Designing a Transitional Food Guide
A mini case study in health design and patient experience
Summary
This is a food guide that I made for a friend who was working with her doctor to heal her GI tract after years of chronic illness. The challenge was to create a tool for helping her manage her diet.
The Patient Story
She had been working on her gut health for several years and eventually decided to try a more drastic treatment: the elemental diet. After two weeks of prescribed fasting, it was time to carefully reintroduce foods. This was confusing because the diets she was prescribed to reintroduce food were somewhat at odds with each other, and the educational materials provided by her doctor were difficult to parse. While it was ok to eat certain foods on one diet, they were to be avoided on the other.
She also felt afraid of failure. Eating had always been her go-to coping strategy for times of emotional uncertainty, so she was particularly worried that she would get stressed out, eat a bunch of candy, and undo all the hard work she had already done.
“What CAN I eat?”
To begin, I went through all the information and synthesized it into a custom spreadsheet so I could understand it better.
Since the dietary information was confusing, I wanted to make sure that she didn’t have to struggle to answer the question “What CAN I eat?” I wanted to make sure she could focus on choosing from the foods that were allowed instead of abstaining from the foods that were forbidden.
Flexible Daily Plan
At first, I thought that making a meal plan for the week would be a good idea so she could do the planning ahead of time and then try to follow through with the plan. Actually, meal planning was going to be too rigid because she didn’t know how she would react to the foods as she reintroduced them. Instead, we made a list of foods that she can and should try to eat the first week and a similar list for the second. Each day she would make a mini-plan that was usually pretty simple but helped her focus on taking it one meal at a time.
When we reviewed the initial layout of the chart together, she wanted to add a label the top of each day with the new food she planned to introduce so she could have something to look forward to.
The chart also needed to be flexible. She needed to be able to respond to her body and adjust her plan as she reintroduced foods. There was space to record what she ate, how she was feeling physically, and anything else that might be happening emotionally.
The Marathon
Since the focused restrictions would last at least two to three months before she could really start to heal, I wanted to help her see the big picture. For this, I outlined a timeline and broke it down into different phases. She had already done the hard part in the first two weeks, so we filled that in as completed. While the food guide helped her focus on taking the diet one day at a time, the timeline was there to provide a sense of accomplishment and scope to the overall process. Every week, she could fill in another chunk of the timeline and see how far along she was in reaching her goal.
The aim was to break the whole process down into manageable steps. A lot of patients go through periods of focused treatment and lulls in their overall journey. There are sprints and there are marathons. While the food guide was mainly focused on the sprint, the timeline was there to represent the marathon.
Setting an Intention
Then we sat down and physically drew out the chart together. This could have easily been done with a spreadsheet and may become a spreadsheet for her in the future, but for this first step, it felt important to take the time to physically commit it to paper. It also allowed us to make it really really big.
We put it on the fridge where she could see it every time she came to the kitchen to get something to eat. This helped her stay focused on her goal and think about her intentions. Though she prefers to use her phone for most things, she decided it would be better to be able to just look at a physical chart on fridge instead of opening an app on her phone.
We also discussed a backup plan for what would happen when she wanted to eat something that wasn’t on the list. If she made a mistake and ate the wrong thing, it was important to forgive herself and get back on track.
Into the Unknown
The first few days of food reintroduction were hard. Restarting a digestive system is a painful process. Each day, she made a plan and adjusted it as she learned which foods she could and couldn’t eat.
By the third week, she didn’t need the chart as much. I count this as a win since the main goal was to help her feel less overwhelmed and act as emotional support for the transition so she could stay on track with her diet. Recording every single thing she ate was helpful, but ultimately it was a secondary goal.
“I’m adjusting to a new level of happiness”
I saw that the real motivating factor in sticking with the plan was that she ultimately started to feel a lot better. She had felt sick for so long that she was elated to suddenly have a ton of energy and not feel generally terrible all the time. I also noticed that as she began to feel better, she was a lot less interested in engaging with charting or record-keeping. She was lucky, but for patients who try unsuccessful treatments, the motivation to stick with a plan is much harder.
In this specific case, she already knew how to cook, so planning specific recipes wasn’t necessary. This might need to look different for someone who was less confident with cooking and meal planning.
What I Learned
I learned that limiting the number of decisions we have to make helps focus our goals.
Organizing information from doctors and understanding a treatment plan can be very confusing.
Keeping records helps us communicate our long term health stories.
Our relationship to food can be extremely emotional, so changing that relationship also means changing how we express and cope with our emotions. Eating as a social event changes as well.
Creating a sense of scope through a timeline helps us see where we are going, celebrate the milestones, and remember that there are sprints and there are marathons.
