January 30th, 2016

Ars Technica Looks at the Calorie

Ars Technica has a nice longform piece about calories.


Things they cover: the bomb calorimeter, a couple of adjustment lists for when humans digest things noticeably differently from what the bomb calorimeter says is in the food. The observed fact that people with different gut bacteria seem to get really different amounts/kinds of things out of what otherwise seems to be the same food. Attempts to measure basal metabolic rate.

Their conclusions are conservative. If nutritionists think we should reduce calories in by a couple hundred calories a day to lose weight, and all of the above plus the usual issues with accurate portion control mean that we probably can't reliably _get_ control over total calories in accurate to the hundreds place, then no wonder dieting doesn't work.

Also, their recommendations are conservative: focus on diet composition and satiety, rather than calories.

They do have some speculation: personalized recommendations. But the overall thrust of the piece is unwarranted in its optimism:

"There should be a better metric ... And it’s likely there will be. Science has already shown that the calorie is broken. Now it has to find a replacement."

Let's pretend for a moment that we actually could measure calories in accurately. (Bwah ha ha ha ha) PRETEND HARDER YOU ARE DOING IT WRONG How does this help? The equation is calories in vs. calories out. If you want to gain, you must consume more than you use. If you want to lose, you must consume less than you use. HOWEVER the primary user of calories is basal metabolism(I'm assuming that we are not allowing people who exercise to the tune of 20 plus miles a day or their caloric equivalent to participate in this analysis. Go. We're not interested in you.), and we already know that the more you eat, the more that sucker consumes -- and the less you eat, the less it consumes. (Homeostasis For the, well, something.) And we are actually really bad at estimating basal metabolic rate in a given person who is attempting to modify their gross health metrics.

Screw this calorie thing. Let's figure out a cheap, portable, accurate way to measure BMR. Not BMI. BMR. And then in addition to whatever other crap you measure (waist, thigh, weight, etc.), we should also be measuring BMR. And if BMR takes a nosedive, it gets priority one for improvement, because everything else is gonna get worse until we do.

ETA: Apparently I should not say BMR. I should say RMR.


I am not endorsing anything else these people are saying.

Single Payer

Almost exactly a year ago, the Governor of Vermont said, you know? We're not going to do single payer after all.


Why? Well, that's a little tricky to decipher. Vermont has a lot of small businesses that do not supply health care to their workers, so this was straight up added cost -- a big hike in the employer payroll tax (exactly what Senator Sanders proposes for the US as a whole) and a big hike in income taxes for the worker. Obvs, if you were already paying for health insurance, and it was taking a _bigger_ percentage of your income, this would be an improvement. Apparently, this worked out to a good deal if your household makes less than $150K or thereabouts, and a bad deal otherwise.

In the ensuing year, a variety of people have weighed in on _why_ the economics and politics of single payer in Vermont did not work out. But they're so blue! And it's such a small state! It clearly would be cheaper overall! Etc. Well, there were some issues. People who didn't _live_ in Vermont who _worked_ in Vermont were sort of an interesting case. People who worked for the federal government while in Vermont were an interesting case. Etc.

Here's a postmortem:


This is the quote that I think a lot more people should be paying attention to.

"At some point, perhaps 5 to 15 years from now, as the size and scope of Medicare, Medicaid, and the ACA subsidy structure balloon far beyond today's larger-than-life levels, our political leaders may discover the inanity of running multiple complex systems to insure different classes of Americans."

Inanity is a tricky concept: some synonyms include vapid, fatuous, shallowness, pointlessness.

This author thinks it is crazy/stupid/laughably nuts that different classes of Americans might want different kinds of health care.

I guess I don't need to worry about this ever happening, then. Because if that's the perspective backing this horse, it ain't never gonna win any race it runs in.

I think you can make a ton of solid, valid arguments for single payer -- and I say that recognizing that precisely what constitutes single payer is undefined. What I _don't_ think you get to do is to just dismiss out of hand all the counter arguments, wishes, preferences, etc. embedded in the status quo as crazy. You actually _do_ have to deal with all of that. That is how politics works. I am sorry. I wish it was not so. And yet, there it is.