Petitioning Premier of Ontario: Repeal the "Healthy Menu Choices Act"
In January 2017, the Healthy Menu Choices Act will come into force. Under this Act, chain restaurants (defined as those with 20 or more locations) will be required to prominently display nutritional information on their menus. Calorie counts will be listed in a font size at least as large as the price of the item. The act is unspecific regarding other nutrition information. We oppose this Act on the grounds that having calorie counts prominently displayed on menus will be detrimental to many individuals with eating disorders and in recovery from eating disorders.
A conservative estimate of the prevalence of eating disorders is 1-3%. While this figure may not sound impressive, it equates to approximately 130 000 individuals when extrapolated to Ontario’s population. Importantly, this figure does not include those who are never diagnosed with eating disorders because of the significant barriers to obtaining a diagnosis (including stigma, shame, and lack of physician training to address and diagnose eating disorders in all but the most obvious and stereotypical of cases). Eating disorders carry the highest mortality rate of all mental illnesses, and have significant impacts on the quality of life and health status of those suffering and their family members. Those with eating disorders, at risk for eating disorders, or in recovery from eating disorders will be negatively impacted by legislation that forces them to encounter caloric information whenever they look at a menu.
The argument will be made that obesity is of graver concern than eating disorders right now in Ontario and worldwide. We encourage a separation, however, between a body size and a mental illness. Anyone, regardless of body size, ethnicity, socioeconomic status, gender, ability, etc. may experience eating disorders - including restrictive eating disorders. Further, those who are most targeted by such initiatives may actually be at a greater risk of developing eating disorders. A recent study by Lebow, Sim & Kransdorf (2015) revealed that adolescents who had been overweight or obese “represent a substantial portion of treatment-seeking adolescents with restrictive eating disorders,” and argue that extreme weight loss is problematic in the adolescent context in particular.
We argue that this act is unhelpful insofar as it positions caloric content as the most important aspect of decision-making around food. This is a dangerous perspective regardless of a person's body size or the presence or lack thereof of an eating disorder. Dietary science is continually in flux, particularly where weight loss is concerned. Researchers disagree about the relative importance of calories in overall health. We know still less about the effects of displayed calorie counts on both health behaviours and health outcomes. Leaving aside a debate about whether weight loss is a desirable outcome, we should consider whether implementing calorie counts on menus actually leads to the suggested outcome: a reduction in overall caloric intake.
The evidence around the effectiveness of providing calorie counts on menus is limited and conflicting (Capacci et al., 2012; Sacco, Lillico, Chen & Hobin, 2016). While some researchers suggest that providing calorie counts on menus will reduce overall caloric intake (e.g., Pulos & Leng, 2010) and argue for policy changes like the Healthy Menu Choices Act (e.g. Roberto, Larsen, Agnew, Baik & Brownell, 2010), others suggest that attempts to change behavior by offering information is unlikely to lead to long-term change, if it has an impact at all. For adolescents in particular, "providing menu labels in their current format may not be an effective strategy to increase healthy food selection" (Evans, Weiss, Meath & Chow, 2015). Researchers have found that the implementation of calorie counts on menus leads to no change (Tandon et al., 2011).
Beyond being ineffective, we argue that providing calorie counts on menus will be harmful to a significant segment of Ontario’s population. The assumption that underpins such legislation is that a reduction in caloric intake is necessarily a positive thing. These efforts are put forth in the interest of reducing obesity by reducing calories; providing calorie counts does nothing to provide information about eating in tune with bodily cues, honouring hunger and fullness, and engaging in healthful behaviours.
The impact of calorie counts on menus on people with eating disorders and in recovery has not been studied directly. We can, however, draw obvious links between the tracking and monitoring behavior many with eating disorders engage in and the danger of calorie counts on menus. People with eating disorders are often meticulous about intake: common symptoms of eating disorders include reducing amount of food, following strict food rules (including calorie count limits), food rituals, social competitiveness around eating, feeling guilty after eating, and more (Treasure, Claudino & Zucker, 2010).
People with eating disorders cannot simply “choose not to look” at calorie counts on menus. By having this information readily available and prominently displayed on menus, those with eating disorders and in recovery are confronted with numbers that can impact their choices and, consequently, their health. Many seeking to recover from their eating disorders will be actively working to challenge themselves to eat foods for which they do not know the nutritional content; this is often a step forward in recovery that this legislation precludes.
We urge you to repeal the Healthy Menu Choices Act, which infringes on the mental and physical health of people living with and in recovery from eating disorders. Given the lack of evidence for the effectiveness of calorie counts on menus and the possible danger of this information, this Act is highly problematic and should be reconsidered.
While the research supports our argument, it does not capture the experiences of those who will be impacted by this Act. Amanda Acchione's story captures the challenge of navigating this world.