Table 1 Studies reporting qualitative and quantitative data relating to participants experiences and support vs. opposition for calorie labelling.
From: Does menu calorie labelling cause or exacerbate eating disorders?
Study | Sampling approach | Participant informationa | Methodology | Results relating to eating disorders |
|---|---|---|---|---|
Qualitative studies | ||||
Duffy et al. [6] | 11 participants Online interview England Must have experienced an ED in past or currently have an ED (self-reported) | 5 recovered from ED (100% Female) 6 current ED (83% Female) Age 18+ | Open-ended questions examining participants experiences and opinions of calorie labelling ‘Can you talk me through a recent experience you have had of calories on menus and the impact (if any) this had on your eating disorder symptoms?’ ‘How has the introduction of the policy impacted your eating disorder symptoms?’ ‘Have you found any strategies (if required) that have helped at this time?’ Self-report | Negative effects of calorie labelling Six themes established, all themes found negative impacts of calorie labelling for those with EDs: Theme 1: A personal attack on those with EDs Theme 2: Placing calories in the spotlight Theme 3: Normalising calorie counting Theme 4: Making appropriate meal choices more burdensome Theme 5: Negatively impacting ED symptomatology through loudening ED thoughts and altering food choices Theme 6: Strategies now needed to deal with calorie labelling Benefits of calorie labelling No benefits were identified |
Frances et al. [7] | 399 participants Online survey UK Must have experienced an ED in past or currently have an ED (self-reported) | 91% Female, 5% Non-binary, 2% Non-conforming, 2% Male, <1% preferred not to say Age 16+ | Open-ended survey questions examining experiences, challenges and impacts of calorie labelling Self-report | Negative effects of calorie labelling Five out of the six themes established found negative impacts of calorie labelling for those with EDs: Theme 1: Negative impact on relationships /increased tension when eating out Theme 2: Exclusion and increased isolation from eating out, increased shame Theme 3: Restricted food freedom Theme 4: Dis/embodiment; food chosen was not what was actually wanted/needed, but selected because of the calories Theme 5: Anger that calorie labelling is seen as beneficial for health which does not reflect participant experience Benefits of calorie labelling One of the six themes established found positive impacts of calorie labelling for those with EDs: Theme 6: Increased feeling of control, responsibility and accountability for their recovery / helping reduce anxiety |
Putra et al. [8] | 1273 participants Mixed methods Online survey UK, fluent English Must have past or current GP diagnosis of mental health condition (including ED) | 583 with an ED (75% Women, 21% Men, 4% Non-binary/ other) Age 18+ Mean age 32 | Free-text responses relating to perceived effects of calorie labelling policy on current ED symptoms Self-report | Negative effects of calorie labelling Two of the four themes established found negative impacts of calorie labelling for those with EDs: Theme 1. Hyper-fixation on calories and potential relapse from ED recovery Theme 2: Negative effects on mood through increased guilt and anxiety, and reducing enjoyment of eating out Benefits of calorie labelling Two of the four themes established found positive impacts of calorie labelling for those with EDs: Theme 3: Increased feelings of reassurance and feeling informed about foods Theme 4: Feeling in control of eating and enabling planning of food intake |
Raffoul et al. [9] | 13 university students Campus-based menu labelling study Semi-structured one-to-one interviews Canada ED status not reported. Please insert new subheading below this row titled 'Quantitative studies' | 10 Women, 3 Men Mean age 19 | Closed and open-ended questions examining participants experiences and feelings about calorie labelling ‘Can you name a specific time when you saw calorie labels and tell me how you felt or reacted?’ ‘Can you tell me about how seeing labels with calorie content makes you feel, considering your relationship with food?’ Self-report | Negative effects of calorie labelling Two of the four main themes established found negative impacts of calorie labelling: Theme 3: Labels affect their own or others’ relationship with food by exacerbating EDs, causing shame around eating and leading to calorie fixation Theme 4: Labels lead to an increase in disordered eating thoughts and feelings of shame and regret around food choices Benefits of calorie labelling Within Theme 4 some participants also described how labels may help reduce shame around food choices by providing information and thus reducing ‘overconsumption’ and the associated guilt |
Quantitative studies | ||||
Frances et al. [7] | 399 participants Online survey UK Must have experienced an ED in past or currently have an ED (self-reported) | 91% Female, 5% Non-binary, 2% Non-conforming, 2% Male, <1% preferred not to say Age 16+ | One closed question exploring challenges of calories on menus: ‘Have you experienced challenges due to having calories on menus?’ Self-report | 91% had experienced challenges because of calories on menus |
Putra et al. [8] | 1273 participants Mixed methods Online survey UK, fluent English Must have past or current GP diagnosis of mental health condition (including ED) | 583 with an ED (75% Women, 21% Men, 4% Non-binary/ other) Age 18+ Mean age 32 | Examined acceptability and perceptions of calorie labelling policy through Likert scale questions ‘Businesses like restaurants, fast food outlets and coffee shops should be required to display the calorie content of their foods on menus or menu boards.’ ‘Seeing calorie information on menus or menu boards will make my eating disorder symptoms…’ ‘I will feel anxious if I see calorie information on menus and menu boards when eating out.’ ‘Compared to eating out without calorie labelling information, calorie labelling will make me feel more guilty when eating out.’ ‘Compared to eating out without calorie labelling, calorie labelling will make me feel more afraid about eating out.’ Self-report | 43% of participants with an ED agreed or strongly agreed with implementation of calorie labelling policy, 11% were neutral, 46% disagreed or strongly disagreed 55% of participants reported calorie labelling may worsen ED symptoms 63% of participants with an ED agreed or strongly agreed that seeing calorie information would make them feel anxious when eating out 70% of participants with an ED agreed or strongly agreed that seeing calorie information would make them feel more guilt when eating out 52% of participants with an ED agreed or strongly agreed that calorie labelling would make them feel more afraid about eating out |
Raffoul et al. [9] | 13 university students Campus-based menu labelling study Semi-structured one-to-one interviews Canada ED status not reported | 10 Women, 3 Men Mean age 18 | Closed and open-ended questions examining participants experiences and feelings about calorie labelling ‘Can you name a specific time when you saw calorie labels and tell me how you felt or reacted?’ ‘Can you tell me about how seeing labels with calorie content makes you feel, considering your relationship with food?’ Self-report | 100% identified at least one negative impact of calorie labels on either their own and/or others’ relationship with food 38% stated calorie labels may be harmful for those with EDs or lead to more people developing an ED 85% of participants supported calorie labels and their implementation |
