the HAES® files: Raising a Ruckus: Calorie Counts on Menus

by Health At Every Size® Blog

by Andrea LaMarre, MSc.

Over the past week I have been asked, more times than I can count: “What are you making such a big fuss about?” This question has come on the heels of a recent change in legislation in my home province of Ontario that has made it law for restaurants with over 20 locations to include calorie counts on their menus. These calorie counts are abstracted from all other nutritional information, and they must be as large as the price of the item.

In early December, I was approached by a number of others from within the eating disorder research, advocacy and prevention community who suggested that I start a petition to have this legislation repealed. Alarmed that the legislation was to come into effect, presumably without consultation from the eating disorders community, I did so. Just after Christmas, after approximately 400 people had signed the petition, I started to receive media requests – dozens of media requests. Suddenly I found myself with the interesting task of providing the kind of sound bite for an article that would make people at least pause for thought around this new item on the menu.

Throughout the media storm, I’ve noticed an interesting trend: articles tend to capitalize on the shock value of higher calorie items, leaving out a number of points that I think are important to keep in the conversation. In the rush to tell the world how many calories are in a poutine (a Canadian treat of fries with curd cheese and gravy), many have left out key pieces of information that might help to explain why this legislation leaves me feeling disillusioned. While I understand the desire to get the public interested in these stories, I fear that the decontextualized accounts leave out the real impact that such legislation can have on people’s lives – and reinforce some of the possible harms associated with the counts.

First, I think it is important to contextualize this legislation in the “evidence” around calorie counts on menus, and what is being defined as a successful outcome. There is very limited evidence, from the few studies that have been conducted, that calorie counts lead to measurable changes in health over the long term. Often, studies cannot account for other meals in the day. Researchers may measure “health” using only weight or BMI as a metric, and they do not account for mental health in a meaningful and culturally appropriate way. “Effective” is therefore defined as resulting in the individual choosing a lower calorie option. However, the lower calorie option is not always the healthiest choice for a person – physically or mentally.

We consume foods for many reasons; Health at Every Size® (HAES®) principles suggest that we can understand food as more than a caloric value. From a dietary science perspective, there are other important aspects of the food we eat – from fats to proteins to vitamins and minerals – there is more to the picture. We forget, sometimes, that people in the general population may not be as interested in seeing food as a whole picture. When calories are explicitly positioned as what matters, this becomes further entrenched in societal imagination.

Another important part of the calorie-count-on-menu picture is a consideration of the inherently social aspects of eating. Much like the media stories that have covered this legislation, people in real life tend to panic over the higher calorie options at restaurants. “My goodness!” someone might cry, “can you BELIEVE how many calories are in that cupcake?!” Why yes, I can. And I’m going to eat it, because I haven’t had a cupcake in a while and it’s a feast for the senses. And no, it is not a “cheat day.” A perspective on food that promotes all foods fitting into a healthy diet is seemingly quite uncommon. It is important to consider what kind of impact these comments might have on someone who is struggling to escape the grips of diet culture, that has kept them in a state of ill health for, likely, a long time.

We cannot ignore, however, that when I eat a cupcake, I will be judged less harshly than someone with fewer privileges eating the same cupcake. We also cannot ignore what this kind of legislation means in terms of the societal surveillance of bodies. Weight stigma – whether overtly hostile or benevolent – is common in our society. Those in larger bodies – and those in otherwise marginalized bodies – are watched more. People make moral judgments about what they do, and what they eat. There is no winning in this situation – eat what is seen as a healthy option and there is an assumption that this is a rare occurrence, rather than a regular pattern of eating; eat what is described as “bad” and face chastisement and often hostility, judgment for “not taking care of yourself.” Again, these stigmas and this watching goes double or triple for those whose bodies are not seen as fitting the norm on the basis of ability, gender, race, class, sexuality, and more.

Many of my conversations about the legislation have focused on the need to avoid posting the counts because of the potential harms to those with eating disorders. These conversations often make clear a fundamental misunderstanding of the difference between “eating disorder” and “obesity” in how journalists place these at opposite ends of a spectrum. They ask me, ”Sure, this could be hard for those with eating disorders. But isn’t obesity a bigger problem?” The framing of this question presumes that those in large bodies could not possibly suffer from eating disorders, or that if they do, it is binge eating disorder.

It is also worth noting that eating disorders have a high cost; eating disorders have the highest mortality rate of all mental illnesses. This is especially true when afflicted individuals do not have access to appropriate and timely treatment, as is common amongst those whose disorders are not recognized or legitimized in the mainstream medical community. To reiterate: you cannot tell whether a person has an eating disorder based on appearances alone, and often restrictive and binge-purge type eating disorders are missed in fat people because of a lack of understanding of the complexity of the relationship between food behaviours and weight.

“Why not just avoid those restaurants where calories are posted?” some ask me. “Why not just frequent local, farm-to-table, restaurants?” Well, the truth is I can, and I often do. But there’s an aspect of privilege missed in this suggestion. The assumption that everyone has unlimited access to that kind of restaurant ignores food insecurity, accessibility, and time limitations. In raising concerns, I have been accused of suggesting that we create a trigger-free environment for “special snowflakes.” I ask, in return, what support is there for those attempting to manage their triggers and work through their (often deep-rooted and socially reinforced) issues with food, particularly when their distress may not be recognized by those in positions of power? Given the lack of appropriate and timely support for those with eating disorders – especially when they do not fit the stereotype – I say we need to be doing everything we can to avoid making life even more challenging for those who struggle.

I am commonly framed as not being empathetic to the plight of those who would like to know the nutritional content of their food. However, I recognize that sometimes, people are curious, and that some people genuinely find this information helpful. Even for some in recovery from eating disorders, tracking calories can help prevent undereating. Intuitive eating does not come easily, or ever, in some cases. But, I can’t help but wonder whether this information can be made available to those who wish to see it in another format – one that is not required viewing for all who enter a restaurant.

The onus is placed, here and often, on the consumer to be the one making “the healthy choice” – read: the low-calorie one. This is one of many examples of how we are forcing responsibility for health onto individuals without providing adequate resources for them to fall back on should the choice be more complicated. It isn’t really about the calories; it’s about how our society interprets peoples’ bodies and their decisions around what they eat.

 


Andrea LaMarre, MSc., is a PhD Candidate and Vanier Scholar (CIHR) in the Department of Family Relations and Applied Nutrition at the University of Guelph. She is also a blogger at Science of Eating Disorders, co-chair of the Waterloo-Wellington Eating Disorders Coalition, and an ASDAH board member. Her work focuses on how people in recovery from eating disorders and their supporters define and understand recovery, and how these lived experiences can contribute to building better healthcare systems for those who struggle with food- and body-related issues.

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