The Food and Drug Administration (FDA) claims it is helping America stay healthy with the Patient Protection and Affordable Care Act's mandate to display calories on restaurant menus and vending machines. Recent studies have shown that this mandate actually has little or no impact on the ordering behaviors of the general population. What has yet to be addressed, however, is the deleterious effect of this mandate on the estimated twenty million women and ten million men who struggle with eating disorders during their lifetimes (Wade, Keski-Rahkonen, and Hudson, 2011). For those working toward recovery, this policy impedes a foundational part of their efforts.
Our culture is by no measure unaware of health and weight. In fact, by elementary school, 40-60 percent of girls are already concerned with their weight or afraid of being fat (Smolak, 2011). The cultural saturation of messages promoting thinness combines in a subset of individuals with genetic, biological, and social factors that make them vulnerable to the mental health condition most associated with fatality. Eating disorders can manifest in wide range, including anorexia nervosa, bulimia nervosa, and binge eating disorder.
Many people with eating disorders develop an obsessional focus on numbers: weight, clothing size, calories, fat grams, and body measurements. The preoccupation with numbers can consume their lives in a never-ending effort to count, cut, and control. Calorie counting is rampant among the various forms eating disorders can take. Unfortunately, this behavior is not only a potential symptom of an eating disorder—it is one that exacerbates the disease. When people are deprived or restricted, they are at dramatically increased risk of binge eating. This is because of a built-in survival mechanism that tells people to seek sources of fat and sugar for energy to prepare for the next famine. When they experience deprivation, efforts to store energy kick into gear, which can lead to a cycle of binge eating, guilt and shame, restriction, and in some cases purging. At this point the body once more perceives deprivation, and the cycle begins again.
A fundamental part of recovery from an eating disorder, then, is avoiding the focus on numbers and learning to provide the body with consistent nutrition. As a clinical psychologist working with eating disorders, I ask my clients to stop weighing, stop counting, and stop eliminating entire foods or food groups. I ask them to go back to restaurants that they have avoided in their efforts to control their bodies and behaviors. I ask them to learn to trust themselves. The FDA is training them not to.
The FDA's mandate to display calories has a devastating effect on the recovery of those who seek to heal from this disease. Put aside the fact that a calorie count is not representative of the nutritional value or nutrient content of the meal. This initiative perpetuates the idea that numbers should be a focal point in managing health. The message that these individuals fight to correct in therapy is reinforced every time they step into a chain restaurant and see long lists of calorie counts. To avoid this message, people with eating disorders would have to avoid a vast number of food establishments, further limiting the lives they are working so hard to expand.
For those who do continue to dine out, another consequence presents itself. Both my underweight and obese clients say they experience increased shame when they see calories posted next to food they may wish to order. For those with anorexia, this tends to reinforce the idea that avoiding the food is noble and strong. For those who binge eat, some say they avoid what it is they truly want as a result of the shame and end up binge eating later. Others make the ordering choice that they would have made without the calories posted, but feel worse about themselves afterward. This may sound like it would deter people from making certain ordering choices, but shame (unfortunately or not) is seldom an effective tool in behavior modification. If it were, eating disorders and many addictive disorders would have ceased to exist long ago.
There is also a subset of individuals with eating disorders who choose to push back against the constant messages they receive, both internally and externally, about what to eat. These clients tell me that they react to the information on the menus by tossing caution to the wind and ordering out of resentment and rebellion, trying to prove a point to an audience they cannot see or name.
With calorie counts fueling both shame and the pursuit of an arbitrary definition of health, my clients find themselves listening to numbers instead of to their bodies. Many of my clients tell me they do not even read the food descriptions on menus anymore—they skip straight to looking at the calorie counts, and pick whichever item has the lowest caloric content. While nutritional and psychological therapy works to help individuals with eating disorders eat intuitively, caloric labeling urges them to base their food decisions on a piece of data that is separate from individual nutritional needs.
Health is a noble pursuit, and one I certainly support in all of my clients. However, forced awareness of caloric content in pursuit of health is misguided. Not only does it suggest that thinness is the primary measure of health—which research repeatedly shows is not the case—but it impedes movement toward true health in a population at high risk. As is usually the case, one-size-fits all public policy, even with the best of intentions, always carries with it unintended consequences.