Dr. B’s Professional Spotlight: Hanna McAlister, RD, Discusses New Nutrition Facts label’s Impact on Eating Disorders

“If we use a food label to determine how much we should be eating, we have a high potential of either depriving our bodies of nourishment, which could end up leading to binging later or eating more food than our body needs, in an effort to ‘clean our plate’”.

-Hanna McAlister, Registered Dietitian (RD)

The U.S. Food and Drug Administration (FDA) indicated that the Nutrition Facts label on packaged foods and beverages was updated to help consumers make informed decisions about foods to contribute to “lifelong health eating habits” (FDA, 2020).  Updates to the label include the use of a larger font size and more details regarding calories, sugars, serving size, and more. 

But is the FDA’s intention of creating a healthier lifestyle truly helpful for everyone? For individuals struggling with eating disorders, self-esteem is often dependent on body shape and weight (Diagnostic and Statistical Manual of Mental Disorders 5th ed.; DSM-5; American Psychiatric Association, 2013). In turn, this can lead to obsessions with food labels for many with eating disorders and disordered eating. For others with this psychological disorder, checking labels is a pattern of the past as caloric information has been memorized with great scrutiny. Now that the FDA has changed the Nutrition Fact label for the first time in over 20 years, it is time to re-evaluate the anticipated ramifications this update may have on food restriction, binge eating, and intense fears of weight gain.

In order to examine the outcomes of this change from a professional perspective, this blog spotlight consists of an interview with Hanna McAlister, a registered dietitian. Hanna began working with eating disorders as a Dietetic Technician in 2011.  She began working in the public health by working at the Women, Infants, and Children (WIC), a Supplemental Nutrition Program, where she completed her dietetic internship.  She became a Registered Dietitian (RD) in 2016 and returned to treating eating disorders, which is now her professional niche.  She has worked as an RD in all levels of care: inpatient, residential, partial hospitalization, and intensive outpatient.  She continues to treat clients with eating disorders and co-occurring issues related to substance abuse.

Dr. Ballardo: From your perspective as a registered dietitian, how might the new serving size on Nutrition Fact labels impact individuals with eating disorders

Hanna:  Using a serving size listed on a box is not an accurate way to determine our hunger and fullness. Every individual has different energy (calorie) needs and a number on a box is not likely to be an accurate representation of that. For an individual with an eating disorder, this may cause extreme preoccupation with the specific serving size listed and if they potentially ate more than “one serving”. Take macaroni and cheese for example. A typical box has 2.5 servings. However, how much you eat of that box should be determined based on your own hunger level at the time. Potentially, that is all you make for dinner rather than having it as a side dish. In that case, the whole box may be what you need to satisfy your hunger. No one should have the authority to determine that, besides yourself.

Dr. B: Can you share a few thoughts on intuitive eating? How might this food label change impact intuitive eating?

Hanna: Intuitive eating is being able to listen to and honor what our body wants and needs, judgement free. If we use a food label to determine how much we should be eating, we have a high potential of either depriving our bodies of nourishment, which could end up leading to binging later or eating more food than our body needs, in an effort to “clean our plate”.

Intuitive eating is centered around nourishing our bodies by allowing for balance of all types of foods. Supplements, such as a multivitamin, are generally not needed for an intuitive eater because they are able to get a wide variety of vitamins and minerals by choosing foods that their bodies are “asking” for every day. 

The food label change could cause an intuitive eater to question their food decisions or second guess eating a certain amount. It could cause an intuitive eater to start placing judgement on themselves for “eating that much” and then ultimately hurt their relationship with food.

Dr. B: Calories also appear to be in a larger font on new food labels.  Do you think this will increase guilt associated with eating that many people on diets struggle with feeling?

Hanna: Absolutely! Most diets are centered around calories, obsessing over them, counting them, typing them into apps. Making the calories stand out more on the food labels is an insult to injury. An individual caught up in a dieting cycle or with an eating disorder, more often than not has an emotional response to just the word “calories”. 

Dr. B: Why do you think Potassium and Vitamin D were added to food labels? What do you think about this change?

Hanna: I feel that potassium being added is most helpful for someone who is on a therapeutic diet and in need of that information. For example, someone on dialysis would benefit from knowing how much potassium is in a certain food item since they generally have a set amount they are required to consume or limit themselves to. 

Vitamin D was added probably because most Americans are low in it. Likely due to our decreased time in the sun from working indoors and the general fear of skin cancer.

These micronutrients being highlighted are great for educational purposes, when the right person is looking. However, the fact that this is a “new addition” and the subtext being “we need to monitor this” could cause preoccupation in the eating disorder population. Both of these nutrients have the potential to be toxic when taken in a supplement form and should always be consumed under the care of a doctor or dietitian. 

Dr. B: Do the changes to the food labels seem to be impacting your current work with clients? If so, what are some common struggles you hear people talk about in regards to the changes?

Hanna: Of course these changes are impactful but not everyone might be aware why. Working with the eating disorder population, I hear the word “calories” out of most of my clients mouths more than once a session. Not every client is aware that these changes were made, however, they could be made more aware of calories, serving sizes, ect. because of the new layout. This is very likely increasing preoccupation on the most triggering thing for them.

Dr. B: What recommendations do you have for parents and loved ones who are trying to help their child or partner avoid obsessing over food labels?

Hanna: Using the senses! Focus on how food smells, tastes, feels in their mouth (& hands) and even how food sounds (is there a crunch?). 

Seek professional dietary counseling and therapy to support you or your loved one!

Dr. Tracy Ballardo, Psy.D., and Hanna McAlister, RD, worked together for years treating eating disorders within a multidisciplinary team of dietitians, dietary technicians, therapists, nurses, mental health workers, and psychiatrists in all levels of care: inpatient, residential, partial hospitalization, and intensive outpatient. 

Hanna McAlister is accepting new clients for dietary counseling via telehealth.  In order to schedule an appointment with her, please email hm.balancedpeach@gmail.com.

Dr. Ballardo is accepting new clients for online therapy.  To schedule an appointment, please email DrTracyBallardo@gmail.com.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders  
            (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

U.S. Food and Drug Administration. (2020). The new Nutrition Facts label: What’s in it for you?
              Retrieved from: https://www.fda.gov/food/nutrition-education-resources-
              materials/new-nutrition-facts-label#subscribe