BY: Abby Liles

DATE: 24 April 2017

A study published in the International Journal of Eating Disorders by Drs. Ann Haynos and Christina Roberto evaluated the outcomes of calorie labeling on restaurant menus in individuals with eating disorder symptoms and threshold eating disorders. Few studies have examined the potential negative effects that calorie labeling may have on individuals who have eating disorders or who are vulnerable to developing eating disorders. Public health concerns have largely been directed towards reducing the prevalence and incidence of obesity in the United States by implementing calorie labels in restaurants (FDA, 2014). The goal of the Haynos and Roberto study was to assess how individuals who reported eating disorder symptoms or frank eating disorders selected restaurant items in the presence or absence of calorie labeling.

The study was conducted at a mid-size university, and participants completed the study through online surveys. Women over the age of 18 were eligible to participate. The measure used to assess for eating disorder characteristics was the Eating Disorder Examination Questionnaire (EDE-Q). Two primary variables were used to account for eating disorder characteristics: global eating disorder symptoms and an eating disorder diagnosis. The global EDE-Q score reflected self-reported eating behaviors and evaluation of restraint, eating concerns, weight concerns, and shape concerns. The eating disorders captured were anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) (Fairburn & Beglin, 1994).

After completing the EDE-Q, participants were randomly assigned to a survey that either presented menu choices with calorie amounts attached to food items, or menu choices with no calorie amounts included. The menu items were derived from widely known restaurants in the United States, and included appetizers, main entrees, side dishes, desserts, and drinks. Participants were instructed to base their food choices off of personal budget and what they would realistically order in a restaurant. After choosing menu items, participants were asked to answer another series of questions, which included items such as perceived healthfulness of the restaurant, liking of menu items, importance of taste, importance of health/nutrition, and importance of emotion when ordering menu items.

The sample included 718 adult women (age range = 18-71). Based on EDE-Q criteria, 7 individuals exhibited symptoms for AN, 23 for BN, and 66 for BED. Due to the small number of individuals with AN or BN, participants were classified into three groups: AN/BN, BED, or no eating disorder diagnosis.

Results indicated that individuals diagnosed with AN/BN restricted their calories more when presented with calorie amounts than individuals with AN/BN who were not shown calorie amounts. Individuals with BED consumed more calories when presented with calorie amounts than individuals with BED who were not shown calorie amounts. Individuals who were not diagnosed with a specific eating disorder but showed signs of disordered eating did not change calorie intake in the presence or absence of calorie amounts. Additionally, individuals with AN/BN reported lower likelihood of choosing foods based on taste, and higher likelihood of choosing foods based on health/nutrition and emotion compared with individuals with no eating disorder.

Overall, this study suggests that including calorie amounts on restaurant menus may exacerbate eating disorder symptoms for individuals who already have an eating disorder. When presented with calorie information, individuals with AN or BN are more likely to restrict their calorie intake, whereas individuals with BED are more likely to increase their calorie intake. A major limitation of this study was that the scenarios presented were only hypothetical, which may be different from how participants would order in actual restaurants. However, this study presents important implications for future policy research for how to address obesity as well as eating disorders. This study also highlights the unexpected and potentially adverse effects that calorie labeling have on individuals with eating disorders.