Counting the cost of calories

“I have struggled with my weight my whole life really. Atkins, Weight Watchers, paleo, you name a diet, and I’ve tried it,” says Caley, a 34-year-old woman from Edinburgh, “but disordered eating is just that - a disorder - one which I struggle to control without concentrated, direct intervention.

“I would love that to take the form of medication, as obesity is a disease, after all, but I also look at calorie counting as a type of medication. I work out my daily calorific needs for my height and age, then I just stick to that number by writing down what I eat during the day on my phone’s notes app. I’ve lost five pounds in the last month.”

Caley isn’t her real name, as like many people she feels there’s a stigma around obesity and worries she would open herself up to ridicule, even from friends, colleagues and family.

However, for Caley, calorie counting hasn’t been plain sailing: “I’ve always been conscious of calories – as a big person I can’t help it, but this is the third or fourth time I’ve tried this seriously. The first week or so is full of determination, but the hunger pangs, mood swings and poor sleep quality really start to kick in after about a fortnight. From there it’s a constant struggle to not binge and return to my usual eating habits.”

Calorie counting is a simple approach to weight loss. It reduces a diet to energy in and energy out, as the body needs a set amount of calories to keep running, and so eating below that number means it has to find alternative fuel: fat. Low carb and fad diets can reduce water weight dramatically – but as fat is just stored energy, the only way the body can lose it is to use it, and that only happens in a calorie deficit.

This basic approach to fat loss has led to the Scottish Government consulting on introducing calorie counts to restaurant menus, following similar measures which have already been implemented in England and Wales.

Eateries south of the border with more than 250 staff must now print how many calories are in meals on their menus, websites, and on delivery platforms. Many larger companies, such as McDonald’s, already provided calorie and nutritional information, and the legislation does not affect smaller food outlets, such as local takeaways.

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For this feature, Holyrood sat down with MSPs from across the chamber in Scottish Parliament's canteen:

Alex Cole-Hamilton MSP

Tortelloni formaggio with chips, salad and garlic bread

Estimated calories: Tortelloni 150g: 386kcals; Chips 100g: 231 kcals; Garlic bread x2: 200 kcals. Total: 817kcals.

“When I first got married my metabolism just slowed down, I was my heaviest. I was probably about two and a half stone heavier than I am now, and that was just easy living really. Then I went to Weight Watchers, and I lost a lot of it, and I've never really regained it.

“There was definitely a moment where I thought, do my clothes still fit me?

“I now do intermittent fasting between the hours of 8pm and 12 noon, and all I have in that time is black coffee and water.”

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The rationale behind introducing calorie counts to menus is clear – there is a wide disparity in the amount of calories served in restaurants, even those serving the same types of food. A 2021 study by Food Standards Scotland found the average pizza meal contains 970kcals, but can be as high as 3080kcals – 50 per cent higher than the recommended daily calorie intake for women.

The same study found that main meals in restaurants had the widest disparities between establishments, and individual dishes, with the average main meal containing 812kcals, but going as high as 5070kcals – at least two days’ worth of food.

The Scottish Government’s 12-week consultation, which launched on April 8^th, seeks views on the types of food and drink that would be covered by any changes and the types of businesses which would take part in the initiative.

Speaking at the time, public health minister Maree Todd MSP said: "Two-thirds of the population living in Scotland is recorded as living with overweight or obesity - a key factor in our plan to address this is calorie labelling.

"We know that giving people more information, such as the number of calories in meals, will enable people to make healthier choices when eating out or ordering in.

"This is not novel practice - calories are already required on retail food purchases and calorie labelling for out-of-home sites is mandated in many other countries."

In December last year, a Public Health Scotland report found the proportion of P1 children at risk of becoming overweight or obese rose sharply between 2019/20 and 2020/21, up from 10 per cent to 15.5 per cent. The report also found children from the most deprived backgrounds are almost three times as likely to be at risk of obesity compared to those from the least deprived (21 per cent against eight per cent).

Frances Bain, a mission manager at Nesta, an innovation charity, says calorie counts help change the ‘food environment’, which she says is a key strategy to tackling obesity: “The focus of Nesta’s work is to shift the narrative away from personal responsibility around obesity.

“So for 30 years, all the policies around education, awareness-raising and telling people to eat less haven’t worked, as obesity has gone up and up and up.

“The consensus now is it's about changing the food environment around us, which promotes healthy food and makes it easier to choose a healthy option, and harder to choose an unhealthy option, and therefore we can have a shift in population health without relying on people's behaviour, people’s willpower and people's resources.”

Calorie counting, however, is a blunt tool not without its critics.

Beat, the UK’s eating disorder charity, has been opposed to the introduction of calorie counts on restaurant menus ever since the proposals were floated in England and Wales. Their main concern is that prominently displaying calories will hinder the recovery of people with disordered eating, who can fixate on calories and eat less than they need.

A recent survey conducted by Beat, of people with eating disorders, found 93 per cent of people either living with an eating disorder or recovering would find calorie counts on menus would be ‘negative or very negative’ for those people.

“We know from our beneficiaries and also from what we hear when we talk to people - we talk to people on our helpline and we see comments on our social media posts - that we know that an awful lot of people with eating disorders are not supportive of this and it would be detrimental for them,” said Emma Broadhurst, Beat’s national officer in Scotland.

“We also know that there's very limited evidence to say that this actually will do anything to address eating habits within the general population.”

To illustrate her last point, Broadhurst pointed to a 2018 study in the US, which found there is only a small body of low-quality evidence supporting the idea that calorie counts on menus lead to a reduction in calories purchased.

Although a more recent study found that calorie labelling in US fast food restaurants was associated with a four per cent reduction in calories per order, this reduction diminished after a year, suggesting any small differences that may occur are not maintained.

“Eating disorders have the highest mortality rate of any mental illness in the UK,” added Broadhurst.

“Anorexia actually has the highest mortality rate of any mental illness, and the government is willing to put those people at higher risk right now, by putting calories on printed menus.”

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Emma Harper MSP

Steak and gravy pie, with salad and six chips

Estimated calories: Steak and gravy pie: 450kcals; half portion of chips: 116kcals. Total: 566kcals.

“When I asked one of the canteen workers for six chips one day, because six chips is ten grams of carbohydrates, they looked at me like I was daft.

“I’m like ‘no, no, there's a reason why I don't want to take chips with everything, or potatoes’. The salad bar is fantastic for me as a type one diabetic, but I do need to make sure I get some carbs on board. So I think if menus or restaurants ended up having smaller sized portions, that might help.”

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Counting calories, according to Tom Coughlin, Scottish Rugby’s lead nutritionist and consultant, is a very simplistic tool for a very complex problem. In his role at the Scottish Rugby Union, Coughlin educates men and women from the lowest age-group teams, all the way to elite-level stars.

His approach to weight loss, he explains, is much more holistic than simply counting calories: “When I work with an individual, there's so many things that I go over with them because it is such a complex area.

“I'll often try and just help understand them a bit better. I'll talk to them about the various influences of their behaviour and their nutrition choices.  

“So I'll chat to them about their environment at home, what it's like, what their shopping situation is like, I'll chat to them about their family, if they've got partners, kids or maybe flatmates, because all these people can influence what's actually around at home.

“I’ll also check on their skills and abilities in the kitchen because that's a massive barrier to actually improving your nutrition.”

In parliament, the introduction of calorie counting onto restaurant menus has been proposed by the SNP government, and welcomed by the Scottish Conservative opposition. Representatives from both parties sat down with Holyrood in the Scottish Parliament’s canteen, to talk through the proposals and their own personal approaches to eating well.

The SNP’s Emma Harper, a former nurse a member of the Scottish Parliament’s health, social care and sport committee, said the government’s consultation aims to “find the balance” between tackling obesity and treating eating disorders.

“Beat has concerns about putting calories on menus,” said the South Scotland regional MSP, “but my understanding is that the public health approach and the Food Standards Scotland work that's fed into the consultation has been quite diligent in how they're looking at evidence.

“And ultimately, tackling obesity is what the goal is.

“I have type one diabetes myself, so I've been counting carbs since I was 12 years old. So I'm quite knowledgeable about what is on the plate in front of me because that means I give myself a certain amount of insulin.

“We need to encourage people to look at what calories they are taking in, how much salt they are taking in, and it's a whole process of looking at what we need to do to help support them.”

The Scottish Conservatives’ Sue Webber, also a former nurse, said she has seen first-hand the effect obesity can have on an individual’s health, and wants calorie counts to inform choice, but does not want the legislation to burden smaller businesses.

“I think for an individual with a small business, that's their own business that they've got, and they're employing three or four people with a menu that might change daily, so for them to work out the calorific value, it would be a disproportionate burden on them.

“These big chains, they have big teams of people deciding menus, and they can do a lot more of the research and portions are also very, very managed.”

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Sue Webber MSP

Brown roll with carved ham, salad and mayonnaise

Estimated calories: 400kcals.

“I’ve dieted – I’ve tried Slimming World, I’ve tried Weight Watchers, and none of them really helped. I was doing the Noom weight loss programme recently, which I felt I did quite well with, but then along came the election, and I also adopted a puppy, and my whole life changed.

“Me and my partner plan our meals, we know what we’re having for our evening meals, and I tend to make a packed lunch, but when you’re on the hoof, and you’re having a bit of a slump, I’ll have a bit of chocolate – but there’s nothing wrong with that. You shouldn’t give yourself a row.”

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The Scottish Liberal Democrats, however, have concerns about the possible damage to people living with eating disorders.

Liberal Democrat leader Alex Cole-Hamilton, who also joined Holyrood for lunch in the Parliament’s canteen, said: “This is something we're watching closely, and I think the Lib Dems probably come down on the side of the disorder charities, about putting calories on menus.

“Firstly, because a lot of nutritionists will tell you it’s about what the calories you’re putting into your body are, as in the balance of the foods you’re getting, the fibre, whether you’re getting fresh vegetables, whether you’re getting the right balance of protein, and how simply focusing on calories can actually mask the truth behind what you’re eating.

“Secondly, and probably more importantly, it puts a lot of pressure on people who are suffering and can exacerbate eating disorders, and I think we would favour a halfway house, where calories are available on request, so you can make your own decision about that rather than having it broadcast to you.”