Calorie Counts and Eating Disorders: A Neuroscience Approach

On May 12th the British government announced that it would require large restaurants in England to display calorie information on food items prior to customer purchase.¹ The intent: encourage people “to make healthier food choices.”

Several experts in eating disorder research, medicine, and charity work, however, have argued that these measures would discourage healthy eating practices.³

Calorie counts on menus are already displayed in other areas of the world. Consequently, let’s consider, from a neuroscience perspective, why calorie labeling on restaurant food items could increase eating disorder frequency.

An Atmosphere of Stress

We experience stress when we encounter something “negative,” and what we label as negative is determined by our unique biology and experiences.¹¹

While several brain regions regulate stress, the bed nucleus striatum terminalis (BNST) is particularly important.¹⁷ This region synthesizes information from several different brain regions about our experiences, evaluates it, and helps us determine what we should approach and what we should avoid.¹⁵

This information is then sent from the BNST to the hypothalamic paraventricular nucleus (PVN), leading to the activation of a stress pathway (hypothalamic-pituitary-adrenal axis) that produces cortisol.¹⁸ The primary job of cortisol is to prepare our bodies to manage stress.

Are calorie counts making eating out stressful?

Source: cottonbro/pexels

Individuals with eating disorders experience stress from a variety of sources, but food⁵ and social judgement^10;19 stress are common.

Consequently, calorie labeling in restaurants might be stressful for an individual experiencing/or susceptible to an eating disorder. This could lead to anxiety about future food encounters and social evaluations.

Increasing Uncertainty

Anxiety is different from stress.¹¹ It’s what we experience when we think about future, uncertain situations involving a stressor. The two aren’t isolated from one another, though.²⁰ Neurocircuits for anxiety and stress overlap and interact, with each relying on the BNST for threat evaluation.

Like with stress, the BNST helps us decide if our thoughts are worrisome or pleasurable.¹⁵ These decisions depend on a complex orchestration of certain cells, chemicals, and subregions in the BNST. Unfortunately, we’re only just beginning to understand these relationships.¹⁶

When We Feel Anxious, We Try to Reduce it

Anxiety and eating disorders cooccur, with roughly 70-94% of individuals experiencing anxiety prior to eating disorder onset.⁴ This is problematic because, over the course of an eating disorder, anxiety might contribute to its maintenance. This is because eating disorders behavior might reduce anxiety.²¹

How does eating disorders behavior reduce anxiety? One possible explanation is through ghrelin secretion.⁹

Ghrelin is the body’s “hunger hormone.” Its primary job is to motivate us to eat by making us hungry. Prior to eating, ghrelin levels rise, and following food intake, ghrelin levels fall.

Stress has also shown to elevate ghrelin levels, as ghrelin’s secondary job is to relieve anxiety.⁹

People diagnosed with a restrictive food intake disorder have different ghrelin levels.⁷ Instead of a modest rise prior to food intake, ghrelin is excessively secreted and stays elevated.⁸ Consequently, for some individuals, food restriction reduces the anxiety they feel when encountering food.⁶

Therefore, having calorie counts on food menus could encourage food restriction among those currently experiencing, recovering from, or susceptible to an eating disorder.

Eating Disorders Essential Reads

When an Eating Disorder Isn't Just About Body Image

The Quiet Radicalism of Looking After Your Body

Reframing Compulsive Weight Management as Healthy

Another problem with the UK’s approach to “fighting obesity” is that it promotes “techorexia.” Techorexia is the reframing of compulsive weight management as healthy, and it’s a dangerous mentality for those with compulsive tendencies.²

Compulsivity is common in anorexia nervosa, as these individuals often struggle to feel in control over their environments.¹² Subsequently, they stick to ritualistic routines and rigid thinking patterns to feel "agency" over a chaotic world.¹³ This reduces anxiety.

Individuals experiencing anorexia nervosa are good at adhering to strict behaviors because they often struggle with cognitive and behavioral flexibility.²² Cognitive and behavioral flexibility is the ability to change your thoughts and/or behaviors in response to a change in the environment.

Put a little differently: it’s feeling comfortable with the randomness and spontaneity you encounter in everyday life.

Note that this isn't subtype specific. Individuals with bulimia nervosa and binge eating disorder also demonstrate dysfunction in cognitive and behavioral flexibility.¹⁴ Therefore, individuals across eating disorder subtypes might find it difficult to break maladaptive eating patterns (i.e., binge/purge cycles) when encountering menu calorie counts.

Similarly, individuals diagnosed with an eating disorder often don’t recognize hunger and satiety signals.²³ This is due to dysregulation in a brain region called the insula. The insula is our brain’s regulator of internal experience; it guides us in knowing when, what, and how much to eat.

For those with an eating disorder, ritualistic eating patterns help manage eating uncertainty. However, if individuals are not listening to their body’s needs, destructive eating patterns could endure.

Calorie counts on menus make it easier for individuals experiencing eating disorders to continue destructive eating patterns that maintain their illnesses.

What Can We Do Better?

What’s dangerous about encouraging compulsive calorie surveillance is that we still don’t know exactly what causes an eating disorder.

Consequently, creating an atmosphere of calorie counting and food fear could push more individuals to develop one.

Consider instead teaching individuals to listen to their bodies about what they need. Yoga and similar practices have shown to help increase interoceptive awareness. Also, courses on nutrition could help us understand how best to fuel our bodies and brains. Finally, in today’s culture of Instagram perfection, it’s important to learn to enjoy food and respect our bodies.

These are only some of the reasons why menu calorie counts could contribute to eating disorders frequency. And it's also an example of why we need neuroscience to help shape public policy.