Distress Associated with Clean-Eating: Understanding the Views of Healthcare Professionals

Eating disorders (EDs) have traditionally been perceived as illnesses that predominantly afflict young, White females. Recent times have shown an evolution in the complex and nuanced way that EDs can manifest, and there is growing appreciation that people of all ages, genders, and ethnicities can experience disordered eating. Research has been slow to adapt to this changing landscape, and certain populations and eating presentations remain understudied. This thesis addresses these knowledge gaps, particularly in relation to the male experience of EDs and the widely debated notion of harmful healthy eating.

A comprehensive literature review was conducted to identify and synthesise published research on male barriers to help-seeking for EDs. Eight studies (with quantitative, qualitative, and mixed-methods designs) were shortlisted and analysed using a narrative synthesis approach. Results identified the presence of diverse barriers that operated across socioecological systems. Some bore similarity to those described in the female ED literature, however gender-specific barriers were also identified and understood as a response to unhelpful normative constructions of masculinity. Several ideas were discussed for clinical interventions to reduce barriers to professional care, and the importance of deconstructing stereotypic perceptions of masculinity and EDs was emphasised.

In acknowledgement of the growing body of literature on ‘orthorexia nervosa’, the empirical project focused on understanding how distress associated with ‘clean’ and healthy eating presents in the UK. Twelve healthcare professionals from different disciplinary backgrounds were interviewed about their views and clinical experiences of ‘clean-eating distress’. Data were thematically analysed, generating four higher-order themes pertaining to the conceptualisation of clean-eating distress, factors associated with its development and maintenance, and recommendations for clinical intervention. Results highlighted a general recognition of the problematic nature of this eating presentation, however mixed opinions and contention existed about its conceptualisation and how it should be addressed by healthcare services.