Calorie Counting Regulations take wrong approach to tackling obesity
As Parliament winds down for summer recess, I’m gearing up for my first ever regret motion, setting out why I believe the impending Calorie Labelling Regulations take a wrong-headed approach to the obesity challenge.
I fully support government’s commitment to addressing the worrying levels of overweight and obesity. My concerns are not with the Regulations’ underlying intentions; my concerns are that evidence and lived experience suggest they will have little impact on reducing obesity at a population level, while causing significant harm to people with, or at risk of, eating disorders.
Eating disorders are not a niche condition. They affect 1.25m UK citizens, people of all ages, backgrounds, ethnicities and genders, and have the highest mortality rate of all mental health conditions. Obesity is not a mental illness, but many people live with both: Professor Gerome Breen, leading the EDGI study to better understand genetic and environmental risks for eating disorders, suggests 30 per cent of people with extreme obesity also have a diagnosable eating disorder. This complex interface between the two needs to be taken into account in identifying strategies and solutions to tackle obesity.
And yet the government’s obesity strategy takes a simplistic, "personal responsibility" approach that assumes we all have volitional control over our body weight. This is just not true: metabolism, environment, poverty, psychology and genetics all play a part, with hundreds of genes implicated in obesity and, in some cases, influencing up to 80 per cent of a person’s predisposition to be overweight. Last year, 100 obesity specialists signed up to a statement saying "the assumption that voluntarily eating less and/or exercising more can entirely prevent or reverse obesity is at odds with a definitive body of biological and clinical evidence developed over the last several decades".
While studies supporting calorie labelling are (according to government’s Impact Assessment) "of questionable quality" with "mixed results," the evidence of negative consequences for eating disorder sufferers is strong. Labelling drives people with anorexia and bulimia to eat less and people with binge disorders to eat more. It leads to unhealthy behaviours like use of laxatives, diet pills or vomiting after food. And it increases the risk of disorders developing in the wider population.
When I was unwell, restaurants terrified me
Calorie counts are also a poor indication of nutritional value. Food is digested differently, depending on how it’s processed and cooked. For the geneticist Dr Giles Yeo, "the important question is not how many calories, but how many usable calories, through digestion and metabolism, can your body extract from it". Professor Tim Spector’s research on twins shows huge variations in the amount of energy we each extract from the same food. Why count calories, when calories don’t count?
Unless you have had, or been close to, the lived experience of eating disorders, it’s hard to understand the extent to which calorie counting overtakes lives. In the eating disorder charity Beat’s survey of affected people, 1,118 people, 93 per cent of respondents expressed dread of the consequences of these Regulations. One described her disorder as "thriving off counting calories," an all-consuming obsession that "ruined my life". Recovery is fragile, with learning to eat in public a key part of the pathway. Typically, this takes place in exactly the affordable restaurant chains these regulations affect.
Another wrote "When I was unwell, restaurants terrified me. Despite panic attacks, I overcame that fear. Had there been calorie counts on the menu, I don't know if I’d have coped." In total, 4,484 eating disorder sufferers wrote to 630 MPs bravely sharing their stories.
Some will argue that public health campaigns always involve trade-offs, with inevitable small harms to some the price of larger gains for many. The slight risk associated with my mammogram is outweighed by the benefits of being screened for a disease for which I have an actual risk. But is it ethically justified for a public health measure to hurt people with no risk of the disease? If labelling was likely to significantly reduce obesity levels, the prioritisation of physical over mental health that these regulations represent might be justified. But all the evidence suggests it will not.
We need instead an integrated approach to weight-related problems across the spectrum, bringing together eating disorder and obesity experts to develop strategies that effectively address the needs of one part of the community without compromising the health and wellbeing of another. Without this, we abandon that fundamental ethical principle, of "first, do no harm".
Baroness Bull is a crossbench peer
If you’re worried about your own or someone else’s health, you can contact Beat, the UK’s eating disorder charity, 365 days a year on 0808 801 0677 or beateatingdisorders.org.uk
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