WINDHAM — I was approximately two years into my recovery from anorexia nervosa when I walked into a Panera Bread restaurant with my daughter to have a quick, post-lacrosse game dinner one late spring evening. Going out to eat was always difficult when I was trying to recover from my eating disorder, but the newly imposed Food and Drug Administration menu-labeling rule presented a new threat to my hard-earned recovery.
For many who are trying desperately to recover from a disease that demands our full attention to numbers (weights, calories in, calories out, BMI), our new health mindset requires us to ignore what a weight-phobic nation deems the most important value of food – calories. Now, standing in front of a menu-board full of choices where I once saw soups, sandwiches and salads to choose from, I simply saw my old foes – numbers – spontaneously stimulating the subconscious derision of an eating-disorder voice, demanding I choose a meal based on the lowest sum.
It has been just over a year now since the Affordable Care Act’s menu-labeling rule was put into practice by the FDA to address obesity in the United States. In an effort to provide consumers with more information about calorie content in foods eaten outside of the home, restaurant chains with 20 or more locations are now required to post the number of calories in their offerings both inside their menus and on their menu boards. The new FDA rule does not just involve chain restaurants, either – it also extends the menu labeling rule to takeout restaurants, vending machines, entertainment venues (e.g., movie theaters), cafeterias, coffee shops, grocery stores and more, making it impossible to ignore calorie content if one chooses to attempt to eat outside their home.
While it is true there are those who are required to be more thoughtful about their food choices as it relates to calories (e.g., diabetics), forced caloric awareness can be problematic for an equally vulnerable population – specifically those in danger of, diagnosed with or in recovery from deadly eating disorders. Eating disorders, such as anorexia nervosa, bulimia, binge eating disorder and orthorexia, affect an estimated 30 million Americans, and this number increases if people with subclinical disordered eating behaviors are included. Eating disorders historically have had the highest mortality rate of all mental illnesses, surpassed only recently by the opioid epidemic. Among the eating disorders, mortality rates are highest for those with anorexia nervosa; females ages 15 to 24 with anorexia have an annual death rate nearly 12 times higher than the death rate due to all causes of death among their peers without anorexia.
In a society that values thinness and even equates it with health, it isn’t any wonder that a misguided policy such as mandated menu labeling exists to aid Americans in choosing foods with lower calories to promote better health. It is important to note that just as one cannot determine someone’s overall health by their relative weight and size, neither is it accurate to judge the nutritive value of the food we eat simply by its measure of energy.
What’s more, in a recent study of the impact of menu labeling on food choice by people suffering from eating disorders, it was found that those diagnosed with anorexia nervosa or bulimia nervosa ordered significantly fewer calories when exposed to menu labels then when there were no labels, and they were more likely to choose items based on emotion (i.e. fear or anxiety) in the presence of the labels. In this same study, it was found that the foods chosen by those who did not have eating disorders did not reflect a significant decrease in the number of calories, with or without the calorie labels.
While obesity has been deemed a public health issue, one-size-fits-all policies that aim to address the needs of one population should be scrutinized to the extent that they potentially exacerbate the ill health of another at-risk segment of the population, particularly when the risk includes considerable rates of mortality. Therefore, it is critically important to (re)-consider whether the new menu labeling rule actually addresses the public health issue it is aimed at mitigating and to consider its negative impact on those afflicted with eating disorders.
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