The patient made a ________ of arranging the food on his plate.

The word "formal" implies a specific level of seriousness or official procedure. While it can suggest a structured approach, it does not capture the personal or habitual nature that "ritualistic" conveys. Arranging food is not typically an official act, making this choice less appropriate.

"Formalizing" refers to the process of making something official or systematic. This term would imply that the patient is in the act of creating a formal method of arrangement, rather than simply describing the existing behavior. It does not fit the context of a completed action regarding the arrangement of food.

While "ritual" is closely related to "ritualistic," it functions as a noun rather than an adjective. The sentence requires an adjective to modify the act of arranging, making "ritual" grammatically incorrect in this context. Therefore, it cannot accurately describe the patient’s action.