How many meals do you eat a day? Chances are you said three without having to even think about it. Now quick: How many times a day do you drink? Don’t know? It’s probably something that you really have to stop and think about. Let’s see: There’s your morning cup of coffee. Then maybe some juice with your breakfast. Then, the second cup of coffee at the office. An iced tea with lunch (“Oh and upsize that please since the large costs the same as the small.") Perhaps, another cup of coffee to stay awake midday. A glass of wine while you’re cooking dinner. The soda with your evening meal. And maybe a glass of water beside your bed in case you get thirsty in the middle of the night. Were you keeping count? If that day sounds anything like yours, that’s 8 drinks all of varying size and calorie content. All without much thought.

If you’ve had weight loss surgery, you know how we dietitians feel about consuming anything without thought! Often patients try so hard to make the right food decisions that we lose focus when thinking about beverages. For instance, I had one patient who was trying so hard to make the right choices. She was 6 months out from surgery and wasn’t losing nearly as much weight as she had expected. She said she was following our guidelines -- eating 3-4 times per day, focusing on lean proteins for meals and snacks, and drinking mostly water throughout her busy day as a stay-at-home mom of two toddlers.

“What do you drink at night?” I asked. At night after the kids are in bed, she recalled, she loves to have a drink – or two – with her husband. Goldschlager was their favorite, and when I pressed her to really think about it, she estimated that she was drinking about ½ a pint a day. That’s more than 800 calories! She had no idea there were so many calories in one drink.

Still not convinced? A recent study found that sugar-sweetened beverages increased the desire for fatty, salty and/or savory foods when consumed with a higher protein meal. In addition, the amount of energy spent on the breakdown and storage of food was reduced, as was the tendency of the body to burn fat for energy. Researchers speculate this may lead to overeating and a greater tendency for calories to be stored as fat. So that sweetened drink is not only adding calories but could be making you eat more too.

WHAT NOT TO DRINK

Soda is usually the first product that comes to mind when we ask patients to name a high-calorie drink that you should avoid when trying to reach or maintain a healthy weight. But there are so many other offenders that fall into the high-calorie category. Let’s look at a few so you don’t get fooled like my patient did.

Alcohol

Unlike soda, that bottle of wine or spirits does not come with a nutrition fact label so it’s not easy to figure out exactly how calorie laden alcohol can be. A simple rule is the higher the alcohol content of your beverage, the greater the calories. For example, a glass of wine that is 10% alcohol will have fewer calories than one that is 15%.

Once you get into mixed drinks, such as margaritas and cocktails, that use fruit juices and a variety of alcohols, the calories really start to add up. For instance, a Long Island iced tea, typically made with vodka, tequila, rum, triple sec, gin, and cola, can have as much as 500 calories or more!

Does this mean that you cannot drink alcohol at all? Of course not, as long as you choose wisely, know the limits and partake only once in a while. For example, instead of a full calorie beer, which is 7% alcohol and may have more than 200 calories, you may want to try a light beer. There are many options that are around 100 calories.

“Healthy” Drinks

I’m always skeptical of anything that screams “healthy” on the label. Beware of this variety of beverage that tricks you into thinking it is good for you. This includes flavored milks (including flavored nut and soy milks), drinks that are sweetened “naturally” or claim health benefits (like some probiotic drinks and teas) and juice. Yes, juice is all natural and has vitamins, but the truth is you are much better off eating a whole orange (which contains fiber and will help keep you full) than drinking an 8-ounce glass of OJ with no fiber. (See below.)

RELATED: DO DETOX DIETS WORK?

Energy and Sports Drinks

Who wouldn’t want a drink that promises to give you energy? If it comes with an additional 168 calories and 9 teaspoons of sugar, like a 12-oz. Red Bull does, I would pass. Drinks that provide energy in the form of caffeine are also loaded with sugar and have been shown to have other poor health effects, such as elevating blood pressure. (1) Sports drinks, like Gatorade, aren’t much better. Unless you are doing intense exercise for 90 minutes or more, you don’t need a sports drink to rehydrate. Water works just fine.

Drinks That Are Really Desserts

This may seem obvious, but I decided to create this category because often the main ingredient in these drinks seem harmless (like coffee or yogurt) but once blended up with a bunch of other ingredients, you end up with almost a full meal’s worth of calories. You probably already recognize that a milkshake is a high-calorie treat, so let’s look at its close cousin, a smoothie. A 16-oz. peanut banana protein smoothie at a popular chain comes in at 470 calories, 71 grams of carbs and 54 grams of sugar. That’s about the same as small vanilla milkshake at McDonald’s. Although most of the sugars in the smoothie are naturally occurring, it still contains a large amount of carbohydrates just for one drink.

WHAT SHOULD I DRINK?

All in all, remember that calories are calories whether they’re coming from food or drinks. The difference is that the food leaves you feeling fuller and gives you important nutrients that you cannot get from most liquids. This is why the only drink with calories the dietitians and doctors at New Jersey Bariatric Center will recommend is a protein shake or glass of low-fat milk. You should aim to drink 64 ounces of fluid a day and the majority of that should come from water.
That said, if you want a bit of variety or just miss your old favorite beverage, try these calorie-free or lower-calorie swaps.

Circulation. 2015;132:A12689.