Obesity, eating disorders and calorie counting on menus: implications for young people
This blog originally was written for and published by the Association for Young People's Health, April 2022. Thanks to First Steps and The International Society for Psychotherapy and Counselling. Original blog HERE
New changes to food labelling may have particular implications for young people who experience over weight or eating disorders. Jeremy Sachs outlines the issues…..
Public health interventions
As of April 6th 2022, restaurants, cafes and takeaways with over 250 staff have been required to print how many calories are in meals on their menus, websites, and delivery apps (Just Eat / Deliveroo etc.) At the same time, NHS England plans to open 15 new Complications from Excess Weight (CEW) clinics for children and youth across the country, in line with the NHS Long Term Plan. According to the NHS website, Part of this longterm plan is to:
“provide a targeted support offer and access to weight management services in primary care for people with a diagnosis of type 2 diabetes or hypertension with a BMI of 30+ (adjusted appropriately for ethnicity), where we know we can have a significant impact on improving health, reducing health inequalities and reducing costs”
One group to be affected by the prevalence of obesity is children and young people. Among four and five-year-olds it rose from 9.9% in 2019-20 to 14.1% in 2020-21. Among 10 to 11-year-olds, the increase is from 21% to 25.5% in the same period. Excess weight in children and young people comes with multiple physical health complications, as well as concerns to specific to this age group. The first indicators of longterm health conditions begin at this age, including ¾ of life long mental health disorders – poor healthcare at this time can echo throughout a young person’s adulthood.
While the effectiveness of the CEW clinics remains to be seen, criticism of calories on menus has been loud. Partly, this has been questioning its effectiveness. One older study in the US observed only “…a small decrease in mean calories purchased per transaction (approx. 60 calories) after implementing calorie labelling in a large franchise of fast-food restaurants. This reduction diminished over one year of follow-up.
Nutritionally too, it misses some critical factors about the importance of food; fibre, carbs, proteins etc. However, the criticism that chimes the loudest in the psychological world is the effect calorie counting will have on eating disorders and particularly young people living with them.
I spoke with Zoe Burnett, board member of the International Society of Psychotherapists and Counselling and Specialist Support Officer at First Steps, who work across the midlands and the rest of the UK, providing care and support for children and their families, young people and adults affected by eating difficulties and disorders. She says that “…one in four young people who start to count calories develop disordered eating.” She tells me about working with young people specifically to not count calories, as part of recovering from an eating disorder. She fears listing calories on menus will catalyse the eating disorder voice that fuels destructive and sometimes fatal behaviours around food.
“What helps your young people with eating disorders?” I ask her. “Trained professionals who can work holistically, peer support and support with mental health,” she answers.
These interventions don’t only benefit young people with eating disorders. On April 6th 2022, the Association for Young People’s Health (AYPH) published their work with SHINE Academy, highlighting the needs of young people and parents living with excess weight issues. AYPH carried out engagement work with young people and their families and a scoping review of existing research on young people’s perspectives on excess weight and related health services. A summary of both reports says young people living with excess weight issues value:
An appreciation of and response to the mental health elements of their experiences.
Healthcare staff and doctors who explained things clearly, “in a way I understand,” with an empathic and non-stigmatising approach
Peer support is safe community settings
These findings appear to mirror the needs of Zoe’s young people at First Steps managing eating disorders. The message from both groups of young people with excess weight and eating disorders seems clear, it is essential to work holistically, be mindful of how mental health affects eating behaviours, enable access to empathic professionals and peers, and put young people’s voices at the centre of their own support and healthcare.
This also leaves the question of whether, if there is a similarity in what young people want in their treatment, could that also be reflected in the risk factors for both issues? A study from 2006, Prevention of obesity and eating disorders: a consideration of shared risk factors,  pointed to psychosocial pressures; media, weight-related teasing etc, and suggests that “identification of risk factors that are shared among these weight-related disorders is an essential step to developing effective prevention interventions.” Yet they are still viewed and, in some cases, treated differently in health services, as either psychological (eating disorders) or physiological (obesity).
It remains to be seen whether calories on menus impact the way young people eat in the UK. However, with the absence of young people’s voices in the public health decision-making, there is a real fear among youth workers, therapists, and charities it will have the wrong kind of impact, by encouraging eating disorders or exasperating shame around weight.
For more information on eating disorders
 https://www.bbc.co.uk/news/business-60989825  https://www.longtermplan.nhs.uk/online-version/chapter-2-more-nhs-action-on-prevention-and-health-inequalities/obesity/  https://digital.nhs.uk/data-and-information/publications/statistical/national-child-measurement-programme/2020-21-school-year  Estimating the effect of calorie menu labeling on calories purchased in a large restaurant franchise in the southern United States: quasi-experimental study  https://www.nationaleatingdisorders.org/blog/voice-your-head  Jess Haines, Dianne Neumark-Sztainer, Prevention of obesity and eating disorders: a consideration of shared risk factors, Health Education Research, Volume 21, Issue 6, December 2006, Pages 770–782, https://doi.org/10.1093/her/cyl094