When I was studying nutrition at university, one of the most deceptively complex and interesting topics of discussion was why people choose to eat the foods they do. Most people believe that cost and taste are the only real factors in the decisions they make about what they eat every day, with some people having religious or ethical reasons factoring into their choices. In reality, there are thousands of ways in which our choices are influenced, and it is my opinion that disability is one of the most over-looked of these influences.
Firstly, many disabilities and chronic illnesses place restrictions on what foodstuffs can be safely consumed. Those with allergies would die from anaphylactic shock without rapid access to adrenaline (a.k.a. epinephrine), and while a food intolerance is less likely to kill someone, the symptoms caused are often painful and deeply unpleasant. Diabetics, particularly those with Type 1 Diabetes Mellitus, must keep a close eye on their blood glucose levels so as to avoid falling into a coma, and rare conditions like Phenylketonuria prevent people from being able to metabolise a particular amino acid that is found in everything from breast milk (and therefore must be bottle-fed with a specific formula in order to survive) to common sweeteners. People like me who lack a gall bladder must always be conscious of their fat intake in order to avoid steatorrheoa (unless you have a strong stomach, do not Google that), and those who have diverticulosis often have to avoid grains which are prone to getting stuck in the little pockets lining the intestinal wall that characterises this disease, causing infection. It’s important to remember that disease can also promote the consumption of particular foods, such as in the case of nutrient deficiency.
However, having a physiological reaction to a particular food is just one way in which disability impacts food choice. While online shopping and delivery options have made supermarkets and shops more accessible in general, the accessibility of the website itself restricts what companies disabled people can buy from. Similarly, in stores, the space for movement and way the shelves are stacked limits what disabled people can reach and therefore purchase, and the location of stores in regards to car parks and public transport impacts what stores we can travel to.
The cost of food also plays a major role in food choice for everyone, and since disabled people are often among the poorest of the population with the highest living costs, the impact of disability upon finances has a knock-on influence on food choice.
Food preparation is also a major concern for many disabled people, and while the public lambasts pre-prepared foods for being lazy and using a little extra plastic, they can be literal life-savers for those who struggle to cook. The same can be said of delivery services who will bring cooked food to your door, although this is expensive, but a lot cheaper than accessing a carer.
This sounds obvious but, once you’ve prepared the food, you need to eat it. If you lack teeth or struggle to swallow, hard, crunchy foods are simply too difficult to eat. If peristalsis (the muscle action that pushes food from one hole to the other) is weak then your appetite will decline as food will remain in your gut for longer, something which I often experience as a result of muscle fatigue and weakness.
On top of all of these factors, disabled people are subject to the different likes and dislikes of any group of people. I enjoy fish but despise shellfish. I eat meat, but can also go without it quite easily. I hate mushy peas.
I would always advise against judging someone’s diet based on what you see in their shopping basket, partly because it’s impossible to get an accurate snapshot of someone’s diet from seeing a McDonald’s bag in their hand, but mostly because diet and food choice are far more complex than this brief article can encompass. You might be seeing someone on a treat day, someone on a bad day, or just someone on a busy day. They could be buying food for someone else entirely.
Even more importantly, another person’s size and weight are not yours to judge unless you are an on-duty health professional who understands that BMI is just one indicator of risk, and not a direct cause of illness. There are many conditions that cause weight changes beyond the control of diet and exercise alone, even something as simple as the way fat is distributed beneath the skin and around organs can have a vast impact on appearance and cannot be reliably controlled.
If you want someone to blame for the overall weight gain of the population, you have to look beyond individuals. Food manufacturers use the cheapest ingredients possible to maximise profits, and these are often the unhealthiest as well as being poor in quality. Retailers put more special offers on chocolate and crisps than they do fruit and vegetables, meaning that those with less money have to choose between being hungry or unhealthy. It has taken government intervention to ensure that sugar-free soda is cheaper than the original, and that the advertisement of certain foods to children, who are the most easily influenced among us, is restricted in the UK.
While we must all try to take some responsibility for our health, different people do not have equal access to healthy options, and that is beyond their individual control. A lot more can be achieved with compassion and understanding, rather than prejudice and nasty comments.