# The challenges of eating out for young people with eating disorders: a thematic analysis of the perspectives of young people, parents and carers, and clinicians

## TL;DR

This study explores the difficulties young people with eating disorders face when eating out in cafés, highlighting emotional, social, and environmental challenges to improve recovery support.

## Contribution

The study identifies six specific themes of challenges in café environments, offering insights for targeted interventions like virtual reality therapy.

## Key findings

- Café environments trigger intense emotions like anxiety and stress for individuals with eating disorders.
- Challenges in cafés include social interactions, food choices, and unpredictable situations.
- The study found that challenges are highly individual and vary based on diagnosis and recovery stage.

## Abstract

Social eating is a key aspect of recovery for many individuals with an Eating Disorder (ED). To develop effective interventions to support recovery of social eating we need to understand the challenges that people with ED face when eating in public spaces. This study was conducted in the context of the development of a virtual reality graded-exposure café intervention for people with ED. The current analysis explores stakeholder perspectives on the challenges that people with ED face in café environments.

People with lived experience of ED (n = 15), parents/carers (n = 4) and clinicians (n = 6) took part in semi-structured focus groups and 1:1 interviews. Transcripts were analysed thematically.

We identified six major themes: (1) Facing the unexpected and unknown; (2) Cafés elicit difficult emotions; (3) Challenges are highly individual; (4) Challenges relating to the physical café environment; (5) Challenges of social interactions in cafés; (6) Challenges of the process of choosing and consuming food and drink.

This study highlights the challenges cafés present for people with ED, many of which also apply to other social eating scenarios. These findings will enable more targeted support and development of novel interventions to help people with ED return to social eating.

The online version contains supplementary material available at 10.1186/s40337-025-01471-z.

Many people with an Eating Disorder (ED) find it difficult to eat in social settings such as cafés, and to eat socially with family and friends. For many individuals with an ED being able to do this is an important part of recovery. To help us provide targeted support in this area we first need to understand the challenges that people with ED face when eating socially in public spaces.

We conducted interviews and focus groups with people with lived experience of ED (aged 14–25 years), parents/carers, and clinicians. Participants described cafés as difficult places where people with ED had to face unexpected challenges, and may experience intense difficult emotions including feeling anxious, stressed and overwhelmed. The noise and busyness of the physical café environment contributed to these feelings. Interactions with other people in cafés also posed a challenge including in relation to fears about judgement of appearance and food choices. Challenges around looking at menus with and without calories, and choosing and ordering food were also highlighted, as well as actually consuming food and drink. Despite common themes, challenges faced are individual and may depend on ED diagnosis and stage of recovery.

Although this study focused on the challenges faced in cafés to inform the development of a virtual reality (VR) café intervention, many of the findings relate to any social eating or public scenario. This detailed understanding about the challenges people with ED face in these scenarios will enable clinicians and potentially individuals’ wider support networks to provide more targeted support of social recovery, as well as informing the design of our virtual reality café.

The online version contains supplementary material available at 10.1186/s40337-025-01471-z.