I used to NEVER eat vegetables. I know, a nutrition professional not eating vegetables? Do you find yourself in a similar boat except, you still aren’t able to eat “x” food? Or is it a loved one that you’re struggling to convince to eat a certain type of food? No amount of bargaining or convincing ever seems to work…
These could be cases of “picky eating” or it could be something more. Join me as we walk through Avoidant Restrictive Food Intake Disorder (ARFID) and cover 10 facts about what it is and how to treat it. Even if you or a loved one don’t have ARFID, you might find some helpful tools and advice!
1. ARFID is a serious eating disorder.
ARFID stands for Avoidant Restrictive Food Intake Disorder. It is an eating disorder defined by a continued failure to meet nutritional and/or energy needs. ARFID is just as serious as other eating disorders like anorexia and bulimia. It can cause severe deficiencies in calories (energy), macronutrients (think carbohydrates, fat, protein), and micronutrients (think vitamins and minerals). It requires swift and aggressive treatment to fix these nutritional imbalances.
2. ARFID looks different for each person.
This is an eclectic eating disorder, meaning ARFID looks different for different people. It could be:
- Avoiding food because of a fear of how it will make you feel afterwards, such as having nausea or abdominal pain.
- Not eating enough due to a fear of choking or vomiting.
- Having a low appetite and general disinterest in/dislike of food.
- Avoiding foods based on certain sensory characteristics, such as texture or smell.
It is important to know that, in order for it to be Avoidant Restrictive Food Intake Disorder the feeding disturbance or food restriction cannot be due to another physical or mental illness- for example: not eating because you have the flu would NOT be ARFID.
3. ARFID can affect anyone.
When many people think of ARFID, they think only of children and adolescents. This is simply not the case. While it can be more frequently diagnosed in this age group, ARFID can affect people of all ages. It is possible that adults with ARFID went undiagnosed or untreated as children. Avoidant Restrictive Food Intake Disorder also affects people of all genders.
4. Those with ARFID are not motivated by weight loss.
With ARFID, the inability to meet energy/nutritional needs is not due to concern about weight gain, desire for weight loss, or negative body image. In fact, many people with ARFID report wanting to gain weight to be bigger/stronger/healthier and more similar to their peers.
5. ARFID can impact growth and development.
Those with ARFID often experience recent weight loss and/or poor growth and development. For children, they may have fallen off their normal growth curve on a growth chart. Food avoidance and/or limited food intake can cause nutritional deficiencies. Examples of nutrients a patient may not have enough of are calcium, vitamin D, iron, and B vitamins.
6. ARFID can impact social functioning.
Imagine if you couldn’t go to a friend’s house for fear they would serve foods you don’t eat due to their texture? Or if you avoided eating foods you loved because of how worried you feel afterward? ARFID can make social situations more challenging to navigate. It can be hard to go to parties, go out to eat, or simply have a normal family dinner. Those with ARFID may feel like they are missing out on life because of their avoidance of food and eating,
7. Not everyone with “picky eating” has ARFID.
Some people are naturally more selective with the foods they eat. Others are more adventurous eaters. This variation is very normal. Kids often are pickier eaters than adults but tend to grow out of that with consistent exposure to different foods. Just because someone is more selective with the foods they eat doesn’t mean they have ARFID. However, if avoidance of food or limited intake is negatively affecting physical health and/or psychological and social functioning, it is important to seek help from a trained professional to assess for ARFID (ie: therapist, dietitian, or psychiatrist).
8. ARFID Treatment involves repeated food exposures.
A food exposure is repeatedly exposing someone to a feared food (or stimulus or situation) in a systematic way to desensitize them. Take the example of a scary movie: when you watch the movie for the first time, you don’t know what to expect and everything about it is fear-provoking. However, watch the same scary movie for the fifth time, and all of a sudden, it’s not so scary anymore because you know what to expect.
Oftentimes in treatment, the person with ARFID will make a list, with the help of a therapist or dietitian, of foods they have been avoiding for any reason and rank which foods are more anxiety-producing than others. The goal is to then try the foods on the list repeatedly, starting with those that cause the least worry. Once a new food has been introduced and tried successfully, it can be added to the individual’s normal diet. Did you know that it can take 10-12 times of trying a new food to know if you really like it? This is why repeated exposures are so important in treating ARFID.
9. ARFID treatment team is essential
People with ARFID do recover and go on to live very full and productive lives. They are able to expand the foods they eat and renegade in the social aspects of their lives. Just as with other eating disorders, a support network is key to treating ARFID. Family/friends can assist with meal preparation, food exposures, and anxiety management.
10. A Registered Dietitian can help with ARFID treatment.
A dietitian can help to:
- Increase the amount of food eaten – A dietitian is able to assess the extent to which someone with Avoidant Restrictive Food Intake Disorder is meeting their nutritional needs. When needs are not being met, a dietitian can provide a meal plan to help increase calorie intake. This often will include utilizing preferred food items at first, ie: food items that the individual with ARFID already feels comfortable eating.
- Increase the variety of foods eaten – Those struggling with ARFID often have a select group of foods they are comfortable eating. A dietitian can help a patient to create lists of preferred foods, fear foods, and “willing to try” foods. A dietitian can then help to decide which foods are most nutritionally important to be exposed to and how to begin the process of incorporating them.
- Monitor for proper growth and development – Especially for children and adolescents with Avoidant Restrictive Food Intake Disorder, monitoring growth and development is essential. A dietitian can assess growth patterns, identify barriers to growth and development, and implement interventions to target those barriers.
- Provide nutrition education – A dietitian provides general nutrition education on the importance of macronutrients and micronutrients for overall health and key food sources of those nutrients. A dietitian can also make recommendations for dietary supplements if needed.
References for ARFID treatment:
- Thomas, J.J. and Eddy K.T. (2019). Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents & Adolescents. Cambridge: Cambridge University Press.
- Thomas, J.J. and Eddy K.T. (2019). Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents & Adolescents. Patient and Family Workbook
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition (dsm-v).
Blog contributions by Amaris Galik
Rebecca Bitzer loves to empower Registered Dietitian Nutritionists (RDNs) and their clients. Co-author of Welcome to the Rebelution: Seven steps to the nutrition counseling practice of your dreams and Taste the Sweet Rebellion: Rebel against dieting.