A systematic review of 16 studies suggests that mandatory out-of-home nutrition labels may reinforce disordered eating behaviors, raising concerns for policymakers.

Study: Impact of out-of-home nutrition labelling on people with eating disorders: a systematic review and meta-synthesis. Image Credit: Danicek/Shutterstock.com

In a recent review article published in BMJ Public Health, researchers summarized what is currently known about how nutrition labeling by restaurants and other food businesses affects people with eating disorders.

While these interventions are put in place to target obesity, they may negatively affect people with restrictive eating disorders. These unintended consequences must be considered by policymakers looking to improve public health.

A global obesity epidemic

The World Health Organization estimated that one in eight people in the world lived with obesity in 2022; since 1990, adolescent obesity has quadrupled, while adult obesity has more than doubled. People living with obesity are at a higher risk of developing multiple health problems, including certain cancers, stroke, heart disease, and diabetes.

In efforts to control the global obesity epidemic, governments have introduced several policies to reduce calorie intake. In recent years, countries such as England have implemented measures that require food-serving businesses like restaurants to add calorie labels to their products.

Though these policies are aimed at reducing obesity, they could also negatively affect people living with eating disorders that often result in disturbed eating behavior and are associated with concerns regarding body image.

Nutrition labels contain details regarding calorie intake, which could increase stress for people with restrictive eating disorders when they eat out.

Since eating disorders such as binge eating often co-occur with obesity, they could even exacerbate the issue they aim to solve. The negative health impacts of a policy must be balanced against its possible benefits. Therefore, understanding these impacts is critical.

Identifying relevant research

Researchers identified studies that reported quantitative or qualitative data assessing the impacts of out-of-home nutrition labels, including traffic-light ratings (which code products red if they are high in a particular nutrient, amber if they contain medium amounts, and green if they contain low amounts), equivalent exercise indications, and calorie content, on people with eating disorders.

After an initial search that yielded 758 studies, researchers identified 16 studies that met their search criteria.

They then extracted information on sample size, country, publication year of the study, author, and participant characteristics such as socioeconomic status, ethnicity, gender, and age.

Most of the published research came from Western countries such as the United States, Canada, and the United Kingdom, with the remaining two from Saudi Arabia.

Researchers also included data on how eating disorders were identified and the study designs used. To make findings as meaningful and relevant as possible, people with lived experience of eating disorders were consulted and involved in the study design and plans to disseminate the results.

Understanding the impacts of labeling

Studies using quasi-experimental and experimental designs often included university students as participants. One analysis found that one week after calorie labels were used, there were no changes in eating behavior, body impact, or calorie intake.

Another found that the majority of interviewed students viewed traffic-light food labels in a positive light but that 16% raised concerns that the labels could trigger eating disorders.

Studies that focused specifically on people with eating disorders. One study that included female undergraduates as participants found no differences in disordered eating or food choices when calorie labels were introduced.

However, another found that people with bulimia or anorexia nervosa ordered fewer calories with calorie labels, while those with binge eating disorders ordered more.

Cross-sectional surveys similarly reported mixed findings, with some studies finding no impact of nutrition labels and others, including one study conducted in Saudia Arabia, showing that calorie label use was linked to more disordered eating and greater concerns about weight.

Another noted that those with restrictive eating behaviors spent more time looking at calorie labels, eventually choosing options with fewer calories. People living with eating disorders also reported less support for calorie labels than those with other mental health diagnoses.

Qualitative research on this field identified important themes, suggesting that nutrition labels could make people with eating disorders hyperaware, leading them to focus more on calorie content than hunger or preference.

They could also facilitate the eating disorder and ruin the enjoyment one gets from eating out, leading to isolation and frustration.

These policies, participants felt, did not effectively address obesity and disregarded potential harm to those living with eating disorders. On the other hand, some people felt safer when they saw calorie labels, as they could reduce their anxiety about portion sizes and feel more confident when eating in social settings.

Conclusions

The current evidence suggests that some individuals with eating disorders find calorie labels harmful or triggering, while others see them as tools that enable safer social eating.

However, the review identified important gaps in the research, including the absence of diverse experiences and representative samples, which should be addressed through future studies.