'An extra fight I didn't ask for': A qualitative survey exploring the impact of calories on menus for people with experience of eating disorders.

Objectives: The UK government made it mandatory for large restaurants and cafes in England to display calorie labels on menus. Existing evidence identifies minimal potential for benefit, but significant potential for harm to those with eating disorders. To date, only one published study has directly explored the impact of this legislation on those with eating disorders. This study explores the impact of calorie labelling on menus on adults with experience of eating disorders in England.

Design: A qualitative online survey was designed and distributed, and 399 adults with current or past experience/s of eating disorders completed the survey.

Methods: Reflexive thematic analysis was used, informed by a critical realist approach.

Results: Six themes were developed: (1) impacts on relationships, (2) exclusion and increased isolation, (3) restricted freedom, (4) dis/embodiment, (5) anger and frustration at the perpetuation of diet culture and (6) we are all responsible for ourselves. Most participants felt calorie labels on menus is detrimental to their eating disorder and/or recovery. People are navigating multiple opposing cultural narratives around health, bodies and eating disorder recovery that can put additional barriers in place to developing a relationship with food and body that they would like.

Conclusions: Calorie labelling on menus is likely to adversely impact those with eating disorders. Menus with calories should be available separately but should not be the first or only one provided. People with experience of eating disorders should be directly involved in the development of public health legislation and policy that is likely to affect them.