My husband and I used to have an annual tradition when we lived by the Financial Center of Dubai and were short one kid. At the start of the school year, we would pick a night to hit DIFC and restaurant hop, eating our favorite dishes at each spot. We would start with the fatty tuna and wagyu beef sushi at Zuma before hitting up Roberto’s for the beef carpaccio pizza, and end the night at La Petite Maison with the cheesecake. It was a pricey night, but after a summer spent mostly apart, it was our way of celebrating being back together in our adopted city, doing the thing that it’s most famous for – dining out.
With an average of 100 food outlets opening in Dubai every month, and a restaurant footprint (measured as number of restaurants/food outlets per million inhabitants) that is higher than NYC and second only to Paris, there is no doubt that the dining-scene game in this city is strong. From ultra high-end to obscure homegrown brands, and from authentic street-corner cafés to an alphabetical list of fast-food chains, the globally attuned dining scene in Dubai is a lesson in self-indulgence. If you asked any resident, they can surely name at least five of their favorite dishes in five different food outlets that they would happily eat for the rest of their lives.
But what if those dishes came with an associated calorie count? Would we think twice about ordering our favorite meals? Would we enjoy them as much? And what would the impact be on our mental health?
Well, we’re about to find out. A new regulation by Dubai Municipality (DM) is requiring all Dubai food establishments to disclose the calorie count of their dishes on menus. The thought behind this is to ensure consumers are aware of the nutritional value in the dishes, in the hopes that they can become healthier by making better-informed food decisions. It’s an unprecedented move in this part of the world, but also telling. Indeed the fact remains that the Middle East – in particularly GCC countries – are critically overweight.
Below, we weigh the pros and cons of this new mandate.
“The Middle East is the second highest region in the world dealing with obesity, with 75 percent of the population being obese or overweight. Obesity in the UAE is double the world’s average, according to a report entitled ‘Global Burden of Disease Study 2013’, which shows that over 66 percent of men and 60 percent of women living in the UAE are obese and overweight,” says Dr. Carine El Khazen, Clinical psychologist, Eating Disorder Practitioner, Director of the Eating Disorder and Obesity Program at the American Center for Psychiatry and Neurology, and Vice President of the Middle East Eating Disorders Association (MEEDA).
“The modern treatments for obesity include cognitive approaches to change the way food is perceived, but relies also on calorie counting to create a moderate calorie deficit. In order to achieve this caloric deficit and to teach patients to maintain weight loss in the long term, there is an emphasis on calorie counting and psycho-education on the calorie content of food. For those obese patients, we believe calorie counting is an effective way to lose weight and to keep it off – and there is a strong body of evidence that suggests it does. In those cases, it is possible that calorie labeling in restaurants can help them gain awareness of the calorie content ingested and possibly make different choices or work to balance it out during the day,” Dr. El Khazen concedes.
When you factor in the fact that 78 percent of the UAE population eats out up to twice a week, with no real clue as to how much they’re consuming, it’s clear to see how labeling calories can prove to be helpful.
Referring to the World Health Organization’s (WHO) definition of obesity (“abnormal or excessive fat accumulation that presents a risk to health”, whether physical health or mental health), she says that the general population underestimates the calorie content of all foods, with 50 percent of the obese population and 20 percent of the “normal weight” population misjudging their caloric intake. When you factor in the fact that 78 percent of the UAE population eats out up to twice a week, with no real clue as to how much they’re consuming, it’s clear to see how labeling calories can prove to be helpful.
In the United States, calorie information on menus is now a nationwide regulation. But is it helping Americans eat better? The science is still weak. However, what has been found is that calorie labeling reduces the amount of calories a person consumes by 30 to 50 calories per day. That’s around two marshmallows. While that may not seem like much, the FDA believes that over the period of one year, those calories add up to over 18,000, which could shave a few pounds off the waistline. When it comes to child obesity, it’s much the same (at least on that front). A study in the American Journal of Preventative Medicine found that it only takes an elimination of 64 calories a day to reduce child obesity rates by 2020.
As far as the food business is concerned, being forced to be transparent about calorie content may push food producers to reformulate what they are serving so that it is healthier, and using the status of its healthy attributes as a marketing tool.
“This is also something consumers might have asked for. It also shows a certain level of transparency and concern from restaurants towards their customers,” says Florence Gillet, a Certified Eating Psychology Coach based in Dubai.
Calorie labeling also works when you are surprised by the findings. For example, not many people know that one Starbucks Banana Nut muffin is 440 calories. I certainly didn’t – especially not when I would pair it with a tall caramel macchiato (180 calories) every morning on my way to university. Had the calories been labeled clearly in front of me, it wouldn’t have been so hard to figure out why I was steadily gaining weight. Whether I would have decided to switch to a skinny muffin is now a moot point, but I would have been better informed at the time. And we can’t deny that knowledge is power, irrespective of what you do with it.
But there is a flip side to calorie labeling, and it’s pretty grime.
For those suffering or recovering from eating disorders and body dysmorphia, counting calories – one of the first things ED (eating disorder) therapists discourage – is not beneficial. In fact, it’s detrimental, as it reinforces the idea that calorie counting is necessary and that weight loss is always the goal. This isn’t something to be taken lightly, especially when you consider that, every 62 minutes, a person dies of an eating disorder and that anorexia nervosa is the leading cause of death among all mental illnesses, according to the Eating Disorders Coalition.
Even without an eating disorder, we have become a global culture obsessed with food.
“For ‘at risk’ teenagers who present a predisposition to developing EDs, this regulation can be part of the trigger that will start the food obsessions, calorie counting, and so forth, all of which are the first signs of developing an ED,” says Dr. El Khazen. “All eating disorders start with a diet and 35 percent of occasional dieters progress to pathological dieting (disordered eating) and as many as 25 percent progress to full-blown eating disorders. And what is calorie counting if not a diet?” says Dr. El Khazen. “Those with EDs or recovering from EDs would be receiving cues that the food they need in order to recover are “excess calories” rather than their medicine. That would be either a reinforcing message that their ED ways are the ‘right’ ways (such as counting calories) or that what they are trying to achieve in recovery is the ‘wrong thing’ (such as letting go of the calorie count). Having said that, unfortunately, ED sufferers don’t need restaurants to label calories for them, because most are already tracking their calories using apps or the internet. However, it’s clear that making this information so readily available will make stopping such a behavior more challenging.”
Even without an ED, we have become a global culture obsessed with food. Whether through fad diets or from a “health” perspective, there is nothing women love lamenting about more than their weight. When females gather together, we talk about food for a disproportionate amount of time – whether about the latest diets, what we are about to eat (with passionate excitement), or about our inability to lose weight. Because it is always on our minds. Because most of us grew up with an unhealthy relationship with food. Because, for many of us, a large part of our self-worth is tied to our weight. Take your pick.
It’s therefore easy to imagine how seeing calories on a menu could trigger that insecure, weight-conscious part of us that believes thinness is the cure to all our problems.
“This regulation is reinforcing our society’s current obsession with food and ‘healthy eating’, hence creating an added layer of anxiety on an act that should be a natural and a spontaneous one. For those parents that are already very anxious about what they are eating and feeding their children, it can lead to even more restrictions and more food labeling that can only be detrimental and potentially lead to the development of EDs,” Dr. El Khazen says.
Additionally, worrying about the content of calories in our food leads to stress eating and that isn’t good either, says Gillet. “Constantly being exposed to information related to our weight can lead to added stress, food fears, and obsessive eating behaviors. Stress implies sympathetic nervous system dominance. It can cause nutrient excretion, higher cholesterol, higher cortisol, less gut flora population, less thyroid hormone, more insulin resistance, more inflammation, and many more issues. Have you ever felt like the food you ingested when stressed was getting ‘stuck’ in your esophagus or your stomach? Well, it is literally what happens. And stress can be caused by real threats or imagined threats, like feeling bad for choosing the high-calorie option on the menu. The result is the same: Digestion is impaired, and that can lead to a cascade of unwanted health symptoms,” Gillet says.
Furthermore, there is the small issue of how these calories will be measured. “In theory, restaurants should test the food in a lab, putting a sample of each meal in an instrument called the ‘bomb calorimeter’ – but this procedure would cost too much. Even in the United States, most companies simply add up the calories of the various ingredients in the foods using a standard nutrient database,” says dietician Carina Ghossoub. “Keep in mind that, in the US, the FDA allows food companies a 20 percent margin of error in the accuracy of the calories listed on the package labels. There is no systematic policing of labels to ensure that calorie counts meet even that lax degree of accuracy. The responsibility for label accuracy still remains with the food companies, who usually undercount calories by a little, but sometimes by a lot,” says Ghossoub.
There is the small issue of how these calories will be measured.
Also, the evidence has been stacking up against the calorie deficit as a long-term weight-loss strategy. Studies have shown that, while you can certainly lose weight on a calorie-restricted diet, you are most likely to put it back on again.
“This strategy also reinforces the idea that calorie counting is an effective way to nurture good health. But the ‘calories in, calories out’ model has been widely debunked. One, because only looking at calories is not enough to judge how healthy a meal is. For example, many nutrient-dense foods are high in calories. Two, because calorie burning happens in a completely different way in each and every individual. You and I might consume the exact same foods (and calories) over a certain period of time, yet obtain wide variations in weight over that period, because our metabolism, hormones (like hunger and satiety), and gut health are completely different. Our bodies ‘use’ these calories differently,” said Gillet. Moreover, relying on calorie counting disconnects individuals even further from their natural hunger and fullness cues, she adds.
Rather than focusing on numbers, Gillet believes we should be concentrating on other factors, such as eating more of the foods that nourish our bodies and soul, the benefits of a good night’s sleep, learning to eat mindfully, the importance of gut health, leading a more active lifestyle, and learning to listen to our bodies when it comes to what feels good.
“I suggest lowering the supermarket prices of fresh produce and encouraging home-cooking by offering free and easy cooking classes or providing easy online links to cooking simple meals. Another helpful message in line with that is to encourage family meals. Home-cooking and family meals seem to be good preventative measures for obesity,” adds Ghossoub.
From a public-health perspective, there are other ways that could work better, too – such as the price and accessibility to fresher produce, limiting the number of fast-food outlets per district, and introducing healthier options in public places such as parks and recreational areas, Dr. El Khazen suggests.
Weight stigma also needs to be addressed. “‘Combating obesity’, in my opinion, can only happen by fighting weight stigma (the relentless discrimination people face for living in a larger body), as it is proven to affect health a lot more than weight itself as it leads to yoyo dieting, self-hate, shame, and potentially dangerous eating behaviors. Remember that body diversity is a reality, and individuals are not entirely in control of their health. It would also be great to see more policies that aren’t weight-centric, but that focus on recognizing body diversity and inspiring flexible eating based on our hunger, satiety, nutritional needs, and pleasure. The key, once again, is to stop obsessing over numbers like weight, calories, and BMI, and instead to open up ways for people to integrate behaviors that are truly health-promoting in their daily lives and can be sustained long term. Health is much more than a number on a scale or a calorie count,” concludes Gillet.
Takeaways to Consider
While we’re largely supportive of being more well-informed when it comes to our food choices, being healthy does not mean being thin. Health comes in different shapes and sizes, and using a one-size-fits-all approach to our health simply doesn’t work.
Secondly, the way we eat is so largely related to how we feel, so letting a number on one side of a menu dictate behavior is ultimately deciding how we should feel – and no one (certainly not a number) should decide that for us. Get informed, but also remember that, ultimately, food is meant to bring us joy, not anxiety.