Report Moves Debate Beyond Calories

Recently, the journal Obesity Reviews published a paper titled “Pathways and mechanisms linking dietary components to cardiometabolic disease: thinking beyond calories.” Written by 22 scientists from an astonishing array of institutions both here and abroad, it might be the document that finally changes the debate about sugar-sweetened beverages.

Up until now, the food and beverage industries have infamously insisted that a calorie is a calorie, regardless of its provenance —- that it matters not if a person takes in 100 calories from 12 ounces of broccoli or from eight ounces of Coke. But it does matter — in a very significant way, that could impact efforts to reduce consumption of soda and other sugar-sweetened beverages. As Dr. Pretlow says:

The paper finds that soda and other sugar-sweetened beverages increase health risks when compared with the same number of calories from other carbohydrates such as starch. That’s a big deal because it contradicts the beverage industry claim that “all calories are created equal” and it could remove what has been a big legal hurdle in getting warning labels, soda taxes, and other public policies to limit soda consumption passed.

According to the report’s Summary, while all calories definitely do count toward positive energy balance and fat gain, some weigh in more heavily than others due to “additional mechanisms that are not mediated solely by caloric content,” because “various dietary components or patterns may promote obesity and cardiometabolic disease.”

The content of the paper is based on the presentations and discussions from the 2017 CrossFit Foundation Academic Conference, which was held in July of 2017. The conference title was “Diet and Cardiometabolic Health — Beyond Calories.” The main question asked there was:

Is it only the quantity of calories that matters, or are there specific pathways/mechanisms by which commonly-consumed dietary components may contribute to obesity and cardiometabolic diseases independently of their energy content?

As it turns out, there are specific pathways and mechanisms that account for the mysterious ability of some calories to be more harmful than others. To put it another way,

Emerging research is presented exploring the possibility that responses to certain dietary components/patterns are influenced by the metabolic status, developmental period or genotype of the individual; by the responsiveness of brain regions associated with reward to food cues; or by the microbiome.

Saturated fatty acids are singled out for blame, and sugar-sweetened beverages are indicted as promoters of cardiometabolic diseases “by mechanisms that are additional to their contribution of calories to positive energy balance.”

The topics discussed by the presenters included the response of brain reward regions; the microbiome; the high-carbohydrate diet; fructose, glucose, and starch; and saturated and unsaturated fats. The entire conference is available via YouTube, although the first couple of minutes are without audio.

Non-nutritive sweeteners were also discussed, and — good news for a lot of people! — apparently aspartame does not promote weight gain. In the paper that brings it all together, the authors also outline the challenges involved in narrowing down and pinpointing the exact mechanisms. The notion that all calories are not created equal enrages the industry, which will fight back tooth and nail.

Your responses and feedback are welcome!

Source: “Pathways and mechanisms linking dietary components to cardiometabolic disease: thinking beyond calories,”, 05/14/18
Source: “Diet and Cardiometabolic Health – Beyond Calories,”, 07/21/17
Photo credit: The_Doodler on Visualhunt/CC BY-SA

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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