Dear the Royal Society for Public Health,

My name is Nicole Wootton-Cane, and I am writing to you today concerning your recent proposals for activity equivalent labelling on food. Though I understand where these propositions have come from and appreciate the need this country has to combat the rising levels of obesity, there are other highly damaging consequences that I strongly believe would emerge if your proposals were to continue. Equating caloric intake with exercise is an unhelpful and potentially seriously dangerous obsession for many, and I do not feel the full consequences of your proposal to the population of this country have been fully considered.

Though obesity is an issue, it is by no means the only growing problem this country is facing with food. The Joint Commission Panel for Mental Health estimate that over 1.6 million people in the UK are directly affected by eating disorders[1], whether this be anorexia, binge eating or any other form of disordered eating. A study by the Health and Care Information Centre, published in February 2014, found that there had been an 8% rise in the number of inpatient admissions to hospital for eating disorders in the 12 months previous to October 2013. This is a statistic that continues to rise, with up to 18 new cases of bulimia per 100,000 people per year[2]. Eating disorders are an unacknowledged epidemic this country is facing, and the consequences are just as severe and costly as those of obesity.

I also believe it is just as important to consider the potential causes of obesity. Though sometimes it may be caused by a simple lack of awareness paired with little physical activity and a high calorie intake, it is estimated that up to half of all adults who are overweight suffer from Binge Eating Disorder[3](BED). BED is a mental illness and therefore will not simply be cured by food packaging or awareness of the harmful consequences of being overweight; psychological treatment is required. ‘Modern malnutrition’ is another term used to define a modern diet that results in obesity. Modern malnutrition is more common in those from lower socioeconomic groups – those who receive lower incomes consume a smaller variety of foods that are higher in saturated fat and salt because this food is so cheap and easily accessible[4]. It is therefore unreasonable to expect that your proposals would effectively tackle obesity, as the causes of overeating are clearly more complex than a simple lack of awareness concerning food labels. Tackling poverty, food costs and mental health issues should therefore high priorities for a government looking to combat high obesity levels and this is where I believe the focus should be invested, rather than fixating on food packaging.

Food and exercise are two very different, and very important, areas of human health. Though they are interlinked, I believe that the proposition outlined broadcasts the idea that all food needs to be earned through exercise or burned off afterwards, which is simply not the case. According to government guidelines, an adult human needs approximately 2000 calories a day in order to maintain a healthy weight. Some of these calories will be burned off through daily exercise such as walking, but the vast majority will go towards the bodily functions that we barely even think about – keeping our body temperature stable, pumping the blood around our body, keeping our cells healthy and brain activity. Without food, our bodies would deteriorate; it is essential that we intake more calories than we burn, otherwise our bodies will cease to function, and eventually our hearts will stop beating.

Exercise is a tool often used by those with eating disorders, in particular restrictive ones, to burn calories, therefore resulting in a higher calorie deficit and faster weight loss. Because of this, sufferers will often equate food with exercise and burn off most of or all of the food they eat, resulting in their bodies not receiving adequate nutrition and being forced to drop weight even if they cannot afford to. The idea of equating food to exercise and a low calorie diet to ‘good health’ is therefore entirely unsustainable; even when one is attempting to lose weight it is only healthy to have a small deficit. The implications that all food needs to be burned off, an idea which is entirely untrue and potentially incredibly unhelpful and dangerous to many people within the population, even those who are severely obese. The plan to put the amount of exercise needed to burn off the calories in a food product is actively encouraging people to cause calorie deficits when their bodies actually need the energy to function and survive. For example, if I were to walk into any supermarket this lunchtime to purchase a meal, it is likely that I would find a perfectly nutritious sandwich potentially in the range of 400-700 calories. If your proposals were to go ahead, the packaging on this sandwich would advise me that I would need to run at about 9.2 kilometres per hour for approximately one hour to two hours (depending on the caloric value of the sandwich), immediately implying that the meal contains nutrition that needs burning off through a fast, long run. This is in fact untrue; it is likely that I would have burned off that 400-700 calories by dinner time by walking, engaging in brain activity and from other bodily functions. In this case, burning this amount of calories by exercise would actually leave me in deficit, and unable to effectively perform these functions, including decreased brain function which is a common difficulty in individuals with eating disorders due to malnutrition. I believe that your proposals are seriously risky, as it is fair to assume that these labels would only encourage guilt, potentially resulting in a steeper rise in eating disorders. This labelling would encourage obsessive thinking around food and exercise, linking the two which is typical of disordered eating and could therefore be highly damaging.

Eating disorders cost the NHS between £80-100 million per year, with the overall economic cost being estimated at £1.26 billion per year[5], yet eating disorders are entirely ignored when considering food packaging standards and regulations. As somebody in recovery from anorexia nervosa myself, I can guarantee that if these reforms were to go ahead I would struggle greatly to continue progressing with my recovery as exercising to compensate for eating was a huge part of my disorder and something that I am still working on overcoming. I am also very aware that I do not only speak for myself; excessive exercise is a common behaviour exhibited by many with anorexia nervosa[6] and other eating disorders alike. You have a responsibility to not only look out for the wellbeing of those in this country who may be struggling with overeating and obesity, but also the 1.6 million with eating disorders. The proposed reforms would not only be ineffective, as they would merely encourage guilt in both those who have issues with food at either end of the spectrum, and would only encourage the association of food with exercise which is entirely unnecessary and unsustainable.

I hope you take this petition and letter into account when making your decision on whether to enforce your new policy or not. You are right in believing that there is work that must be done to protect the physical and mental health of this nation, but this is not it.

Yours faithfully,

Nicole Wootton-Cane

[1] http://www.jcpmh.info/wp-content/uploads/10keymsgs-eatingdisorders.pdf
[2] http://www.priorygroup.com/eating-disorders/statistics
[3] http://eating-disorders.org.uk/professional-training/binge-eating-in-obesity-master-class/
[4] http://www.fph.org.uk/uploads/bs_food_poverty.pdf
[5] http://www.jcpmh.info/wp-content/uploads/10keymsgs-eatingdisorders.pdf
[6] Kron L, Katz JL, Gorzynski G, Weiner H. Hyperactivity in anorexia nervosa: a fundamental clinical feature. Compr Psychiatry. 1978;19(5):433–440. doi: 10.1016/0010-440X(78)90072-X.