Understanding Dining-out Experiences of People with Food Hypersensitivities
This article is co-authored by Christina Chung, Francisco Nunes, and Nervo Verdezoto and is a summary of our paper from the 2021 ACM CHI Conference on Human Factors in Computing Systems.
Arthur had a lunch gathering with two friends. He was excited to hang out with his friends at a new place, but he was also nervous about the experience as he was allergic to gluten and intolerant to milk protein. After thoroughly checking the menu, Arthur found out that the only safe option for him was a small cup of fruit salad while his friends enjoyed pizza and chocolate cakes.
Food hypersensitivity, including food allergies, food intolerance, and celiac disease, are more and more prevalent. Studies show that around 200–250 million people are living with food allergies and around 1% of people with celiac disease in the world. Dining out is extremely challenging for people with food hypersensitivities because it is often difficult for them to figure out what and where they can eat. Restaurant staff could be important allies in dining out safely. However, in many cases restaurant staff lack important knowledge about food hypersensitivities and how to care for these clients, despite the strict regulations in place, causing the likelihood of cross-contamination and negative reactions. Although there are a few restaurant recommendation systems focusing on food allergies, very few technologies support people navigating safe and enjoyable dining out experiences.
To understand people’s challenges, practices, and strategies of people with food hypersensitivity, we interviewed 19 people with these conditions. The study was conducted in Portugal, where dining out is seen as an opportunity to satisfy food needs and a deeply social activity. Meals in Portugal tend to be long and it is very common for families or groups of friends to eat together in restaurants for lunch or dinner. Being unable to fully participate in meals can have a considerable impact on people’s quality of life.
What do people do to avoid negative reactions when eating out?
Avoiding eating out in unfamiliar places is a common strategy to avoid negative reactions and embarrassing conversations about food hypersensitivities. However, because dining out plays an important role in participant’s everyday social life, they describe a series of laborious practices they did to participate in these social gatherings.
Learning about a restaurant before going there
Going through online restaurant review systems, such as Tripadvisor or Zomato, is often the first step people take to check if a restaurant is safe for them. Although these systems may not have food hypersensitivity-related content, participants would read the menu, check the meal photos, and look for clues about hygiene practices or previous experience with the staff from customer reviews. Some participants also went to restaurants’ websites and called places beforehand to verify the information they gathered online.
Another source of information often comes from people they know who have food hypersensitivities. Participants said that they trusted these experiences more, but many of them knew very few others who had similar food hypersensitivities, which restricted the amount of advice they could receive.
Investigating if a restaurant is safe
Once arrived at a restaurant, participants acted like a detective — checking the physical environment and hygiene practices, reading the menu in detail, and asking a bunch of questions regarding the food to the restaurant’s staff. For example, Sarah, who is allergic to cabbage, lettuce, and wheat flour, said “I need to see the kitchen and the places where food stays before going to the table or to wash. If I cannot see these, I will not stay there. I have to understand the hygiene, if the dish is clean, if the staff has clean hands (…) when [staff] brings the things to know how they picked up the cutlery with the hands… if they touched the food on the plate. “
While these steps are necessary to avoid a negative reaction, participants need to know how foods are prepared and know what questions to ask. For example, Jessica, who has celiac disease (cannot eat gluten), is always vigilant for the cooking methods of rice. She explained that rice cooked with chicken stock cubes contains flour (and thus gluten), which means she can have a reaction. Therefore, when seeing rice on the menu, she needs to remember to ask staff whether stock cubes were used and whether they can cook the rice without stock cubes for her meal.
These strategies are also emotionally demanding. Many participants shared that they were treated as picky customers and nuisance by the staff. Sometimes they had to go on several rounds of questioning before ordering, which made them nervous as everyone else at the table kept waiting.
Ordering available meals and playing safe
Just like Arthur’s experience at the beginning of this article, participants were often left with very few options on the menu after asking necessary questions. Sometimes participants chose the food with fewer ingredients so it was less likely for restaurants to include unsafe ingredients. When participants asked to remove unsafe ingredients, these ingredients were often removed, but not replaced, even though they play an important role in the flavor. As a result, participants had to eat “uninteresting and tasteless meals,” which took away their enjoyment of dining out.
Correcting meals and educating staff
Even after scrutinizing the menu and asking all the questions, very often participants still receive meals with unsafe ingredients. When that happens, participants had no choice but to reorder or return the food. However, not everyone understands the complexity and severity of food hypersensitivities. Participants reported being treated with rage or hostility from the staff.
Many participants also had suffered from negative reactions because restaurant staff did not have proper knowledge and training about food hypersensitivities. Rita, who is allergic to nuts and stone fruits as well as intolerant to flour and lactose, described an experience when she had one of the worst lactose intolerance reactions because the restaurant staff told her the codfish cakes did not contain lactose. After that, she went back to the restaurant to confirm that her meal was not allergen-free and hoped her feedback would improve the food practice of the restaurant.
Opportunities for technology design
Many people with food hypersensitivity feel the need to actively manage their risk of having a negative reaction, even when there are strict regulations in place (e.g., major food allergens labeling in the European Union and in the United States). Individuals usually do not have control over restaurant workflow and how the staff is trained. They also may encounter these situations when traveling. There are design opportunities for technology to support people to enhance their dining out experience.
Supporting the practical knowledge development of people with food hypersensitivities
Participants in our study already had in-depth knowledge about what they could eat, what questions to ask about the restaurants, and where to search for potential information. However, accumulating this knowledge took time. Developing practical skills to observe an environment or interact with restaurants could be emotionally taxing, too. Expanding on prior work on self-experimentation and peer support network, technologies supporting people with food hypersensitivities could focus on the variety of aspects about eating (e.g., meal preparation, serving process, or hygiene practices) and connect them with others with similar experiences to build on practical skill development and provide emotional support.
Including food hypersensitivity information in online restaurant reviews
Although participants in our study already look at online reviews to find useful information to help them determine where to eat and what to eat, the information is scattered and difficult to evaluate. Many online platforms have started to include information supporting a wider range of needs (e.g., wheelchair accessible transits on google map, or breastfeeding-friendly locations). Online restaurant review systems could better support people with food hypersensitivity by including more specific review criteria, such as marking unsafe ingredients, rating staff knowledge, or assessing restaurant willingness to adapt meals. This type of information could then in turn encourage restaurants that already provide good support and motivate others to improve their service and training.
Increase information and support about food hypersensitivities for restaurant staff
Food hypersensitivity is complex and it can be challenging to train restaurant staff. Technologies could provide support to prompt simple practices (e.g., separate utensils and surfaces used for different types of food preparation) and check potential food hypersensitivities (e.g., suggesting precautions that should be taken in the kitchen and potential adaptations when learning about a specific type of food hypersensitivity). We need more research to understand restaurant workflow, staff existing experiences, and their challenges dealing with food hypersensitivities. Moreover, we hope future technologies could potentially improve the safety and dining experience of individuals while supporting restaurant staff.
To read more, please see our paper from the 2021 ACM CHI Conference on Human Factors in Computing Systems. If you have similar experiences, want to know more about the research, or want to share your thoughts, we would love to hear from you! Please contact Francisco Nunes (firstname.lastname@example.org), Christina Chung (email@example.com), and Nervo Verdezoto (firstname.lastname@example.org).