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13 April 2022

Calorie counts are not the answer to obesity

Such a blunt approach will do more harm than good.

By Wera Hobhouse

Since last week, large food businesses in England have been required to display calorie information on their menus. The move comes as part of the government’s new obesity strategy — an effort to improve the nation’s health in response to studies linking obesity to an increased risk of hospitalisation from Covid-19.

Few would oppose the aim of tackling obesity rates. The 2019 Health Survey estimated that 28 per cent of adults in England were obese and a further 36 per cent were overweight. Obesity is linked to a number of serious health problems, including strokes, high blood pressure and diabetes.

On the surface, calorie labelling seems to make sense. People are encouraged to make better informed, healthier choices. In turn, restaurants are incentivised to provide healthier options. But in practice, calorie labelling simply does not work. It may even do more harm than good.

Calories are merely a unit of energy. They do not indicate nutrients, proteins, healthy fats and so on. A low-calorie meal does not necessarily mean a healthier choice.

Worse still, reducing food to a calorie number overlooks the complex relationship that many people have with food. Multiple studies have found that calorie tracking causes significantly higher levels of dietary constraint and eating concerns. A survey conducted in the US found that 73 per cent of respondents with eating disorders suggested that tracking their calories had contributed to their disorder.

Beat, the UK’s eating disorder charity, has warned that calorie counts on menus could cause great distress for people suffering from or vulnerable to eating disorders. Something as simple as going for a meal with friends or family becomes humiliating or even scary.

Specialists and survivors alike add that eating in a restaurant can play a large part in recovering from an eating disorder. It is a way for someone to learn to let go of their anxieties and challenge their eating disorder.

When the obesity strategy was announced, I was inundated with emails from constituents — some who had experienced an eating disorder themselves, some who had seen their loved ones suffer. One told me they would feel “compelled” to read calorie labels, another that they nearly cried when they heard the announcement. All of them feared that calorie labelling could reduce sufferers’ chances of recovery or, worse, cause a relapse.

Roughly 1.25 million people in the UK suffer from an eating disorder. As it stands, less than half of people fully recover, and recovery takes three times as long as having the disorder itself. These debilitating illnesses can seriously damage a person’s self-image, their relationships and their social life.

Eating disorders have the highest mortality rate of any mental illnesses. And, while it is estimated that obesity costs the NHS £6.1bn each year, eating disorders cost the UK somewhere between £6.8bn to £8bn. We need a strategy that addresses the issue of obesity without creating another, equally costly problem.

Frustratingly, evidence of calorie labelling’s efficacy is “mixed and incomplete”, according to the British Medical Journal. A study in the US — where calorie labelling has been mandatory since 2018 — found only a small decrease in mean calories purchased per transaction. This reduction diminished over one year of follow-up.

It is also worth mentioning that many people with eating disorders also live with obesity. Up to 30 per cent of people seeking weight management services would meet the diagnostic criteria for binge eating disorder. Research shows that those suffering from binge eating disorders are in fact more likely to order food with significantly more calories when presented with this information. Failure to recognise this risks creating an obesity strategy which harms the very people it is trying to help.

So, what does an effective obesity strategy look like? Compassion should be the main driver. Rather than shaming people into choosing “healthier” options, the socioeconomic drivers of obesity need to be addressed. It is no coincidence that adult obesity is almost twice as prevalent in deprived areas, with the gap in child obesity following a similar pattern. It is not a question of “greediness”, as this legislation implies, but evidence of health inequalities.

Unless the government understands what leads people to make the choices they make around food, we cannot hope to tackle the problem. This means education around cooking and the nutritional value of food. Instead of praising restrictive eating, people should be supported with the knowledge and resources they need to improve their lifestyles.

The importance of body positivity cannot be overstated either. Many forms of disordered eating begin with insecurities about body image. People must be taught — whether through positive representation on television or as part of the school curriculum — that a healthy body takes many forms.

While this legislation remains in place, I implore everyone to look beyond these superficial numbers. Let’s be compassionate to ourselves and others when it comes to mealtimes.

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