The Cost of 'Calories-on-Menus' for Eating Disorders

Trigger warning: This blog talks about eating disorders and disordered eating. Due to the context of this blog post, I will refrain from using exact calorie information. Details can be found in the sources mentioned where applicable.


A triggering main with extra anxiety and a side of half-baked health policy, please!


Calories on menus — are you optimistic about the autonomy this change promises, or fearful about damage it could be inflicting?


Or are you indifferent, observing neither help nor threat to peoples’ eating behaviours?


Having lived with an eating disorder during my undergraduate years, my reaction last year to the announcement of putting calories on menus was one of concern. How did we see almost 50% more eating disorder diagnoses in 2020, yet this new legislation may provide a more challenging environment for those developing and recovering from eating disorders? Especially in an environment where getting help for eating disorders, including early intervention, is harder than ever.


Whilst acknowledging that for some individuals, calorie information may be a helpful starting point for looking after their health more, it’s quite the opposite for many who struggle with eating disorders and disordered eating behaviours. This legislation was proposed by the Department of Health as part of their plan to reduce obesity, and it will be interesting how the Office for Health Promotion plan to ‘tackle obesity and improve mental health’ with this universal change in food labelling.


To note, this perspective of this blog does not necessarily extend to other topics regarding food, nutrition, and physical health. Broadly, there remains a need across the population for adequate and healthful movement, and sufficient nutritional intake that reflects up-to-date research about the roles of different foods in our health.


Neither is this blog anti-diet, or written to discourage one to discard responsibility for their own health. Rather, this is an observation of a population-wide change that could be as intrusive and dangerous for some as it is helpful for others. A healthy relationship with food must also be considered alongside the challenge of defining a healthy intake of food.


Photo by Will Esayenko on Unsplash

What is the calories on menus legislation?


On 6th April 2022, the new Calorie Labelling Regulations came into force. This means that large businesses serving ready-to-eat food, e.g., restaurants, bars, bakeries, cafes, must display calorie information on menus (at tables, menu boards, electronic and take away) and on food items on display. This also includes all hot drinks. The following must be displayed:

  • The energy content of the food in kcal

  • The portion size to which the calorie information relates

  • The statement that ‘adults need around [common number] kcal a day’

Additional guidance states that the information is easily visible “by using the same font type or style of lettering, colour, size and background [as the] corresponding food item.”


What might be particularly challenging about calories on menus for those affected by disordered eating, especially with restrictive elements?


Photo by Sivani B on Unsplash

Many of us will have been, or are, ruled by calories. Every decision surrounding food and physical activity can be difficult. Essentially, anything linked to energy input or energy use can be governed by the underlying fears that drive eating disorders, and followed by the related guilt.


Whilst we are not asking the public to tread on tiptoes around disordered eating, there is no doubt that eating disorders can be damaging.


For many, attempting to leave and recover from disordered eating, forgetting kcal figures from both food and physical activity is a vital challenge that’s necessary to overcome the automatic mental arithmetic that results in restrictive or dangerous choices. Therefore, it can be unnerving and even triggering to be confronted with calorie information that appeals to current and historic disordered thinking.


Not to forget all those who may be vulnerable to developing an eating disorder and disordered eating patterns, due to the normalisation of reducing the role of food to the calories it provides, or as the rhetoric pushes, to the calories it ‘saves’.


What about the existing calorie information on most packaged and supermarket food?


Usually, the calorie information, unless advertised as a selling point, is much smaller in print that the name of the product, and not often near the price information. So it is much easier, as many of us are used to doing, to avoid calorie information on such packets because it is not forced in front of us in the same size font. Familiarity with these products can often help too.


Additionally, it’s not the crude calories alone listed on these products, but more useful nutritional information for more people, eg. carbohydrate measures for those with diabetes.


Considering reasons for calories


These changes do help introduce a choice for those who are interested and have no underlying disordered eating cognitions. Also, it may help particular individuals with the management and prevention of health conditions, for whom, under medical supervision, it is advised they maintain a specific calorie intake.


If only we had a blueprint


As Prof Tim Spector commented, “While the calorie can crudely measure the amount of energy in a food, it fails to account for the differences in how an individual will process that food and take energy from it, or how differently a food will be digested based on its processing or cooking methods.”


Similar changes in calorie labelling in the US have resulted in little to no observable beneficial impact on peoples’ food choices, as found in this systematic review and meta-analysis.


A 2018 Cochrane Review looking at nutritional labelling on menus found, little evidence that calorie labelling significantly reduces consumers’ choice and total consumption. There were only three randomised controlled trials, all of low quality, that suggested that calorie information on menus may result in a small reduction in the number of calories someone purchases.


Numerous professionals, clinicians, and advocates have spoken out about the danger of calorie labelling in this format, as highlighted in Beat’s response to the government’s plan, before it was implemented. Beat is the UK’s leading eating disorder charity, providing a national helpline, advocating for more education and treatment of eating disorders, and supporting family and friends close to those with eating disorders. Beat’s recent survey of people affected by eating disorders in Wales shows that 98% of those surveyed think that calories on menus will have a negative or very negative impact, and 96% did not agree with the introduction of calorie labelling.


Photo by Markus Winkler on Unsplash

Will calorie information ‘fix’ weight management?


In a recent blog post about weight management, Registered Dietitian Kaego Okafor unpacks the complexities of weight management.


Two of the key reasons why weight management may be difficult are emotional eating and habitual eating. Many of those who seek weight management identify emotional eating and/or habitual eating as a struggle, so things like finding coping mechanisms, forming new habits, and re-learning fullness and hunger signals.


Kaego said that those who are encouraged to take part in weight management do know the basics of nutrition, but are not fairly equipped and encouraged to work through and process determinants, like emotions and stress, that influence eating behaviour. The relationship between nutrition and weight is not a simple, single-factored causal relationship.


Are calories on menus just a sticking plaster?


Calorie labelling is a relatively cheap strategy, and effectively attempts to shift the responsibility of eating behaviours, food choices, obesity and related health concerns onto the individuals in our population. This move bypasses the responsibility of the government, businesses, and societies to provide a variety of foods across the nutritional spectrum that are accessible and meet individuals’ needs.


Even with disordered eating concerns aside, this calorie strategy alone sweeps a host of problems under the carpet. With increasing food poverty, demands on people’s time due to factors such as employment and financial stress, surely calories on labels are a savvy way to give the visual impression of public health change, but perhaps with little real health benefit across the population in this current context.


Photo by Tim Mossholder on Unsplash

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Do you struggle with calories on menus?

  • Phone ahead to ask if a restaurant also has menus without calorie information — this is legal when provided upon request. Not all chains are aware this is allowed (discussion with waiting staff, May 2022).

  • Choose the same dish as someone else on the table, or ask waiting staff what they would recommend

  • Ask someone to read the menu aloud without saying the calories

  • If the menu is single-use, ask someone or yourself score out the calorie information with a pen, or fold the menu to hide the numbers

  • If comfortable, quietly let one of your party know you would prefer not to look at the menu but use one of these alternatives provided. They can help look out for anything helpful and minimise any attention.

Resources


Podcasts:

Don’t Salt My Game, Train Happy Podcast, The Head First Podcast, Food Psych Podcast


Instagram accounts:

@DieteticallySpeaking (Disordered Eating Specialist Dietitian), @MyLifeIsForLiving (trainee Clinical Psychologist), @HopeVirgo_ (Campaigner), @R_McGregor Renee McGregor website (Sports Dietitian), @DrJoshuaWolrich (NHS Doctor & Nutritionist), @KaegosKitchen (Registered Dietitian), @HeadFirst0 (Health Psychologist), @PixieNutrition (Nutrition Counsellor & Psychotherapist), @IsaRobinson_Nutrition (Registered Nutritionist and Nutritional Therapist) @EmilyTalksRecovery (Journalist)


Books:

Just Eat It — Laura Thomas PhD The Inside Scoop on Eating Disorder Recovery: Advice from Two Therapists Who Have Been There — Reichmann & Rollin


Beat (UK Eating Disorder Charity) Helplines and Getting Help

Interested in taking part in eating disorder research? Find out more about EDGI (Eating Disorders Genetics Initiative), a research study exploring the genetic and environmental risk factors in individuals who have experienced an eating disorder.


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Header photo by Anna Shvets