Calories on menus: a parent's guide

How to support teens with eating disorders or food related anxiety under this new eating out rule.

Apr 13, 2022

Another policy from the Ministry for Daft ideas has made headlines. It’s one that as a mum of four, including three teens, I wish they’d had a grown-up look at properly before sending it out into the world.

This new idea is to put the calories of dishes on menus at large chain restaurants, where families eat out. It is supposed to tackle the UK’s growing problem with obesity. It won’t (it didn’t in America according to all the research I have read) and many chain restaurants have been doing this for a while here with no measurable effect. It is illogical at best but dangerous at worst. Dangerous because as those of you supporting teens with eating disorders or anxiety around food will know highlighting calories on menus may make their lives more problematic, especially during these more testing times; we’re in the middle of exam revision season, we’ve just come out of a pandemic, there isn’t much more stress you can load on a teen frankly.

We know from recent surveys that the pandemic fuelled eating disorders in young people. In the US the New York Times reported a 25% increase in hospital admissions of people with eating disorders in the year from March 2020. And in the UK data released to the BBC by NHS Digital showed the number of under-20s admitted over the past year with eating disorders was nearly 50% higher than in 2019-20.

The Government says it sought advice from experts and mental health professionals, but I cannot find anyone supporting this specifically in the press, only a few quotes from master chef Greg Wallace, who once lost four stone and claims to exercise with a trainer at least five times a week. In 2017 he told The Independent he didn’t believe in diets, so I hope he wasn’t one of the experts consulted!

Anyway I’m not here to question the politics of this upsetting policy, I’m here to help you if you’ve had to reassure a troubled young mind grappling with these calorie headlines and if you want to continue eating out happily with your adolescents, a family activity which encourages a deeper connection with your teens and is of course unavoidable when it comes to wider family celebrating significant moments.

So what can we all do to make this easier for parents and care givers looking after teens with eating disorders? I asked Dr Tara Porter, an NHS psychologist and psychotherapist who has worked as part of CAHMS (child and adolescent mental health services) for more than two decades. She is dealing with teens and eating disorders, alongside other family trauma, on a daily basis and has some helpful strategies which may work for you.

These are questions that were asked on my Instagram and I hope I’ve covered the main concerns you raised there. Obviously all adolescents are different and you may need professional help but I know that as a mum of teens, especially girls, I lived in fear of flicking the eating disorder switch even though logically I understood there are so many different factors which affect our children’s mental health.

But if you need a little guidance then here’s what Dr Porter advised:

1) How do we as parents deal with the new menus with calories laid out on them if we are supporting an anxious eater or a teen with food related issues/disorders?

Dr Porter: I think the work for this as a parent is twofold: it is about what you do generally with them talking about food, eating, weight and shape in everyday life, and what behaviour you model, and then it’s about what you do specifically about this meal out.

So, firstly what we generally do as parents in the home. I think this is about modelling good habits with food, and by that I do not mean so called “healthy” habits of low calorie, low fat diet. I mean modelling balanced habits of being able to eat all foods in moderation, stopping when we are full, enjoying mealtimes, and not being sanctimonious about snacking. As I discuss in my new book You Don’t Understand Me: The Young Woman’s Guide to Life we should be encouraging the complexity of discussion about food – thinking about concepts like hunger, fullness, a sense of satiety after eating, which I believe is strongly linked to eating what we fancy. If we really fancy the burger, but have the salad “to be good”, we are likely to overeat later as we have not satisfied ourselves.

Food and eating are linked to culture, religion, celebration, family and love! The problem with calorie counting (and much of the talk of healthy eating or dieting) is it is so reductive – it turns something crucial, wonderful, complex and joyful into a single factor.

For the specific meal, if you have an eater who you think is going to be upset by the calorie content, talk the meal through before you go. Ask them how it is going to be for them; is it going to be hard? Are they going to feel pressure from the eating disorder? Is it going to be competitive with other people to eat less? Or to eat the lowest calorie thing? Or is it going to be easier for them? Many eating disordered patients count calories anyway and some may find it a relief to know what they can eat within their allowance.

2) How do we respect their fears when eating out with them in a supportive way.

Dr Porter: In my work with eating disorders patients, and with work with anxious patients more generally, they take different attitudes to how they want their fears dealt with. Some young people find it helpful to confront their fears in that public setting – it challenges them to do more than they can at home. The intrinsic social pressure is helpful for them to push into their fears. For other young people they prefer to do their fear challenging in private. Some prefer to have their fears recognised and acknowledged, (“well done, you did it!”) but most would feel self-conscious about this, and prefer for everyone else to continue as usual.

It’s often the challenge of a special meal or event that pushes young person to challenge their fears eg having a slice of cake at someone’s birthday; and meals or snacks out beforehand can be a planned part of a journey towards that ‘special’ meal. So that might sound like “I know you are not keen to come out tonight, but lets see it as a practice. Dad and I are keen to see that you can manage this, before you head of on your own”

It is usually good to have a backup plan for the meal itself ie where they should go if they need some time out or what they should do or how they should signal this to you. Your expectations should also be clear “we want you to have a proper main course, not the salad” but of course dealt with equanimity if they don’t meet them. Never underestimate the power of talking things through beforehand, thinking of possible problems, knowing what they think would be helpful.

3) What do your teen patients tell you is a helpful way their parents react when eating out?

Dr Porter: Eating with a child with an eating disorder you are always balancing your empathy of how it feels for them, with your boundary that eating enough food is non-negotiable. It is worth thinking about that non-negotiability for a moment; living with someone with an eating disorder may warp our thinking. The eating disorder may drag some parents into its illogicality.

A parents’ support is usually a variation on the theme of “I know this is hard/ you are scared, but this has to be done”. The parent’s job is to try to keep their anorexic young person’s motivation for their long-term goals alive whilst he or she is facing their greatest fears: often patients find their motivation is strong when they are not near food but dissipates in front of the meal. By analogy, someone with anorexia sitting with a meal and be expected to eat, is like an alcoholic sitting with a glass of wine and being expected not to drink. Anything you can say to support, encourage, guide, or channel them through is to be encouraged.

It is always important to try and stay calm, and what helps is trying to separate the eating disorder from the person. In psychology we call this externalising, and as parent you might do this so as not to blame your child. You could say to yourself “The eating disorder loves a good fight. If I get cross the eating disorder will use it as the perfect excuse not to eat anything”. Your child did not choose to have the eating disorder. But most of all remember, you are human not a saint, and be compassionate to yourself if you don’t manage to stay cool; say sorry; move on; tomorrow is another day. I can’t think of a single family I’ve worked with who hasn’t made mistakes, got cross, had ups and downs along the way.

When you are eating out specifically, an agreement needs to be negotiated about how this is going to be managed. An anorexic patient fighting against their own recovery, could “use” the excuse of eating out to get away with more eating disordered behaviour than they could do at home, knowing that their parents won’t make a fuss in public or at an occasion. For a young person doing better with their recovery, it is worth checking what they think would be helpful, eg sitting by you or away; pre-ordering their meal; making eye contact; or reminding them to eat.

4) How do we discuss our feelings on the headlines and the news around calorie counting on menus at home?

Dr Porter: With honesty but relatively calmly. It’s good to discuss emotions with our children and give them an emotional vocabulary but is not generally great to be out of control with emotions. So, if you feel really angry about it, you might want to say that in a calm voice, explain why, and what you are going to do about it eg write to your MP or sign a petition.

One of the major things that drives an eating disorder is a search for control in an uncertain world, and it is perhaps good to reflect that we often don’t have control about things, and we have to learn to cope with that. It feels hard, and we are allowed to be sad or angry about it, but then we have to move on. Bearing uncertainty or disappointment that things are not how we want them to be is part of life. Model that as a parent.

5) How important is it for families to 'connect' via meal times and how do we make that easier for anxious eaters?

Dr Porter: Generally, it is super-important to connect via mealtimes as a family, and this is one of the great sadnesses for families when their child is in the throes of an eating disorder that they lose that for a while. However hard parents work to stay calm, it becomes a tense time for everyone. Having some standard conversation up your parental sleeve to try to keep the illusion of calm – word games such as everyone at the table telling 3 truths and 1 lie about their day can ease the tension.

For anxious eaters, I think it is important to understand what the anxiety is about. Is it social? Being with teasing siblings. Are they worried that people are going to judge them and what they eat? Is it about texture and taste? Or quantity? Or fear of choking perhaps?

With anxiety, it is a super thin line between reducing the anxiety by sensible means on the one hand, and giving in to the anxiety and therefore fuelling it, on the other hand. As a parent, your task is to navigate that thin line. The only way to get over anxiety is to eventually confront it, but if a child is forced to confront and isn’t consenting to confronting it, it may make the anxiety worse. Throwing children into the deep end of the pool makes them scared of water; it doesn’t make them learn to swim. Getting them onside to agree to confront their anxiety step by step is the best approach. There is a very good book on anxiety for younger children (say under 13) ‘What to do When you Worry too Much’ (by Dawn Huebner, PhD, is a clinical psychologist) which explains this, but please get professional help if feel you are not able to cope.

Keep communicating with everyone in the family about how to manage the meal, as non-anxious siblings can feel super resentful, and in doing so model important compromising and listening skills to your tweens and teenagers. Sometimes parents need to let go of important mealtime principles to keep everyone on side. Eg watching TV at some meals or having music on, or some people living the table before others.

And remember, you can always make a new time to hang out together as a family – movie night or card night – if mealtimes are temporarily too difficult. This difficult time will pass: you can get your family meals back again in the long term.

6) How do we help our pre-teens develop a relaxed attitude to eating out with us?

Dr Porter: The word I use the most in my work with children and adolescent mental health is “balance”. So balancing how much eating out is done (pre-teens and teens may prefer to be at home gaming or chatting to their friends) and where it is done (not just either the parent or the child’s choice of restaurant every time). Most adults love a long leisurely meal, chance to chat over a drink, but that is often boring to pre-teens and teens, and, of course, it is developmentally appropriate that they are beginning not to want to hang out with us as parents all the time. They’ve heard everything we have to say! Gently reminding them of your expectations, and give and take, can prompt them not to be to egocentric, eg “I’m so pleased you got to go go-kart racing this afternoon, but it was a lot of waiting around for us, and now its your turn to wait patiently whilst we have a drink”.

So I hope this advice is timely and helpful. And please pre-order Dr Porter’s book “You Don’t Understand Me, A Young Woman’s Guide To Life” for your daughters, I have find it extremely helpful and my teens are dipping into it as we speak.

You Don't Understand Me book

I’ve popped the latest NHS advice below too in case this is useful and the eating disorder charity BEAT’s advice too.

https://www.theguardian.com/commentisfree/2022/apr/01/calories-menus-obesity-eating-disorders

https://www.beateatingdisorders.org.uk/get-information-and-support/get-help-for-myself/advice-for-eating-out-with-calorie-labelling/

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