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Food is the underlying theme in Tender at the Bone. It ties the various aspects of Ruth's life together, from the sumptuous menu she explores with Aunt Birdie, to cooking her father's favorite dishes for her future husband, Doug. As a small child, Ruth is horrified at her mother's poor sanitation practices. Ruth discovers that she likes people who like to eat and those who like to cook. Yet, she also learns that being fond of food is dangerous. Those who enjoy food the most are the ones most likely to be killed by her mother's tainted dishes.