My Friend Is a Picky Eater

This week’s post is a response to a question I received:

“I just saw a friend I haven’t seen in a few years. She used to be really healthy, but she’s lost a lot of weight and is very picky about what she actually eats these days. She says she’s doing it for her health, but all she eats are vegetables. Does she have an eating disorder?”

That’s a great question and the answer is: it depends. After all, if you’ve ever had a child, you’ve likely encountered a picky eater. Most children display neophobia (fear of new things, including unfamiliar foods) for the first few years of their lives. But as we get older, most of us outgrow the “picky eater” stage.

There are some individuals that never really outgrow this stage and will continue to have lifelong preferences that affect their food choices (e.g., avoiding “mushy” foods or having rules about certain foods not touching one another on their plate). As long as this pickiness doesn’t interfere with an individuals’ ability to get their nutritional and caloric needs met, we usually just chalk it up to "quirks" and continue to call it picky eating.

However, if this pickiness is relatively new, your friend might have avoidant-restrictive food intake disorder (ARFID) or anorexia nervosa, which is cause for concern. Avoidant-restrictive food intake disorder (ARFID) is a category of eating disorders where an individual's picky eating leads to difficulty getting their nutritional and/or caloric needs met. This may result in difficulty gaining or maintaining an appropriate weight for their height, missed growth spurts in childhood and adolescence, and significant weight loss. Those with ARFID usually also have significant nutritional deficiencies (e.g., not getting enough calories, missing certain key nutrients from their diet).

Note that AFRID is not the same as anorexia nervosa, which is often accompanied by restrictive food intake, although there are some similarities. Both disorders are often accompanied by weight loss and/or difficulty maintaining appropriate weight for height. Both disorders are characterized by restrictive food intake.

The key difference is this: those with ARFID are not restricting food intake because of body image concerns. Rather, their restrictive food intake usually has more to do with sensory properties of certain foods than with any concern about their body shape or size. In addition, those with ARFID have typically had it their entire lives, although we may occasionally see a case of ARFID develop after food poisoning or an illness where a person had difficulty keeping food down and become afraid to eat.

At what point should you become worried? If you think you or a loved one may suffer from ARFID, here are a few guidelines for when to seek help:

• They have difficulty gaining or maintaining appropriate weight for height, missed growth spurts in childhood and adolescence, and significant weight loss.
• They are becoming dependent on oral nutritional supplements in an effort to avoid offending foods.
• Their eating habits are interfering with their ability to have a "normal" everyday life.

What if you know someone who has eating disturbances, but ARFID doesn’t seem to fit? In the past decade, psychologists are becoming increasingly concerned with a type of “picky eating” that is associated with fear of weight gain and body image. For example, many patients who end up developing symptoms of anorexia nervosa may start off restricting a few foods, but unlike those with AFRID, that list of restricted foods keeps growing.

If that sounds more like your friend than AFRID, here are a few warning signs to look for:

• Skips meals, takes tiny portions, will not eat in front of other people, eats in ritualistic ways, or mixes strange food combinations.
• Chewing and spitting
• Shops and cooks for the entire household, but will not eat
• Always has an excuse not to eat
• Becomes "disgusted" with former favorite foods like red meat and desserts.
• Will eat only a few "safe" foods.
• Boasts about how healthy the meals are that she or he consumes.
• Becomes a "vegetarian" or “vegan” but will not eat the necessary fats, oils, whole grains, and the denser fruits and veggies (such as sweet potatoes and avocados) required by true vegetarianism. Instead, they choose primarily low-fat items with low levels of other nutrients, such as lettuce, tomatoes, sprouts, and so forth.
• Drastically reduces or completely eliminates fat intake.
• Reads food labels religiously.
• If she or he breaks self-imposed rigid discipline and eats normal or large portions, excuses self from the table to vomit and get rid of the calories.
• Loses, or tries to lose, weight.
• Has frantic fears of weight gain and obesity.
• Obsesses about clothing size.
• Complains that she or he is fat even when clearly not.
• Spends lots of time inspecting self in the mirror and usually finds something to criticize.
• Detests all or specific parts of the body
• Self-worth is tied to thinness.

Eating Disorders Essential Reads

When the Shoe Fits, Wear It: Understanding Body Weight Set Point

Psychological Maintenance Processes of Binge-Eating Disorder

Eating disorders are serious issues. Although relatively new to the category of eating disorders, ARFID is no different. If you think you or a loved one may suffer from ARFID or any other disorder, please seek help. It is only with increased awareness of the signs and symptoms of eating disorders that we can get more individuals into appropriate treatment. The earlier we can get someone who suffers into treatment, the better their chances for recovery. That is something we can all benefit from.