Table 1 Summary of themes emerging from guided discussion with 20 participants

Eat a variety of foods [15]

Eat lots of carbohydrate [14]

Eat less fats, oils and extra foods [11]

Eat a variety of foods [16]

All foods are ok including fun foods and fats/oils [14]

AGHE-03 [1]

REAL Food Guide [19]

Nil response

• Increased relevance of content e.g. “It relates to the eating disorder. Like with the stuff as the top of the pyramid....you have your own little triggers and things, and the pyramid actually knows this”

• Some felt the AGHE endorsed eating disorder cognitions, e.g. “The message from the pie (the AGHE) versus the pyramid is about the same, but I look at this (the AGHE) and I know I could easily manipulate that for my eating disorder.”

• Participants disliked the placement of the extra foods separately to the core foods as they felt this indicated “bad foods” [15], and “don’t eat these foods” [16].

• Some liked the placement [3], because it reinforced their disordered beliefs: “I’m happy with the extra foods being separate…. You can exclude these and never have them again”.

• Placement of fats and oils in the extras section was disliked by half the sample [10] e.g. “They should say that there are good fats that you should have”.

• Participants felt a sense of reassurance at seeing “fun foods” included in the REAL Food Guide, e.g. “It’s good because it shows you it can be normal to eat small amounts of these foods every day, and that helps reduce any guilt you might feel about eating these foods”.

N/A

Some participants liked the inclusion of diet foods and fillers [7] stating that “this section is very relevant to people with eating disorders” and “you should think… why are you eating these? And that’s helpful”.