Recently, healthcare professionals have attributed ‘extreme picky eating’ as a new eating disorder known as Avoidant Restrictive Food Intake Disorder (ARFID), said to develop in young children and becoming dangerous if left untreated. With more on this story, we spoke to Dr Rosan Meyer, a specialist paediatric dietitian.
Sputnik: How would you characterise this relatively new eating disorder?
Dr Rosan Meyer: So, first of all what people need to realise, it is an eating disorder and was firstly recognised in 2013. The primary characteristic of this eating disorder is that you have a patient, and that can be a child or an adult that actually has a feeding disturbance, so an apparent lack of interest in eating of food or avoidance based on a sensory characteristic of the food that can be colour, or texture of the food, and as a result of that, they have failed to meet the appropriate nutritional requirements. That can take a variety of different characteristics but this goes to the core and to the heart of it. What distinguishes ARFID from other eating disorders, however, is that children or adults who have this, have a specific eating pattern not with the primary objective to reduce their weight, or because of body composition issues. So, it's really very different from other eating disorders.
Sputnik: What problems does ARFID, or 'picky eating' as a general way of describing it, create for sufferers?
Dr Rosan Meyer: Firstly, ARFID is much more than picky eating. Many children have picky eating and that, in particular between two and five years of age, is quite a normal developmental stage; it can be part of neophobia they go through where they refuse to eat old favourites or show their likes and dislikes, but ARFID is much more. Many of these children eat less than 20 foods, they are brand specific, they're colour specific, texture specific... so the specificity of the foods that they prefer actually overrides the hunger and satiety. So, a child with ARFID, to just say; 'Oh, just wait when they're hungry, they will eat...' that does not apply for a child with ARFID because actually, the fear of eating is so significant, that they will actually not eat.
Sputnik: Are there any connections between ARFID and other disorders and illnesses and ultimately, are there any other treatments for ARFID suffers?
Dr Rosan Meyer: At the movement, the primary link that we found with other developmental disorders is in particular autism, where you have sensory integration disorder. Now sensory integration disorder means when we make our food choices, foods have sensory characteristics; that's a specific colour, specific smell, specific texture to it, and we have found in particular that's an overlap between ARFID and autism. So, research in terms of other developmental disorders are certainly still in the infancy but I think any developmental disorder where you have sensory integration, or sensory choices of foods, and I've seen for example, children with food allergies where they've become very specific, where there can be an overlap, but I think at the moment that's still very new in terms of research. In regards to treatments, it's a multidisciplinary treatment plan that means it's not only dietetic-led; so, for me as a dietitian, but we have psychology sometimes we need psychiatry, we need pediatricians, gastroenterologists - so it's really a lot of different treatment modalities.
At the core of it, is you correct nutritional deficiencies and make sure a child grows, or for an adult that they don't lose weight, and then depending on what their driving factors are; for example, if there's fear, then it's really that a psychologist needs to address that and work with them, whether that is through Cognitive Behavioural Therapy. On the other side, if it's more texture, and that the child is concerned about chewing then it’s for example, a speech therapist that looks at all motor skills. So, there's not one specific treatment pathway, but several and that depends on the child itself. I would urge people therefore also to visit the ARFID charity for more information on that because there are a lot of useful tips, and also how to access health care professionals.
