A qualitative exploration of anorexia nervosa patients’ perceptions of macronutrients

Background Patients with anorexia nervosa (AN) respond differently to the macronutrient content of foods in terms of what they eat, prefer and desire (Sunday et al., 1992). Attitudes and cognitions toward foods have been found to be a good predictor of food consumption (Shepherd & Stockley, 1985). However, little research has qualitatively examined AN patients’ perceptions of macronutrients and how this might affect their food choices. The aim of this study was, therefore, to qualitatively explore AN patients’ perceptions of and attitudes towards macronutrients and consider how this might impact upon food choice and potential need for dietetic support.Method Purposive, convenience sampling was used to recruit inpatients with AN from one independent specialist eating disorders hospital in England. Nine patients aged 18-57 years agreed to take part in the study. Eight of these were white British females and one described herself as mixed-race Chinese. Individual semi-structured interviews were undertaken using a topic guide and audio-taped. Interviews were transcribed verbatim and seven transcripts were analysed manually using a five-step process of thematic analysis (Braun & Clarke, 2006). Saturation of themes was reached by the end of the seventh interview, with no new themes emerging. Approval for this study was obtained by the University of XX Ethics Committee.Results Three main themes emerged: Emotional Responses, Physical Effects and Health. All fats and carbohydrates evoked feelings of guilt and fear but only the ‘fat content of proteins’ was considered frightening. Fats were viewed as ‘fattening’ and the cause of ‘instantaneous weight gain’. Carbohydrates were associated with feeling ‘bloated’, ‘heavy’ and ‘too full’. Protein was associated with building muscle which some patients found aesthetically pleasing. Fats and carbohydrates were both seen as being bad for health and the body but only the ‘fat content of proteins’ contributed to its ‘badness’. No macronutrients were deemed to be essential for health. Given the choice, most patients described choosing foods with the least amount of any macronutrient, particularly with regards to fats.DiscussionA distinct aversion to dietary fat was clearly observed which is consistent with other studies showing AN patients dislike or avoid high-fat foods (Affenito et al., 2002). Unlike fats and carbohydrates, protein was viewed more positively due to its association with building muscle which could explain why some studies have found that AN patients consume a greater proportion of energy from protein than healthy controls (Hadigan et al., 2000). AN patients perceived fats, carbohydrates and proteins to affect their body in different ways and with different emotions and health implications assigned to them that were often inaccurate. Conclusion This study demonstrates that AN patients have misconceptions about macronutrients which may contribute to poor intake and suggests there is a potential role for dietitians in the treatment of AN