Individuals with restrictive eating disorders' experience of the introduction of calories on menus in England: An interpretative phenomenological analysis study.

OBJECTIVE: In April 2022 the Calorie Labelling (Out of Home) Regulations came into effect in England where cafés, restaurants, and takeaways with over 250 employees were required to provide calorie labelling on menus. Concerns have been raised regarding the potential negative impact this could have on individuals with eating disorders (EDs), yet this has not been explored using qualitative methodology. METHOD: Eleven participants with a current or previously diagnosed restrictive ED were interviewed in September 2022. Interpretative Phenomenological Analysis (IPA) was used to explore their experience of the introduction of calories on menus. RESULTS: Using IPA we established six themes and seven subordinate themes. These included the introduction of calories on menus as an 'attack' on individuals with EDs; the prominent visual display of calories as an attentional pull; normalising of calories counting; the impact on behaviour; and associated strategies for managing. CONCLUSION: This contributes to research surrounding the implications for public health policies on individuals with EDs, especially their ability to reinforce and amplify disordered thoughts and behaviours, and the need for greater consideration of how to minimise impact and potential harm of large public health campaigns.

"It's not about wanting to be thin or look small, it's about the way it feels": an IPA analysis of social and sensory differences in autistic and non-autistic individuals with anorexia and their parents.

BACKGROUND: Despite increasing evidence to support an overlap between autism and anorexia nervosa (AN), underlying mechanisms remain poorly understood. Social and sensory factors have emerged as promising targets in both autism and AN, however there remains scope to compare these differences across autistic and non-autistic experiences of AN. Drawing on dyadic multi-perspectives, this study explored experiences of social and sensory differences in autistic and non-autistic adults and their parents and/or carers. METHODS: Using interpretative phenomenological analysis (IPA), dyadic interviews were conducted with 14 dyads, with seven autistic dyads and seven non-autistic dyads. Data analysis was subjected to a triangulation of interpretations: (1) the participants themselves; (2) a neurotypical researcher; (3) and an Autistic researcher with lived/living experience of AN. RESULTS: IPA identified three themes in each group, with similarities and differences between autistic and non-autistic dyads. Similar themes were identified regarding the importance of social connectedness and socio-emotional difficulties, as well a common lack of trust in the social and sensory self and body. Autism-specific themes centred on feelings of social 'defectiveness', disparities between sensing and expressing certain cues, and lifelong, multi-sensory processing differences. Non-autistic themes reflected social comparisons and inadequacy, and sensitivities to the learning of ideals and behaviour through early experiences. CONCLUSIONS: While similarities were observed across both groups, there appeared to be notable differences in the perceived role and influence of social and sensory differences. These findings may have important implications on the delivery and modification of eating disorder interventions. Specifically, they suggest that while treatment targets may look similar, subtle differences in underlying mechanisms and approaches may be required for Autistic individuals with AN across sensory, emotion and communication-based interventions.

A call for autism-led research exploring definitions of recovery in Autistic individuals with an eating disorder.

RESEARCH GAP: It is now established that definitions of recovery in eating disorders (EDs) should be informed by the lived/living experience of individuals and consider a broad range of physical, behavioral, and psychological factors. Autism is a common co-occurring condition in EDs reflecting unique needs and experiences; however, very little research to date has explored definitions of recovery from EDs in Autistic populations. The current article will briefly review what we know about autism and EDs, before addressing how we can apply and extend what we know about broader ED recovery research to the unique needs of Autistic individuals with ED. SUGGESTED APPROACH: We propose that future studies are urgently required exploring definitions and conceptualizations of recovery in Autistic individuals with EDs, rooted in autism-led, participatory research approaches and incorporating physical, behavioral, and psychological factors. DISCUSSION: Benefits and possible obstacles of implementing the proposed approach are discussed, before the authors outline specific suggestions for participatory designs and targets for future studies. Multidimensional and mixed method approaches to ED recovery will work toward integrating clinically measurable outcomes with lived/living experience perspectives. PUBLIC SIGNIFICANCE: EDs are common in Autistic individuals, however, very little is known about definitions of ED recovery in this population. Cross-disciplinary, research-driven definitions involving lived/living experience at all stages of the research process will generate meaningful and translational research.