Why You Should Rethink Calories
Virtually all weight loss recommendations from the U.S. government and professional nutritional organizations rest on the notion that “a calorie is a calorie”—a strategy with appealing simplicity.
“Just eat less and move more,” they say. “Consume fewer calories than you burn off, and you’ll lose weight.” There’s just one problem: This advice doesn’t work—not for most people over the long term. Obesity rates remain at historic highs, despite an incessant focus on calorie balance by the government, professional health associations, and the food industry (witness the “100 calorie pack ”). Furthermore, the customary method to reduce calorie consumption since the 1970s—a low-fat diet—has failed miserably.
Although the focus on calorie balance rarely produces weight loss, it regularly causes suffering. If all calories are alike, then there are no “bad foods,” and the onus is on us to exert self-control. This view blames people with excess weight (who are presumed to lack knowledge, discipline, or willpower)—absolving the food industry of responsibility for aggressively marketing junk food and the government for ineffective dietary guidance.
All too often, people hear the message, “It’s your fault that you’re fat”—as if they could simply will away the extra weight. In a sense, being heavy has become prime evidence of a weakness of character, provoking prejudice and stigmatization. Overweight children commonly experience teasing, abuse, and bullying from peers, sometimes with tragic consequences. Adults face endless indignities, from work-place discrimination to insensitive characterizations on television. Not surprisingly, high BMI is sometimes accompanied by major psychological distress, including anxiety, depression, and social isolation.
The “calorie is a calorie” concept also has prompted development of some patently bizarre products, such as “low-fat” candy, cookies, and salad dressings, typically containing more sugar than the original full-fat versions. Are we really to believe that, for someone on a diet, a cup of cola with 100 calories would make a better snack than a 1-ounce serving of nuts containing almost 200 calories?
New research has revealed the flaws in this way of thinking. Recent studies show that highly processed carbohydrates adversely affect metabolism and body weight in ways that can’t be explained by their calorie content alone. Conversely, nuts, olive oil, and dark chocolate—some of the most calorie-dense foods in existence—appear to prevent obesity, diabetes, and heart disease. In truth, the obesity epidemic is not about willpower or weakness of character. All this time, we’ve been diligently following the diet rules, but the rulebook was wrong!
In a recent study published in the Journal of the American Medical Association (JAMA), my colleagues and I examined twenty-one young adults with high BMI after they had lost 10 to 15 percent of their weight on diets ranging from low fat to low carbohydrate. Despite consuming the same total calories on each diet, the participants burned about 325 calories a day more on the low-carbohydrate diet than on the low-fat diet, amounting to the energy expended in an hour of moderately vigorous physical activity. So the type of calories we eat can affect the number of calories we burn.
Over the last few years, we seem to have been moving toward the tipping point, with reputable scientists acknowledging the previously unthinkable possibility that all calories aren’t alike. Even Weight Watchers, for decades the leading advocate of calorie counting, now assigns “0 Points” to fruit. Meaning that if you had the fortitude, you could eat a 10-pound watermelon containing most of your daily calorie requirement “for free”—in flagrant defiance of the calorie-counting approach to weight loss. The entire concept of calorie balance seems to be tottering!
How to Eat Healthy When Dining Out
It’s time for a new approach, but how do you put Dr. Ludwig's theory into practice? First and foremost, take back ownership of what you're putting in your body. That means making healthy food choices, of course, but it also entails doing the necessary research to understand how certain foods—and food preparations—affect the nutrition of a dish.
This is a little trickier when you're dining out, as you don't have total control over what goes on in the kitchen. Still, you can ask for modifications to the menu, and ask for clarification about dishes with red-flag words as descriptors—namely, "crispy," "crunchy," "drenched," and "loaded," says Joy Saudargas, MA, RD, LDN, a registered dietitian and nutritional counselor. "Restaurants don't know your health history," she continues, so the onus is on you to maintain healthy eating habits.
Is this to suggest that you can't indulge every so often? Not at all. "The point of going out is to enjoy yourself, so don’t overthink substitutions or restrict your options to the point that you feel deprived," adds Theresa Shank, RD, LDN. In fact, this registered dietitian and nutritional counselor gives the green light when it comes to sweets and booze—just aim to share your dessert when dining out, and don't indulge in alcohol and sweets on the same day.
Meet the Expert
Below, the dietitians clue us in about the healthy foods to order at a restaurant, whether you're dining in or grabbing takeout. Plus, read about which foods to avoid—and how to modify a dish so that it fits into your healthy meal plan.
What to Order at a Thai Restaurant
- Papaya salad. This mash-up of julienned green papaya, tomatoes, and string beans is rich in fiber, potassium, and papain, an enzyme that supports healthy digestion. Fish sauce, lime juice, and brown sugar contribute to the salad's low-fat dressing.
- Pad Thai with extra vegetables and grilled meat. "I always ask them to sauté my tofu versus deep fry," says Shank, because less oil is used in the preparation of the dish.
- Summer rolls. Stuffed with blanched veggies and herbs like mint, Thai basil, and cilantro, this Thai appetizer is a healthier, lower-fat alternative to fried spring rolls. For an extra boost of protein, order yours with added tofu or shrimp, and dip sparingly into any accompanying peanut sauce.
What to Order at a Japanese Restaurant
- Naruto roll. This type of healthy sushi roll subs in cucumber for starchy rice, cutting carbs and adding a veggie-packed crunch. "I always order one sushi roll with rice and one wrapped in cucumber," Shank tells us.
- Nigiri or sashimi, especially those containing heart-healthy avocado. "These two types [of rolls] don't usually contain fried ingredients," says Saudargas. She also suggests skipping any dishes prepared tempura-style (read: deep fried) or drenched in sauces.
- Miso soup with seaweed and vegetables. Made from fermented soybeans, miso is rich in protein, beneficial bacteria, and essential vitamins and minerals.
- Edamame. Typically served in the pod, these young soybeans are low in carbs and a good source of protein and fiber: a 155-gram cup of shelled edamame beans contains approximately one-third of an adult's RDA of protein. Bonus: "Edamame make for a fun appetizer to share with friends!" says Saudargas.
- Seaweed salad. Seaweed is one of the few non-animal sources of B12. Because it's sourced from the sea, it's naturally high in sodium, so ask if your salad can be prepared with low-sodium soy sauce and without added sugar.
What to Order at a Chinese Restaurant
- Any dish that's steamed instead of stir-fried, preferably those with lots of veggies and lean protein. Vegetable dumplings, Buddha's Delight, chicken and broccoli, tofu dishes, and shrimp entrees are all solid choices—just be sure to request that any sauces be served on the side.
- Brown rice. Brown rice contains all parts of the grain, proving brown rice to be higher in protein and fiber than its milled counterpart, white rice. That means it'll keep you fuller longer.
What to Order at a Gastropub or American Restaurant
- Grilled chicken, broiled or roasted fish, and other lean protein-forward dishes. "Choose salmon, shrimp, tuna, or chicken breast over red meat (beef, pork, or lamb) as these options have less total fat," advises Shank.
- A smaller portion of your favorite food, e.g., a coconut shrimp appetizer. "You're still having something enjoyable, but the quantity is smaller," says Saudargas. In fact, she advises against food deprivation altogether, as declaring a favorite food off-limits isn't sustainable over the long term. "Being mindful about what you are eating is very important, but it is also important to enjoy yourself while enjoying foods that satisfy you mentally, physically, and emotionally," she says. So go ahead and order the foods you love, but don't overdo it—portion control and moderation are key here.
- Salad. Leafy greens and veggies are the obvious choice when trying to eat healthy, but be sure to ask for the dressing on the side: "Restaurants are notorious for overloading salads with dressing," warns Saudargas.
What to Order at a Mediterranean Restaurant
- Hummus with veggies. Protein- and fiber-packed chickpeas (a.k.a. garbanzo beans) serve as the base for this pureed dip, which also commonly includes olive oil and tahini (sesame seed paste). Not only will hummus satisfy your hunger, the three above ingredients have been proven to have anti-inflammatory properties.
- Avgolemono soup. This traditional Greek soup combines eggs, lemons, rice, chicken, and chicken stock to create a comforting one-dish meal. As an added bonus, beginning a meal with soup has been shown to decrease hunger and reduce the diner's total calorie intake by about 100 calories.
- Souvlaki. These meat-and-vegetable kabobs are grilled, which helps keep the added fats at a minimum. Go for chicken instead of pork or lamb, as chicken is the leanest option: A typical order of chicken souvlaki has just 260 calories and eight grams of fat.
What to Order at a Mexican Restaurant
- Guacamole with veggies instead of chips. This creamy, avocado-based dip is high in fat, but it's the monounsaturated variety—the kind that can contribute to lowered LDL (bad) cholesterol. Better still, avocados are an excellent source of fiber while being low in sugar. The downside? Guacamole goes down easy, so it's not hard to breeze past the recommended 1/2-cup serving size. Tip: Ask if the kitchen adds extra fat to the recipe, often in the form of mayo or buttermilk.
- Fish tacos. As long as the fish is grilled or baked instead of fried—and you load up on pico de gallo and salsa instead of creamy condiments—fish tacos are a healthy choice. If you're watching your carb intake, ask for your tacos to be wrapped in lettuce instead of a taco shell.
What to Order at an Italian Restaurant
- Minestrone soup. This hearty Italian soup offers a medley of pasta, veggies, and beans in every bowlful. It's as nutritious as it is delicious, with ample fiber and protein to keep you satiated between meals. If you ever make minestrone at home, sub in fresh tomatoes and unsalted broth to lower the sodium content.
- Bruschetta. Piled high with antioxidant-rich tomatoes and drizzled with heart-healthy olive oil, this crunchy appetizer is the perfect complement to an entree of lean protein.
- Pasta with red sauce on the side. Cutting back on carbs? If the dish comes with a protein (e.g, meatballs), ask for it to be plated atop sautéed spinach instead of noodles, suggests Shank.
What to Order at an Indian Restaurant
- Tandoori chicken. This dish is named for the tandoor, a cylindrical clay oven popular in Indian cooking. Since the dish is baked, it remains low in fat, as all of the flavor comes from the marinated meat and the char from the oven.
- Chana masala. Chickpeas (an excellent source of plant-based protein) and tomatoes form the foundation of this savory dish. Heads up, vegans: This healthy takeout food is typically prepared without animal ingredients.
Excerpted from ALWAYS HUNGRY? Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently by David Ludwig, MD, PhD. Copyright © 2016 by David S. Ludwig, MD, PhD. Reprinted with permission from Grand Central Publishing. All rights reserved.