516136 research-article2014

HEA0010.1177/1363459313516136HealthKristensen and Køster

Article

Contextualising eating problems in individual diet counselling

Health 2014, Vol. 18(3) 319­–331 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1363459313516136 hea.sagepub.com

Søren T Kristensen and Allan Køster Metropolitan University College, Denmark

Abstract Health professionals consider diet to be a vital component in managing weight, chronic diseases and the overall promotion of health. This article takes the position that the complexity and contextual nature of individual eating problems needs to be addressed in a more systematic and nuanced way than is usually the case in diet counselling, motivational interviewing and health coaching. We suggest the use of narrative practice as a critical and context-sensitive counselling approach to eating problems. Principles of externalisation and co-researching are combined within a counselling framework that employs logistic, social and discursive eating problems as analytic categories. Using cases from a health clinic situated at the Metropolitan University College in Copenhagen, we show that even if the structural conditions associated with eating problems may not be solvable through individual counselling sessions, exploration of the complex structures of food and eating with the client can provide agency by helping them navigate within the context of the problem. We also exemplify why a reflexive and critical approach to the way health is perceived by clients should be an integrated part of diet counselling.

Keywords environment and health, ethnography, narrative analysis, nutrition, post-structuralism/ postmodernism

Introduction Eating-related health problems seem hard to solve. One such example is obesity which is considered to be a major health problem globally, increasing the risk of a number of diseases (World Health Organization (WHO), 2000). Research indicates that only a minor proportion of people who lose weight succeed in maintaining their weight loss Corresponding author: Søren T Kristensen, Department of Nutrition and Health, Metropolitan University College, Pustervig 8, 1126 Copenhagen, Denmark. Email: [email protected]

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(Anderson et al., 2001; Shepherd, 2002; Svetkey et al., 2008) and that most people have regained their weight within 5 years (Wadden and Stunkard, 2002). Besides the physiological consequences, studies indicate that the phenomena of ‘yoyo-weight’, signifying that people alternately lose and gain weight, can cause lower self-esteem and emotional problems (Foreyt et al., 1994; Wadden et al., 1988). Furthermore, studies show that weight maintenance is associated with great personal costs, that is, constantly having to be aware, plan and govern eating and feeling different from other people. Those capable of maintaining the weight loss typically compensate for these costs by improvements in their social and everyday life with regard to career, health and stigmatisation (SarlioLähteenkorva, 2000, 2001). Besides physical activity, changing diet is considered to be a vital component in managing weight and chronic diseases or optimising nutritional status. Traditionally, approaches to diet counselling tend to be oriented towards changing individual health behaviour by providing knowledge on nutritional recommendations. This approach has been challenged by the motivational interviewing framework and the emerging field of health coaching among others as being too narrow. Whereas motivational interviewing has been defined as ‘a client-centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence’ (Miller and Rollnick, 2002: 25), health coaching has been defined as ‘the practice of health education and health promotion within a coaching context, to enhance the wellbeing of individuals and to facilitate the achievement of their health-related goals’ (Palmer et al., 2003: 92). Although the health goals of the individual are emphasised in these definitions, the overall context is to assist the clients in adhering to treatment and lifestyle recommendations in order to improve health in terms of reducing risk factors for chronic diseases. In motivational interviewing, counsellors typically aim to increase awareness of the health problem with regard to risks faced and consequences experienced and to help clients to envision and be motivated for a better future. Janette Gale and Helen Skouteris (2013: 16) sum up the components most often included in health coaching as being a provision of health education and information, behaviour change and modification support, motivation enhancement, problem-solving support and psychosocial support. These components primarily reflect an individualised approach. However, the literature on health coaching also emphasises the importance of environmental and cultural influences to lifestyle change (Linden et al., 2010: 166). This is typically achieved through a short interview identifying and addressing barriers for behavioural change (Gale and Skouteris, 2013). There can be little doubt that the ambition of addressing health issues in a more comprehensive way including individual motivation and environmental factors is recommendable, but several issues can nevertheless be raised. First, one might ask to what extent motivational interviewing and health coaching is really committed to following the agenda of the client when it comes to the decision whether or not to follow official health recommendations. Second, besides the difficulties mentioned above in solving the problem of eating-related health problems and the controversial issue of evidence for the lasting effect of these approaches, it can be seen as a justified concern that counselling and health promotion focussing on individual motivation runs the risk of causing more harm than good by conferring more agency to the individual person than what is realistically possible (Armstrong, 1993; Crawford, 1984; Nettleton and Bunton, 1995). In this

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respect, counselling can contribute to ‘victim blaming’ (Crawford, 1977). Finally, and most importantly, with regard to the focus of this article, the ambition of taking the environment into consideration tends to be restricted to easily identifiable barriers, such as triggers and cues, based on the assumption that food choice is determined by specific causalities (Wardle, 2010). It is our contention that the integration of environmental and contextual influences on food choice in diet counselling and health coaching needs to be worked out in a much more radical and systematic manner. Instead of treating the activity of food and eating as a behaviour caused by triggers and cues, we suggest a focus on food and eating as a complex and contextualised phenomenon including bodily practices, intentions, symbolic meaning, social interaction and a wide range of structural conditions of everyday life. We will address this complexity by employing the concept of eating problems. By eating problems, we do not refer to a clinical category, that is, eating disorders, or failure to accommodate to official health standards, but to an empirical category reflecting the clients’ own assessment of their food and eating practices as being problematic (Kristensen, 2003). This differs from the approach of traditional diet counselling and health coaching, and is a point of departure for what we call a radical contextualisation of health problems. By radical contextualisation, we suggest that the problem, contrary to clinical assessments, should be defined from the context in which it is embedded. How radical contextualisation can be applied in working with eating problems will be shown by first presenting narrative practice as a context-sensitive counselling framework, focussing on the concept of externalisation and the principle of co-researching the problem in a lifeworld perspective. Second, we will suggest how the process of contextualisation of eating problems in diet counselling can be informed by the use of qualitative studies in food and eating. This will be further illustrated using cases from a research project recently carried out at a health clinic situated in a university college. Third, we will touch upon how the choice of counselling-strategy needs to reflect the specific contextual character of the individual eating problem. Finally, we will discuss some of the implications of the outlined approach with regard to working with eating-related health problems in general.

Narrative practice as a context-sensitive framework for counselling processes The range of frameworks used in counselling and psychotherapy are often criticised for being too individualistic and narrowly focussed on the life of the ‘inner self’, while paying little or only superficial attention to the complexity and subtlety of contextual influences on human intentions and behaviour (Richardson et al., 1999). If this criticism is justified, a reasonable explanation for this state of affairs could be that most counselling and psychotherapy frameworks have been drawing heavily on theory and research that focus on individual psychology, while only marginally being oriented towards theories and research within the social sciences. As a result, the underlying understanding of human behaviour and agency that emerges in these counselling frameworks tends to take internal psychological processes as the point of departure. A recent and notable

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exception to this tendency is the development of what is called narrative practice or narrative therapy. Narrative practice was developed by Michael White and David Epston (White, 2007; White and Epston, 1990), and contrary to mainstream counselling theory, narrative practice explicitly draws on social theory and social philosophy in its understanding of human behaviour and agency. Following the French philosopher M. Foucault, White argues against the notion of a sovereign, centred core self and, in its place, emphasises the poststructuralist idea of a constituted self, that is, the self as a result of a comprehensive process of subjectification (Foucault, 1977; White and Epston, 1990). The self is, in effect, primarily constructed by the contextualisation it receives through social negotiation, power relations and cultural processes. It is from this perspective that the focus on the narrative is justified. Following what White and Epston call the text analogy (White and Epston, 1990), and drawing on significant developments within anthropology, philosophy and social constructionist psychology, narrative is claimed to be a key organising principle through which identity, thoughts and experiences are constituted in a process of internalising social norms and discursive practices. As such, counselling processes that wish to take the contextualised nature of the individual subjectivity seriously can address the issues through the medium of narrative. Some of the key ideas for working contextualised in narrative practice relate to what is called the principle of externalisation (White, 2007) and counselling as co-researching the problem (Epston, 1999). Following what is often referred to as the linguistic turn in modern philosophy in terms of ascribing a potent role to language in our understanding of reality, the idea of externalisation is an attempt to reflect the decentred understanding of human subjectivity in the language we use during counselling processes. This is important since our use of language has significant implications on how we understand and locate problems. In narrative practice, Michael White has summarised this idea in the dictum, ‘the person is not the problem, the problem is the problem’, with the purpose of conveying that problems in general have a social and cultural history and should be treated as such. The basic characteristic of externalisation is a shift in how we speak. It is about changing the adjectives people use to describe themselves into nouns. Within the field of eating problems, an example could be a rephrasing of the sentence ‘I am a binge eater’ into an explorative investigation of ‘what makes binge eating appear?’1 The strength of externalising the use of language is exactly that it facilitates an investigation in which the client and the counsellor collaborate as co-researchers into the exploration of the problem. Externalising use of language furthers such an investigation, insofar as it creates a distance between the client and the problem, and thereby invites to an open investigation into the context of the problem. The process of a collaborative investigation into the client’s lifeworld is a hallmark of narrative practice and is referred to as co-researching (Epston, 2001). The idea of coresearching in counselling sessions is inspired by interpretive anthropology where people are encouraged to interpret and study their own lives, and as such become members of the research process (Epston, 2001). Contrary to the use of co-researching in anthropology, co-researching in narrative practice is aimed at facilitating individual learning processes rather than gaining cultural insights. Nevertheless, both can be an outcome. In our work with eating problems, we engage in a collaborative mapping of how the client’s

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problem is continually constituted through social interaction and historical context. Specifically, we practice exploration by using an externalising language and actually mapping the client’s narrative on flip overs or white boards. Besides materialising the narrative, and thereby retaining the spoken words, this graphic externalisation makes it possible to investigate the complexity of the context and discover relations and dynamics of the problem. Collaboratively writing the narrative on flip overs also serves as a collective documentation giving the counsellor and the client a shared reference for new discoveries. A pivotal point in this exploration is negotiating, what is referred to as, an experience near the name of the problem (White, 2007). Contrary to standard diagnostic thinking, the process of naming the problem arises from local contextual insights. The act of giving the client the authorship of the problem is considered to provide agency when it comes to navigating in the landscape of the problem.

Contextualising eating problems in narrative counselling processes In the following, we will illustrate how the contextualised nature of eating problems can be addressed in actual counselling through the process of co-researching into the lifeworld of clients. This will be done by the use of data collected from narrative diet counselling sessions in a research project recently carried out at a health clinic situated in a university college.2 As part of the project, a literature study of social science research on food choice and eating problems was carried out. This study qualified the use of logistic, social and discursive eating problems as useful analytical categories in the practice of co-researching into eating problems. By analytical categories, we mean that they cannot be reduced to individual eating problems on the empirical level on which they often occur simultaneously and in dynamic interaction. The analytical categories were applied by the use of conversation maps containing specific themes and questions.3 Being both explorative and paying attention to specific predefined issues based on insights from existing research, these maps resembled interview guides used in semi-structured qualitative interviews. Also, these maps shared the idea of qualitative interviews by striving to achieve a conversational atmosphere and by following the associations of the clients as a way of exploring their lifeworld. In the following, we will qualify each category through references to the sociology and anthropology of food and eating and exemplify how they were used in the practice of counselling.

Logistic eating problems In the counselling sessions, some of the clients experienced logistic eating problems. By logistic we refer to how the activity of eating was coordinated with schedules and chronologies in everyday life, such as study, work, leisure and family life, and to other activities at various places. In most cases, this was interrelated with how the body’s needs and desires for food were experienced and managed in everyday life. Also, part of logistic eating problems related to the way structures of everyday life interact and collide with social and cultural norms regarding eating, such as commensality, that is, the practice of eating together, and the eating of ‘proper meals’, that is, home-cooked, complex meals

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(Douglas and Nicod, 1974). Often these clients had comprehensive knowledge about healthy eating but found it difficult to practice. One of the clients having an issue with gaining weight from time to time initially named her eating problem as ‘chaos’ and ‘inconvenience’. She described her problem in the following way: ‘Actually I know what I ought to eat, I just cannot do it when confronted with the realities of everyday life’. She didn’t experience any problems keeping her weight and eating in preferred ways when living in surroundings where her meal patterns were structured in advance. As an example, she was not confronted with eating problems when staying at a folk high school, a place where young people stay with full accommodation for a shorter period, meaning that she did not have to plan and prepare her meals on her own. This contrasted with her everyday life being a student living in a dorm with only few external structures governing her eating and only practicing commensality occasionally. Without a firm structure, she found herself overwhelmed with sudden hunger which she would relieve through impulsive snacking and sometimes even binge eating. The collaborative exploration consisted in a detailed unpacking of this chaos by asking questions related to eating locations, mealtimes and bodily experiences of the need and desire for food and other activities during the day in her everyday life. This process led to ‘lack of structure’ as a new naming of the problem and uncovered that besides the priority she gave to managing and structuring her meals, structural conditions were important contexts for the problem, that is, access and availability of food, school schedules, spare time activities and the lack of social obligations and social occasions in which she could anchor her meals and eating. Whereas, this client experienced a lack of social obligations and structure, other clients experienced too many obligations as their main problem. Examples of this were clients who would like to give more priority to the purchasing and the preparation and the eating of meals than work and other obligations allowed for. One client initially named his problem of gaining weight due to eating fast food as ‘stress’. The collaborative co-research showed that he found it difficult to give priority to his meals due to his job as a software developer, which he described as competitive and mentally demanding where he was exhausted from prolonged periods of concentration. The process of coresearch led to ‘irregularity’ as a new naming of the problem, due to too many unpredictable agendas intervening in his daily meal patterns. In both cases briefly described here, the mapping and the naming of the problems emerged through a detailed collaborative exploration of the way in which the problems were embedded in the broader and structurally conditioned lifeworlds of the clients. The exploration was informed by social research into how meal patterns are affected by societal changes. Belonging to the sphere of reproduction, eating and meals have been analysed as historically less important than activities belonging to the sphere of production (Rotenberg, 1981). This pattern has not changed over the recent years. Modern life enforces planning and organising of social lives around ever more complex structures of time and space. These processes are often referred to as a de-routinisation that has made it still more difficult to eat proper meals (Warde, 1999). In a qualitative study investigating how bodily sensations of hunger, appetite and satiety were managed in everyday life, it was concluded that the prevailing cultural model of meal patterns is detached from, and in conflict with, modern social organisation of time and space (Kristensen and Holm,

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2006). The reason why the process of collaborative co-research into logistic eating problems, by means of social science insights, is assumed to be helpful is twofold: First, being a daily routine embedded in the practices of everyday life, eating is governed by a wide range of preconscious decisions (Wansink, 2006). This corroborates the need for a thorough exploration in order to qualify a transparent mapping and naming of the problem. Second, it gives a much more realistic understanding of both the limits and the potentials in the ability of the clients to navigate and practice agency in relation to the eating problem than traditional diet counselling and health coaching typically provide. In the cases described, the initial understanding of the problem of not being able to oblige oneself to a healthy diet, changed to a matter of ‘lack of structure’ and ‘irregularity’. If the counselling process had not explored the intricacies of the problem, but immediately engaged in a motivational approach, it might have missed the eating problem altogether.

Social eating problems By social eating problems, we refer to the client’s close relationships and social interactions around food and meals. This includes not only socialising in connection with meals, or commensality, but also individual meals, to the extent that social needs and values also influence individual eating practices. Special focus is on typical food and meal-related conflicts and ambivalences, that is, related to meal preparation and to the maintenance and affirmation of social relations, to experiencing intimacy and closeness, and to normative expectations concerning the meal, that is, the priority given to commensality, menu choices, eating times, table manners and topics of conversation. An example of a social eating issue was a client experiencing difficulties including vegetables in her diet. While traditional counselling and health coaching would address this problem by perhaps educating, motivating and goal setting, a collaborative exploration showed that these strategies probably would have failed since the problem was rooted not in the relation between the client and the food but in the patterns of social interaction. Having moved in with her boyfriend and his two teenage daughters from a previous relationship, she found herself in a complex and difficult situation becoming part of a family to whom healthy eating was not given the same priority as she did herself. When she tried to introduce a more healthy diet to the family, she was confronted with hostility and what she named an ‘you-are-not-our-mother-like-attitude’ as a reaction to what she saw as a way to be responsible and to care for the family. After a while, she found herself giving up on her intention to improve the diet of the family but also to maintain her own preferences for healthy eating. When this pattern became evident to her, she renamed the eating problem as ‘being invisible’, reflecting her difficulties giving voice to her food preferences and the wish to care for her new family. In this case, the collaborative exploration of the eating problem was qualified by questions mapping how social interaction and normative expectations related to food and eating, that is, how eating with different people at different occasions affected the problem. The questions asked were informed by social science research on the significance of meals, gender and family life. In this research, it is a well-known phenomenon that especially food-responsible mothers adjust to other family members’ needs by sacrificing their

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own preferences in order to maintain harmony in the family and receive gratitude (DeVault, 1991; Ekström, 1991). The very same insight also qualified the exploration of cases in which the problem was experienced from the perspective of the person provided for. This was exemplified by a client who initially named her problem as having too little variety in her diet due to ‘pickiness’. During the exploration in the counselling process, it became evident that this was not primarily a health-related problem, but rather a problem with regard to the implications pickiness had on her ability to socialise around food and eating. She found it painful that she was unable to honour the effort and the care offered in family meals and she felt excluded having to reject food that others could share, appreciate and talk about. Seeing herself as a very social and polite person, this was an unpleasant recognition, but at the same time an eye opening insight. In both cases, the process of co-research made the clients wonder why they had not considered it an option to eat preferred food different from the menu served at social meals. Besides the practical implications, this initiated a collaborative co-research on the normative idea, also documented in qualitative studies, about how social bonds are constructed and confirmed by eating the same food (Fischler, 2011). These examples of radical contextualisation added to the complexity of what initially seemed to be narrow health problems and rejected the idea of simple solutions. By involving the clients and making them contextualise their food and eating practices, possibilities of agency were created and foundations were laid for what later in this article will be described as navigating in the context of the problem.

Discursive eating problems By discursive eating problems, we refer to clients for whom thoughts about their eating were governed by discourses related to health, body, gender and eating. This could be problems related to health beliefs, disease perceptions, body ideals and culinary expectations coming from popular magazines, political reasoning, scientific recommendations and the promotion of nutrition regimes. Although not always part of the initial understanding of the problem, these clients’ relationships to food typically had the character of being overloaded by meaning and identity. An example of a discursive eating issue was a woman who initially sought help in order to control her craving for chocolate – a problem she initially named ‘addiction’. During the process of a collaborate exploration of the problem, this definition of the problem changed and was renamed ‘control’. Investigating the extent of her chocolate eating and asking questions about the ways in which the problem affected her way of thinking about herself and her relation to food, it became apparent to her that she actually had an acceptable consumption of chocolate, and that the real problem was her restrictive way of thinking about her diet. Often this prevented her from dining with her friends because she was afraid of not being in control of her food choice. Another example was a client who had succeeded in losing weight gained while suffering from a depression. In the first counselling session, he asked for help and motivation to exercise and hold on to his diet in order to lose even more weight. This was motivated by a wish to reach his ideal weight and body image referring back to his time as an athlete years back. Besides the weight issue, he named his problem as being a ‘colaholic’ referring to his giving in to

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cravings after periods of excessive training and dieting. He therefore would like to be better at complying with diets. However, after a collaborative exploration, this changed because he realised that the activity of dieting actually ‘feeded’ the ‘colaholic’ by creating cravings and a need to let go. This insight led to a new naming of the problem as ‘perfectionism’. Again, both cases are illustrative examples of how the client’s initial understanding of the problem changes radically in the course of the collaborative exploration, that is, moving from ‘addiction’ to ‘control’ and from ‘colaholic’ to ‘perfectionism’. This exploration was informed by studies on how our subjectivity in general is shaped by discursive influences which, as described above, have been a major inspiration to the narrative practice. The phenomenon of food and eating is no exception in this matter. Research documents that an increasing number of discourses are related to health, body and eating (Bordo, 1993; Counihan, 1999; Coveney, 2006). The importance of contextualisation is evident in the sense that engaging in a thorough investigation of the problem, instead of accepting the clients’ initial expressions of the eating problem, brings about renewed perspectives and prevents also that the counselling processes result in exacerbating the problems rather than mitigating them. That is, in not being adequately critical in distinguishing the voice of the discourse from which the problem stems, from the eating problem as discursive, the risk is feeding into the very voice that produces the problem. This is also an important point with regard to the growing field of health coaching where a critical attitude is called for, particularly during the process of goal setting, if the coaches should not just function as what you might call mere ‘agents of normalisation’ (Markula and Pringle, 2006).

From exploring the problem to navigating in the context of the problem As demonstrated in the previous paragraphs, eating problems can be radically contextualised and the layers of meaning contributing to the constitution of the problems can be investigated through the process of co-researching supplemented by analytical categories developed from social science research. Letting the problem emerge from its context through this type of exploration is different from diagnosing the problem based on professional assessment. Paraphrasing a key Aristotelian principle of science stating that the method of investigation always needs to fit the nature of the subject matter, it might be said that the strategy to remedy an eating problem must fit the nature of the problem itself. This strategy arises out of a collaborate exploration. In general, the overall aim of a radical contextualisation of the eating problem is to confer agency to the client by providing him or her with the ability to navigate in and critically resist influences through making visible the complex relationship between structural conditions, social interaction, discursive patterns and individual intentions. In cases of discursive eating problems, this means, for example, that rather than feeding into the problem, by motivating adherence to the discourse, discursive eating problems should be met by a process of deconstruction which aims at loosening the grip of the discourse in order to make room for a more preferred relationship with food and eating (Russel, 2007). Similarly, a logistic eating problem should not be individualised to a matter of individual willpower and motivation but focus should be shifted towards

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how the client can navigate in the structures that contribute to the constitution of the eating problem. One of the criteria for the choice of strategy is to assess the degree to which the eating problem in question involves issues of identity. While social and discursive eating problems typically involve questions of identity, this seldom is the case when it comes to logistic eating issues. An implication of this is that the way individual agency can be supported when it comes to logistic issues is closely related to daily practices which may not be reflected when it comes to the activity of eating as being a bodily routine. Also dealing with logistic issues often involves solutions of practical problems, whereas a shift in perspective typically is called for when it comes to social and discursive problems. Unfortunately, going through the variety of strategies available in narrative practice would exceed the context of this article. What is important, however, is giving attention to the complex nature of eating problems as such, and how this complexity needs to be reflected in the strategies with which we meet these challenges.

Concluding remarks and perspectives In this article, we have argued that the complexity and contextual nature of individual eating problems need to be addressed in a more systematic and nuanced way than compared to what traditional counselling and health coaching typically involve. We have suggested narrative practice as a critical and context-sensitive counselling approach. More specifically, we have illustrated how principles of externalisation and co-researching can be combined with social science research in food and eating as a counselling framework using logistic, social and discursive eating problems as analytic categories. This approach contributes to the process of radical contextualisation of eating problems providing the client with genuine authorship by naming and working with the problem as experienced in context. Furthermore, we have argued that even if the structural conditions causing the eating problems may not be solvable through individual counselling sessions, exploring the complex structures of food and eating often provide clients with agency and help them to navigate in the context of the problem. Also, by having a reflexive and critical approach to the concept of health, the narrative approach suggested in this article differs from diet counselling and health coaching by explicitly dealing with the potential harmful consequences of engaging in disease prevention and health promotion. This is not a critique that aims to undermine the importance of dealing with the pending health challenges, but an attempt to be mindful of the complexity and the issue of power relations involved in the field of food and eating and allowing this to be manifest throughout the counselling process. Funding The research was publicly funded

Notes 1. The practice of externalising use of language is not new but was, for instance, used in the language game of ancient Greece (Robinson, 1989). 2. In the research project, 15 clients were recruited through the health clinic of Metropolitan University College. Clients were recruited among students and staff at the college. Besides

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narrative diet counselling the clinic offered traditional diet counselling. The clients voluntarily chose narrative diet counselling following an announcement on a webpage and were informed by a secretary who gave additional information on the differences between traditional and narrative counselling. By traditional diet counselling, we refer to diet counselling as a solution-oriented method, often with weight loss as the aim with a focus on the counsellor’s expert knowledge on nutrition. In this kind of counselling, diet anamnesis and diet plans are often used together with individual motivation strategies. All clients went through three counselling sessions and one evaluation interview took place one month afterwards. The conversations were taped and transcribed. Coding and condensation were used in analysing the data. 3. In this article, we will primarily focus on the explorative part of the maps, whereas we will only touch upon the learning strategies attached to the different categories of eating problem.

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Author biographies Søren T Kristensen is an anthropologist with a PhD in the Anthropology and the Sociology of Food. He is Senior Lecturer and Head of Research and Development at the Bachelor’s Degree in Nutrition and Health, Metropolitan University College, Copenhagen, Denmark. Allan Køster is a philosopher with a clinical specialist degree in narrative therapy. He is Senior Lecturer at the Bachelor’s Degree in Global Nutrition and Health, Metropolitan University College, Copenhagen, Denmark.

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