Useful for Some; Fatal for Others
Photography from a report into contemporary food design published in Disegno #8 (image: Nick Rochowski).
One medium apple: 81 (90, to be safe). A cup of watermelon: 50. A bagel: 165, 170 when rounding up. A slice of Margherita pizza: 290, so it might as well be 300.
As a recovering anorexic, I don’t need charts or information tags to tell me the calorie content of most foods. They are branded onto my subconscious through years of obsessive food behaviours – and I wish they weren’t. I’m not alone in harbouring this kind of encyclopaedic knowledge of how much energy foods contain. An estimated 1.25 million people in the UK suffer from eating disorders, and that number rises year on year, with the lower end of the age range decreasing at the same time. That’s disturbing, especially considering that anorexia has the highest mortality rate of any mental disorder. Ten per cent of anorexics don’t make it through the illness. Most sufferers of restrictive eating disorders are acutely aware of calories.
***
A short while after the UK’s prime minister Boris Johnson disappeared from the public eye having contracted Covid-19, he reemerged in July 2020 like a phoenix from the ashes with a new drive to Get Britain More Thin. “The urgency of tackling the obesity timebomb has been brought to the fore by evidence of its link to increased risk of Covid-19,” ran his Better Health campaign line, and so it was official: the man whom the nation’s right-wing press would have you believe could do nothing wrong supposedly got so ill because he was (self-admittedly) “too fat”, and so Britain must get thin. Fast. A verb as well as an adverb, sadly, and one of the keystones of the objectives set out for the nation. Useful for some; fatal for others.
A series of initiatives were put forward in record time, with the aim of saving the NHS £100m by encouraging overweight people to lose an oddly specific 5lbs. Proposed means to help people lose those 5lbs included a ban on junk food advertising before the watershed (fair enough); the launch of a weight loss app (scores of them already exist, but not an entirely terrible idea); and mandatory calorie counts on menus of restaurants with more than 250 employees (an entirely terrible idea).
While there are holes to be picked in all of the proposals, it is the mandatory calorie count initiative that has the potential to be the most destructive, and the hardest to avoid. One of the unexpected takeaways from the months that the UK spent in lockdown was that society suddenly became aware of the things it had been taking for granted. Time spent with friends; bags of flour; the gym; restaurants. Restaurants, we realised, are a cornerstone of British leisure culture. Much missed over their months of hibernation, their place in society was made clear by the fact that when restrictions eased and the Chancellor Rishi Sunak’s Eat Out to Help Out scheme [whereby diners could claim a 50 per cent discount on food and soft drink bills from participating restaurants to incite a boost in the hospitality industry, ed.] was introduced, 100m meals were eaten in restaurants under the scheme during August. That’s a lot of meals, and a lot of menus. Were calorie counts to be made mandatory in restaurants, most people would be unable to avoid them and, as a piece of national policy governing information design, its effects would be considerable. For me and the 1.25 million people like me who are affected by eating disorders, this aggressive form of societal control would be at best unhelpful and, at worst, potentially fatal.
Of course, a national policy to reduce obesity is important. There is undoubtedly good intention behind the government’s proposals, but they fail to take into account not only the sensibilities of restrictive eating disorder sufferers, but also the general human condition. Obesity and eating disorders are not separate issues: many obese people suffer from eating disorders, and in many cases obesity can be a symptom of eating disorder-related behaviours. Also, people don’t get fat because they don’t know the number of calories in things. Everyone already knows a Big Mac is packed with calories – McDonald’s has been putting it on the menus in its restaurants for years. Everyone still eats them. No-one is surprised to find out that a KFC bargain bucket is not a low-calorie option. This is to say nothing of arguments advanced by fat activists, either, who have challenged the idea that being overweight is always necessarily equivalent to being unhealthy. “[‘Fat’] is a neutral word,” noted the activist and comedian Sofie Hagen in a 2019 article for The Guardian. “If you look it up, it doesn’t say good or bad.”
A 2017 study led by Philippa Hay, chair of mental health at Western Sydney University’s school of medicine, found that anorexia accounts for around 8 per cent of eating disorder cases – not an enormous proportion, admittedly, but when you consider that binge eating disorder accounts for 22 per cent, bulimia for 19 per cent, and other specified feeding or eating disorder (OSFED) 47 per cent, it is unsurprising that many sufferers are already concerned about how a blanket policy such as the proposed calorie counts will trigger them. Eating disorder charity Beat published a report in June explaining why such strategies are “concerning” and why it does not believe the approach will prove effective, while a number of Change.org petitions have also been launched by eating disorder sufferers.
At the risk of overgeneralising, the stereotypical image of an anorexic counting calories is pretty accurate much of the time for many sufferers. As such, to see calorie counts boldly shouting out from the pages of a menu would be the essence of the overused word “triggering”. It could prompt a relapse for a recovering sufferer, or push someone already on the precipice of a very serious illness over the edge. Many people with eating disorders develop an obsessional focus on numbers: weight, clothing size, calories, fat grams, and body measurements. The constant struggle to control these numbers is unbelievably time-consuming, and something that must often be unlearned before the illness itself can be sent into remission. To be confronted with the numbers that I have tried so hard to put to one side would be a kick in the teeth for my recovery. Research supports my suspicions: a 2017 study by Ann Haynos and Christina Roberto found that people with anorexia nervosa or bulimia “ordered food with significantly fewer calories when the menu included a calorie count compared to when there was no calorie count stated, whereas people with binge eating disorder ordered food with significantly more calories when the information was provided”, which doesn’t sound encouraging for either camp.
When I reached out to other sufferers on Instagram about their views on calorie count on menus, the responses echoed my thinking. “I went through a period of my life suffering with an eating disorder and at the time I visited LA, which is actually the perfect place to have an eating disorder because so many restaurants would have the calories on the menu,” SJ, a recovered anorexia sufferer, told me. “Because of the extreme fear of numbers, I would even opt out of healthy things or just throw them back up because everything was a numbers game to me. I would be frightened to see those numbers on restaurants in the UK, because now I see eating out as a pleasurable experience and I know I would be counting in my head, adding everything up and fretting about numbers. I fear for those who have suffered longer and harder than me”.
SJ’s thoughts were almost identical to those of author Lydia Davies, who has written two books about her journey from being an anorexic on the brink of death, to a happy and healthy image of recovery. “After spending a near decade trying to re-train my brain to not associate food with numbers, by simply forcing myself not to look it up, I am now faced with the prospect of not having the choice. Eating out may go back to being a triggering, anxiety-inducing experience again,” she told me. “Part of recovery is learning to find pleasure in food again, and being able to enjoy the social aspect of sharing meals and eating out. To reach this point takes great courage, strength, hard work and time. I think it’s a real shame and extremely disappointing that eating disorders have failed to be considered in this drastic and damaging decision. It says a lot about how seriously mental health is really being taken, especially given the significant rise in eating disorders and other mental health illnesses during the pandemic.”
Davies’s second point resonates with me intensely. I entered a new round of therapy just before lockdown began in the UK. Not only could I not get outside to exercise, but the hospital where I have treatment was converted to a Covid-19 ward, forcing me to adapt quickly from the safety of my daily hospital sessions and supervised meals to the uncertainty of one Zoom call per week with my therapist. As society slowly emerges from this unusual period, with our “lockdown bodies” and our newfound social anxieties, there could not be a worse time for calorie counts to appear in what we are learning to savour as our leisure time. We do not need more anxiety.
It isn’t astonishing that eating disorder sufferers would be affected by the introduction of calorie counts on menus, but since the policy’s announcement and the subsequent backlash there has been little information about how menus will have to be redesigned to accommodate the numbers on the pages. Many restaurants take pride in the minimalism of their menus, often reducing dish descriptions to single words for the sake of style. How would such carefully designed documents look with clumsy numbers printed on them? The government has championed a “traffic light” system for labelling on supermarket food items (with a hard-to-ignore red hue for unhealthy items, and calming green for the “safer” options), which if applied to menus would make calorific food figures even harder to avoid for those who might be triggered by them.
Recent studies have shown that displaying calorie counts on menus actually has little or no impact on the ordering behaviours of the general population. ‘Estimating the effect of calorie menu labelling on calories purchased in a large restaurant franchise in the southern United States’ is a 2019 study published in the British Medical Journal, which found that while calorie counts did initially lead to a 4 per cent reduction in calories per order, “this association diminished over time”. I can relate to that. It’s like when someone discovers that drinking a glass of wine actually has more calories than they thought. They minimise their intake for a few weeks before eventually realising that they didn’t drink wine for dietary purposes anyway, and soon return to exactly how they were before.
I am aware that my ED-tainted lens means that I may not be the best-equipped person to speak on behalf of the general public. As such, I asked someone who is (self-proclaimed) overweight how they feel about the new proposal. “Restaurants are not the place to spread this message,” replied Andy. “It’s tokenistic. It would not affect my choices. I’m 42, male, fully aware that I’m already fat and unattractive, and I’m past caring. Calorie counts might have affected my choices when I was younger and cared more. That’s 300 calories, that’s 900 calories; I’m still going to be fat tomorrow – who cares?”
One of the reasons why calorie counts on menus would have been unhelpful for Andy, he says, is that he would most likely eat “smaller choices in company, and then secretly eat alone”. This has been a common finding in studies, with most calorie counters tending to make up for lost calories at restaurants when they get home – one of the main reasons why most dieticians and doctors warn against crash dieting, and why crash dieters often end up heavier than they were at the start of their calorie-counting “diet”. “I used to get the salad in public and grab a burger on the way home,” Andy told me. Even as an anorexic, I know the shame of eating alone late at night, having cut my calories during the day.
So, what might be more constructive? There is an unavoidable health issue in the UK that pertains to food intake. Government statistics on obesity for 2020 have shown that the majority of adults are overweight or obese – a figure that stands at 67 per cent for men and 60 per cent for women, and there can be no doubt that the issue has to be ameliorated. Clearly it would be shortsighted to attempt to tackle it solely by placing energy counts on menus, rendering restaurants off-limits to an entire section of society. A better angle could be to address information surrounding nutrition as opposed to the cold, hard data of the calorie count. Let’s not forget, you could eat an avocado and have consumed many more calories than if you had eaten a packet of Doritos.
Supermarkets have been under pressure to help curb the UK’s expanding waistline for years, for instance, and one of the most effective methods that has been implemented into our daily routine – and subconscious – is the aforementioned “traffic light” system, which grades supermarket items by calories, sugars, fats and salts. Someone with an eating disorder can pick up an item and the first thing that will catch their eye is the colour (if the salt level is in red, it may fall within your calorie allowance, but still be unhealthy), as opposed to focusing instantly on the number of calories, which is usually written in a small font underneath its percentage of an adult’s daily recommended allowance. The differing font sizes on the front of supermarket packaging nutritional information labels make the unavoidable numbers less affronting to eating disorder sufferers than a single glaring figure would be, and may be something that restaurants could take into account when they redesign their menus. Similarly, perhaps the numbers could be displayed on the reverse of the menus so that diners have the choice of engaging with the information or not.
“There are definitely people who could benefit from having the calorie figures available, but I see no reason that this can’t be something that is hidden on the flip of a menu or something that can be enquired about so that it doesn’t need to be right in the face as a huge potential trigger to anyone with an eating disorder,” says James, someone who is staunchly opposed to calorie counting having lost a lot of weight through doing anything but. “Things could simply be labelled as high calorie (with details available on request), as a more sensible and caring alternative that would cater to to all people without creating unnecessary stress for eating disorder sufferers.”
As our post-Covid leisure culture gradually gets back on its feet and more restaurants open, more opportunities to socialise become available to me, and I relish the freedom that they bring. I look at menus with the hope that all I will see in terms of numbers will be the price. I have eaten fish and chips in the park with friends, and, although I would have been able to work the calorie count out in my head, I didn’t; I ate a deep-dish pizza on a date, the calorie count of which would probably have totalled an entire day’s energy for me had I checked, yet I still went on to finish a full three meals that day. I am increasingly aware that my NHS eating disorder therapy finishes in a matter of weeks, after which I will have limited support from my eating support team unless I am re-referred to the service. The responsibility of preventing relapse falls solely on me, and the health strategies of the government. I am not alone in my position, and I feel the sensibilities of every sufferer in the same position as I am, even more so should the new policy proposals be implemented as they stand. As a society, we can’t afford to reduce one of our newly-permitted tastes of normal life to be reduced to a number.
Words Georgia Bronte
This article was originally published in Disegno #27. To buy the issue, or subscribe to the journal, please visit the online shop.