‘McDonalds is unhealthy’
‘Are you sure you want to eat that?’
‘You should try this new diet’
The constant commentary on what we eat is inescapable and remarks such as these haunt us perpetually, coming from friends, family, adverts and the media. Children grow up watching their parents endlessly cycle through diets like fasting, calorie restriction, and juice cleanses, perpetuating the culture of self-hatred which our world seems to foster. Adolescents punish themselves for eating and many ignore the innate, survival instinct of hunger, in pursuit of the ideal ‘thin’ body type. For many people, this obsession rapidly transforms into an eating disorder.
The NHS Health Survey for England in 2019 found that 16% of adults screened positive for a possible eating disorder, up from 6% in 2007; a statistic that is appalling but not surprising, considering the calorie-centric nature of our health guidelines. The government recommends 2,000 calories a day for women and 2,500 calories a day for men without regard for size, age, metabolic rate or exercise levels, taking an arguably reductive stance on health which fails to acknowledge the complexity of weight management. Andrew Radford, Beat’s Chief Executive suggested this when he said, ‘the number of calories consumed is not a reliable indicator of health’ and promoted a move away from ‘obesity-shaming’ - the word shame being particularly indicative of the current guilt-motivated attempts to reduce obesity.
The calorie legislation that was introduced on 6 April, 2022 is a perfect example of such an approach. These new rules state that all businesses with over 250 employees must display calorie information on non-packaged menu items. This means that not only are we being pummelled with judgements from those around us, but we cannot even select a meal without knowing exactly what is in it. This means that for those with an eating disorder, or at risk of developing one, eating out will never be free from a lingering sense of guilt; it will only become so much harder to silence the voice in their head saying ‘maybe I don’t need a pizza; perhaps a salad with fewer calories is better’.
In all restaurants, asking for an alternative menu without the calories displayed is an option. This option however, seems like an escape route for the legislators of such a rule who wish to gracefully sidestep any responsibility for worsening weight-issues. When facing scrutiny a cursory nod towards the token blank menu is all that’s required to salvage their caring visage; adequately concerned for mental wellbeing yet valiantly working to solve obesity. Meanwhile, the embarrassment of requesting a different menu and the secretive nature of eating disorders will prevent this strategy ever having an effect.
For someone with anorexia nervosa, a menu with calorie information very rapidly becomes an obsession, a source of intense distress and sometimes a fatal temptation. The tendency is to fixate on the number accompanying each dish instead of on the food itself, so that the choice becomes a game of Where’s Wally for the lowest calorie meal instead of a red, stripy hat. Characteristically, like the other people in Where’s Wally drawings who are rendered irrelevant, any consideration of nutrition, recovery or health vanishes the moment calories are introduced into the equation. This is a serious worry considering the fact that eating out and learning to choose food intuitively, based on hunger and taste, is an important stage of eating disorder recovery.
So, whilst it is important to acknowledge that obesity is rising, the number of people suffering with an eating disorder is also increasing, and the slight reduction of the former will likely exacerbate the latter. It has even been suggested by some, that there won’t be a positive impact on obesity statistics with which to justify such a change.
A similar strategy was adopted in the US several years prior to the UK, and studies there demonstrated a slight change initially, but no long-lasting effect.
We are all familiar with the stereotypical image of an ‘eating disorder’: thin, pale, underweight. However, this is often not the case and some eating disorders are accompanied by obesity. According to Beat, 30% of those who seek weight management services would qualify for binge eating disorder, indicating that a significant number of those who are overweight would not benefit from the new legislation either. Those who binge eat are actually more likely to select higher calorie items, contrary to the aim of the law which is to ‘make healthier food choices’.
Beat is the UK’s Eating Disorder Charity and naturally has an influential stance on the issue. They have strongly urged governments to relinquish the mandation of calorie labelling and issued three statements;
The Government should not mandate calorie labelling on menus.
The Government should take an integrated public health approach to obesity and eating disorders.
The Government should consult with experts from the field of eating disorders, including people with lived experience, in all campaigns and legislation to address obesity.
The message from Beat is clear - these new rules will invariably damage the mental health of many people, including those with eating disorders, their families, the NHS workers (who are overrun with those seeking treatment for an eating disorder), and the many thousands of people at risk of developing an eating disorder should they be allowed to obsess over calories. They also acknowledge the delicate nature of weight issues and the link between them and obesity. Neither can be treated as a separate illness but must be dealt with in a mutually beneficial way, hence the ‘integrated public health approach’.
Health is not just a number, and weight is not only a physical attribute, but also a mental one. The introduction of calorie labelling must therefore account for the mental impact as well as the physical one it may have. Even if obesity levels did decrease, we must continue to question whether it is due to healthier, more fulfilling lives or whether it is because of calorie restriction, shame and starvation. For those with an eating disorder, the quality of life is as low as those with coronary heart disease; this is not a world I want to see actualised.
Undoubtedly, obesity is a huge problem but so are eating disorders, which has led me to this simple conclusion; something must be done but this is not it.