When I first noticed the calorie counts at my local pizza place, it changed the way I read a menu. I was no longer simply choosing something to eat: I was deciding whether I should eat at all.
Counting calories is a common habit among those with eating disorders, and as someone who has struggled with disordered eating all my life, I was no different. At my worst, I set daily limits and meticulously recorded the calories in everything I ate and drank so I could be sure to burn it all off later. If I wasn’t able to verify the calorie count in a certain food, I’d double the highest number I came across so that I couldn’t possibly end up with an intake over zero.
I didn’t go to the pizzeria looking for a healthy option; I went because it was late and I had no substantial food in my apartment. I know pizza is just a food, not inherently good or bad, and something to be enjoyed occasionally. But the numbers on the menu hung over me like threats. Though I’ve been trying hard to move away from obsessing over calories, having the information right in front of me brought a new level of shame to my decisions, sending me back into that same disordered mindset.
The calorie count for the walk-in pizza slices exceeded what I used to allow myself to eat in a day. I panicked and left without getting anything.
I wouldn’t have made that decision without the Healthy Menu Choices Act, a bill that came into effect on January 1, 2017. Under it, any chain restaurant with 20 or more locations in Ontario must prominently display calorie counts on its menu. The measure is intended to take the guesswork out of nutritional content so consumers can make informed and healthy choices. At that pizza place, I did what the Ontario government wants me to do: I didn't eat the high-calorie food. In fact, I ended up skipping dinner completely.
David Jensen, a spokesperson for the Ministry of Health and Long-Term Care, says reaction to the bill has been favourable. “We received positive feedback from many Ontarians who welcome the legislation and are happy to have the information needed to make healthier decisions,” he says. Jensen adds that the government cast a wide net when they developed the bill, speaking not only with restaurants, health professionals, and dietitians but also with people who shared their views on how the act would affect those with eating disorders. He did not, though, specifically name eating disorder advocacy groups or individuals with lived experience among those consulted.
Andrea LaMarre is a PhD candidate at the University of Guelph, where she researches eating disorder recovery. She feels that “the eating disorder voice was very much excluded from the initial discussions” and doesn’t know of any advocacy groups or research communities who were consulted. “It’s not like they’re out to get people with eating disorders — it’s just not on their radar at all,” she says.
In December 2016, LaMarre created a petition on Change.org, urging Premier Kathleen Wynne to repeal the act on the grounds that it is “detrimental to many individuals with eating disorders and in recovery from eating disorders.” The petition argues that displaying calories on menus encourages the “tracking and monitoring” behaviour that many people with eating disorders have. There are more than 1,000 signatures, and LaMarre plans to send comments from supporters to the premier.
Although the province has so far been unresponsive, LaMarre is grateful to have a conversation about eating disorder–related issues. She hopes that the attention generated by her petition can highlight the lack of support for people with eating disorders — 1.5 per cent of girls between the ages of 15 and 30 — and move the conversation beyond calorie counts.
Menu labelling is popular among Ontarians: A 2011 Ipsos Reid poll found that 95 per cent supported listing nutritional information on menus. And the ministry cited two studies that supported the legislation, both of which concluded that menu labelling influences food choices, reducing the amount of calories purchased or consumed.
But while listing nutritional information may be a more transparent approach, it also promotes the idea that a reduced-calorie diet is an inherently positive thing. Em Osborne, a gender studies student and body-positive activist in Kingston, Ont., says that counting calories isn’t the best metric for health, since it doesn’t take into account the nutrients in food. Instead, it focuses on staying within the average recommended limit of 2,000 calories.
“[You] can eat 2,000 calories a day, but it could be all donuts — which we understand isn’t healthy,” Osborne says. “But you stayed within your 2,000 calories. So isn’t that healthy, according to this idea of recommended calorie intake?”
And 2,000 daily calories is a pretty broad guideline: an individual’s recommended calorie intake will differ depending on age, height, weight, activity level, and basal metabolic rate. The Healthy Menu Choices Act acknowledges this by requiring a “contextual statement” on each label explaining that “individual needs vary.” But the statement doesn’t give any additional information on how to determine your own recommended limit or apply it to your lifestyle.
Jensen agrees that there’s more to healthy eating than knowing the caloric value of a food item. However, he believes that knowing the number of calories “is an important part of getting the right amount of energy people need every day, and can start the conversation about healthy eating.”
But Ben Donato-Woodger, who has recovered from anorexia, is concerned about what kids take from that conversation. “The issue is that [calorie information] doesn’t only go to adults, it also normalizes a way of thinking for kids, who might see calories as the be-all and end-all,” he says, rather than learning to understand and respond to hunger cues. For that reason, Donato-Woodger worries the Healthy Menu Choices Act may encourage disordered eating patterns in children.
Ontario’s health and phys-ed curricula for children in grades 1 to 8 and grades 9 to 12 include ways to apply “basic knowledge of basic nutrition principles and healthy eating practices … to develop a healthy eating plan,” and to understand the social determinants of health. Eating disorders, though, are only briefly mentioned in both curriculums, with discussion limited to disordered eating in relation to substance use, and possible signs of anorexia and bulimia.
“I feel the way that schools teach about eating disorders is too catastrophizing,” Donato-Woodger says. “It doesn’t recognize the spectrum on which people develop eating disorders, which is where you actually want to do the most education and prevention. There’s no focus on prevention in any of it.” He adds, “There needs to be some kind of education around diet discourse and the diet industry. We know that when certain industries normalize certain ways of thinking, it causes eating disorders.”
Rather than advocating that people keep track of their health and diet through calories, Donato-Woodger would like to see a different classification scheme, one that flags components like processed simple sugars and trans fats. But even then, he acknowledges that people from lower-income background can struggle to afford healthy food. “Telling them how many calories are in French fries is not going to change the fact that fries are a lot cheaper than buying potatoes that aren’t processed,” he says.
There’s also the problem of inadequate provincial support for people trying to recover from eating disorders. Only 12 of Ontario’s 4,100 psychiatrists specialize in disordered eating. And according to the National Initiative for Eating Disorders, there are currently only 20 beds across Ontario for adult in-patient treatment programs. Donato-Woodger says that if the Healthy Menu Choices Act is left intact, Ontario should commit to funding treatment. “I think the best-case scenario is to create space for a conversation about how the government could meaningfully help people with eating disorders.”
Iris Robin is a freelance writer in Toronto.
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