Unintended consequences of public health policies spark debate on their impact on vulnerable populations.
Study: Does menu calorie labelling cause or exacerbate eating disorders? Image Credit: Krakenimages.com / Shutterstock
An article published in the International Journal of Obesity describes the impact of menu calorie labeling on the potential exacerbation of eating disorder symptoms in people living with eating disorders.
Background
In April 2022, the UK government developed a policy for the Out of Home Food Sector to control the ever-increasing prevalence of obesity. This policy mandated that all larger restaurants and cafes with more than 250 employees include calorie information on their menus.
The policy was implemented to help the public make healthier dietary decisions. This legislation covered all unpackaged foods and non-alcoholic drinks, while alcoholic drinks above 1.2% ABV (alcohol by volume) and food items only on a menu for 30 days of the year or less were exempt.
Previously, mandatory calorie labeling on menus had been introduced in the United States, Canada, and Australia in 2018 and 2019. Existing evidence indicates that calorie labeling only modestly impacts the calorie-ordering behavior of consumers. It has also been observed that calorie labeling is significantly associated with a reduction in calorie content per dish, which might be due to its impact on product reformulation.
79% of the UK general population supports the inclusion of calorie information on menus in the out-of-Home Food Sector. However, the policy has received some criticism from the public.
A survey of Twitter responses from 276 people has reported that about 71% of them have negative sentiment towards the policy, which could be associated with their concern about the impact of the policy on people with eating disorders.
The UK’s leading eating disorder charity, BEAT, has also criticized the policy. It has been observed that the policy may increase the vulnerability of people who are at higher risk of developing eating disorders.
The policy has also been found to exacerbate eating disorder symptoms and perpetuate body weight stigma in people with clinically-confirmed eating disorders.
Impact of calorie labeling on people with eating disorders
Only a small number of studies have investigated calorie labeling-related opinions and experiences of people with eating disorders using qualitative methods.
The findings of these studies have indicated that calorie labeling can lead to hyper-fixation of calories, restriction on food choosing freedom, reduction of eating out opportunities, increased feelings of anxiety, guilt, and shame around food choices, and inhibition of eating disorder recovery.
Besides these negative impacts, some positive sentiments have also been identified in these studies. While some participants have reported that calorie labeling can increase feelings of reassurance, control, and accountability of consumed food, some believed that the information provided on menus may help prevent overconsumption of food and subsequent guilt. However, others argued that these feelings of control may reinforce disordered eating behaviors.
Quantitative data obtained from these studies revealed mixed reactions. While the policy is supported by 43% of participants with diagnosed eating disorders, a significant majority (91%) of participants have reported experiencing challenges because of the calorie labeling, and 55% have reported worsening of their eating disorder symptoms.
One study examined calorie labeling-related adverse outcomes in 2015 among 299 undergraduate female students who are at higher risk of developing eating disorders. The study measured various eating disorder disturbance scores before and after implementing calorie labeling in the university cafeteria.
The findings revealed no adverse effects of calorie labeling on these at-risk participants. However, since the participants were categorized as high-risk populations based on Eating Attitudes Test scores rather than a formal eating disorder diagnosis, the scientists believe that further studies are needed to extrapolate these findings on people with diagnosed eating disorders.
Further studies are also needed to understand the impact of calorie labeling on people living with obesity and an eating disorder, as well as on those living with different types of eating disorders, including binge eating disorder, anorexia nervosa, and bulimia nervosa.
Considering the challenges people with eating disorders may face, the UK government has permitted businesses to provide menus without requested calorie information. However, a recent observational study has reported that on-request calorie-free menus are available only in 12% of 90 food outlets. Moreover, ordering foods without calorie information may be distressing for people with eating disorders by drawing further attention to their disorder.
Mandating restaurants and cafes to provide menus with and without calorie labeling can eliminate the stigma of publicly requesting menus without calorie labeling. This dual approach could reduce the potential negative impact on individuals with eating disorders while still supporting public health goals.
Study significance
The study finds that the UK government’s new public health policy of calorie labeling has the potential to cause or exacerbate eating disorders in at-risk people or those living with eating disorders.
Although many people with eating disorders support the policy, it is crucial to ascertain that the policy is not increasing body weight stigma or encouraging restrictive eating behaviors. Given the limited evidence, further research is essential to fully understand the long-term impacts of calorie labeling on this vulnerable population.