My goal is to raise awareness of the risks of dysphagia diets so that SLPs can better support patient autonomy and ethical-decision making. I’m discussing key findings from a survey of 326 speech-language pathologists (Ward & Bowman, 2025). In the process, I share four risks of modifying solid food texture and nine risks of thickening liquids. As the authors state, this is not a complete list of possible risks.
Free DIRECT download: Possible risks of dysphagia diets – patient handout. (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- Do SLPs know the risks of dysphagia diets?
- What are the risks of dysphagia diets?
- How well did the SLPs do on the survey?
- Do SLPs consider the risks of dysphagia diets?
- Why should SLPs obtain informed consent?
- How often do SLPs obtain informed consent?
- When we know better, we do better.
- Related Eat, Speak, & Think posts.
- References.
Do SLPs know the risks of dysphagia diets?
Ward & Bowman (2025) surveyed 326 speech-language pathologists to find out how familiar they were with 13 known risks for modified texture diets (MTDs).
MTDs encompass any combination of altering food consistency, increasing liquid viscosity, or restricting the manner of oral eating and drinking.
Ward & Bowman (2025, p. 2)
Experience treating dysphagia spanned from less than one year (7%) to 21+ years experience (21.8%) (see the paper for full details). The SLPs filled out an online survey with multiple choice questions about their dysphagia practice to answer three questions:
- Do SLPs know the risks associated with MTDs?
- Do SLP consider the associated risks?
- Do SLPs obtain informed consent from patients by informing them of those risks?
Before we get to the answers, let’s talk a minute about the risks of modified diets.
What are the risks of dysphagia diets?
The following is not a full list of known risks of a modified texture diet. Ward & Bowman (2025) selected a subset of risks for their survey: four for altered solid textures and nine for thickened liquids.
Modifying the texture of solid foods has been shown to increase the risk for several adverse outcomes, including:
- Malnutrition.
- Dehydration.
- Poor recovery from illness.
- Decreased quality of life.
And here are some of the possible risks associated with thickened liquids:
- Dehydration.
- Urinary tract infection.
- Decreased quality of life.
- Constipation.
- Poor recovery from illness.
- Slowed digestion.
- Constant feeling of thirst.
- Respiratory infection.
- Interference with medication absorption.
Reasons for possible adverse outcomes associated with modified food texture or thickened liquids include decreased nutritional value and decreased enjoyment or acceptance of the altered diet (Wu et al., 2021).
How well did the SLPs do on the survey?
Not well.
In fact, more than 1 in 5 SLPs couldn’t identify a single known risk. And only 6% recognized all 13.
Of the 326 SLPs who submitted the survey, 253 answered the questions in which they selected the risks associated with modified solid textures and thickened liquids.
It’s possible that some SLPs answered the questions when tired or rushed, but let’s assume that their answers generally reflect their knowledge.
The following numbers are rounded up, from Table 10 (Ward & Bowman, 2025).
Here are the percentages of SLPs correctly selecting the risks of modified foods:
- 77% – decreased quality of life.
- 72% – malnutrition.
- 44% – poor recovery from illness.
- 33% – dehydration.
And here are the percentages of SLPs correctly selecting the risks of thickened liquids:
- 75% – dehydration.
- 60% – urinary tract infection.
- 47% – decreased quality of life.
- 45% – constipation.
- 40% – poor recovery from illness.
- 1% – slowed digestion.
- 1% – constant feeling of thirst.
- 1% – respiratory infection.
- 1% – interference with medication absorption.
Lots of room for growth, wouldn’t you say?
Do SLPs consider the risks of dysphagia diets?
The second question Ward & Bowman (2025) ask is whether SLPs consider the risks of modified textures (n = 194) or thickened liquids (n = 190) before recommending them.
Here are the percentages of SLPs who reported that they consider the risks of thickened liquids before recommending them (rounded, from Table 6):
- Almost always: 70%
- Very frequently: 23%
- Occasionally: 5%
- Rarely: 2%
And here are the numbers for modified solid foods (rounded, from Table 7):
- Almost always: 54%
- Very frequently: 32%
- Occasionally: 10%
- Rarely: 4%
- Almost never: 1%
So, as a group, this set of SLPs doesn’t consistently consider the risks of their recommendations for modified texture diets.
It would be interesting to have follow-up questions to better understand when clinicians aren’t considering the risks!
Why should SLPs obtain informed consent?
Put simply, our patients should understand the treatments we propose, including:
“…the potential benefits and harms, whether there are reasonable alternative treatments, and what will happen if treatment does not go ahead.”
O’Keeffe et al., 2023, p. 2
O’Keeffe et al. (2023) point out that not all food-related interventions require informed consent. Offering assistance or a culinary-inspired option are not medical treatments and do not require informed consent. Here are some examples:
- Cutting food for someone.
- Offering gravy for a dry dish.
- Common-sense advice, such as “don’t gobble your food”.
On the other hand, thickening liquids or substantially altering the texture of food for medical reasons are interventions that require informed consent, because there are possible harms. (O’Keeffe et al., 2023, p. 2)
Discussing the ethics of informed consent for dysphagia intervention is beyond the scope of this article. If you’re interested in learning more, you could start with the above open-access paper.
How often do SLPs obtain informed consent?
Ward & Bowman (2025) asked SLPs how often they inform patients of the possible risks associated with thickened liquids. Here is the distribution of responses for the 199 SLPs who answered this question:
- Almost always: 50%
- Very frequently: 24%
- Occasionally: 17%
- Rarely: 7%
- Almost never: 3%
And here are the responses for how often SLPs say they inform patients of the possible risks associated with altered food textures (n = 198):
- Almost always: 40%
- Very frequently: 25%
- Occasionally: 22%
- Rarely: 8%
- Almost never: 5%
Again, we have much room for improvement in this arena.
When we know better, we do better
As SLPs, we face a constant barrage of new information. It’s easy to miss essential information that impact patient care. Informed consent for dysphagia diet recommendations is one of those critical areas.
To support informed consent for dysphagia diets, we need to understand the potential benefits and harms of our recommendations. The old days of preventing aspiration at any cost are gone.
Do the best you can until you know better. Then when you know better, do better.
Maya Angelou
We know better now. But there is always more to learn! What questions do you have about the risks of a dysphagia diet?
Related Eat, Speak, & Think posts
- Learn how to assess dysphagia risk with the BOLUS framework.
- 10 factors that increase risk of aspiration pneumonia.
- How to help an adult with eating and drinking.
- How to make minced & moist food at home.
- How to make pureed food taste good.
References
- O’Keeffe, S. T., Leslie, P., Lazenby‑Paterson, T., McCurtin, A., Collins, L., Murray, A., Smith, A., & Mulkerrin, S. (2023). Informed or misinformed consent and use of modified texture diets in dysphagia. BMC Medical Ethics, 24(1), Article 7. https://doi.org/10.1186/s12910-023-00885-1 [open source]
- Ward, M. G., & Bowman, A. S. (2025). Oropharyngeal dysphagia management and informed consent: A survey of speech-language pathologists’ practice patterns when recommending modified texture diets. Frontiers in Rehabilitation Sciences, 6, Article 1520240. https://doi.org/10.3389/fresc.2025.1520240 [open source]
- Wu, X. S., Miles, A., & Braakhuis, A. J. (2021). Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review. Healthcare, 9(6), 624. https://doi.org/10.3390/healthcare9060624 [open source]
Free DIRECT download: Possible risks of dysphagia diets – patient handout. (Email subscribers get free access to all the resources in the Free Subscription Library.)
Featured image by atlasstudio on Canva.com.
AI Disclosure:
I used AI tools to assist me with this article. I used Google Notebook LM to create a podcast-style summary of Ward & Bowman (2025) and eight related research papers, and I consulted ChatGPT to help refine structure, phrasing, and readability. I read the research cited here. I wrote the article, thoughtfully made changes based on the suggestions from ChatGPT, and ensured accuracy to the best of my ability.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
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