ARFID: When Extreme Picky Eating Affects Health 

In this article: 

• Avoidant/restrictive food intake disorder (ARFID) is an eating disorder in which you restrict food intake due to concerns like choking or sensory dislikes. It affects about 1 in 20 adults.
• Consequences related to nutrition can include weight loss or low body weight, malnutrition, and dehydration. 
• Your healthcare team may include your primary care doctor, a mental health professional, and a gastroenterologist. 
• Some ways to improve nutrition are to try different types of foods and different methods of preparing them to find textures and flavors that you can tolerate and enjoy. 
• Talk to your healthcare provider about any nutritional or physical or mental health concerns.
• Reach your health and weight loss goals with Lark’s 24/7 personalized coaching to help establish healthy habits around nutrition, physical activity, and more everyday choices. 

Avoidant/restrictive food intake disorder (ARFID) is a condition in which you restrict food intake due to concerns like choking or sensory dislikes. It can lead to malnutrition or weight loss, but small changes can help improve dietary quality if you have ARFID. Here’s what you should know about recognizing ARFID, getting help, and finding manageable ways to support your health. 

What Is ARFID?

The DSM-TR, which is the American Psychiatric Association’s current set of diagnostic guidelines, categorizes ARFID among Feeding and Eating Disorders. Patients with ARFID limit the types of foods they consume or the amounts. According to the National Eating Disorder Association reasons for limiting food can include lack of interest in food or a sensory dislike of sensory characteristics like taste or texture.

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Some people with ARFID are afraid food will harm them such as through choking or vomiting, Sometimes ARFID appears after trauma like a choking event as a child. Though someone with ARFID may be underweight, the cause of ARFID is not usually a distorted body image as in an eating disorder like anorexia. 

Who Has ARFID?

According to an article in the Journal of Eating Disorders, about 5% of American adults have ARFID. It often starts in infancy or early childhood and appears as extreme picky eating, but It can also develop later, especially after treatment for a serious medical event. 

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People with ARFID may also be at higher risk for autism, depression, anxiety, and ADHD. 

Nutritional Concerns of ARFID

People with ARFID may have malnutrition due to undereating or to avoiding entire food groups. People with ARFID can also report feeling full before meals and feeling unable or unmotivated to eat normal portions of food.

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 Here are some possible effects of ARFID, according to Cleveland Clinic. 

• Underweight
• Dehydration or electrolyte imbalance
• Nutritional anemia
• Osteoporosis
• Low blood pressure
• Cardiac arrest

Though ARFID may be related to avoiding certain foods, it’s possible for ARFID to raise the risk of obesity in some individuals if they tend to avoid high-fiber foods like vegetables, and instead rely heavily on highly processed foods that are associated with weight gain. 

Approaches to Addressing ARFID

If you have ARFID, it’s best to work with your healthcare provider for treatment. Together, you can establish goals and create a plan for working towards them.

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Here are some common goals when treating ARFID.

• Reversing or preventing nutritional deficiencies
• Reducing fear of specific foods or eating
• Increasing appetite or portions of food consumed if underweight
• Expanding dietary variety, or the range of types of foods you eat
• Increasing the ability to enjoy social situations that may involve eating 

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Each case of ARFID is different. It’s important to note your individual preferences and symptoms, as well as to work closely with your healthcare team, to see which strategies may work best for you. 

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Assessing Your ARFID

Taking small steps to increase dietary variety and make portion sizes more appropriate can help prevent or reduce symptoms of ARFID. It can help to identify current patterns. 

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Your healthcare team can help you make discoveries in the following areas. 

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Types of foods you consider “safe.” It varies by the individual, but “safe” foods can be those with mild flavors or textures that are consistent throughout. They may feel comfortable and familiar. Chicken, plain pasta, bananas, white bread, potatoes, peanut butter, and milk are examples of foods that may feel safe.

Types of foods you tend to avoid. Each person may have their own reasons for avoiding certain foods or food types, but commonly excluded foods can have strong flavors, be unfamiliar, or have mixed or unpredictable textures as in chunky mixed dishes like casseroles and stews. Some people dislike textures they perceive as slimy, such as that of cooked vegetables. You may also avoid foods if they remind you of a bad experience you had, like choking on a piece of meat as a child. 

Patterns of fullness that interfere with your ability to eat enough. You may feel full before meals, or fill up quickly once a meal starts. This may happen more often in social situations like parties or when eating with friends or another large group. 

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In addition, a dietary assessment, body weight measurements, and laboratory tests can help identify any nutritional deficiencies you may have. 

Small Changes with ARFID

Your healthcare team can help you make small changes that feel safe and doable to you. Here are some strategies that may help.

• Use the blender to add new foods if smoothies feel safe because their texture is smooth. For example, if you’re deficient in protein, try blending in protein powder to a smoothie with milk and a banana. Or, if you need more vegetables, try adding carrots or spinach to a smoothie. You can also blend soups, stews, and casseroles to get more vegetables and protein.
• Replace small amounts of refined grains with whole grains. For example, if white rice is a “safe” food for you, try using 1 part of brown rice to 2 parts of white rice.
• Prepare foods differently to see if their taste or texture improve. For example, if you find cooked vegetables to be slimy, try crunchy raw carrots or bell peppers, or roast brussels sprouts so they’re crispy and dry. If you think broccoli tastes too strong, try cooking it more to decrease its bitter taste.
• If you are afraid that certain foods will harm you, try changing the way you consume them. For example, if you’re afraid of choking on cottage cheese, strain it before eating it. 
• Replace a “safe” food with a similar food. For example, if peanut butter is safe, consider almond or cashew butter to expand your variety. 

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Experts like a nutritionist or mental health professional can help with each step. Keep checking in for guidance and to monitor progress. 

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Here’s a meal plan to consider when making changes to your diet. 

Tips for a Balanced Diet with ARFID

It’s important to balance your meals as you work towards a healthier diet with ARFID. This can be a change if you’re used to a high-carbohydrate diet, which is common on ARFID. That’s because “safe foods” are often high-carbohydrate, refined starches like white bread, potatoes, and pasta. Sugar-sweetened foods like sweetened cereal and fruit drinks are additional options that are commonly “safe foods” with ARFID, and are high in refined carbohydrates. 

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When you include protein, healthy fats, and fiber in your meals, you support aspects of health like blood sugar, weight, heart health, and energy levels. When planning your meals, try to balance them.

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Start by identifying foods from various food groups that you already eat. Examples may include carbohydrates like bread and potatoes, proteins like chicken and yogurt, and foods with healthy fats like peanut butter.

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Look for any missing food groups like fruit or vegetables. Try to add items from those groups. It may take some creativity. For example, if you can’t tolerate raw fruit, try peeling, cooking, and pureeing apples to eat as applesauce. Or, you might try pureeing cooked eggplant with ground turkey to add vegetables. 

How Lark Can Help

Having ARFID can challenge nutritional status, but small changes can help you choose a healthier diet. Lark can help you make positive choices on a daily basis. Your Lark coach is available 24/7 for encouragement, nutrition and physical activity coaching, and habit tracking. Lark can help you make healthy choices and establish habits that fit into your lifestyle so you can lose weight and keep it off with or without GLP-1 medications. 

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Click here to see if you may be eligible to join Lark today!

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