\fancyhead [R] Smell and Taste Disorder Impact on Eating Habits: a cross-sectional observational study

\fancyhead [R] Smell and Taste Disorder Impact on Eating Habits: a cross-sectional observational study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 10 May 2025 V1 Latest version Share on \fancyhead [R] Smell and Taste Disorder Impact on Eating Habits: a cross-sectional observational study Authors : Camp L [email protected] , Duncan Boak , Garner N. J , and Carl Philpott 0000-0002-1125-3236 Authors Info & Affiliations https://doi.org/10.22541/au.174686967.70968778/v1 353 views 202 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Smell and Taste disorders (SATDs) are underreported. There is a wide range of aetiology but recently we have seen growing prevalence related to Covid-19 infection. SATDs have broad implications for people’s lives, including, a significant impact on nutritional intake and eating behaviours which we further explore here. Methods: This was a cross-sectional observational study using an online questionnaire to gather data. Questions covered aetiology of SATDs, impact on BMI, social eating habits and enjoyment of food. Results: A total of 794 participants responded of which 75% were female and the majority (46%) 56-70 years. Since the onset of their SATDs: 46% reported no change in weight, 24% weight gain, 15% weight loss, 52% felt it impacted how healthily they ate, 59% dined out less or not at all anymore, 59% no longer enjoy preparing food at home, 58% do not enjoy eating out and 54% do not enjoy eating at the homes of friends/ family/ partners. Conclusion: We have built on existing literature highlighting the impact SATDs have on participant eating behaviour. Although there is clearly an impact on diet and social behaviours around food/ eating it is hard to know the full health and economic impact. Especially when we consider that poor nutritional intake has been linked to cognitive decline in an older age group, it is an important area for further research and it may be beneficial for healthcare providers to offer tailored nutritional advice and discuss possible coping mechanisms upon diagnosis of SATDs. Smell and Taste Disorder Impact on Eating Habits: a cross-sectional observational study \fancyhead [R] Abstract Background: Smell and Taste disorders (SATDs) are underreported. There is a wide range of aetiology but recently we have seen growing prevalence related to Covid-19 infection. SATDs have broad implications for people’s lives, including, a significant impact on nutritional intake and eating behaviours which we further explore here. Methods: This was a cross-sectional observational study using an online questionnaire to gather data. Questions covered aetiology of SATDs, impact on BMI, social eating habits and enjoyment of food. Results: A total of 794 participants responded of which 75% were female and the majority (46%) 56-70 years. Since the onset of their SATDs: 46% reported no change in weight, 24% weight gain, 15% weight loss, 52% felt it impacted how healthily they ate, 59% dined out less or not at all anymore, 59% no longer enjoy preparing food at home, 58% do not enjoy eating out and 54% do not enjoy eating at the homes of friends/ family/ partners. Conclusion: We have built on existing literature highlighting the impact SATDs have on participant eating behaviour. Although there is clearly an impact on diet and social behaviours around food/ eating it is hard to know the full health and economic impact. Especially when we consider that poor nutritional intake has been linked to cognitive decline in an older age group, it is an important area for further research and it may be beneficial for healthcare providers to offer tailored nutritional advice and discuss possible coping mechanisms upon diagnosis of SATDs. Key words: olfactory dysfunction, taste disorder, eating behaviour \fancyhead [R] Summary: • A cross-sectional study to better understand the self-reported link between SATDs on both diet and social eating habits • We found 39% felt their weight was impacted, 24% gain and 15% loss, and 52% felt how healthily they ate was affected • Common themes reported by participants were tending to eat foods with stronger flavours, typically sweet, salty and spicy • Social habits were impacted with 59% of participants stating they either dined out less or not at all anymore • The area is not well understood and further research is needed to get a better understanding of the impact that smell and taste dysfunction has on the food preferences, diet and nutrition of those affected and to develop interventions to support patients Background Smell (olfactory) and taste (gustatory) disorders (SATDs) encompass a wide range of problems and have a significant impact on the individual’s lives. A recent meta-analysis calculates overall prevalence at 22% of the general population and showed when self-reported prevalence is underestimated 1,2 . These disorders are linked to increasing age, and additionally with the link to Covid-19 highlighted recently, SATDs are becoming ever more common. Previous research documented the significant impact SATDs have on quality of life. This impacts all elements of day-to-day life and frequent issues identified in the literature include: poor mental health, safety concerns, an employment impact and nutritional problems 1-5 . In addition, studies have shown this patient group face several barriers to diagnosis and treatment, which is a major source of frustration and concern, often resulting in personal financial expense 6 . The impact of SATDs on dietary habits and nutritional status has received limited research attention. Smell and taste have evolutionarily been key in avoiding toxins and enabling us to seek nutrition 3 . Disruption to these systems results in a variety of behavioral changes including altered appetite, decreased enjoyment of food and effects on personal nutrition 7 . As a result, there can be an impact on nutritional intake, energy intake, body weight and general physical health with mixed results shown in research 3, 7-11 . Although issues have been identified, the full extent of nutritional impact is not known. Furthermore, existing literature has mixed results identifying a clear gap for further research. In addition, very few studies have looked at the impact of SATDs and social eating impact, although some evidence shows reduced dining out in this patient group 12 . \fancyhead [R] Objectives The primary purpose of this cross-sectional study was to better understand the self-reported link between SATDs on both diet and social eating habits. This research will help identify an often-overlooked problem and help establish how we can identify and better address it, as well as what further areas require research. Methods Study design The was a cross-sectional observational designed study. We released our online, 15-question survey from 26 th of July 2024 to 15 th of August 2024. No ethical approval was required, in line with Health Regulation Authority guidance (https://www.hra-decisiontools.org.uk/research), as all survey data were anonymised. \fancyhead [R] Setting The survey was generated by Fifth Sense (UK based charity for SATDs) using Microsoft Forms and distributed via Fifth Sense’ newsletters and social media. Survey access was free and responses were gathered throughout the United Kingdom. \fancyhead [R] Participants Participants were those with self-reported SATDs. Demographic data was collected on the participants, including, age, gender, location and aetiology. Data sources and measurement The survey opened by obtaining informed consent with a statement of objectives and that findings would be subsequently published. No participant identifiable data was requested or captured. No objective smell and taste testing was used in the study. BMI data was collected by giving a link to a BMI calculator, if not already known. Data was gathered via free text answers as well as multiple choice questions and Likert scales. The full survey has been attached, Appendix 1 . Variables The 15 questions collected a range of data covering general demographics, self-reported BMI and changes to this, social eating habits and enjoyment of food/ social eating. The survey used multiple choice questions to categorise duration and cause of SATDs, current BMI and effect of SATDs on weight and perceived healthy eating. Five-point Likert scales were used to assess SATDs impact on social eating habits (frequency range given) as well as enjoyment of eating and drinking (strongly agree to strongly disagree). Free text responses allowed participants to give more nuanced responses to how they felt their health, eating and social lives had changed. Bias The study asked for some retrospective data, leaving a possibility of recall bias. No formal diagnosis was made, nor did participants undergo psychophysical testing; this is however in keeping with our previous studies that show strong correlation with patients seen in smell and taste clinics 13 . Fifth Sense distributed the survey which could lead to selection bias of responses from those actively seeking support, albeit we would view these individuals as those most likely to require support. Study size and statistical methods As an explorative cross-sectional survey, no minimum or maximum study size was set. Descriptive statistics have been applied to data. Figures were created using Microsoft Excel. Results \fancyhead [R] Demographics In total, 794 participants responded to the survey, and all responses were analysed. The majority (75%) identified as female and were 56-70 years (46%). Most (95%) participants actively still experience their SATD and had had symptoms >5 years (56%). Anosmia was commonly (53%) the primary issue (although symptoms are not mutually exclusive). A full breakdown of participant demographics is shown in Table 1. Self-reported BMI, of the 678 who calculated this, showed that although just under half were in the ‘healthy’ category (47%), the same proportion had a high BMI (overweight (31%), obese (14%), morbidly obese (4%) with only 4% underweight. \fancyhead [R] Health impact In terms of self-reported weight changes: 46% reported no change, 24% weight gain and 15% weight loss. When asked how participants felt their SATDs impacted their eating, 52% felt it had impacted how healthy they eat, followed by 39% who thought it had not and 9% who were unsure. When asked how they felt diet had been impacted there was a range of responses. Common themes reported were tending to eat foods with stronger flavours, typically sweet, salty and spicy. However, some felt as they couldn’t ‘taste’ anyway they made more effort to eat healthier. A few participants did comment on weight changes with one person even reporting hospitalisation due to weight loss from their disorder. Some self-management techniques were noted for example seeking texture or one participant only eating one thing at a time to be able to taste more. Full quotes and further examples are detailed in Table 2 . Table 1: Breakdown of participant demographics \fancyhead [R] Variable Percentage frequency Age 70 29% Gender Female 75% Male 24% Nonbinary 0% Transgender 0.1% Prefer not to say 0.3% Location East Midlands, England 10% West Midlands, England 7% North West, England 10% North East, England 5% Yorkshire, England 7% South West, England 12% South East, England 20% London, England 8% East of England 9% Scotland 8% Northern Ireland 1% Wales 3% Primary Symptom Anosmia 53% Hyposmia 14% Hypogeusia 12% Parosmia 9% Phantosmia 1% Parageusia 4% Ageusia 3% Unknown 4% Aetiology of SATD Unknown 26% Covid-19 23% Sino-nasal disorder 17% Viral infection (other than Covid-19) 12% Head injury 11% Congenital 4% Other 4% Medical treatment 2% Exposure to toxins 0.6% Neurodegenerative disorders 0.5% Table 2: Examples of participant responses to how their SATDs have impacted how healthily they eat Type of impact Example Impact on weight ‘I have to force myself to eat and have lost a stone and a half.’ ‘At its worst, I was hospitalised and had to be tube fed. My weight dropped so significantly due to taste distortion impacting my ability to tolerate most foods.’ Cravings for certain foods ‘Salt and sugar are the only things I can really taste, so I eat more of them than I should’ ‘I tended to eat lots of sweet things as I could taste them better. I also felt less satisfied after meals so I over ate.’ ‘I can’t “taste” much, so eat very salty or sweet foods to get any pleasure. Unfortunately these are not usually the healthy foods!’ ‘I will often eat food that has the strongest taste, rather than choose based on healthy options.’ Approach to diet/ motivation ‘I don’t think it has affected how healthily I eat as I tend to stick to the same diet even though I can’t smell or taste anything’ ‘Eating is a chore. There is no reward. I just eat whatever is easiest. The effort of cooking and preparing food isn’t worth the time nor effort.’ ‘The main reason for eating is now to be healthy since less pleasure in taste.’ ‘No point in eating sweet things as there is no enjoyment!’ Food choice ‘I tend to eat healthier foods with lots of different colours and textures.’ ‘I tend to eat a less varied diet, finding texture of food more important’ ‘I don’t like certain textures in food (dry textures or food where the inside texture is different to the outside texture eg blueberries, peas & sweetcorn. I also tend to eat quite simply, one thing at a time, as I can taste more this way - I can taste less overall when there are multiple tastes together in one mouthful.’ Social attitudes towards eating We used Likert scales to investigate how SATDs impacted participants social eating habits. The biggest changes in behaviour were related to eating out and ordering takeaway food; 58.7% reported either dining out less or not at all anymore since their SATD and 43.3% no longer, or less frequently purchased takeaway food. The full result breakdown is shown in Figure 1 . Figure 1 Percentage of participants (788 participant responses) carrying out certain eating behaviours, split by frequency since onset of SATD When participants were asked about the impact on social eating habits common themes were: no longer deriving any enjoyment from eating out and so either avoiding completely or ordering the cheapest option, feelings of boredom around food and just eating to live, feeling self-conscious of their own cooking and so no longer inviting others around to eat, feeling resentment or embarrassment when asked if they had enjoyed their meal when out and concerns about looking ungrateful when eating other’s food and feeling they can’t comment on the food. A minority did still enjoy eating out due to the social aspect of it. Those who do still eat out, appear to have a preference towards stronger tastes or textures and will order foods they have memories of tasting before. For those with congenital anosmia participants often commented they had no change as had always lived this way. Enjoyment of eating When it came to enjoyment of eating experiences, we see a similar weighting of responses. When preparing food at home; 58.7% report no longer enjoying this vs 38.5% that still do. For eating out, 58.3% do not take enjoyment from this vs 39.3% that do. For eating at the homes of friends/ family/ partners, 53.9% do not enjoy this vs 41.2% that do. For enjoyment of drinking alcohol, there was no significant difference between those who no longer enjoyed this (40.9%) vs those who did (41.4%). Full results are seen in Figure 2 . Figure 2 Percentage of participants (784 participant responses) who enjoy different eating behaviours to different extents, since the onset of SATD Although a minority, it was still a significant amount of people who felt eating outside of their home caused anxiety (34.2%) or felt isolated when eating in public (37.6%). Twenty percent even reported that food now tasted repulsive ( figure 2 ). When asked what restaurants could do to help improve the experience for those with SATDs, most were unsure. Some comments included: focusing on texture and appearance, highlighting what has stronger tastes/ giving more descriptive menus, spacing of seating/ outdoor seating, and greater understanding from others. Discussion Key findings Following Covid-19 there have been growing numbers of people with SATDs, with olfactory disorders reported in 34-86% of acute cases and 5-27% persisting beyond 6 months 14 . As seen in previous research we saw post-infectious aetiology as a top cause and a higher response rate from females 4,15-17 . We observed a clear link between SATDs and nutritional intake with 39% feeling their weight was impacted and 52% feeling how healthily they ate was affected. Social habits were impacted with 59% of participants stating they dined out less/ not at all anymore and 34% even reporting that eating outside of the home caused anxiety. Limitations We did not formally assess BMI but gave a link to a BMI calculator and received responses from most participants. The survey was published in English and pushed via outlets within the UK limiting responses to English speakers. There was some attrition in responses to questions throughout the survey, although this did not dramatically influence response number. Interpretation Effect of SATDs on nutrition There is clearly a link between SATDs and eating habits. Our survey showed 39% of participants felt their SATDs impacted their weight and 52% felt it impacted how healthily they ate. Commonly participants were more likely to taste stronger tasting food e.g. salty, sweet and spicy, concurrent with other studies, where participants gravitate towards these foods or consume lower quality diets 9,12,16,18-19 . Choosing stronger flavours and increasing attention to food texture can help compensate to maintain ‘food liking’ 20 . Reduced satisfaction with food can cause compensatory overeating, of often unhealthier food categories, in attempt for increased satisfaction 8,9 . Another study showing weight changes in this patient group, reported it was those who could actively recollect smells and taste that were more likely to gain weight, possibly secondary to cravings 16 . The relationship between weight change appears related to SATD type. Reports show those with complete anosmia or reduced senses are more likely to overeat, and those with self-reported taste disturbances are more likely to undereat. Most reporting taste disturbances will however have loss of retronasal olfaction. Those with congenital anosmia were less likely to have any weight change 10,11 . In addition, one study showed duration of impairment impacted weight, as it was those with symptoms >2 years that were less likely to present with weight loss 11 . Other research linked those at a higher BMI having reduced sensitivity to salt and sweet taste levels 21 . SATDs in obese patients however appears related to metabolic dysregulation rather than an altered eating pattern 8 . One study specifically looking at chemosensory loss in Covid-19 patients reported increased alcohol consumption 19 . However, this was a very small-scale study and we didn’t see such themes here. A further implication to consider is the link between poor olfaction and higher mortality and frailty. It is estimated those >80 years have an increased olfactory impairment prevalence of 63%, often not recognised 22 . Growing evidence links loss of olfaction as an early sign of neurodegenerative disease and has shown SATDs can cause malnutrition and weight loss. Changes in eating behaviour caused by SATDs which are unaddressed due to lack of support and/ or treatment may have implications on health later in life e.g. increased mortality and frailty, but more work is needed to better understand this link 23 . We can see broad trends in nutrition linked to SATDs, but it would be worthwhile investigating specific nutritional intake closer to better establish what help could be offered to this patient group to improve nutritional intake and quality of life. Effect of SATDs on eating behaviour and quality of life Social eating behaviours were greatly impacted by SATD, 58.7% either dined out less or not at all anymore and 43.3% no longer or less frequently get takeaway food. We see similar results from another study that showed 39% no longer looked forward to dinner invitations and 47% went out to eat less frequently 12 . Our participants explained the change due to mixed feelings including, embarrassment when asked how food tastes/ not feeling they can compliment a friend’s cooking, lack of enjoyment of food so not wanting to spend money and a feeling of isolation or anxiety surrounding eating. This has the potential to impact people’s relationships and social lives 24 . Previous research has shown SATDs impact enjoyment of food 4,5,15-17,19,23 . Results of which have been replicated here, showing that over half of our participants reported no longer enjoyed eating out, preparing food and eating with friends/ family. This is unsurprising, given olfaction is a key determining factor in taste and those with SATDs commonly report food tasting either bland or unpleasant altogether. This has resulted in them no longer wanting to spend money on an unenjoyable experience. Even in the homes of friends and family, participants report feelings of embarrassment and a lack of understanding from others. Another frequent survey theme was texture and appearance of food, which for some still offered some enjoyment. Other research showed the impact of additional factors involved in eating, e.g. colour, texture, packaging and environment when consuming food/ drink, on perception and subsequently consumption 25 . It is possible we could enhance the eating experience for people with SATDs utilising these elements. Impacts on weight, health and social interactions all contribute to an overall decrease in quality of life. Although some of our findings suggest there is an incentive to eat healthier, potentially the barriers of SATDs make it difficult to maintain. It’s even reported that reduced pleasure from food is the leading cause of patients seeking medical attention 17. This overall impact on quality of life can contribute to mental health disorders such as anxiety and depression which we more commonly see in this patient group 4,16,24 . Generalisability This study built upon existing evidence that SATDs have a significant impact on eating behaviour, with some evidence of weight change, and a subsequent impact on social eating. Responses came from a large UK participant group affected by SATDs. Although prevalent in the UK, SATDs are underreported, and many patients report barriers within the NHS to get further help with diagnosis and support living with their conditions 6 . It seems there is a notable impact on nutrition and social habits which can in turn affect relationships and mental health. 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Authors Affiliations Camp L [email protected] University of East Anglia Norwich Medical School View all articles by this author Duncan Boak Fifth Sense View all articles by this author Garner N. J University of East Anglia Norwich Medical School View all articles by this author Carl Philpott 0000-0002-1125-3236 University of East Anglia Norwich Medical School View all articles by this author Metrics & Citations Metrics Article Usage 353 views 202 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Camp L, Duncan Boak, Garner N. J, et al. \fancyhead [R] Smell and Taste Disorder Impact on Eating Habits: a cross-sectional observational study. Authorea . 10 May 2025. DOI: https://doi.org/10.22541/au.174686967.70968778/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. 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