Do calorie counts on restaurant menus lead to healthier choices?

Take Wetherspoon, which has displayed calorie counts for all meals since 2011. Last year, it became the first pub or bar chain in the UK to extend this policy to its drinks, in what the chairman called a 'logical step'.

"We are a very transparent company. We have nothing to hide. Calories help customers with their food/drink decision-making," explains spokesperson Eddie Gershon.

A road to better choices?

The big question is whether calorie counts on menus really do make us healthier. Looked at one way, the answer would appear to be a resounding yes. Two thirds of British adults are classed as overweight or obese, placing them at higher risk of various chronic health conditions. Intuitively, it seems that informing people about the calorie content of their food would guide them towards healthier options.

On top of that, few people want to be kept in the dark about what they're eating. In a recent poll by Diabetes UK, only 29% of respondents said they felt well-informed about what's in their food. Nearly three quarters (73%) said that if all cafés, restaurants and takeaways used a consistent food labelling system, it would help them make better choices.

"We often don't realise the energy content of what we eat and in general we tend to underestimate our energy intake," says registered dietician and BDA spokesperson Kirsty Barrett. "Being more mindful of calories, especially if you're eating out frequently, is something I advise patients to do."

It's an argument the British government is taking seriously. In June, ministers unveiled plans to halve childhood obesity by 2030. The proposed measures (which are subject to consultation) include banning junk food adverts before the watershed, removing unhealthy foods from supermarket checkouts, and - saliently - publishing calorie information on menus. If the plans go ahead, American-style legislation could be on the cards.

"The Department of Health and Social Care will consult on introducing clear, consistent calorie labelling on menus in restaurants, cafés and takeaways, so parents can make an informed choice about what their families are eating," said a government statement.

What it'll mean for restaurants

Unfortunately, it's hard to say how much good this will actually do. While information is power (especially for dieters who are worried about sabotaging their regimes), mandatory calorie counts aren't always to everyone's advantage.

According to Kate Nicholls, CEO of the industry body UKHospitality, there's little reason to suspect it would lead to healthier menus or healthier consumer choices.

"Businesses already strive to provide more transparency and choice for customers, but it is unclear at best whether any legislative changes to compel venues to label calories would fundamentally change menus," she says. "A cursory glance at the menus of large US restaurant chains would suggest not."

She points out that mandatory labelling would hit smaller businesses hard. Along with restaurants that change their menu regularly, they would face a significant cost burden and might find their ability to innovate restricted.

"As healthy eating continues to grow as a cause for concern for customers, venues will certainly take this into account when they design menus, but they will have to juggle it among other priorities," she says.

The impact on eating habits

Gershon at Wetherspoon confirms that calorie labelling doesn't necessarily lead to a dramatic shift in purchasing habits. He says that, while it probably does help people make better decisions, it's up to us to use the information as we see fit.

"Low-calorie dishes and healthy options are very popular, but in the same light so are the high-calorie options," he says. (Good news if you thought you'd be the only one ordering that 1,565 kcal breakfast.)

In a recent study, which combined results from various earlier studies, researchers found that adding calorie counts to menus led to diners eating around 12% fewer calories per meal. However, the team noted that further studies would be needed to come to a more definite conclusion.

A similar study last year was more damning, concluding: "Menu labeling away-from-home did not result in change in quantity or quality ... of calories consumed among US adults."

Low calorie doesn't equal healthy

Evidently, this is an area that could benefit from further research. But aside from whether they do help people eat less, there is another issue with mandatory calorie counts - namely that they give you incomplete information.

"Low calorie does by no means equal healthy," points out Barrett, of the BDA. "As calories are only a measure of energy it doesn't really tell us anything about the nutritional content of the meal."

You only need consider that an avocado contains about the same number of calories as a chocolate bar, and a bowl of soup something similar to a bowl of Coco Pops, to see why this is such a problem.

"You could have two meals with similar calorie content, one of which contains a good mix of protein, unrefined carbohydrate and fat, while the other lacks protein and is high in fat and sugar," says Barrett. "But you can't tell this from looking at the calorie information."

She adds that she would prefer nutritional labelling to go beyond calories, perhaps mentioning how many servings of fruit and vegetables a meal contains.

"People often think that a small side salad counts as 2-3 portions of vegetables, but it's likely less than this as 80 g is generally what is considered a portion," she says. "I personally quite like the traffic lights that are used on product packaging as they stand out and are easy to interpret."

The mental health implications

A further problem is that, while calorie counts are beneficial to some people, they can be actively detrimental to others. For those suffering from eating disorders, being unable to escape from calorie counts can heighten anxiety around food.

"Seeing calorie counts on menus can make it harder to choose what they want rather than what the eating disorder tells them to choose," says Emily Rothwell, clinical advice coordinator at Beat. "It can heighten a focus on calories and may lead the person to feel like they have to exercise a certain amount in order to 'burn off' the calories."

Even once the person is recovering, calorie counts can be problematic - they can increase feelings of guilt and confusion, and may stand in the way of recovery goals.

Ellen Maloney, a Beat ambassador who was first hospitalised with anorexia nervosa aged 12, says that for a long time she only ate in restaurants that provided nutritional information about their food.

"It made me feel safe and in control," she says. "What I've learned through recovery is that the feeling of safety I got by controlling my food intake was an illusion. Now I go out to eat with friends and family to places without nutritional information on the menu and it's easier not to know. The whole point of eating out is to enjoy the company and the food so that's what I focus on. If I am confronted by numbers on a menu, that's all I can think about."

She explains that, when you're trying to eat more intuitively, numbers can serve as a distraction from all the signals that are truly important. And for people with a history of calorie counting, those numbers can be hard to tune out.

"I think this says a lot about the new policy to put calorie counts on menus; it is encouraging people to look at numbers as if numbers are all that matter, and to be healthy, we just need to eat less," she says.

Beat's advice is that, for people who may be triggered by calorie counts, it can be helpful to look at the menu beforehand, so that they're fully prepared. They can also contact the Beat helpline for support while out (for example, through Twitter direct messaging). It's crucial to remember that eating disorders can affect people of all ages, genders and backgrounds, and that while recovery is always possible, it's best to seek help at an early stage.

Possible compromises

Barrett agrees that having calorie counts on all menus may increase feelings of guilt around eating.

"I think a good compromise, which some restaurants already do, is to highlight meals that are lower in calories (usually under 500 kcal). This helps people make lower energy choices without the need for calorie counts on all meals," she says.

She suggests that restaurants could do more to provide low-energy choices, and to increase the vegetable/salad portion of meals. However, she feels that calorie labelling will really only benefit those who eat out regularly.

"For those who do so infrequently, the odd higher energy meal isn't going to cause an issue if they're eating well the rest of the time. I think it's really important to keep eating out as enjoyable as possible," she says.

Calorie labelling on menus, then, remains a surprisingly complex issue. As restaurants move in this direction, it will fall to each one of us to decide what we want to take from it - be that helpful information to further our health goals, or something to ignore altogether.

"Healthy can mean something different for each person and focusing solely on calories I don't think is particularly helpful," says Barrett.