Calorie Counts on Menus are Probably Not Making Us Healthier.

The UK has just implemented mandatory calorie counts on menus of all restaurants that have 250+ employees. The law has been implemented to ‘help consumers make healthier choices,’ and to ‘tackle obesity and improve the nation’s health.’

We’ve had this law in Canada for a while now, and it’s also been active in the US since 2018. I’m acutely aware of it, because when I go into a restaurant with my kids and there are calories listed on the menu, I physically cringe. 

According to the UK’s Public Health Minister, the aim of putting calories on menus is to make it ‘as easy as possible’ for people to make ‘healthier food choices’ in restaurants. This is pretty much the universal reason why calorie counts on menus exist. 

Along with the calorie numbers in restaurants and on packaging, there’s the statement that adults need around 2000 calories a day.

I get that governments want to give people what they feel is relevant. And people seem to want it, at least, in theory. In the US, 20% of calories consumed come from restaurants; in 2020 in the UK, an estimated 8.6 million people visited restaurants 2-3 times a month. So why wouldn’t we want as much information as possible to help us decide which food choices to make?

Are calorie counts on menus effective?

Consider the fact that many people probably have no idea what a calorie is and how calories directly affect them. These people won’t be able make sense of the numbers they see on menus. 

Surveys show that the majority of people want calorie counts on menus, and governments believe they’ll help us order lower-calorie meals. But research tells us that these numbers may not be all that effective in achieving that. 

A 2019 study on menu calorie counts published in BMJ found that while menu calorie counts were initially associated wth a small reduction in calories per order, the effect diminished within a year. 

A 2020 randomized controlled study in the Journal of Policy Analysis and Management  suggested that knowing the calories of food in restaurants was linked to a 3% reduction in calories per order

A 2018 review of 28 studies in Cochrane found that menu calorie counts may cause consumers to order lower-calorie food, but also determined that the evidence that exists around this topic is low-quality. A 2017 study in Obesity came to pretty much the same conclusion.

Still, there will always be people out there who believe that calorie counts on menus have some value. We should recognize them, and know that we aren’t all the same when it comes to how we like to make our food choices.

Good for some people, but not exactly groundbreaking as a whole.

There are also people who may be triggered by seeing calorie numbers on menus. Those with eating disordered or disordered eating may be harmed from this initiative. In the UK, 1.2 million people have an eating disorder diagnosis. Lifetime prevalence of eating disorders worldwide is 7.8% (and this does not include ‘disordered eating,’ which is different). 
I am fully in support of having nutrition information available for those who want it. But is having it front and centre really necessary?

Interestingly, the UK law allows for customers to request a menu without calories listed, presumably for those with eating disorders.  

That being said, as a dietitian, I don’t recommend calorie counting at all. I’ve written a lot about this, including in my post about calorie goals (We’re Still Using Calorie Goals. Here’s Why That’s a Problem). While some people swear by calorie counting, I just don’t think it’s necessary. Pretty much, ever.

You can read the post linked above, but let’s just say that calorie counting is flawed in several ways. 

Each of us processes calories differently. Two people eating the same meal may absorb different amounts of energy from it. Calories aren’t an exact science!

The FDA allows the calorie numbers on food packaging to be off by 20% in either direction. This is on packaged food, which is most often made in a controlled environment. Restaurants are much less controlled. 

If there’s more than one person making food in a restaurant, calories in that food can vary widely. There’s just no way to standardize everything, especially in a fast food situation.When food is being prepared by multiple people in a restaurant environment. Maybe Johnny puts two times more special sauce on the same burgers than Kate does. 

Calories alone don’t take into account the quality of the food; having fewer calories doesn’t always mean that a choice is healthier. A 100 calorie cookie ‘snack pack’ is less filling and less physically nourishing than a higher-calorie choice of an apple with peanut butter. Regardless of calories, the nutrients in a food can also have an effect on how we process it. If you have two fast food meals that are equal in calories, but one is higher in protein and fibre than the other, you’ll most likely absorb fewer calories from the protein and fibre-rich meal because of the thermic effect of food and the fibre content.

As far as the 2000 calories in a day number, that’s a whole other story. Most of us actually don’t know precisely how many calories we need in a day, and this number changes depending on how active we’ve been, if we’re ill, our consumption over a few days…it’s not static.

When food labels in the US were being developed, the FDA decided that 2000 calories a day was a round number that didn’t encourage overconsumption and was also easy to use for Daily Value percentages (among other reasons). The fact that 2000 calories is below what the majority of people need was recognized, but not deemed to be a dealbreaker for instituting that calorie level on the labels. 

This is the thing: while calorie counts on menus may be helpful to some people, they have some pretty serious downsides. As a registered dietitian, I find these numbers – and the thinking behind them – problematic.

Here’s a few reasons why:

They reinforce the notion that fat people are always eating high calorie food and are always unhealthy, and that thin people are healthy. We know this is blatantly false. 

They’re also another symbol of diet culture that I don’t want my kids exposed to, thank you very much. And no, I don’t believe that kids need to know the calories in food to learn how to nourish their bodies properly. Food should be measured in joy, satiety, and satisfaction, not numbers. 

The guilt and shame of choosing what’s listed as a ‘high-calorie’ option may be more harmful than just eating what you want, enjoying it, and getting the heck over it. I never advocate for using external cues when making food choices, and calorie counts on menus are just that – external cues that may be somewhat informative, but ultimately shouldn’t make our food decisions for us.

(Everything You Need to Know about Metabolism)

All sorts of things happen when we consciously make the lower-calorie choice. We may not be as satisfied. We may gain a sense of permissibility because we’ve (theoretically) made a ‘healthier’ choice. We may feel like we should eat past the point of fullness because our meal has fewer calories.

Calories when you’re in a restaurant are a mostly common sense, anyhow. You know that a double burger has more of everything than a single burger. Knowing the relative energy in food is enough to make ‘better’ choices if that’s what you’re into. It’s also a given that when we eat in restaurants, we’re getting meals that are likely much larger, and higher in sodium and energy than what we’d make at home. 

The answer isn’t to choose a lower calorie meal at restaurants; it’s to eat fewer restaurant meals to begin with. 

But here’s where this whole situation gets tough: calories on menus are a mere distraction from the barriers to health that exist for many people who eat a lot of ultra-processed and restaurant foods. Because the people who would benefit from health incentives are the people who most often eat these foods out of necessity. 

What good are calories when our society all but ignores the social determinants of health? If we want people to be healthier,  we’re going to need to understand that peoples’ health – and often their food choices – are a symptom of so many other more impactful things that calories on menus won’t even touch: The places they live. The healthcare they can and can’t access. The amount of money they earn. Their education level. Their comfort level with buying and making their own food. Their ability to actually buy that food. Their gender. Their employment status.

A simple start would be to start teaching nutrition in schools, and having free classes where kids (and adults) can learn how to cook. Subsidizing foods like fruits and vegetables, dairy, and proteins so that more people could afford them would also be helpful. 

Improving the mental health system, especially for people with eating disorders – at the systemic level would also go a long way in terms of population health. Studies show that major mental health diagnoses like anxiety and depression may be associated with an increase in sugar and fat consumption and a decrease in fruit and vegetable consumption, which 

(We don’t all have the same 24 hours in a day. Here’s why.)

Calorie counts on menus are like a pebble in the rock quarry of population health. While they may be helpful for some people, they’re more like a distraction from the bigger issues around health and wellness.