Calorie labels on restaurant menus may worsen eating disorders, experts flag

Calorie labels on restaurant menus are negatively impacting people with eating disorders, suggests a new study published in the journal BMJ Public Health, led by researchers at King’s College London, UK.

The “first of its kind” review found that individuals who have been diagnosed with an eating disorder changed their behavior if presented with a menu featuring calorie labels. This included avoiding restaurants, triggering eating disorder thoughts, and paying more attention to calorie labels as identified by eye tracking research.

Some people with eating disorders reported that seeing menu labels reinforced their eating disorder beliefs.

“Our study highlights that people with lived experience of eating disorders are frustrated at being left out of the conversation around calorie labels,” says senior author Dr. Tom Jewell, lecturer in Mental Health Nursing at King’s College London.

“Striking a balance between the positive and harmful impacts of calorie labels on menus is vital in any public health policies. Policymakers should consider the impact on both obesity and eating disorders when making decisions about nutrition labeling.”

“A recent review found that calorie labeling has a modest effect on people’s behavior but this needs to be counterbalanced with the potential harm it does for people with eating disorders.”

Calorie labels a “blunt instrument”?

The study contrasts previous research published earlier this month, suggesting that when applied at scale, food calorie labeling could lead to “potentially meaningful impacts” on population health. That particular study reviewed 25 randomized control trials, discovering that calorie labeling led to small reductions in calories selected (1.8%) and consumed (5.9%).

The same researchers call for additional policies to support healthier diets as they found that only 22% of surveyed consumers use calorie information on menus to make food choices.

The King’s College London researchers reevaluated existing research to further examine how nutritional labels on menus impact people with a lived experience of eating disorders or disordered eating. It reviewed 16 studies from the UK, US, Canada, and Saudi Arabia, which included 8,074 participants in total.

The report highlights that people with eating disorders can feel their condition is “perceived as less important” in light of obesity prevention policies.

However, they note physical health cannot be measured by a single indicator such as weight. “Some argue that calorie labels can be seen as a blunt instrument to fix a complicated problem and that people with eating disorders could be losing out.”

Consumer education efforts

Food labelling came into force in England in 2022. Restaurants, take-outs, and cafés with 250 employees or more must display the calories of the food and beverages they sell on menus, online menus, and take-out platforms.

The measure was an attempt to curb rising obesity levels. The US and Canada have also made calorie displays mandatory. However, few policies targeting obesity have considered the potential impact on eating disorders.

The eating disorder charity Beat estimates that at least 1.25 million people in the UK have an eating disorder. The number of people admitted to hospital with an eating disorder has risen approximately 7% each year since 2005–2006.

“Our study provides an important addition to the evidence base around calorie labels. Typically, there is a lot of focus on whether policies are effective in reducing obesity, but it is also critical to investigate whether these policies inadvertently harm people with eating disorders,” says co-author Dr. Nora Trompeter, Research Fellow University College London.

“Our review also shows that more research is needed to fully understand the impact of calorie labels on individuals with eating disorders. For example, none of the studies included young people.”

The paper, titled “Impact of out-of-home nutrition labeling on people with eating disorders: a systematic review and meta-synthesis,” is published in the British Medical Journal Public Health.

To address the possible adverse effects of calorie labeling on consumers with an eating disorder, researchers have previously suggested restaurants also create calorie-free menus for people who might find seeing calorie information challenging. 

Diet research advances

In dietary research this week, foodservice provider Sodexo published its latest whitepaper presenting a new “neuroprotective diet” that “simplifies the science for people who want to eat for lifelong brain health.”

A recent study of 21,561 people found that plant-based diets shape healthier microbiomes and have better cardiometabolic outcomes. Omnivore, vegetarian, and vegan diets are gaining popularity and are spotlighted for making a positive impact.

Meanwhile, scientists writing in the journal Cell developed a diet mimicking eating habits in non-industrialized communities that can significantly reduce the risk of a number of chronic diseases. They confirm that industrialized diets — high in processed foods and low in fiber — have contributed to a substantial rise in chronic diseases like obesity, diabetes, and heart disease in affluent countries such as Ireland.