Food and visual impairment

This business of 'being on holiday' is really quite good - not having lectures, coursework, revision, exams, clinical placement or employment means there is time to do things I want to do.

There are still things that must be done, and some deadlines are starting to loom again, not least the start of my clinical placement on Monday. My uniform has arrived - it is a long white tunic labelled 'Student Dietitian' that is slightly too big, and black trousers that need hemming. I've also received detailed instructions on how to get into the department that must have been developed in the light of some very stupid students. For example, the letter contains the following statements: "...we are on the first floor so you need to use the stairs or the lift. We are at the opposite end from the lift so you need to make your way along the corridor..."

I have also sacrificed some of my free time to help out at an event held by my previous employer - the same type of event where I volunteered last September, but this time taking place in Birmingham. Again, it was a chance to catch up with old friends and colleagues, but with a few added extras:
1) I wore clothes and shoes similar to those I will need to wear on placement, to see if I can survive for a day. I can, but only just.
2) I was put in charge of looking after one of the VIP attendees for a few hours. He is an interesting man with unconventional ethics and a knack for causing immense amounts of trouble for his colleagues by making provocative public statements.
3) I talked to some people about my research project about food choices for people who have vision impairments.

The scope of the research project that we have agreed on is very tiny indeed. Just 6 to 8 interviews lasting for an hour at most, asking people a bit about how they choose what food they buy and cook and eat out, which I then analyse for 'themes' and write up my findings. It's clear that such a small number of subjects will not be representative of the thousands of blind and partially sighted people in the UK, let alone the world, but we have to be realistic for a university project.

There doesn't seem to be any other research going on in this area, and I have so many ideas. Without wishing to anticipate outcomes, it is clear that people with poor sight will not easily be able to read ingredients lists or nutrient contents on food packets. It is likely that the food they buy will be 'easy' to prepare and eat without sight, and I am curious to know whether these choices turn out to be nutritionally unbalanced in any way - ready meals that are high in fat and salt, for example. The 'healthy eating' messages that are put out by government and others may not be fully accessible to this group of people either, but then neither is the advertising from food retailers and manufacturers.

There will obviously be a wide range of cooking skills, knowledge and abilities out there, and nutritional knowledge will vary widely as well. The length of time that someone has been losing their sight will affect cooking ability, as well as age and gender. Are people who are blind from an early age given better instruction in cooking than those who lose their sight later in life? Do they bother to cook at all? What is the difference between food choices of people with different levels of useful vision, and different methods for reading print? Do people who can use the internet and do their food shopping online read the additional nutritional information that is available? Is it accessible, and meaningful?

There is also a medical angle: diabetes is known to cause visual impairment (retinopathy), and macular degeneration is associated with obesity (without looking it up I'm not sure if it's causative or not). Perhaps certain food choices associated with obesity predispose an individual to macular degeneration, or the excess adipose tissue produces higher levels of hormones affecting the macula, or an obesogenic lifestyle contains factors that also affect the macula? It is known that the increasing prevalence of childhood obesity is associated with sedentary behaviours, and independent exercise is not easy when you can't see - I know one extremely fit gentleman who is blind, and he regularly goes hill-walking and cycling (tandem), but I think he is the exception.

Then there are the visual aspects of food and its effect in weight management. We make food look good for a reason, and if you can't see how appetising a dish looks, do you eat a different amount? I have been using a smaller plate to try and reduce the amount I eat, but that tactic would be wholly ineffective if I couldn't see the food on the plate. How do hunger, satiety and vision relate to one another? Does a blind person choose how much to eat using the same mechanisms as someone who can see, and which techniques for weight management are most effective for this group?

And finally, there is the sensitive and tricky area of physical appearance. In general we find thin people more attractive to look at than fat people. Some people are therefore motivated to remain thin or to lose weight by their appearance in the mirror (although by no means all: discomfort, health concerns and shopping phobia are obvious alternative motivations). If you can't see what you look like, and what others look like, do you pay more or less attention to your body size?

RNIB is already working on accessibility in the NHS, trying hard to make sure that appointment letters and information leaflets are produced in alternative formats, and signage and guidance around hospitals and health centres is accessible. There's still an awfully long way to go, and I don't think my input would make much difference in this area.

My day of volunteering ended in a nearby hotel with some particularly old ex-colleagues that I hadn't much time to talk to during the event. I caught up with some of the workplace politics, and laughed at more stories from when we were young and foolish. The friend and ex-colleague I met a couple of weeks ago was mentioned, and the story of the time he had burned off all his chest hair while showing his 2 year-old grandchild how a cigarette lighter works. Wrong on so many levels, but if you knew him, you'd have to laugh.

I spent another day in Birmingham on my quest for flat work shoes and sturdy sandals, and managed to find some at last, despite the absence of Lola II in person. The city is hosting an International Food Fair, so I spent a bit of time browsing the various stalls, before meeting up with more lovely ex-colleagues, and more gossip. The next opportunity for this kind of decadence will be after my placement, in September.