A foucauldian analysis of the lived experience of binge eating disorder in Ireland and reimagining the role of the registered dietitian

Abstract

Introduction: Binge Eating Disorder (BED) is regarded as one of the most common yet poorly understood eating disorders (ED), referred to as the “slum of all eating disorders” (Riise et al., 2025 p. 1). This is true in Ireland, where only 10 diagnoses were made in 2024 in the public National Clinical Program for Eating Disorders (NCPED). This raises important questions about gaps in its understanding among health care professionals, the public and the individual themselves. Binge Eating Disorder is a bio-psycho-social disorder and yet little is known about the social facets that contribute to the development and maintenance in Ireland. Registered Dietitians (RDs) are legally regulated health professionals specifically trained to assess and treat nutrition-related conditions. However, publicly accessible treatments for BED tend to focus primarily on psychological interventions and RDs are typically not involved in the care of BED. Aims: This study aims to explore the sociocultural factors that influence the lived experience of individuals with undiagnosed BED in Ireland. This thesis is rooted in a Foucauldian and feminist theoretical framework to critically examine how power influences the understanding and interpretation of BED. This study will conclude by drawing on insights from the Power Threat Meaning Framework (PTMF) to provide practice-based recommendations to advance dietetic care for individuals living with BED. Methods: These aims were addressed through a feminist ethics of care situated within a constructivist paradigm. Qualitative data were generated via in-depth interviews with 11 women who met the diagnostic criteria for BED (American Psychiatric Association, 2022) but hadn’t sought or received a diagnosis. I completed a reflexive thematic analysis of the data and crafted 4 central themes rooted in Foucauldian and Feminist theory. Results: The final themes (and their related subthemes) were: 1. Problematisation through medicalisation (diagnostic criteria of BED, Body Mass Index, agents of medicalisation & problematisation: RDs, mental health professionals & doctors); 2. Problematisation through mothers and families 3. Surveillance as a technology of problematisation through the Panopticon (Direct criticism and comments; anticipation of judgement; objects and apps) and the Synopticon (radio; community; social media; the Synopticon as a place of resistance) 4. Crafting the ethical self through micro resistance and ambivalence. Discussion: I situated my study within the current landscape of Foucauldian and feminist theories of EDs. As this Doctor of Education thesis is geared towards advancing practice for RDs, I concluded by introducing the concept: ‘From Dietitian- Judge to agent of resistance – reimagining Dietetics with the PTMF’, in which I reconceptualise dietetic practice through new practice-based guidelines for conceptualising BED.