Calorie labels on restaurant menus are negatively impacting people with eating disorders, according to a new study involving UCL researchers.
The review, published in the British Medical Journal Public Health, is the first of its kind to evaluate existing research to help build a picture of 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 researchers found that individuals who have been diagnosed with an eating disorder changed their behaviours if presented with a menu featuring calorie labels.
This included behaviour changes such as avoiding restaurants, triggering eating disorder thoughts and paying more attention to calorie labels as identified by eye tracking research.
For example, one American study used a hypothetical menu design (i.e. showing people a menu online and asking what they would order) and found that people with anorexia nervosa or bulimia nervosa selected food with on average 550 calories when they were given calorie labels, as opposed to 1,615 calories on average when they didn't have calorie labels.
The new review also found that some people with eating disorders reported that seeing menu labels reinforced eating disorder beliefs.
In one study from England, researchers found that over half of participants with an eating disorder (55%) reported that calorie labelling may worsen their eating disorder symptoms.
The study also highlights that people with eating disorders can feel that their condition is perceived as being less important in the light of obesity prevention policies.
First author, Dr Nora Trompeter (UCL Great Ormond Street Institute of Child Health) said: "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.
"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."
Food labelling came into force in England in 2022. Restaurants, take-aways and cafes with 250 employees or more must display the calories of the food and drink they sell on menus, online menus and take-away platforms. The measure was an attempt to curb rising obesity levels. The United States 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.
Co-author, Dr Tom Jewell, (King's College London), said: "Our study highlights that people with lived experience of eating disorders are frustrated at being left out of the conversation around calorie labels.
"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 labelling. A recent review found that calorie labelling has a modest effect on people's behaviour but this needs to be counterbalanced with the potential harm it does for people with eating disorders."
The new research follows a recent Cochrane review co-led by UCL researchers that found that Calorie labelling of food on menus and products leads people to choose slightly fewer calories.
