by Amy Jones
Monday, 11
April 2022
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11:41

Calorie counting menus will make eating disorders worse

Successive lockdowns have already exacerbated the problem nationwide
by Amy Jones
Credit: Getty

The first part of a key government drive to tackle obesity came into force last week. From now on, diners will be greeted with calories on menus when visiting restaurants, cafes and takeaways with more than 250 employees.

Many people will be supportive of such a policy — after all, rates of obesity have ballooned during the pandemic, particularly among children, and some intervention is urgently needed. However, the benefit of including calorie counts on menus remains to be seen. Research from America — where the practice of putting calories on menus is widespread — has shown mixed results, with many studies showing no overall impact on calories consumed.

Alongside these significant questions over the benefits of the policy there are other concerns. When the plan was first announced, eating disorder charity BEAT condemned the changes, stating:

“Requiring calorie counts on menus risks causing great distress for people suffering from or vulnerable to eating disorders, since evidence shows that calorie labelling exacerbates eating disorders of all kinds.”
- BEAT

In fact, a BEAT survey of individuals with experience of eating disorders found that 93% thought that calorie labelling on menus would have a ‘negative’ or ‘very negative’ effect, with some respondents arguing that, even for those without diagnosed disorders, such labelling risked encouraging obsession over calories and anxiety around eating.

This belief is borne out by the data. A recent study found that 1 in 10 dieters who calorie counted became bulimic, with participants admitting to behaviours such as skipping eating for days after a ‘binge’, eating ice and misusing laxatives. Such negative effects aren’t just limited to anorexia and bulimia — for those with binge eating disorder, the inclusion of calorie counts on menus has actually been found to increase calories consumed.

To make matters worse, this change also comes on the background of already soaring rates of eating disorders. Doctors have described a ‘tsunami’ of illness, especially in the young, with experts suggesting that isolation during lockdown, combined with a lack of control and freedom triggered eating disorders.  As restrictions became more stringent, controlling food became a way for many to deal with the loss of control felt in nearly every other aspect of their lives.

This crisis hasn’t just been limited to new diagnoses; for many with pre-existing eating disorders lockdown had a devastating effect. Recently, a Channel 4 documentary chronicled the heart-breaking experiences of former Big Brother contestant Nikki Graham, who died of complications associated with anorexia in April 2021. Her mother has been candid about the effect that restrictions had on her worsening illness, as Nikki struggled with social isolation, and the closure of gyms during what she calls a “hellish” lockdown.

As a result of the rise in cases, and worsening of pre-existing illness, waiting lists for treatment of eating disorders have quadrupled, with many mental health services being overwhelmed by demand. These grim statistics are likely to represent only the tip of the iceberg. Even before Covid, some studies suggested that between 80-90% of those who exhibit the symptoms of an eating disorder do not seek diagnosis or treatment.

Much like lockdowns themselves, the policy of including calories on menus has the capacity to cause significant harm and increase rates of disordered eating. Rather than risk worsening an already dire situation for questionable benefit, the government would do better to educate about healthy eating, ensure that healthy food is cheaper, and make access to gyms more affordable.

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Graham Stull
Graham Stull
2 months ago

Thanks for bringing attention to the catastrophic effects of lockdown on childhood obesity and eating disorders, particularly among teenage girls.
Rather than exacerbating the problem with calorie information on menus, we should put our focus on positive outcomes for children. Get them outside, playing real sports with other children. Having fun, getting daylight in their eyes and improving their cardiovascular systems.
No experimental vaccines, no pharmacological ‘solutions’. Just healthy, outdoor fun.

Kieran Saxon
Kieran Saxon
2 months ago

The piece on the growth in child obesity in lockdowns really hits hard. I remember youth football returning and a number of boys who normally had metabolisms like rocket engines turning up with pot-bellies. I still find it really hard to process all the harms that were done to children in the past two years, it utterly breaks my heart.
There are many loud and uninformed activists, many without children, who have been cheerleading policies that did not take an awful lot of analysis to figure out the risk of harm.
Dr Jones and a few notable others have been rare and welcome exceptions. We need more like them, and for social media to stop suppressing their voices.

Chris Milburn
Chris Milburn
2 months ago

I have loved Amy Jones’ writing during the pandemic, but this one really misses the mark.
A small percentage of the population has eating disorders. The idea that we should make general policies based on their needs, and not the needs of the many, is very “2022” thinking. It’s the same reasoning that leads us to have trigger warnings that say “This Netflix program depicts smoking!”. The same thinking that leads us to taking Mark Twain’s works off the syllabus for courses because they were not politically correct enough about race, and someone in the most sensitive 5% of the population might be offended by reading his work.
I’ve had many patients who have benefited from “counting calories”, not in the long term but as a springboard towards understanding how they could be gaining weight despite “hardly eating anything”. (“You mean that muffin I order every morning has 650 calories!”). I don’t suggest that patients with eating disorder histories, or risk factors, go that route, but for many I think it is useful as a short-term learning exercise.
Mandating the posting of calorie counts is a different issue that gets into government overreach and nanny-statism. I would argue against it, but not at all for the reasons that Dr. Jones lays out.

Ian Barton
Ian Barton
2 months ago
Reply to  Chris Milburn

This issue seems parallel to the debate about whether doctors should tell patients they have become “too fat”.
I really struggle to understand why the provision of “inconvenient truths” to the whole population should be curtailed due to the reaction it might cause on a relatively small number of people who need help with wider emotional difficulties.
By that logic, should the mandatory provision of pictures of “smoking-harmed” lungs now be considered an unacceptable practice due to the trauma it would cause in some who saw the images … ?

Last edited 2 months ago by Ian Barton
Kieran Saxon
Kieran Saxon
2 months ago
Reply to  Chris Milburn

Fair points. Agree on your point in general on Dr. J’s writing for Unherd, and that this felt more personal. Nothing necessarily wrong in that, but strength of the Doc’s writing in the past has been a mix of the emotional and objective, whilst a large proportion of the public health community has lost its collective heads to fear and political activism. Calorie counting can be a valuable aid to weight loss, and we’ve seen the impact of obesity and covid. Maybe a better solution would be QR or bar codes for those who want them, as they have to take active steps in that case?

Dave Weeden
Dave Weeden
2 months ago

I know that “making gyms more affordable” sounds like a sensible demand, but it doesn’t really mean anything. Councils provide gyms, and I believe prices are very low, if not zero, to people on benefits. I’m also a great believer in Parkrun, which is free to all. It’s a great idea, but it doesn’t address the obesity problem at all. One objection to running is the cost of shoes (but next week Lidl is selling ladies’ trainers for £11.99), although this applies to gyms too.
It’s not price that puts people off exercise, and making gyms cheaper won’t help. I suggest it would have the opposite effect as people value expensive things over cheap ones–and people are more likely to use a gym they’ve paid for than one they didn’t (although as all gym bunnies know, classes get a lot busier at the start of January and return to normal by February).

D M
D M
2 months ago

Yet another damaging government intervention. Can nothing be left alone? How did such a scheme progress so far with so little evidence demanded as to whether it actually works?

Laura Creighton
Laura Creighton
2 months ago
Reply to  D M

It appears we have a cohort of people, who, despite calling themselves ‘behavioural scientists’ believe that when theory and experiment disagree, you should believe the theory and throw out the evidence. Or say that the evidence means that you are racist, transphobic, or whatever. Proof by ‘I am a smart person with impeccable credentials, and this sounds correct to me’ trumps everything.
Richard Feynman would be rolling in his grave.
https://fs.blog/mental-model-scientific-method/

Last edited 2 months ago by Laura Creighton
Mike Bell
Mike Bell
2 months ago

To me, it’s not ‘calorie-counting‘, it’s just an indication of the number of calories in the dish I’m thinking of ordering to help me make a choice.
Having the calories on food labels hasn’t made people eating disordered.

Alex Stonor
Alex Stonor
2 months ago

Great photo of BJ living in the moment with his cream cake. This approach is echoed in most of their education, health & social care policies that show no awareness of the massive costs in the future, of a nation that is overweight and under-exercised. The lack of creativity is mind boggling.

Mike Bell
Mike Bell
2 months ago

Before making claims for the effects of lockdown, calories on menus etc, why not look at the research?
On lockdown, https://pubmed.ncbi.nlm.nih.gov/34460991/ says the pooled analyses of longitudinal studies showed no significant differences from pre-pandemic levels to the first lockdown phase in Body Mass Index and ED symptoms, “

Graham Stull
Graham Stull
2 months ago
Reply to  Mike Bell

The same meta-analysis also finds that “Fifty‐two percent of the individuals with obesity reported weight increase”
More to the point, this study did not focus on children. Here we have a child-specific study:
Changes in Body Mass Index Among Children and Adolescents During the COVID-19 Pandemic | Adolescent Medicine | JAMA | JAMA Network
which compares BMI for 2019 to that of 2020 for children aged 5 – 17. They found overweight or obesity among 5 – 11 year olds increased by 36 to 42%.