Recent news reports suggest weight loss through dieting by calorie restriction is a not a productive way for individuals to lose weight and keep it off. I don’t think this anti-dieting idea helps individuals who want to understand how to lose weight. Calories, be they fat, protein, carbohydrate, or alcohol all matter and all count. This concept suggests that because the emphasis of many diets is mainly on calories and not on various underlying emotional and/or psychological factors the real causes for food cravings and hunger may be missed and unexplored. Dieting by whatever other means, such as intuitive dieting or intermittent fasting, may help focus on the body’s innate signals around appetite, hunger, fullness, and other food related cravings. However, while this may help to give the dieting individual a better insight into why they overeat and gain weight, no matter what diet is used, calories, especially carbohydrates, still matter very much. Of the two main types of carbohydrates, complex and simple/refined, it is the refined sugars found in pastas, breads, pastries, snack foods that are the main culprit for weight gain, because they cause a quick spike in the release of insulin. This rapid spike in insulin then causes a quick drop in blood sugar which then produces an increase in hunger and a craving for more refined sugars. This creates a vicious cycle of eating refined sugars, hunger, and more appetite for refined sugars. However, fruit and vegetables contain most of their sugar as complex carbohydrates which are broken down and absorbed more slowly so as to produce a greater sense of fullness but with less cravings for more carbohydrates. Unfortunately much of our fast foods, especially foods which are heavily advertised and marketed, contain mainly simple/refined sugars rather than the complex carbohydrates that are in vegetables and fruit. But fruit juices contain more of the simple sugars, which like refined sugars get into the body more quickly and cause a rapid increase in blood sugar. So, eating the entire fruit, with its fiber and pulp, will slow done the absorption of the carbohydrates and not produce an insulin spike. Understanding these differences between carbohydrates is an important concept often glossed over and dismissed by weight loss professionals who are too focused on scale numbers, instead of helping individuals understand the causes and dynamics behind weight gain, as well as appreciating the non-biologic and psychological causes for weight gain. Peter Vash, M.D., MPH.