Think Twice. Should You Really Eat That?

Sylvia Gonsahn-Bollie, MD

I'll never forget the day I ran 13 miles, only to find myself afterward staring at a menu with calorie counts. After my run, I was famished, so I hurried into the first restaurant I could find. It happened to be a popular fast-food restaurant where everyone makes happy childhood memories.

For nostalgia, I planned to order the breakfast platter. However, as I was about to order, I noticed that the platter contained 1440 kcal. That was more calories than I had burned in my 13-mile run! It wasn't worth all the energy I spent running. So, I decided to order a satisfying breakfast sandwich that contained a third of the calories.

My behavior is the type of change that proponents of including calorie counts on menus hope will occur.

In April, Britain became the most recent country to legislate adding calories to menus. However, listing calories on menus is not a new concept. In the United States, the Affordable Care Act has required calorie listings on menus at restaurants with more than 20 locations since 2018. As a result, we are seeing minor impacts on individual food consumption due to menu labeling.

As an obesity specialist specializing in personalized lifestyle optimization strategies, one of my keen interests is creating effective strategies to change unhelpful eating behaviors. Furthermore, I have maintained a significant amount of weight loss for over 8 years. Also, I have years of personal experience with reading calories on menus. So I'm enthusiastic to share my opinions.

New Law, Old Concept

According to Bloomberg, Britain hopes that the measure will improve the country's high obesity rates. Theoretically, viewing the calories on menus decreases caloric intake and eventually reduces obesity levels. The great thing about rehashing an old idea is we can check the data instead of relying on idealism.

In the United States, data on calorie labeling before the FDA enforcement of menu labeling showed little to no impact on calorie intake. However, more recent studies have shown that caloric intake has decreased by 4% at fast-food chains since the US national implementation of menu labeling. Unfortunately, it's too early to see statistically whether there has been any impact on obesity rates.

I suspect that the pandemic weight gain has pushed some people to look at little more closely at the menu labels. We may start to see some benefits of menu labeling within the next few years.

Calorie Counting Isn't Enough

Although nutrition optimization is a significant part of addressing obesity, focusing on "calories in" vs "calories out" isn't adequate. There are over 70 contributors to the energy imbalance that leads to obesity. Nutrition is just one factor.

Furthermore, we must be aware of unintentionally contributing to weight bias. Weight bias is negative stereotypes about an individual based on their weight. People with obesity and minorities are disproportionately affected by weight bias. Specifically, there is an outdated notion that obesity is just a "lifestyle choice." Focusing only on calorie consumption can reinforce the misconception that obesity is a "lifestyle choice" instead of a complex multisystem disease. Moreover, nutrition choices do not occur in a vacuum. Similarly, racism and social determinants of health also contribute to the obesity epidemic and food choices by affecting access to equitable healthcare, healthy foods, safe neighborhoods, and more.

Only focusing on calories without consideration of overall nutrition content is shortsighted. First, all calories aren't equal. Calorie-counting focuses on the quantity of food. Newer studies show that optimizing food quality is critical in obesity management.

For example, a decadent dessert may have the same calories as a superfood salad. But nutritionally, they are different.

Lastly, individual needs vary. The suggestion is to list the statement, "Adults need around 2000 kcal/d" on the menu. However, the 2000 kcal daily requirement is misleading. Specifically, individual caloric requirements vary depending on your health goals. For example, individuals seeking to lose weight may need to decrease their daily calories by 250-500 kcal/d. Therefore, providing a wide range of daily caloric intake would be more helpful. For example, a new statement should say, "Adults require 1200-2000 kcal/ d. Seek clinical advice for your individual needs."

Human Behavior Is Complicated

"I know I shouldn't eat it, but…." I wish I had a diamond for every time someone says that phrase. Unfortunately, the reality is that many people are aware that certain foods aren't the most nutritious choice. Therefore, menu calorie listings are confirmation but not a deterrent from eating less healthy foods.

Many factors, from habits to hormones, affect human food consumption. For example, hormones such as leptin and ghrelin drive our appetite. But obesity is one of many factors that can lead to hormonal dysregulation that affects physical hunger. Additionally, psychological factors also affect influence hunger and eating behaviors. One example is emotional eating. Eating to celebrate or to soothe emotional pain is an often overlooked driver for consuming excess calories. Lastly, old ordering habits are hard to break. Routine ordering and traditions may explain why people continue to order the same foods despite menu labeling.

Given the complexity of human behavior, labeling the menu may not be enough for meaningful change. Individuals may need to find ways to form new habits, such as trying new restaurants or menu items. Restaurants may need to provide attractive healthier options, reduce portion sizes, or omit certain unhealthy items.

More Than Numbers: Mental Health Implications

Mental health advocates raise concerns that menu labeling may be harmful to people with eating disorders or disordered eating. I agree that calories on menus can be triggering for some people. I am a former chronic dieter and calorie-counter. Now I support other high-performing women healing from disordered eating and eating disorders. It is crucial to put safeguards such as unlabeled menus in place. Also, clinicians can check in with vulnerable patients to assess the impact of menu labeling.

Some Final Thoughts

The COVID-19 pandemic collided with the preexisting obesity pandemic in 2020. It was a startling reminder of why our wellness can't wait. People with obesity and other metabolic diseases are more likely to have complications of COVID-19. If we want a healthier future, it is imperative we optimize our health now by effectively addressing obesity and metabolic diseases.

Proponents of menu labeling are optimistic that it will lead to changes to reduce obesity. Unfortunately, it will take many years to see the impact of menu labeling. Even still, it is essential to recognize menu labeling is just one component of addressing obesity. Obesity is caused by more than "calories in" vs "calories out." Obesity is a complex disease with external and internal influences. Addressing obesity requires both public health and individualized strategies.

Lastly, in our zeal to optimize health by reducing the obesity epidemic, we must never forget the humanity of people living with obesity. Obesity is a disease, but it doesn't define the person. People are not obese. People have obesity.

Sylvia Gonsahn-Bollie, MD, DipABOM, is an integrative obesity specialist, specializing in individualized solutions for emotional and biological overeating. Connect with Dr Bollie at www.embraceyouweightloss.com or on Instagram @embraceyoumd. Her bestselling book, Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness is Healthline.com's Best Overall Weight Loss Book 2022 and Livestrong.com's The 8 Best Weight-Loss to Read in 2022.

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