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Zeynep Akbasoglu is currently pursuing a Master’s in Nutritional Sciences at the University of Southern California (USC). She earned her Bachelor of Science in Nutrition and Dietetics and her Bachelor of Arts in Psychology from Boston University. With a passion for integrating her knowledge of both fields, Zeynep focuses on supporting individuals in achieving balanced health, particularly in the areas of eating disorders and sports nutrition.
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Disclaimer: This post contains language and terms that may be triggering for some individuals. Readers are encouraged to proceed with caution and prioritize their well-being while engaging with this material.
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The overconsumption of calories, particularly from dining out, has become a significant public health issue, leading to adverse health outcomes such as uncontrolled blood sugar and blood pressure, and considerable healthcare costs.1 One prominent strategy involves the implementation of menu labeling, where nutritional information, particularly calorie content, is mandated on restaurant menus by the Food and Drug Administration (FDA) aiming to provide consumers with essential nutritional information to make informed choices about their food consumption. These policies are based on the idea that, by increasing transparency and awareness of calorie content on restaurant menus, individuals can make healthier food choices that contribute to the overall effort to improve public health.2 However, there is a growing concern about the unintended consequences of these policies, especially their potential impact on individuals with eating disorders (EDs).3 This highlights the need to examine the complex relationship between menu labeling and its potential effects on the vulnerable population struggling with EDs.
Displaying calorie information on menus, while intended to enhance transparency and informed decision-making can create significant risks for individuals with eating disorders. For those already struggling with obsessive calorie counting, the presence of such information can intensify fixation, contributing to heightened anxiety and stress. The visibility of calorie content may lead to unhealthy comparisons and competition among individuals with eating disorders, potentially reinforcing disordered eating patterns.4 Calorie information may also act as a trigger for people in recovery, potentially leading an individual to relapse into an eating disorder. The fear and avoidance of some specific calorie amounts can be triggered, leading them to exclude certain foods or even food groups completely. Moreover, the emphasis on perfectionism and adherence to strict dietary rules can be amplified, resulting in cycles of guilt and shame.5 Calorie-centric menus may also distract individuals from the enjoyment of their food, reducing the pleasure associated with eating. Research on young adults has shown that while nutrition label use is associated with healthier dietary intake and higher involvement in healthy weight control behaviors, it is also related to engagement in some unhealthy weight control behaviors.6 It's crucial to examine how people use this information, especially those who have unhealthy eating habits, as displaying calorie information has been associated with both positive and negative behaviors.
When individuals are aware of the calorie content in their meals, they often adjust their choices accordingly. This change typically results in a greater preference for healthier options and a decrease in the intake of high-calorie foods. One study investigated the influence of caloric feedback on food choices in the University of Texas cafeteria over a 16-month period where large signs displaying the caloric values of menu items were placed at cafeteria entrances. Findings revealed reduced carbohydrate and red meat consumption, as well as increased intake of salads and vegetables.7 Similarly, another study conducted with middle and high school students explored whether displaying calorie and fat information on restaurant menus influence ordering behavior. Participants were asked to choose meals from various restaurant menus both before and after nutritional information was added. The study found that approximately one-third of the participants altered their meal selections after viewing the calorie and fat content, with many opting for meals with lower calorie counts.8
Although these findings show some improvements in dietary habits, it's crucial to acknowledge that the effects of calorie labels are not beneficial for everyone. Individuals with eating disorders or heightened weight concerns often experience increased anxiety when confronted with calorie labels. This heightened sensitivity can lead to significant changes in their food choices, especially in environments like cafeterias where nutritional information is visibly displayed. One study explored how middle and high school students in Minnesota use calorie information on restaurant menus and its relationship with weight concerns, eating behaviors, and dining preferences. The findings showed that more than half of the participants were aware of the calorie information on menus and used it to avoid high-calorie items and opt for smaller portions. Individuals using menu labels to limit calorie intake exhibited heightened weight-related concerns and were more likely to engage in dieting and unhealthy weight control behaviors, particularly among women reporting binge eating.9 In another study conducted at Simmons College, female college students who reported regularly counting calories were notably more likely to be influenced by the cafeteria food labels compared to those who counted calories less frequently. Moreover, individuals categorized as highly concerned about their weight were also more prone to being affected by the cafeteria food labels compared to those with lesser weight concerns.10 Seeing calorie information on menus can also diminish the pleasure and enjoyment people derive from their meals. This can lead to changes in their orders, as they become more focused on the caloric content rather than the food itself. The presence of calorie labels can cause people to change their orders for less enjoyable but lower-calorie meals, sometimes leading to dissatisfaction while eating. In one study, participants with elevated eating disorder symptoms ordered fewer calories, liked menu items less, perceived the restaurant as less healthy, and were less likely to go to the restaurant. The study found that calorie information significantly amplified existing concerns and behaviors related to eating disorders, leading to lower enjoyment and perceived healthiness of food options. This reflects how calorie information can negatively impact the overall dining experience for individuals with eating disorders.11
While the introduction of calorie information on menus is well-intentioned and designed to improve public health, it can lead to a variety of challenges for individuals with eating disorders. Research has shown that menu labeling can lead to healthier food choices and a reduction in calorie intake among the general population; however, it also reveals a negative effect for individuals struggling with disordered eating patterns and weight-related concerns as the presence of calorie information can exacerbate unhealthy behaviors, increase anxiety, and diminish the enjoyment of eating. It is crucial to identify the balance between providing nutritional information and supporting individuals with eating disorders to address the diverse needs of the population and promote a more inclusive dining environment. On one hand, providing nutritional transparency can empower consumers to make healthier decisions, contributing positively to public health. On the other hand, it is important to recognize and address the adverse effects these policies might have on vulnerable individuals. Policymakers and health advocates must consider alternative methods of conveying nutritional information that does not trigger disordered eating patterns or add to the psychological burden of those in recovery. Future strategies might include offering optional nutritional information or focusing on overall dietary quality rather than just calorie content to promote a balanced and mindful approach to eating. By creating a more inclusive dining environment that respects the varied experiences and needs of all individuals, we can find a solution that supports public health without compromising the well-being of those struggling with disordered eating.
References
1. Kiszko, K. M., Martinez, O. D., Abrams, C., & Elbel, B. (2014). The influence of calorie labeling on food orders and consumption: A review of the literature. Journal of Community Health, 39, 1248–1269. https://doi.org/10.1007/s10900-014-9876-0.
2. Tiwari, A., & Balasundaram, P. (2023). Public health considerations regarding obesity. In Public Health Considerations Regarding Obesity. https://www.ncbi.nlm.nih.gov/books/NBK572122/.
3. Putra, I. G. N. E., Polden, M., Wareing, L., & Robinson, E. (2023). Acceptability and perceived harm of calorie labeling and other obesity policies: A cross-sectional survey study of UK adults with eating disorders and other mental health conditions. The International Journal of Eating Disorders, 56(11), 2049–2061. https://doi.org/10.1002/eat.24031.
4. Chung, D. H., Lee, S., Park, J., & Kim, H. (2024). Does more information mean better choices? A study on calorie display and consumer behavior in restaurants. Food Quality and Preference, 113, 105044. https://doi.org/10.1016/j.foodqual.2023.105044.
5. Bardone-Cone, A. M., Wonderlich, S. A., Frost, R. O., Bulik, C. M., Mitchell, J. E., Uppala, S., & Simonich, H. (2009). Perfectionism across stages of recovery from eating disorders. International Journal of Eating Disorders, 43(2), 139–148. https://doi.org/10.1002/eat.20674.
6. Christoph, M. J., Loth, K. A., Eisenberg, M. E., Haynos, A. F., Larson, N., & Neumark-Sztainer, D. (2018). Nutrition Facts Use in Relation to Eating Behaviors and Healthy and Unhealthy Weight Control Behaviors. Journal of nutrition education and behavior, 50(3), 267–274.e1. https://doi.org/10.1016/j.jneb.2017.11.001
7. Cinciripini, P. M. (1984). Changing food selections in a public cafeteria: An applied behavior analysis. Behavior Modification, 8(4), 520-539. https://doi.org/10.1177/01454455840084004.
8. Yamamoto, J. A., Yamamoto, J. B., Yamamoto, B. E., & Yamamoto, L. G. (2005). Adolescent fast food and restaurant ordering behavior with and without calorie and fat content menu information. Journal of Adolescent Health, 37(5), 397–402. https://doi.org/10.1016/j.jadohealth.2004.10.002.
9. Larson, N., Haynos, A. F., Roberto, C. A., Loth, K. A., & Neumark-Sztainer, D. (2018). Calorie labels on the restaurant menu: Is the use of weight-control behaviors related to ordering decisions? Journal of the Academy of Nutrition and Dietetics, 118(3), 399–408. https://doi.org/10.1016/j.jand.2017.11.007.
10. Fawkes, K., Levy, J., Terry, K., & Edelstein, S. (2010). Female college students’ attitudes about body image and food labels and how they affect purchasing behavior. Topics in Clinical Nutrition, 25(2), 165–171. https://doi.org/10.1097/tin.0b013e3181db7b18.
11. Haynos, A., & Roberto, C. (2017). The effects of restaurant menu calorie labeling on hypothetical meal choices of females with disordered eating. International Journal of Eating Disorders, 50, 275–283. https://doi.org/10.1002/eat.22675.
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