Why are people so hell bent on defending CICO


@Septimius I’m genuinely concerned for his mental health because he is showing signs of memory loss. Or maybe it’s cognitive dissonance?

I agree that I didn’t express myself politely.

The discussion is a train wreck for what it’s worth.

(Michael - When reality fails to meet expectations, the problem is not reality.) #62

I lied. I’d like to add this. @OldDoug I think you’re letting your knowledge and understanding of CIM influence your thinking about CICO. The nuances and subtleties you talk about above derive from CIM not CICO or even EBT. I think you are conflating the two. For the less technical of us: CIM means ‘Carbohydrate Insulin Model’ or more commonly the hormonal theory of obesity; EBT means ‘Energy Balance Theory’ or more commonly calories in calories out, ie CICO.

My understanding of CICO - the common, popular dietary weight loss regimen - is as follows. And I ask anyone who thinks I’ve got something wrong to point it out. Many of you have done CICO multiple times, so no doubt you have first-hand knowledge! According to CICO you gain weight because you eat more energy - calories - than you use. If you want to lose weight then simply eat less and use more energy. Eat less move more. It’s thermodynamics! If you’re not losing weight it’s because you’re eating too much and not exercising enough. It’s science - if it doesn’t work it’s your fault. You’re cheating. You’re not doing it right. Or you need a ‘tummy tuck’. After a year or two of eating a daily caloric deficit you successfully lose those 200 extra pounds of fat - hey presto, see CICO works! If you then start to eat more normally again because you’ve lost all that fat, why continue eating an energy deficit… oops! you regain the weight and more. You did something wrong. After all CICO worked! You lost 200 pounds. Now you’re eating too much and not exercising enough.

CICO - the common dietary regimen - does not acknowledge that energy from different macro sources produces diffferent metabolic results. Instead, it claims a ‘calorie is a calorie is a calorie’. We know for a fact that’s not true and the Fineman/Fine article I linked above links to multiple studies that show it’s not true. We know for a fact that insulin controls fat storage and that elevated glucose triggers insulin to store energy. Yet CICO tells us to reduce fats and eat more carbs. A host of hormones and enzymes control what energy does and where it goes and whether it’s lost or stored. CICO says nothing about any of it. Just gross energy in and gross energy out. Easy peasy.

All of the nuance and subtleties Old Doug attributes to CICO in his various responses above do not exist in the CICO of the real world, only in his imaginary CICO. The perfect CICO that incorporates all the good stuff in the hormonal theory of obesity. Any citations to support your claims?

(Doug) #63

No. But - “calories in, calories out.” So, let’s look at what’s going on with that, and then let’s make our determination, eh? :slightly_smiling_face:

Well of course CICO is going on. I mean, come on… What other thing could be happening?

But no, why would their mass/weight have to change? Have you not been reading this thread?

Heat up something. Does its mass necessarily change? Well of course not. :slightly_smiling_face:

(Doug) #64

Michael, I appreciate your reply in the somewhat freewheeling spirit of things here. :slightly_smiling_face: :stuck_out_tongue:

You’re picking on an old boy who ain’t had a math class in nearly 44 years, but:

-1 squared (to the second power). Isn’t that 1, rather than negative 1? Or maybe it doesn’t matter; I don’t know. :smile: The square root of 1 can be either 1 or -1, right?

It made me think of the algebraic expressions that involve dividing by zero, where you can get some goofy results.

(Doug) #65

Nonsense. “Calories in, calories out.” Let’s see what’s happening there, and then let’s judge how well things are working. Let’s not pretend silly stuff. :wink:

(Doug) #66

No problem, Michael. The future is out there, whatever we have of it. :smile_cat:

I have to say that if there is conflation here, it’s on your part, however. Sure, ‘carbohydrate insulin model.’ But that reflects that the “calories out,” can be changed, even while the “In” remains the same. CICO is not saying “The calories out will necessarily be the same as calories in.” CICO is just noting what is going on, which can include deficits or surplusses, as well as ‘balance.’ It’s certainly going to reflect what’s going on with insulin sensitivity/resistance, per the ‘CIM.’

If we are to consider all cases, then we don’t know if differing macro nutrients on the “In” side are going to alter the “Out,” either at all or substantially, etc. So, let us look at what is actually true in a given situation rather than pretending that it has to be one way or another.

Let us look at both the “In” and the “Out,” for starters. You seem to want to conflate CICO with only the “In” part of it, and that’s just not true.

Okay, and the argument is not that that will necessarily be a good solution for everybody. At the very least - again - we need to see what’s going on the “Out” side.

Do you really dispute that? There, we have both the “In” and the “Out.”

This is still two different things. One is CICO, which includes the “Out.” The other is misstating the possibilities of what the “In” will mean. You and I agree that the nature of what the “In” will mean can be misconstrued (to be totally and specifically correct, “at least in some cases”). But at the very least we need to consider both the in & out, to even have a chance at being correct.

I disagree. CICO isn’t telling us anything, except what’s happening. It’s a statement of quantities and relationship.

Not true. The “Out” reflects the hormonal/enzymatic/metabolic effects. What makes the carbohydrate-insulin model correct, in my opinion as well as in the opinion of many, is that the Out will not necessarily follow the In all the time, because of those factors you mention. Again, let’s look at both the In and the Out, and then let’s judge things. Taking potshots at the whole relationship just because some people are incorrect about part of it is not logical.

That goes a long way, yes. There is intake, metabolism or storage, and excretion/loss. What else is there? CICO tells us a lot. The ‘In,’ and the ‘Out.’ Net storage will show up as weight/mass gain (usually just fat or almost all fat). Excretion, as with unmetabolized stuff - this leaves the body, is almost always a very small part of the whole picture, and is part of the “Out” in any case.

Well yeah. There isn’t any ‘magic’ going on where the physical laws of the universe are contravened.

CICO is a downstream result of hormonal effects, etc. (You and I agree that the ‘Out’ can be altered by the nature of the ‘In.’) Whether we are talking about energy, or matter/weight/mass, in the end it’s all atoms and molecules and their energy states for the human body.

(Michael - When reality fails to meet expectations, the problem is not reality.) #67

I’m trying to refute ‘CICO the dietary regimen’ not thermodynamics. Example: the Hall et al study of the Biggest Loser contestants. Yes, CICO worked thermodynamically:


Of the 16 Biggest Loser competitors originally investigated, 14 participated in this follow-up study. Weight loss at the end of the competition was (mean±SD) 58.3±24.9 kg (p<0.0001) and RMR decreased by 610±483 kcal/d (p=0.0004). After 6 years, 41.0±31.3 kg of the lost weight was regained (p=0.0002) while RMR was 704±427 kcal/d below baseline (p<0.0001) and metabolic adaptation was −499±207 kcal/d (p<0.0001). Weight regain was not significantly correlated with metabolic adaptation at the competition’s end (r=−0.1, p=0.75) but those subjects maintaining greater weight loss at 6 years also experienced greater concurrent metabolic slowing (r=0.59, p=0.025).

Is that a success story?

Or is this a success story:


Conclusion Among overweight and obese young adults compared with pre–weight-loss energy expenditure, isocaloric feeding following 10% to 15% weight loss resulted in decreases in REE and TEE that were greatest with the low-fat diet, intermediate with the low–glycemic index diet, and least with the very low-carbohydrate diet.

(Doug) #68

Michael, it’s two different things. One is the prescription for weight loss - keep the ‘Out’ less than the 'In."

That’s going to work, as stated. Heck, it’s going to work even without regard to the nature of the calories consumed.

Problems arise when people can’t do that, or can’t do it for long enough. And in the real world, I think that people should realize that the prescription won’t fit many people’s lives, temperaments, desires, etc. Doesn’t mean they are bad people, etc., it’s just a fact of often complicated human nature. It also doesn’t mean that physics/mathematics are violated.

If anything, CICO is a big part of why that maxim doesn’t work for so many - because the ‘Out’ can go down with metabolic slowdown, insulin-mediated fat storage, etc.

(Michael - When reality fails to meet expectations, the problem is not reality.) #69

Let me reiterate, Doug. I’m not arguing about total energy in and out. I’m arguing about accounting for what happens between the ‘in’ and the ‘out’. And I think that’s where CICO the dietary regimen fails and people wreck their metabolisms doing it.

CICO claims that all energy ‘in’ is 100% equivalent. The macro nutrient source doesn’t matter, the energy unit is the same and will be utilized without regard for source. We both know that’s false. The Fineman/Fine article I linked above shows exactly why and how it’s false and links to studies demonstrating its falseness.

However, given that input energy equivalence and interchangeable processing is the basic premise of CICO, how does a CICO advocate account for the differences in outcomes of the Jamanetwork study I linked directly above? If a calorie is a calorie and its source irrelevant, on isocaloric diets how could eating more fat and less carbs result in more fat loss than eating more carbs and less fat? Did the subjects on the low carb version of the study cheat by sneaking out to the gym more often?

(Alec) #70

Wow, are we doing this again??? :joy::joy::joy::scream::man_facepalming:


If you’ve found something else that works for you, and it seems to be the case, fantastic! I can understand your enthusiasm.

I was curious by your post and took another look at the world map of obesity. Just looking at this map, you can conclude that for every person who keeps a “normal” weight by sticking to a ketogenic WOE, there are hundreds of million who have actually lived decades with a “normal” weight eating mostly carbs. CICO. They don’t eat enough to become obese. They walk, they cycle, they can’t afford too much food… look at cars per capital in those countries.

In times of war, people lost weight eating almost exclusively carbs. They weren’t eating enough of it to get fat. CICO.

I think keto is a good thing, until it isn’t. And the end of the good thing is the same plague that made CICO seem to stop working: processed foods.

Keto, or CICO, or whatever, it is good if you’re eating real food, food you need to prepare yourself. Then comes all the processed stuff, like chips and sweets and bread you buy ready and cheap for carb eaters, and keto bars, proteins you eat from jars and all the processed keto this and that stuff you have in the USA… and it’ll stop working, too.

People ruin a good thing. Same modus operandi: let’s make it taste like candy, let’s make it easily available. Let’s make money out of it. Let’s make it cheaper.

Anyway, CICO, or anything else, nothing works for everybody. Read this forum and you’ll see people who aren’t losing weight on keto. People who struggle, no matter what they try. We have a huge environmental problem. One person alone can’t win.

Obesity is a problem of too much food made to taste too good, too cheap, too advertised. And of people blaming each other, instead of uniting against the real problem.

The too much food made to taste too good and easily available problem is the CICO downfall and it’s the keto downfall in the making. Wait and see.

Keto community: don’t let it happen. Don’t buy keto processed s**t some try to sell as food. Things sold in plastic wrappings don’t belong in your body. No matter how low in carbs.

Things you can only buy on the internet or at big supermarkets don’t belong in your body, no matter how many carbs they have.

(Doug) #72

Hey Alec. :slightly_smiling_face: It had been a while… :stuck_out_tongue::wink:

Ther difference I see is the presumption that “CICO” means weight will remain stable, or be lost. It’s just a statement of relationship, however, i.e. “There’s this, and then there’s this.” Any consequence, at that point, isn’t defined.

It’s not saying that anything is going to happen, necessarily. Weight can be gained, for that matter.

With more information it can become an ‘If-Then’ statement and away we go…

The changes in obesity are so fast - it used to just be a few percent of adults, worldwide, and now it’s 1 in 7 or 8, and for ‘oveweight’ it’s ~2 in 5.

Processed foods - I wonder how much more of a thing they are now, versus 1990, say. Three decades ago, it was still very much ‘modern times,’ but in the U.S. the biggest change I see is with childhood obesity, which has been drastically increasing.

(Michael - When reality fails to meet expectations, the problem is not reality.) #73

This may surprise you. It’s not just obesity. What matters is what happens between the ‘in’ and the ‘out’.


According to the most recent data from the International Diabetes Federation, about 8.8% of the world lives with diabetes as of 2019, about a 2.4% increase from 2010 (6.4%). This means that about 415 million people around the world are living with diabetes. This is expected to increase to 642 million by 2040.

Countries with the highest diabetes prevalence:

  1. Marshall Islands (30.5%)
  2. Kiribati (22.5%)
  3. Tuvalu (22.1%)
  4. Sudan (22.1%)
  5. Mauritius (22.0%)
  6. New Caledonia (21.8%)
  7. Pakistan (19.9%)
  8. French Polynesia (19.5%)
  9. Solomon Islands (19.0%)
  10. Guam (18.7%)

:point_right: The full list of every country of the world and by regions.

Unsurprisingly, the Marshall Islands, Kiribati, and Tuvalu are all among the ten most obese countries in the world. Being overweight or obese are risk factors for type 2 diabetes. A majority of these countries are located in the Western Pacific. This is because of poor dietary choices and a lack of physical activity.

The Marshall Islands has a diabetes rate of 30.5%, the highest in the world. The obesity rate is the fourth-highest in the world of 52.9%. The majority of those diagnosed with diabetes in the Marshall Islands have type two. Inhabitants have become increasingly dependent on imported, processed foods that are high in sugar since local foods and imported fruits and vegetables tend to be the most expensive.

Kiribati has the second-highest diabetes rate in the world of 22.5%. Kiribati is the ninth-most obese country in the world with an obesity rate of 46.0%.

Tuvalu, the country with the third-highest rate of diabetes in the world of 22.1%, has an obesity rate of 51.6%. This is the fifth-highest obesity rate in the world. Sudan is tied with Tuvalu with a diabetes prevalence of 22.1% but with a much lower obesity rate of 8.6%.

(Michael - When reality fails to meet expectations, the problem is not reality.) #74

I agree with @PaulL that CICO became the initial paradigm simply because when the calorimeter was invented 150 years ago heat in and out were the only measurable things. When that was applied to human metabolism is where matters went wrong. The mistake was thinking that a simple measure can explain the workings of a complex system. The energy in/out is only the description the overall state and ignores all the more important reactions/processes that are initiated/completed within. As I like to phrase it, what really matters for human metabolism is what happens between the ‘in’ and the ‘out’.

The universe is a thermodynamic system with zero in and zero out. So it must not be a very interesting place. :sunglasses:

(Jennibc) #75

That’s not true. I am an obsessive tracker - I weighed and wrote down everything I ate. That is HOW I can make that statement. I couldn’t lose eating 1500 calories a day! When I increased my fat consumption but made sure to cut out the seed oils I was then eating between 1700 and 1900 a day and LOSING weight. It was slowly, but it was 1.5 to 2 pounds a week. Then I plateaued for abut a year and took out all added sugar and months after that started time restricted eating and within a year and half lost the remaining 53 pounds. I have kept it off for two years - all 120 pounds. I still weigh and track my food daily. I credit that with keeping the weight off. I always eat at least 1600 calories (or I don’t sleep well) and usually take in less than 2000.


I truly believe that there are many reasons for weight loss and gain. “Lifestyle modification including diet and exercise may help reverse obesity and improve chronic disease biomarkers but are largely ineffective in achieving sustainable weight loss and glycemic control.” Journal of Biochemical Pharmacology. Jan 2019. The study goes further in that we can create short-term results, but long-term results won’t be sustained by most people. The number one predictor of long-term weight gain is fat loss.


What I just read is you unintentionally reverse dieted and lost weight, that’s also how I got my RMR back up, it doesn’t disprove anything though, we know that’s how our metabolism work. Keep eating too little and it slows down, give it a kick in the ass and up it and it also responds.

(Old Baconian) #78

So lifestyle modification and exercise reverse obesity, etc., without weight loss. Interesting!

So the 80 or so pounds I lost four years ago and never regained and my lower serum glucose mean that my weight loss is unsustainable and my lower glucose is an illlusion?


also CICO is a moneymaker

many rely on it to sell a ton of products. CICO is a multi-billion dollar biz out there, no one wants it to go away.

(GINA ) #80

Society hangs onto CICO because it appropriately punishes fat people for the sin of being fat. They can’t be allowed to join the ranks of the superior thin without atonement.

Trading oatmeal for eggs for breakfast, pasta for steak for dinner and maybe walking around the block if you feel like it will work to help the average Joe lose weight and get healthier, but it doesn’t cause enough suffering.