Easy to Diet or Easy to Die?
India’s new calorie labeling mandates include shame in the margins for the marginalised.
“My sister is uptight and beautiful and probably anorexic, but clothes look awesome on her so…” So it doesn’t matter. So it’s fine. Fleabag is a great show. It is funny, relatable, witty, and in this instance, its dialogue perfectly encapsulates the opinion of lawmakers on health, body size, and eating disorders.
On 17 November 2020, the Food Safety and Standards Authority of India (FSSAI) issued the Labelling and Display Regulation. It mandates that all restaurants with outlets in 10 or more locations must mention calorie counts in their menus against each item. They have to comply with this norm by 1 January 2022.
Restaurants are also required to “clearly and prominently” display the following information: “An average active adult requires 2,000 kcal energy per day, however, calorie needs may vary”. With this message, the Authority delineates a wide generalisation and absolves itself of responsibility by adding a minor caveat at the end, calorie needs may vary.
The latter part of this information represents the ellipses of the before-mentioned Fleabag quote. With those four words, the sentence trails off into something dubious and wavering, when only moments ago it had confidently stated a well-rounded figure (2000 kcal). This is the part charged with knowledge, purposely hidden from view. It is not important to the central plot and so it doesn’t matter. It is fine.
It is also proof that FSSAI is well aware of the limited scope of their announcement. Everyday calories among individuals do indeed vary based on multiple factors including age, sex, height, activity, hormonal behaviour, and environmental temperature. These factors are not always under our control and fluctuate greatly from one person to the next. Therefore, this renders the first part of their message redundant. The implausibility of being able to accurately label the calories in each platter of food cooked at a restaurant poses further challenge to the implementation to this policy. It increases the odds of the number on the menus being merely arbitrary that signify nothing. A closer examination reveals the greater flaws in the policy and the dangerous health implications it is likely to have.
The regulation is reportedly part of an effort to promote healthy eating and has been long coming. In 2018, under the Eat Right Movement, the Authority had asked restaurants to voluntarily provide calorie information on menus. One of the primary goals of the movement was to limit the consumption of fat (particularly trans fat) in the country. The new regulation now allows them to mandatorily enforce the same.
The policy is not unique to India and has been executed at different times in both the UK and USA. It was made mandatory in the UK only months ago when the British Queen announced in April that all restaurants and cafes with over 250 employees will have to mention calorie information in their menus. The practice, albeit popular among policy-makers, has had unsatisfactory results in the past. “A small decrease in mean calories purchased per transaction was observed after implementation of calorie labeling…This reduction diminished over one year of follow-up,” a study published in the British Medical Journal (BMJ) concluded.
Although seemingly well-intentioned, an inherent bias against fatness lies at the heart of this policy. Calories do not indicate health and are only a measure of “how warm your food would make some water if you burned it instead of eating it,” author and activist Ali Thompson explains. Its restriction is primarily concerned with weight control. Therefore, the policy is rooted in weight stigma and the wrongful conflation of weight and health. Had it been otherwise, lawmakers would have insisted on making available information regarding the amount and range of nutrients present in foods rather than their supposed ability to make us fat.
As per tradition, for over two centuries, the medical fraternity has used body weight to signify individual health. First to serve the insurance industry and later the multi-million diet industry. BMI, a eugenicist tool to measure populations, was reinvented as a formula to measure fatness to simplify the process. The index was not intended to measure body mass but the mean of the population, the standard for which were white men. Even Ancel Keys, the man responsible for its reinvention, recognised it as a less than perfect tool. Both, the exaggerated pathology of fatness and the credibility of the BMI, have since been disproven by scientific research. It has also shown that an obstinate insistence on the contrary has worsened health outcomes by propagating weight stigma and poor body image.
A recent report, ‘Changing the perfect picture’, furnished in the British Parliament by the Commons’ Women and Equalities Committee had advised against the calorie count policy and the use of BMI, among other recommendations, urging the government to terminate both. It cited a concerning rise in eating disorders and body dissatisfaction during the pandemic. A lack of access to public spaces like gyms and parks has spiked anxieties related to appearance, disproportionately affecting vulnerable groups including women, BIPOC, and those belonging to the LGBT+ community.
It argued that weight is not the sole determinant of health and current practices treating it otherwise fuel discrimination against fat people. The BMI has become “a kind of proxy or justification for weight shaming,” Caroline Nokes, the conservative chair of the committee had said. They recommended that the government should endeavour to adopt a Health at Every Size approach, rather than centering weight loss.
At such a vulnerable moment, the FSSAI policy actively encourages diet culture. Calories in, calories out is a standard diet chant, propounded as being similar to the unsophisticated act of breathing. However, the medical world has known for over half a century that diets do not work and there is no proven way to make fat people thin. Almost 95 percent of the dieters gain back the lost weight within 2 to 5 years. A study published in the Journal of Social Sciences as early as 1999 revealed that diets are futile and cause damaging side effects. It may lead to insulin resistance, slower metabolism, weak bones and so much more otherwise associated with fatness. Yet, the general reputation of diets remains unfazed. Every old one, once exposed to be a farce, is repackaged and renamed, from Atkins to Keto to something else.
Predictably, it is difficult to accept that there may not be a cure for what is culturally deemed an abominable fate worse than death. We are scuffling through a moral panic. The inherent bias against fatness runs deeper than misinformation about health and is rooted in patriarchy and a lack of bodily autonomy as well. Women particularly are led to believe that their eternal pursuit is to fit into the physical mould provided, an unattainable standard in a state of constant flux.
While conversations around mental health disorders like depression, anxiety, ADHD and others have recently begun to surface in present society; eating disorders and disordered eating are common topics that women have been socialising over for decades. Skipping meals, guilty indulgences, cheat days, body dissatisfaction, and calorie counts are discussed the same way as one would talk about a favourite film. However, this behaviour is never questioned but rather labelled as an aspect of femininity. “Girls don’t eat too much anyway,” a home-owner in Delhi once told this author while discussing rent. Fear of fat and the skinny dogma are infused deeper among them. This fear is justified when viewed as an effort to escape the societal disdain aimed at fat people.
In the eyes of society, fat people embody greed and gluttony, diseased from without and within, an idea perfectly captured in the film Seven. A sore sight, they will either be consecrated and made thin or be eternally damned and die early. It’s an individual choice. And so, many hold on to the hope that the next regime may work or it would mean they have failed. They keep choosing the morally superior alternative, self-inflicted starvation and misery in the form of repentance. This policy normalises what was already the norm. It puts a nail in everyone’s shoe. And in a society where we moralise pleasure and pain, see the former as satanic and the endurance of the latter as a sign of godliness and strength, some may embrace it as justified punishment for their indulgences.
Fat bias materially harms people as it keeps them from dream jobs, equal pay, opportunities, occupying spaces, happiness, and actualisation. Appearance-based discrimination is a reality many face at the hands of those who are expected to provide help and care. There have been several cases of fat people being under-diagnosed or denied treatment because health care workers failed to see past their weight. Eating disorders among them tend to go unnoticed, delaying or depriving them of treatment. People Magazine reported earlier this month that a 27-year-old woman, Amanda Lee, lost significant weight when she was unable to eat due to gastrointestinal distress and pain. She was body-shamed by a doctor who said her condition was a blessing and refused to run diagnostic tests. “Maybe that’s not such a bad thing,” she was told. A subsequent colonoscopy by a different doctor revealed she had Stage 3 colon cancer.
In another case reported by the BBC in April, a 26-year-old woman was denied eating disorder treatment on grounds that her BMI was not low enough. Medical parochialism and bias lead to further harm when the expectant shaming dissuades symptomatic people from seeking consultation. At times doctors refuse to see patients above a certain weight altogether.
Extensive research has divulged the negative impacts of anti-fat attitudes on physical and mental well-being. The mental strain of facing daily stigma and the physiological damages caused by food restrictive diets and extensive exercise makes people susceptible to diseases. Thinness does not guarantee health. Neither is fatness cause for higher mortality nor will weight loss make people live longer and happy. ‘Everything we know about obesity is wrong.’
The previously mentioned committee report also argued against the calorie count policy on grounds that it puts those with or at risk of an eating disorder (ED, the deadliest of mental health disorders) in greater danger. “People with EDs have a pathological need to control their eating. Someone with an ED can feel more in control of what they are ordering (when menus are labelled) and this feeds into their dysfunctional eating,” Tanvi Chatterjee, an M.Phil clinical psychology trainee, told this author. And so someone with Anorexia or Bulimia would order much less food while someone with binge eating disorder would order more. This assessment was backed by the findings of a study published in the PMC journal. It concluded that participants with anorexia and bulimia ordered significantly fewer calories whereas those with binge eating disorder ordered significantly more when the menus were labelled. Calorie counting apps aimed at weight loss have had similar outcomes whereby they exacerbated EDs.
This policy serves as an example of how health has transformed into the new beauty myth. Health, a widely subjective concept, is now measured by an arbitrary set of numbers on scales and appearance. Even though healthy and fit may have replaced skinny as the new buzzwords, they are still used to mean the ‘thin ideal’. By contributing to the recent trend towards healthy or clean eating, the policy spells trouble for those at risk of the novel eating disorder, Orthorexia. Orthorexia is an unhealthy preoccupation with eating food that is considered healthy. It can also signify a blow to one’s self-esteem as often such foods are not equally accessible to all.
It further hijacks bodily autonomy by making health no longer an individual pursuit but rather a goal that is owed to others, particularly the nation-state. Instead of providing greater information to allow making an informed choice, this policy enforces an intervention in an attempt to control.
Fat bodies come with presumptions of poor health, overconsumption, and a lack of self-control and morality attached. It is a communal responsibility to shame and impose self-awareness until fixed. “Should you really be eating that?” is a rejoinder fat people mostly hear from friends, family, and strangers speaking out of a violent and misguided concern. But their lack of judgement is explicit and loud. It has an external voice. An inclusion of calorie count on menus partially does away with the need to make that effort to rain down shame on a person who may already be suffering. Because now they can freely bring it upon themselves just by looking a little bit to the left or right. A minor glance at the margins can trigger an avalanche of shame and disordered eating behaviours that take weeks to subside, with support. In its absence, this new law may have just made it easier to die and not just diet.
An obsession with calories poses tremendous harm to the well-being of those already vulnerable. Health professionals like Tanvi Chatterjee and others instead recommend intuitive eating or eating when hungry to counter our skewed relationship with food. The focus should be on a balanced diet that includes different food groups rather than exclusion and restriction. And while individual efforts can help us recover, we need to supplement those with structural changes to address the institutional discrimination, unequal access to health, and food insecurity. This, and not thinness, should be the aim of public policies.
The British committee report had made 17 recommendations after painting an egregious reality of British society as it stands today. Based on a survey conducted by them, a very small fraction of the population claimed to not be dissatisfied with their appearance. Must we wait to acknowledge our biases and face facts until the situation at home becomes that critical?
Many have hailed the regulation as a positive strategy for the greater awareness it provides. They see it as an opportunity to lead a healthier (and thinner) life. Unlike the Food Authority, this author has attempted to lay out the facts as they are and uncover what lies beneath the surface. What they choose as they walk through Omelas is on everyone else to decide. Does it matter? Or is it fine?