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Speaker 1: This episode includes discussion of eating disorders. We know these

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Speaker 1: topics can be sensitive and even triggering. Please take care

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Speaker 1: of yourself and feel free to pause or skip if

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Speaker 1: you need to. If you or someone you love is

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Speaker 1: struggling with an eating disorder, support is available in the

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Speaker 1: US by calling or texting nine eight eight, or by

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Speaker 1: visiting Nationaleatingdisorders dot org for resources.

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Speaker 2: I'm TT and I'm Zachiah.

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Speaker 1: And this is Dope Labs. Welcome to Dope Labs, a

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Speaker 1: weekly podcast that mixes hardcore science with pop culture and

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Speaker 1: a healthy dose of friendship. In today's lab, we're talking

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Speaker 1: about something that hits close to home for many families,

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Speaker 1: avoidant restrictive food intake disorder.

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Speaker 2: Or our fit. That's right.

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Speaker 3: For years, when we heard about someone who was a

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Speaker 3: picky eater, it often felt like it was brushed off.

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Speaker 3: It's just a phase or a personality quirk. But now

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Speaker 3: there's growing awareness that for some this is a serious

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Speaker 3: medical condition, and so ourfit is a relatively newer diagnosis,

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Speaker 3: and it's important to understand that it differs significantly from

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Speaker 3: typical picky eating.

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Speaker 2: Right.

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Speaker 1: URFID can have serious health and social impacts. We know

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Speaker 1: that it often co occurs with other mental health conditions,

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Speaker 1: and treatment for our FID is also much more intensive

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Speaker 1: and requires a team approach, so a lot of folks

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Speaker 1: to help you out, unlike just trying to encourage a

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Speaker 1: child to eat their veggies. You know.

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Speaker 2: Yeah, it's way more than that.

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Speaker 3: And the conversation around our FID is gaining a lot

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Speaker 3: more visibility, and part of that is thanks to personal

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Speaker 3: stories that have been shared publicly, like that of reality

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Speaker 3: TV star Emily Simpson discussing her son's diagnosis. But perhaps

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Speaker 3: one of the most compelling and widely shared stories that

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Speaker 3: has immerged on social media recently has been from Hannah

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Speaker 3: bringing a new face to this disorder.

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Speaker 1: Yes, I originally stumbled on Hannah's TikTok page and she's

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Speaker 1: this really adorable little girl who was trying different foods.

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Speaker 1: And it's not like, oh, I'm trying sushi or I'm

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Speaker 1: trying snails for the first time. It was basic things

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Speaker 1: like oh, I'm going to try watermelon or I'm going

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Speaker 1: to try cheese. And it really was surprising to me

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Speaker 1: because I'd never seen anything like this before.

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Speaker 2: Yeah, you put Hannah on the map for me.

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Speaker 3: You shared her profile on Instagram because you know, I

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Speaker 3: don't have a TikTok, and she has an account and it's.

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Speaker 2: Called my r fit Life.

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Speaker 1: In each video, Hannah is bravely sampling a single food

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Speaker 1: and rates it on a scale from one to ten.

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Speaker 1: She always pushes herself to eat at least three bites

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Speaker 1: before saying she doesn't want to eat something anymore.

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Speaker 2: Sometimes there's tears.

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Speaker 1: Sometimes she is really pleasantly surprised and is able to

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Speaker 1: add foods to her safe list.

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Speaker 3: And really her honesty and sharing this struck a nerve

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Speaker 3: online and it was incredible for me to see, right,

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Speaker 3: because I had no awareness of arfit, and within just

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Speaker 3: six months her account exploded to like one point four

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Speaker 3: million followers. Yes, and I think this is a beautiful

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Speaker 3: example of science communication, right because we're seeing a personal story, yes,

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Speaker 3: and we're seeing how on platforms like social media it

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Speaker 3: can create a powerful wave of awareness and community for folks.

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Speaker 1: Yes. So to help us dive deeper into the science

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Speaker 1: and human experience of our fit, we're joined by doctor

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Speaker 1: Jessica Body, who works at the Pearlman's School of Medicine

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Speaker 1: at the University of Pennsylvania. I am always on TikTok

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Speaker 1: or Instagram chronically, and there was a few videos that

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Speaker 1: had popped up on my feeds with this young girl

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Speaker 1: and she was talking about how she was going to

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Speaker 1: be trying like cheese for the first time, or trying

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Speaker 1: a pickle for the first time in her life, or

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Speaker 1: trying wheat bread.

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Speaker 2: And I was like, what's happening. I don't get it.

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Speaker 1: And so I looked at the hashtags, and one of

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Speaker 1: the hashtags was ARFED, and so I clicked on it,

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Speaker 1: and then I was introduced to this whole world of

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Speaker 1: folks that are struggling with this avoidant restrictive food intake disorder.

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Speaker 1: And so it really just piqued my interest because it

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Speaker 1: seems like it's mostly very, very small kids that are

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Speaker 1: dealing with this, and so I thought it would be

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Speaker 1: helpful kind of shine a light in this a little

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Speaker 1: bit of a dark corner that people may not know exist,

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Speaker 1: and if they do know it exists, to help them

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Speaker 1: understand how this comes to be.

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Speaker 4: Yep, great, really relevant question.

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Speaker 5: I think if you pulled any parent at like a

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Speaker 5: playground or a school, they would all spark a conversation

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Speaker 5: about picky eating among their kids. Yeah, so it's like

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Speaker 5: both common and then, Yet this arfied name sounds like

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Speaker 5: a bug right, sounds like something. Where did this name

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Speaker 5: come from? And it's relatively new, so it didn't get

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Speaker 5: introduced in the Diagnostics Just manual until twenty thirteen, which

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Speaker 5: is fairly new for an eating disorder, and it is

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Speaker 5: housed in the same category as bolimia and anorexia. But

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Speaker 5: for most folks with ARFID, it's an anxious experience to

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Speaker 5: be presented with a new food. It's really tough to

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Speaker 5: see her eating those foods, and she really looks anxious

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Speaker 5: and uncomfortable, partially disgusted, a little bit gaggy at times,

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Speaker 5: so quite brave that she's recording it, quite brave that

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Speaker 5: she's doing that exposure work. And it really is the

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Speaker 5: recommended treatment for our FID. So I think people wonder,

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Speaker 5: is my kid just picky? Is my kid having this

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Speaker 5: ARFID experience? Where is this diagnosis coming from? And I

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Speaker 5: think it's so new even though it's been around for

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Speaker 5: more than ten years, pediatricians are still getting new information

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Speaker 5: about it and starting to recognize the severity of some

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Speaker 5: kids with picky eating.

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Speaker 4: So I think if it's sort of like picky eating.

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Speaker 5: Like an umbrella term right, you could talk about all

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Speaker 5: people with ARFIT or picky eaters, but not all picky

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Speaker 5: eaters meet criteria for our FA. There's probably a spectrum there,

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Speaker 5: just like with somebody who's afraid of flying on airplanes. Right,

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Speaker 5: you could say, oh, I'm a terrible fly er, I

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Speaker 5: hate to fly, but you get on airplanes and you

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Speaker 5: kind of white knuckle through it all the way up

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Speaker 5: to people who are crying and having panic attacks, or

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Speaker 5: people who will say I won't even book a flight.

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Speaker 4: Like same with picky eating.

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Speaker 5: You could have kiddos who need a lot of nudging

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Speaker 5: to eat their vegetables, like you got to finish that

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Speaker 5: before we have dessert, or you need to eat your

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Speaker 5: fruit before we go play. Kids who respond to that

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Speaker 5: contingency might be mildly picky, but they can get some

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Speaker 5: eating off the ground. Right. Parents are successfully getting those

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Speaker 5: bites in. I think there's parents at the playground who

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Speaker 5: are getting advice from other picky parents and they're like, oh,

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Speaker 5: you know, just.

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Speaker 4: Set out a veggie tray.

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Speaker 5: They'll graze on it, they'll eat what they want, just

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Speaker 5: keep offering it. And the parents of the kids with

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Speaker 5: ARFID are thinking to them like, that's pie in the sky.

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Speaker 5: There's no way my kid's going anywhere near that cucumber.

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Speaker 5: It's not going to happen, And so I think there's

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Speaker 5: this level of frustration. And even when they take these

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Speaker 5: kids to the pediatrician and they say they're really picky,

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Speaker 5: sometimes the pediatrician is looking at their weight saying their

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Speaker 5: BMIs pretty typical, or they've stayed on their trajectory the

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Speaker 5: whole time, and they're not expressing a lot of concern,

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Speaker 5: which makes parents sort of walk away saying, either it's

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Speaker 5: not that big of a deal, or I'm sensing something

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Speaker 5: that's not quite right. They're not eating things from food groups.

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Speaker 5: They're really struggling. Every night's of battle to try to

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Speaker 5: get them to eat the foods that the rest of

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Speaker 5: the family is eating, and they feel really invalidated. So

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Speaker 5: the diagnosis is great that it's now in there, and

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Speaker 5: we're starting to see more clinicians and pediatricians starting to

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Speaker 5: represent that diagnosis in the eating disorder space, but treatment

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Speaker 5: is sort of still like trickling through, and we're trying

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Speaker 5: to get more and more families aware of what the

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Speaker 5: treatment options are, which is exactly what Hannah Arfit and

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Speaker 5: Handle is trying to do she's trying to show how

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Speaker 5: she's doing exposure therapy.

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Speaker 2: Wow.

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Speaker 3: You know when you think about ten years, you could

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Speaker 3: think like, oh, well that's a long time everybody should

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Speaker 3: have a handle on this.

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Speaker 2: But I think you.

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Speaker 3: Raised such a great point about how things may present

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Speaker 3: across different cases. That makes maybe progress and being able

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Speaker 3: to quickly recognize things that could make it difficult. At

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Speaker 3: what point does picky eating cross the line into our

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Speaker 3: fit territory? So, even if you're a pediatrician is not informed,

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Speaker 3: are there specific red flags that parents or even if

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Speaker 3: they're pediatricians listening to this, that they should be looking

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Speaker 3: for to inform their diagnosing.

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Speaker 4: Yeah, definitely.

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Speaker 5: Some of the main red flags that easily get you

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Speaker 5: the ur FO diagnosis, or that you're so limited in

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Speaker 5: what you eat or so avoidant or so restrictive in

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Speaker 5: what you eat that you have a weight loss or

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Speaker 5: a growth deficiency. So pediatricians can see this really easily

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Speaker 5: on the growth charts. They can say, well, she was

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Speaker 5: at twenty fifth percentile when she was like an infinittaller.

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Speaker 4: Now she's sort of fallen off the growth curve.

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Speaker 5: So things like failure to thrive or failure to meet

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Speaker 5: those needs in gain and growth could be a huge flag.

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Speaker 4: However, when we did our research, a.

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Speaker 5: Colleague of mine, Catherine Dollsguard, who big shout out for

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Speaker 5: doing the Picky Eating program at the Children's Hospital of

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Speaker 5: Philadelphia for many years. When we looked at the data

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Speaker 5: on the picky eating group, the BMI was actually quite high,

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Speaker 5: and I kept asking, like, is that right we should

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Speaker 5: this number?

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Speaker 4: Is that the right?

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Speaker 5: What happens with kids with pig eating is that they

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Speaker 5: end up having a bimodal distribution, meaning that there's kids

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Speaker 5: that are actually low weight underweight, but there's also kids

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Speaker 5: that are in the overweight obese category because they're eating

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Speaker 5: breakfast foods and pastas and goldfish crackers and snacking all day, right,

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Speaker 5: because that's the limited food set that they're able to eat.

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Speaker 5: So just weight alone isn't enough to sort of look

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Speaker 5: at whether a kid is picky or significantly picky. So

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Speaker 5: things like nutritional deficiencies can be assessed for and we

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Speaker 5: ask pediatricians to sort of run some panels on kiddos

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Speaker 5: that we're about to start an outpatient therapy to make

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Speaker 5: sure they're not missing anything, because you could have a

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Speaker 5: carb loving kiddo who's like at risk for rickets and scurvy. Right,

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Speaker 5: they're not getting enough ingredients, and so we like to

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Speaker 5: see kids with a protein that they're able to eat,

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Speaker 5: an animal food of some type, and some sort of

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Speaker 5: fortified carb. Then we feel a little bit better that

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Speaker 5: they're not as much risk for nutritional deficiencies. But even

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Speaker 5: like that weight is not necessarily the red flag. We

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Speaker 5: might need to get them in and get some blood

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Speaker 5: work done or some testing if a parent is concerned

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Speaker 5: they're not getting enough of various food groups. The nice

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Speaker 5: thing about the ARPHID criteria that was written in by

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Speaker 5: the people who developed the diagnostic criteria is that you

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Speaker 5: can meet criteria for ARFID just on interference with what

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Speaker 5: they call psychosocial functioning, meaning like, is it a pain

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Speaker 5: to feed this kiddo? Is it hard to take them

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Speaker 5: lunch to school? Is it hard for them to eat

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Speaker 5: at restaurants? Is it hard to travel?

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Speaker 4: Because we have to.

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Speaker 5: Track the restaurants that have the foods that they'll eat.

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Speaker 5: But parents will know, am I making separate meals for

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Speaker 5: this kiddo? Am I bending over backwards to pick off

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Speaker 5: specs and retoast the toast that got to burn, right, Like,

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Speaker 5: it's difficult for a parent and they know that it is,

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Speaker 5: so it honors that difficulty.

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Speaker 4: In having that added to the criteria.

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Speaker 5: I think if you have a kiddo you're really struggling

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Speaker 5: to get them to eat across food groups or expand

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Speaker 5: their diet or eat what your other typical eating kiddo

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Speaker 5: will eat, then you can actually meet criteria just based

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Speaker 5: on that interference alone.

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Speaker 2: Wow.

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Speaker 1: I mean, I think that that's really great to have

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Speaker 1: that type of nuance when we're talking about something like this,

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Speaker 1: which is a very sensitive topic for a lot of people.

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Speaker 1: You talk a little bit about how URFID a new

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Speaker 1: diagnosis within the last you know, ten years, you said

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Speaker 1: that it came to be. Can you talk about in

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Speaker 1: the world of eating disorders, can you explain why OURFID

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Speaker 1: was recognized as a distinct condition and what makes it

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Speaker 1: different from older well known eating disorders like anorexia or bolimia.

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Speaker 5: Great question, And when we have a person in our

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Speaker 5: office that we're assessing for URFID, we ask questions that

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Speaker 5: to rule out those other conditions, because it's really important

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Speaker 5: to make sure that we are identifying what we think

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Speaker 5: we're identifying the treatment's going to differ based on whether

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Speaker 5: someone meets criteria for URFID or anorexia, So super important

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Speaker 5: to get that nuance right. And I should mention we

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Speaker 5: talked about URFID presenting in kids. We see the teens

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Speaker 5: and adults as well. There's an arfid Andrew as well

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Speaker 5: all over Instagram doing the adult version.

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Speaker 4: Of these exposures.

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Speaker 5: And if we had someone like him in our office

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Speaker 5: and we're asking questions like what's behind the food avoid

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Speaker 5: or the food aversion.

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Speaker 4: If it's not because of shape or weight like.

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Speaker 5: We would expect to see in anorexia, we're more confident

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Speaker 5: that it's more about the aversion to the food itself.

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Speaker 5: Within our FID, we think that there's probably subtypes of

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Speaker 5: folks with our FID. So just like we would ask

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Speaker 5: questions about binge eating or bingeting history, weight and shape

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Speaker 5: concerns in anorexia, we can ask some specific questions to

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Speaker 5: see even what subtype of our FOD someone might have.

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Speaker 5: So we see a subset of kids, teens and adults

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Speaker 5: who just historically have had a lack of interest in eating.

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Speaker 5: They're like the opposite of a foodie. So and it's

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Speaker 5: a shame when you have a foody in a household.

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Speaker 5: They don't always understand what it's like to have these

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Speaker 5: like low appetite food apathy kinds of people, because they're like,

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Speaker 5: what do you mean you don't appreciate a good stake,

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Speaker 5: and like they just don't get it. But these books

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Speaker 5: sometimes they have a history of just never really having

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Speaker 5: a strong hunger Q, never having a strong interest in

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Speaker 5: the varieties and flavors of food.

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Speaker 4: It just falls flat.

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Speaker 5: Sometimes it can come from a history of having discomfort

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Speaker 5: when eating. We see kids with like chronic history of constipation,

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Speaker 5: or folks that have had a lot of GI ups

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Speaker 5: and downs or IBD where eating actually has a history

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Speaker 5: of causing them some discomfort and pain, and that sort

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Speaker 5: of association over time creates this learned fear of eating

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Speaker 5: or disinterest in eating, because it just never feels the

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Speaker 5: typical experience of somebody who's eating feels you feel hungry,

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Speaker 5: you grab something to eat, you feel the food is

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Speaker 5: delicious and rewarding, and it reinforces that I should do

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Speaker 5: that again when I get a hunger Q. For folks

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Speaker 5: with ourfait, they might not necessarily get that strong sensation

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Speaker 5: of hunger and the reward from eating.

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Speaker 4: So they're sort of tapped out of that entire system.

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Speaker 5: And when you add that fear layer on top of it,

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Speaker 5: if their history, say you were lactose intolerant, but you

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Speaker 5: wasn't recognized for a long time. Anytime you look at milk,

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Speaker 5: it might sort of have this like, oh, yeah, I

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Speaker 5: didn't feel great.

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Speaker 4: The last time.

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Speaker 5: Might have that milkshake, so it's not feeling as interesting

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Speaker 5: to me. So there's that category of folks with arfod.

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Speaker 5: Then you get folks who are really sensory bothered by food,

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Speaker 5: so things like mushi textures, soft textures. If you think

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Speaker 5: of like a bowl of blueberries and a bowl of

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Speaker 5: goldfish crackers.

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Speaker 4: Every goldfish cracker is.

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Speaker 5: Very predictable in applewl, a bowl of blueberries super unpredictable, like.

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Speaker 4: The squashy mushy one.

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Speaker 5: The really our one, the really tart one, the release

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Speaker 5: like it's a mixed bag. So in terms of it

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Speaker 5: coming from this place of anxiety, I'm going to get

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Speaker 5: a lot less of anxiety eating that predictable, crunchy, sort

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Speaker 5: of smooth carb versus this really unpredictable set of experiences

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Speaker 5: with typically fruits, vegetables, and meats. So those sensory kiddos,

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Speaker 5: I think they're really sensitive. So those types of things,

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Speaker 5: we hear stories all the time, like a chicken nugget

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Speaker 5: manufacturer changed their recipe and now my kiddo won't eat

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Speaker 5: it anymore. Or we change toasters and now we keep

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Speaker 5: burning these slight specks.

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Speaker 4: On the pizza.

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Speaker 5: Now my kid won't eat it anymore. So they're super

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Speaker 5: sensory sensitive and they're really in tune with that. And

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Speaker 5: then the last type of folks with our fad that

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Speaker 5: we will ask more about when we have these folks

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Speaker 5: in our offices are people with folks that have a

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Speaker 5: fear of choking or vomiting or gagging on the food.

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Speaker 4: So the way I like to think about this is if.

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Speaker 5: We were in Thailand together and we were walking around

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Speaker 5: open air market and there's skewers of crickets and scorpions

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Speaker 5: and meal worm burgers, and a guide says these are great,

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Speaker 5: like this is a delicacy here, you gotta try it.

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Speaker 5: I don't know about you, guy, but if you were

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Speaker 5: offered a skewer of crickets, your reaction might not be

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Speaker 5: as positive, even if the person is saying they're great.

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Speaker 5: They're delicious, everyone loves them. Our reactions might be I

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Speaker 5: don't know if that texture will go down well. I

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Speaker 5: don't know if I would vomit or gag. I don't

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Speaker 5: know what that would do to my GI system. We

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Speaker 5: would have the same sort of reaction that a picky

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Speaker 5: eater would have to like a slice of pizza.

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Speaker 4: So you get that category too.

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Speaker 5: So when people are coming into offices, we're asking do

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Speaker 5: you have any of these other subtypes and can we

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Speaker 5: rule out some of those other bigeating disorder or anrexia.

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Speaker 2: Tit and I just talked about this. I ate something recently.

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Speaker 3: It did not treat me well, and we were texting

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Speaker 3: each other and she says, I hate when food betrays me.

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Speaker 2: That's what she wrote to me.

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Speaker 3: And I can't imagine what it must feel like to

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Speaker 3: have all of these things betray you. I think about

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Speaker 3: how much of our day to day life. I'm just

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Speaker 3: thinking about if I were scrolling on Instagram or what

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Speaker 3: as I see on television. Food is everywhere. I'm curious

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Speaker 3: about some of the psychosocial impacts. How does arfit affect

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Speaker 3: someone's social life or friendships. And we've talked a little

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Speaker 3: bit about family dynamics. But I'm particularly interested for teens

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Speaker 3: and adults. You know, as food is such a central

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Speaker 3: social nexus for all of us, what does that look like.

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Speaker 5: Yeah, the amount of shame and anxiety that people with

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Speaker 5: our fit experience in those spaces is really strong, and

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Speaker 5: I think for some people it leads. There's this misnomer

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Speaker 5: in picky eating that kids will grow out of it, right,

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Speaker 5: And I think it comes from the fact that a

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Speaker 5: lot of kids do so some of those like nudge

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Speaker 5: to eat your vegetable. Folks with mild picky eating do

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Speaker 5: grow out of some of those rigidities. And when the

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Speaker 5: folks that are sort of getting passed in the toddler years,

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Speaker 5: elementary school years, middle school years and they haven't expanded

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Speaker 5: their diet, I've had teens say I'm so embarrassed by

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Speaker 5: my toddler lunch. Right, I have an apple sauce pouch

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Speaker 5: and a peanut butter sandwich and I've been doing this

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Speaker 5: since I was five. They're embarrassed. And now I have

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Speaker 5: some adults on my caseload. They talk about going to

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Speaker 5: restaurants and having panic attacks. Someone had I think onion

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Speaker 5: put on her salad and she went to the bathroom

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Speaker 5: and cried full panic attack.

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Speaker 4: And cried, and she's feeling like I know this.

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Speaker 5: Cognitively, I know this shouldn't be such a big deal,

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Speaker 5: but physically it's like the cricket on the plate. It's

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Speaker 5: like it's such an anxiety response and so embarrassing to

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Speaker 5: feel that way and to have to then advocate for

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Speaker 5: kind of clos have the salad remade without onions, or

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Speaker 5: to be facing the consequence of eating something aversive in public,

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Speaker 5: which is the other part of that fear. I think

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Speaker 5: people worry about social judgment for making faces or for

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Speaker 5: struggling to eat something.

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Speaker 4: What if I gag or choke in front of somebody as.

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Speaker 5: I'm trying to get down a new food, because imagine,

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Speaker 5: like it one thing to eat crickets with your friends,

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Speaker 5: it would be another to like be in a job

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Speaker 5: interview and be expected to sort of keep this food down.

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Speaker 5: So the amount of anxiety that people are experiencing is

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Speaker 5: quite high, the good news being that it does respond

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Speaker 5: well to graduated treatment. So I think for some folks

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Speaker 5: who are motivated enough, that's where that's where some of

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Speaker 5: that interference can be turned into a motivator, because it

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Speaker 5: can be the thing that makes me try to Okay, fine, fine,

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Speaker 5: I'll try to down the crickets, which for them could

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Speaker 5: be like I'll try to eat a salad in front

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Speaker 5: of my work colleagues, because that's always offered at the

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Speaker 5: beginning of a business meal, you know. And so with

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Speaker 5: some graduated practice, people can do well looking at least

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Speaker 5: more tolerant of those foods. So our motto is that

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Speaker 5: you get more comfortable being uncomfortable.

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Speaker 4: And you can even see it in Hannah Arfid's video.

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Speaker 5: She showed one recently of like she's eating honeydew melon

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Speaker 5: for the very first time. She's almost in tears. She's like,

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Speaker 5: this is awful. It tastes like cucumber. It's really disgusting.

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Speaker 5: They show her a year later she hasn't even tried

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Speaker 5: honeydew melon that much in the intermediary year, and she

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00:19:23,240 --> 00:19:25,800
Speaker 5: says she's eating it. She's eating it pretty quickly, and

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Speaker 5: she's like, it's not great, it's not my favorite. But

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00:19:28,000 --> 00:19:31,120
Speaker 5: you can tell what the intermediary factor is that she's

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Speaker 5: gotten better at eating things she doesn't like. So for

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Speaker 5: a lot of parents, we have them take liking off

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Speaker 5: the table altogether. So the immediate thing when a picky

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Speaker 5: eater tries something new is to say, okay, so did

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Speaker 5: you like it? And all parents follow victim to this, right,

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Speaker 5: did you like it? I usually try to get people

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Speaker 5: out of it because it's a double bind. If I

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Speaker 5: say yes a picky eater who has ten foods or

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Speaker 5: something really restricted, the parent's going to go out and

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Speaker 5: buy Pasco sized portions of that and they're going to

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Speaker 5: be like, so saye. Saying yes is like, Ooh, I

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Speaker 5: don't know that I want to commit to that. So

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Speaker 5: the urge is to say no. And then saying no

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Speaker 5: means that I've signed up for my parent not only

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Speaker 5: not presenting it again, because I've sort of trained them

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Speaker 5: in this avoidance cycle, but then I've identified I'm not

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Speaker 5: a person that eats honeydew melon. I'm not a person

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Speaker 5: who eats those granola bars and it stays stuck. So

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Speaker 5: I tried to get parents out of the liking dilemma. Altogether,

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Speaker 5: you can tell by their face whether they like it

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Speaker 5: or not, and in the treatment, it's not the goal anyway.

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Speaker 5: The goal is actually to get you practice eating things

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Speaker 5: that you don't like. So instead my response is, oh,

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Speaker 5: I know that one was a tough one. Keep going,

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Speaker 5: you got this, keep those bites down, and if they

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Speaker 5: kind of seem like they like it, then there's like

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Speaker 5: the thought that we could keep gradually introducing it, not

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Speaker 5: costco size introducing it.

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Speaker 1: I'm definitely one of those parents who does that where

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Speaker 1: I'm like, oh, he likes it, get We're going to

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Speaker 1: eat it every day. That's what we're eating every day.

436
00:20:53,119 --> 00:20:54,919
Speaker 2: And then he gets sick of it, and I'm like,

437
00:20:55,240 --> 00:20:59,560
Speaker 2: uh oh, but we have more. So now we're.

438
00:20:59,400 --> 00:21:02,680
Speaker 1: Eating blackberries for the next few days just to get

439
00:21:02,680 --> 00:21:04,280
Speaker 1: through it before they we have to throw them all

440
00:21:04,320 --> 00:21:05,000
Speaker 1: in the trash.

441
00:21:05,240 --> 00:21:06,240
Speaker 2: Yeah.

442
00:21:06,280 --> 00:21:10,760
Speaker 1: When I think of people who have this disorder, we

443
00:21:11,119 --> 00:21:14,200
Speaker 1: don't exist in a vacuum. There's so many other things

444
00:21:14,200 --> 00:21:16,680
Speaker 1: that are going on out And you were talking about

445
00:21:16,680 --> 00:21:19,359
Speaker 1: the anxiety and the fear and the shame that's wrapped

446
00:21:19,440 --> 00:21:21,360
Speaker 1: up in all of this, and it started to get

447
00:21:21,359 --> 00:21:26,800
Speaker 1: me thinking about how having this type of disorder and

448
00:21:27,040 --> 00:21:32,000
Speaker 1: other types of disorders like anxiety, how that could impact

449
00:21:32,000 --> 00:21:36,920
Speaker 1: a person, and how the overlay of these multiple complicated

450
00:21:36,960 --> 00:21:41,840
Speaker 1: diagnoses can really interfere with each other and sometimes hold

451
00:21:41,840 --> 00:21:45,000
Speaker 1: someone back. There was some research that suggested that our

452
00:21:45,000 --> 00:21:50,120
Speaker 1: fit often coexists with conditions like autism, ADHD or anxiety.

453
00:21:50,520 --> 00:21:55,000
Speaker 1: Can you talk about how these overlaps complicate diagnosis and

454
00:21:55,040 --> 00:21:59,040
Speaker 1: treatment and what should a parent and clinicians be aware of.

455
00:21:59,600 --> 00:22:03,719
Speaker 5: We see comorbidity across those diagnoses, and there's actually a

456
00:22:03,720 --> 00:22:06,560
Speaker 5: good amount of meta analyzes out now that sort of

457
00:22:06,560 --> 00:22:10,640
Speaker 5: have done that number crunching. It's the norm for there

458
00:22:10,680 --> 00:22:13,280
Speaker 5: to be an eating disorder among folks with autism, or

459
00:22:13,320 --> 00:22:17,120
Speaker 5: at least eating interference. It's so common for those kiddos

460
00:22:17,160 --> 00:22:20,120
Speaker 5: to struggle, ARFID being one subtype of how that can

461
00:22:20,200 --> 00:22:23,840
Speaker 5: present sensory preferences and some of the nonverbal kiddos having

462
00:22:23,840 --> 00:22:26,119
Speaker 5: difficulty describing what's hard about a food.

463
00:22:26,680 --> 00:22:27,920
Speaker 4: So that's the norm.

464
00:22:28,160 --> 00:22:31,000
Speaker 5: The good news is across all of those comorbidities is

465
00:22:31,040 --> 00:22:33,960
Speaker 5: that the interventions work well for all of those kids.

466
00:22:34,040 --> 00:22:37,240
Speaker 5: So there's been quite a few pilot studies of eating

467
00:22:37,280 --> 00:22:41,280
Speaker 5: interventions for kids with autism and ARFID, and they look

468
00:22:41,320 --> 00:22:45,040
Speaker 5: great when they're responding to that slow graduated food introduction.

469
00:22:45,280 --> 00:22:47,920
Speaker 5: So a parent will typically give up giving a food

470
00:22:47,960 --> 00:22:51,159
Speaker 5: after three to five rejections, but the data suggests that

471
00:22:51,200 --> 00:22:54,800
Speaker 5: even for folks without sensory sensitivities. You need at least

472
00:22:54,800 --> 00:22:57,800
Speaker 5: ten to fifteen tries of a food to even start

473
00:22:57,840 --> 00:23:00,920
Speaker 5: to accept it into this is safe a poison berry,

474
00:23:01,000 --> 00:23:02,200
Speaker 5: it's a safe food.

475
00:23:01,920 --> 00:23:03,240
Speaker 4: To eat category.

476
00:23:03,400 --> 00:23:07,040
Speaker 5: So getting those folks with autism to do multiple tries

477
00:23:07,160 --> 00:23:10,560
Speaker 5: it can take a big behavioral motivational reward lift for

478
00:23:10,680 --> 00:23:12,600
Speaker 5: parents to do it, but I think for the kiddos

479
00:23:12,600 --> 00:23:15,760
Speaker 5: that have more significant eating interference, it's worth it. And

480
00:23:15,840 --> 00:23:19,560
Speaker 5: the protocol works the same in kiddos with autism, So

481
00:23:20,040 --> 00:23:22,560
Speaker 5: that's the good news. And then there's other comorbidities where

482
00:23:22,720 --> 00:23:26,480
Speaker 5: the actual anxiety condition might have to be addressed first.

483
00:23:26,480 --> 00:23:29,320
Speaker 5: So someone who has choking phobia or vomit phobia, not

484
00:23:29,440 --> 00:23:31,640
Speaker 5: eating is part of that picture, but they might need

485
00:23:31,680 --> 00:23:35,200
Speaker 5: specific exposures that address the choking fear or the vomit fear.

486
00:23:35,200 --> 00:23:38,080
Speaker 5: We have a lovely set of vomit exposures that involve

487
00:23:38,359 --> 00:23:42,080
Speaker 5: photos and pictures and videos and sensation you know, spitting

488
00:23:42,080 --> 00:23:44,920
Speaker 5: into the toilet, gagging with your duke brush that get

489
00:23:44,960 --> 00:23:47,520
Speaker 5: that kiddo all the way ready to eat non preferred

490
00:23:47,560 --> 00:23:49,920
Speaker 5: foods because the fear of vomiting might be just part

491
00:23:49,920 --> 00:23:51,600
Speaker 5: of that, or the fear of getting so full that

492
00:23:51,640 --> 00:23:53,879
Speaker 5: I threw up might just be part of that. We

493
00:23:53,960 --> 00:23:57,199
Speaker 5: also see a decent chunk of OCD comorbidity with harfit

494
00:23:57,280 --> 00:23:59,760
Speaker 5: and picky eating. We often with OCD try to get

495
00:23:59,760 --> 00:24:01,800
Speaker 5: to the core fear of what is what am I

496
00:24:01,880 --> 00:24:04,000
Speaker 5: afraid it is that the contamination of the food. Is

497
00:24:04,040 --> 00:24:07,280
Speaker 5: it that the food touched my brother who's contaminated. We

498
00:24:07,320 --> 00:24:09,520
Speaker 5: had a kiddo recently who said, I'm afraid of root

499
00:24:09,600 --> 00:24:11,840
Speaker 5: vegetables because they grow in the ground, and you don't

500
00:24:11,840 --> 00:24:14,400
Speaker 5: know what kind of contaminant they could have absorbed by

501
00:24:14,440 --> 00:24:16,280
Speaker 5: growing in the ground. Right, So there you have to

502
00:24:16,320 --> 00:24:18,720
Speaker 5: kind of get to the underlying logic, start doing exposures

503
00:24:18,760 --> 00:24:22,400
Speaker 5: that address the absurdity of that OCD and throw in

504
00:24:22,440 --> 00:24:24,159
Speaker 5: some eating exposures on top of that.

505
00:24:24,200 --> 00:24:27,000
Speaker 4: So it just complicates the picture. But luckily the treatment's

506
00:24:27,240 --> 00:24:28,119
Speaker 4: very much the same.

507
00:24:28,080 --> 00:24:30,040
Speaker 2: That root vegetable when I don't know, it doesn't feel

508
00:24:30,040 --> 00:24:30,600
Speaker 2: absurd to me.

509
00:24:33,480 --> 00:24:36,439
Speaker 1: I have a quick follow up question because I'm a

510
00:24:36,440 --> 00:24:40,160
Speaker 1: two year old who eats what I feel like, eats

511
00:24:40,200 --> 00:24:45,840
Speaker 1: everything except except vegetables. He did eat them when he

512
00:24:46,040 --> 00:24:49,240
Speaker 1: was a very very small baby. For a parent who

513
00:24:49,280 --> 00:24:53,800
Speaker 1: feels like, oh my child is refusing this type of food,

514
00:24:54,200 --> 00:24:57,160
Speaker 1: Could you give like an age range where you should

515
00:24:57,160 --> 00:25:02,439
Speaker 1: start really paying strong attention and can you talk with

516
00:25:02,480 --> 00:25:05,239
Speaker 1: a little bit more granularity when it comes to the

517
00:25:05,320 --> 00:25:06,760
Speaker 1: plate when we present it.

518
00:25:06,960 --> 00:25:10,879
Speaker 5: I think everybody feels that who's parented a toddler before,

519
00:25:11,560 --> 00:25:14,280
Speaker 5: and what you're hitting on is actually really developmentally normative.

520
00:25:14,320 --> 00:25:17,239
Speaker 5: So I wouldn't be worried yet, because what happens in

521
00:25:17,400 --> 00:25:21,520
Speaker 5: evolutionary terms is that when we go from infant breastfeeding

522
00:25:21,640 --> 00:25:26,040
Speaker 5: and into the early pures, kids are pretty non specific

523
00:25:26,280 --> 00:25:28,280
Speaker 5: and might be sort of dictated by what they were

524
00:25:28,280 --> 00:25:30,680
Speaker 5: fed in utero. So we see moms who are eating

525
00:25:30,680 --> 00:25:33,280
Speaker 5: spicy foods, their kids are more tolerant of spicy foods.

526
00:25:33,600 --> 00:25:36,640
Speaker 5: Moms who are drinking bitter coffee during pregnancy, their kids

527
00:25:36,680 --> 00:25:39,560
Speaker 5: are more tolerant of bitter food. So there's been some

528
00:25:39,680 --> 00:25:42,640
Speaker 5: breast milk research from the Monell Center and Philly that's

529
00:25:42,720 --> 00:25:45,880
Speaker 5: confirmed some of those findings. So, but those early pures

530
00:25:45,920 --> 00:25:48,399
Speaker 5: are often pretty widely accepted. So he was eating like

531
00:25:48,440 --> 00:25:51,760
Speaker 5: braccli puree and all the weird green bean smelling pures.

532
00:25:51,920 --> 00:25:54,520
Speaker 5: What happens when kiddos get to age one or two,

533
00:25:54,560 --> 00:25:57,280
Speaker 5: they start to walk and so evolutionarily, this was a

534
00:25:57,359 --> 00:25:59,879
Speaker 5: dangerous time period because these kiddos could walk off and

535
00:26:00,080 --> 00:26:04,840
Speaker 5: eat fistfuls of poison berries, So human development fascinating. We

536
00:26:04,840 --> 00:26:07,160
Speaker 5: were able to sort of queue these kids to say,

537
00:26:07,160 --> 00:26:09,359
Speaker 5: maybe you should be cautious with how much you're putting

538
00:26:09,400 --> 00:26:12,000
Speaker 5: in your mouth when you're one to two, and you

539
00:26:12,040 --> 00:26:14,920
Speaker 5: should make sure that it's not too bitter. So things

540
00:26:14,960 --> 00:26:17,919
Speaker 5: like veggies, which are quite bitter, spark that like, but

541
00:26:18,040 --> 00:26:20,679
Speaker 5: is it a poison berry concern for these kids? And

542
00:26:20,720 --> 00:26:25,280
Speaker 5: so it's normal for across the spectrum those little walkers

543
00:26:25,320 --> 00:26:28,560
Speaker 5: to start to look more picky. So it's up to

544
00:26:28,640 --> 00:26:30,880
Speaker 5: parents to sort of keep pushing the contingencies. And you're

545
00:26:30,920 --> 00:26:33,480
Speaker 5: right on track for thinking like, how do I get

546
00:26:33,520 --> 00:26:36,800
Speaker 5: him to reapproach These bitter foods are the ones that

547
00:26:36,920 --> 00:26:39,840
Speaker 5: just have that slimy I mean, carrots can be too

548
00:26:39,920 --> 00:26:42,399
Speaker 5: crunchy or too hard to chew down. These things that

549
00:26:42,440 --> 00:26:45,879
Speaker 5: have unusual presentations that might be less predictable than the

550
00:26:45,960 --> 00:26:48,840
Speaker 5: goldfish cracker or more bitter than some of the other

551
00:26:48,880 --> 00:26:51,879
Speaker 5: foods that they eat. So in the what to do category,

552
00:26:52,320 --> 00:26:54,560
Speaker 5: it's funny I joked about the veggie plate before because

553
00:26:54,560 --> 00:26:57,720
Speaker 5: the severe picky eaters won't do it. But in typical development,

554
00:26:57,760 --> 00:27:00,760
Speaker 5: when we can catch kids when they're hungry, the veggie

555
00:27:00,760 --> 00:27:03,880
Speaker 5: plate is an awesome strategy. So something like the kids

556
00:27:03,920 --> 00:27:06,879
Speaker 5: coming home, they want a snack, you know they're gunning

557
00:27:06,920 --> 00:27:10,479
Speaker 5: for like the granola bars and the mini bites, and like,

558
00:27:10,640 --> 00:27:12,840
Speaker 5: you know that that's what they want. We can put

559
00:27:12,880 --> 00:27:15,119
Speaker 5: a contingency in place. Certainly you can have mini bites

560
00:27:15,160 --> 00:27:18,280
Speaker 5: just as soon as you eat these three carrot bytes,

561
00:27:18,320 --> 00:27:20,280
Speaker 5: and we could start with something that's like the least

562
00:27:20,320 --> 00:27:21,800
Speaker 5: aversive of those things.

563
00:27:21,800 --> 00:27:23,000
Speaker 4: We get them really accustomed to.

564
00:27:23,080 --> 00:27:24,879
Speaker 5: Every time I ask for one of those snacks during

565
00:27:24,920 --> 00:27:27,800
Speaker 5: the hungry period, Mom sets out the apple tray with

566
00:27:27,880 --> 00:27:30,240
Speaker 5: the carrots on it, and I know, I sort of

567
00:27:30,280 --> 00:27:33,120
Speaker 5: graze on that before I'm able to get the real thing.

568
00:27:33,560 --> 00:27:35,680
Speaker 4: There's a book called French Kids Eat Everything.

569
00:27:36,160 --> 00:27:38,480
Speaker 5: I Love for like a guide through that, because it's

570
00:27:38,560 --> 00:27:42,720
Speaker 5: essentially it is about offering and modeling and having those opportunities,

571
00:27:42,840 --> 00:27:44,280
Speaker 5: but it has to hit when they're hungry, and for

572
00:27:44,359 --> 00:27:46,240
Speaker 5: some kids they might need more of a nudge than

573
00:27:46,359 --> 00:27:48,760
Speaker 5: just having it out. So for my four year old,

574
00:27:48,760 --> 00:27:51,320
Speaker 5: I was a picky eater when I was little. There's

575
00:27:51,359 --> 00:27:54,439
Speaker 5: a high genetic load for picky eating. I passed it

576
00:27:54,480 --> 00:27:56,359
Speaker 5: on to my four year old. Despite being a picky

577
00:27:56,400 --> 00:27:58,320
Speaker 5: eating expert, I have to give him a ton of

578
00:27:58,359 --> 00:28:01,280
Speaker 5: nudges to get him eating some of these veggies.

579
00:28:01,640 --> 00:28:03,520
Speaker 4: And so nudge is meaning we.

580
00:28:03,560 --> 00:28:07,399
Speaker 5: Might have to have a specific cucumber eating party which

581
00:28:07,440 --> 00:28:10,359
Speaker 5: he's doing his bites and he's getting a reward afterwards.

582
00:28:10,520 --> 00:28:12,679
Speaker 4: How that's set up for parents can really differ.

583
00:28:13,040 --> 00:28:16,440
Speaker 5: So it could be like the full round of cucumber

584
00:28:16,520 --> 00:28:18,160
Speaker 5: has to be eaten and then we can go pick

585
00:28:18,160 --> 00:28:20,360
Speaker 5: out a Pokemon card from your bin.

586
00:28:20,840 --> 00:28:22,680
Speaker 4: It could be points towards something. It could be.

587
00:28:22,640 --> 00:28:25,679
Speaker 5: Special time with parents, which is free and lovely, but

588
00:28:25,800 --> 00:28:27,960
Speaker 5: the heavier lift of the reward might have to happen

589
00:28:28,000 --> 00:28:31,240
Speaker 5: if just setting out the food isn't that interesting. Screen

590
00:28:31,280 --> 00:28:33,439
Speaker 5: time is also lovely for this, So pushing pause on

591
00:28:33,480 --> 00:28:35,639
Speaker 5: a show and saying, oh, finish your cucumber bite and

592
00:28:35,640 --> 00:28:36,879
Speaker 5: then we can push play again.

593
00:28:37,400 --> 00:28:39,600
Speaker 4: That's how we do it in some of the feeding clinics.

594
00:28:39,640 --> 00:28:42,120
Speaker 5: So even the feeding clinic over at Chop will do

595
00:28:42,480 --> 00:28:45,000
Speaker 5: very specific bite for bite rewards. Like we are sitting

596
00:28:45,040 --> 00:28:47,520
Speaker 5: across from the kiddo, we put the piece of carry

597
00:28:47,520 --> 00:28:49,040
Speaker 5: it down. We say eat your bytes, and then we

598
00:28:49,080 --> 00:28:52,000
Speaker 5: can play. As soon as they're chewing, we get back

599
00:28:52,040 --> 00:28:54,920
Speaker 5: into playing whatever little toy or game we're playing with.

600
00:28:55,560 --> 00:28:56,800
Speaker 4: The next bite gets set out.

601
00:28:56,840 --> 00:28:59,640
Speaker 5: If they're refusing, we sort of turn our attention away

602
00:29:00,040 --> 00:29:01,880
Speaker 5: and wait for them to do the bites and then

603
00:29:01,920 --> 00:29:05,280
Speaker 5: we go back to reinforcing the eating with playing in

604
00:29:05,320 --> 00:29:08,400
Speaker 5: that way, So there's some strategies you can start to employ.

605
00:29:08,600 --> 00:29:08,880
Speaker 4: Again.

606
00:29:08,920 --> 00:29:11,120
Speaker 5: The folks with really significant ARPD will laugh at you

607
00:29:11,240 --> 00:29:14,000
Speaker 5: for saying my kid won't eat for a Pokemon card.

608
00:29:14,200 --> 00:29:15,520
Speaker 4: But that's a different protocol.

609
00:29:15,720 --> 00:29:17,640
Speaker 1: Yeah, we.

610
00:29:29,960 --> 00:29:34,520
Speaker 3: See ourfit kind of gaining popularity and people are talking

611
00:29:34,560 --> 00:29:38,120
Speaker 3: about it. I'm curious about how you see social media

612
00:29:38,680 --> 00:29:41,960
Speaker 3: as a tool for people with ARFIT. Do you think

613
00:29:42,000 --> 00:29:44,920
Speaker 3: it's helpful or does it add pressure or is there

614
00:29:44,920 --> 00:29:45,880
Speaker 3: any kind of stigma.

615
00:29:46,280 --> 00:29:48,160
Speaker 5: I think it helps a lot because I think people

616
00:29:48,480 --> 00:29:50,560
Speaker 5: there is like a scoffing with what do you mean

617
00:29:50,600 --> 00:29:53,600
Speaker 5: you don't like that food? Or I think if I

618
00:29:53,640 --> 00:29:57,360
Speaker 5: asked everybody, are there certain foods you don't like? I

619
00:29:57,360 --> 00:29:59,080
Speaker 5: think a lot of people would have a few. And

620
00:29:59,120 --> 00:30:01,320
Speaker 5: even when we look at the you see sort of

621
00:30:01,360 --> 00:30:04,920
Speaker 5: distressed ratings of people's foods. You probably have a pretty

622
00:30:05,120 --> 00:30:07,440
Speaker 5: average rating for most foods, and then there's a spike

623
00:30:07,480 --> 00:30:11,000
Speaker 5: around something like tomato, cucumber. These are like commonly hated

624
00:30:11,000 --> 00:30:15,320
Speaker 5: foods or like cilantro, right is the funny one out right,

625
00:30:15,720 --> 00:30:19,000
Speaker 5: And so there's this really strong dislike for those types

626
00:30:19,000 --> 00:30:22,360
Speaker 5: of foods, and people think they understand what it means

627
00:30:22,360 --> 00:30:24,680
Speaker 5: to not like a food. And I think that's the risk,

628
00:30:24,800 --> 00:30:27,160
Speaker 5: right that if you start dating someone and they're like

629
00:30:27,360 --> 00:30:29,480
Speaker 5: kind of picky, you think I get that because I

630
00:30:29,520 --> 00:30:32,480
Speaker 5: don't like cilantro, But you either muscle through it or

631
00:30:32,560 --> 00:30:35,440
Speaker 5: you just don't order it. And so that's a simple

632
00:30:35,480 --> 00:30:38,000
Speaker 5: solution for someone without our FID. For someone with URFID,

633
00:30:38,000 --> 00:30:41,320
Speaker 5: they're like, my everyday meals are tricky because of this,

634
00:30:41,520 --> 00:30:44,040
Speaker 5: and powering through it is a lot harder for me

635
00:30:44,120 --> 00:30:45,920
Speaker 5: than it is for you. So it's it's almost like

636
00:30:45,960 --> 00:30:48,440
Speaker 5: the semblance of understanding that gets us in trouble a

637
00:30:48,480 --> 00:30:50,160
Speaker 5: little bit there. And I think social media when they're

638
00:30:50,160 --> 00:30:53,120
Speaker 5: showing someone like Arfid Andrew who's gagging and like he's

639
00:30:53,240 --> 00:30:57,520
Speaker 5: just eating cheese right right, He's eating, you know, and

640
00:30:57,760 --> 00:31:00,920
Speaker 5: a banana for the first time, and it looks really

641
00:31:00,960 --> 00:31:03,280
Speaker 5: distressing to him. I think that's helpful to sort of

642
00:31:03,280 --> 00:31:06,120
Speaker 5: see it's not just your run of the mill aversion

643
00:31:06,160 --> 00:31:09,600
Speaker 5: to something. He's really struggling with the sensory experience or

644
00:31:09,720 --> 00:31:13,800
Speaker 5: the taste experience, and it's different for him. So social

645
00:31:13,840 --> 00:31:15,760
Speaker 5: media can be helpful there. I think there's also we

646
00:31:15,920 --> 00:31:19,560
Speaker 5: mentioned it being multidisciplinary. I think there's multiple influencers out

647
00:31:19,560 --> 00:31:21,800
Speaker 5: there that are now speaking to the platform.

648
00:31:21,440 --> 00:31:21,960
Speaker 4: Which is great.

649
00:31:22,040 --> 00:31:24,200
Speaker 5: So you have speech pathologists who are talking about how

650
00:31:24,240 --> 00:31:26,520
Speaker 5: to like quickly quickly chew the food and get it down,

651
00:31:26,600 --> 00:31:28,280
Speaker 5: or manipulate the food in your mouth so that you

652
00:31:28,280 --> 00:31:32,080
Speaker 5: can swallow it quickly. Some folks work with occupational therapists

653
00:31:32,160 --> 00:31:34,719
Speaker 5: because they can help you sort of touch the squishy blueberry.

654
00:31:35,080 --> 00:31:37,200
Speaker 5: And kids who are super super avoidant who would throw

655
00:31:37,200 --> 00:31:39,680
Speaker 5: a tantrum if a blueberry is anywhere in sight, they

656
00:31:39,720 --> 00:31:43,600
Speaker 5: can start doing ot with those folks and start touching blueberries,

657
00:31:43,640 --> 00:31:46,360
Speaker 5: smelling blueberries, et cetera. We tend to see the best

658
00:31:46,400 --> 00:31:50,360
Speaker 5: symptom relief when we get full bites to happen, so

659
00:31:50,800 --> 00:31:52,800
Speaker 5: like touching and playing with foods will only give us

660
00:31:52,800 --> 00:31:56,160
Speaker 5: so much symptom relief. But like you mentioned, getting someone

661
00:31:56,200 --> 00:31:59,440
Speaker 5: with a psychologist, a licensed professional counselor, or a social

662
00:31:59,440 --> 00:32:02,560
Speaker 5: work er. Somebody can do graduated food exposures. That's going

663
00:32:02,600 --> 00:32:03,959
Speaker 5: to be great. I think the more people who are

664
00:32:04,000 --> 00:32:07,320
Speaker 5: out on the platform advertising that or talking about how

665
00:32:07,360 --> 00:32:10,440
Speaker 5: they are therapeutically helping people get through, that's great. The

666
00:32:10,520 --> 00:32:12,720
Speaker 5: folks that are showing their food bites I think are

667
00:32:12,720 --> 00:32:13,480
Speaker 5: the bravest, right.

668
00:32:13,560 --> 00:32:15,600
Speaker 4: They're both being vulnerable.

669
00:32:15,120 --> 00:32:17,680
Speaker 5: In those moments eating those foods, being able to be

670
00:32:17,920 --> 00:32:19,600
Speaker 5: how could you not like cheese? How could you have

671
00:32:19,640 --> 00:32:22,120
Speaker 5: that reaction to cheese? They're at the whim of all

672
00:32:22,280 --> 00:32:26,280
Speaker 5: the comments, and I think they're also modeling for what

673
00:32:26,400 --> 00:32:28,720
Speaker 5: parents can sort of expect to sort of get out

674
00:32:28,760 --> 00:32:31,760
Speaker 5: of an exposure protocol, both that it's hard at first

675
00:32:31,840 --> 00:32:34,959
Speaker 5: and then like with Arf and Hannah, she's looking awesome.

676
00:32:35,000 --> 00:32:37,560
Speaker 5: She's looking much more tolerant of foods than ever before.

677
00:32:37,960 --> 00:32:40,840
Speaker 1: Yeah. I think one of the great things about one

678
00:32:40,960 --> 00:32:44,160
Speaker 1: highlighting this disorder that people might not know much about

679
00:32:44,680 --> 00:32:47,320
Speaker 1: and the experience of it on social media is that

680
00:32:47,440 --> 00:32:50,520
Speaker 1: it shows that one these folks exists. It gives them

681
00:32:50,520 --> 00:32:52,920
Speaker 1: a voice, and then it also shows that there is

682
00:32:53,040 --> 00:32:58,880
Speaker 1: life like during your struggle in life after you're struggling

683
00:32:58,960 --> 00:33:02,200
Speaker 1: and the process of living a life, a full life,

684
00:33:02,640 --> 00:33:06,200
Speaker 1: even though you have this disorder that you're working through.

685
00:33:06,600 --> 00:33:10,680
Speaker 1: It really humanizes folks and it really helps with people's

686
00:33:10,760 --> 00:33:13,720
Speaker 1: understanding and empathy. So the next time maybe you sit

687
00:33:13,760 --> 00:33:16,160
Speaker 1: down with a friend who is picking tomatoes out of

688
00:33:16,200 --> 00:33:18,800
Speaker 1: their burger or sending it back and asking for a

689
00:33:18,800 --> 00:33:21,720
Speaker 1: fresh one, maybe you'll before you say, oh my gosh,

690
00:33:21,800 --> 00:33:26,040
Speaker 1: that's ridiculous, you say, okay, yeah, I've seen people with

691
00:33:26,280 --> 00:33:29,880
Speaker 1: similar types of aversions to types of food, and so

692
00:33:29,920 --> 00:33:31,800
Speaker 1: you won't comment on it, or you say if they're

693
00:33:31,800 --> 00:33:34,320
Speaker 1: feeling like I can't eat this, you're encouraging like, hey,

694
00:33:34,520 --> 00:33:36,400
Speaker 1: it's okay, you can send it back, ask them to

695
00:33:36,400 --> 00:33:38,560
Speaker 1: make you a new one. You could say you're allergic

696
00:33:38,680 --> 00:33:40,880
Speaker 1: or something like that, so that they, you know, really

697
00:33:41,000 --> 00:33:44,520
Speaker 1: come back with something fresh. And that's one of the

698
00:33:44,560 --> 00:33:47,320
Speaker 1: things that I've really loved about watching Hannah and some

699
00:33:47,360 --> 00:33:49,800
Speaker 1: of these other kids that deal with it, is that

700
00:33:50,120 --> 00:33:53,520
Speaker 1: even with my own child, I'm not I don't feel

701
00:33:53,520 --> 00:33:56,920
Speaker 1: like I pressure him so much to like, you have

702
00:33:57,000 --> 00:33:58,720
Speaker 1: to eat this, you have to eat this, because I'm like,

703
00:33:58,800 --> 00:34:02,000
Speaker 1: you know, it might be a wrong dislike and I

704
00:34:02,000 --> 00:34:04,200
Speaker 1: don't want to traumatize. I don't want him the negative

705
00:34:04,560 --> 00:34:07,800
Speaker 1: association with sitting down and having dinner with his parents.

706
00:34:07,840 --> 00:34:10,319
Speaker 1: And so that's one of the things that I love.

707
00:34:10,800 --> 00:34:13,040
Speaker 1: Prior to social media, I know that there was probably

708
00:34:13,080 --> 00:34:16,759
Speaker 1: some common miss or even still now common misconceptions that

709
00:34:16,800 --> 00:34:19,959
Speaker 1: you want cleared up about our FID, whether it's among

710
00:34:20,120 --> 00:34:24,000
Speaker 1: parents or teachers or even healthcare professionals. Can you talk

711
00:34:24,040 --> 00:34:26,680
Speaker 1: about some of those misconceptions and kind of like where

712
00:34:26,719 --> 00:34:28,600
Speaker 1: they come from and clear them up for us?

713
00:34:28,920 --> 00:34:29,240
Speaker 4: Yeah?

714
00:34:29,280 --> 00:34:31,439
Speaker 5: Sure, I think you tapped into one, which is sort

715
00:34:31,440 --> 00:34:34,120
Speaker 5: of like that tussle between do I force them to

716
00:34:34,160 --> 00:34:37,280
Speaker 5: eat this? How do you even force somebody to eat something?

717
00:34:37,800 --> 00:34:40,399
Speaker 5: Are we like to clear the plate kind of family or.

718
00:34:40,360 --> 00:34:43,000
Speaker 4: Are we not? And that struggle?

719
00:34:43,080 --> 00:34:45,759
Speaker 5: So how do I advocate for their independence and that

720
00:34:45,800 --> 00:34:48,320
Speaker 5: this might be one of those foods that spikes dislike

721
00:34:48,400 --> 00:34:51,360
Speaker 5: for them or like you often get a one parent

722
00:34:51,400 --> 00:34:53,200
Speaker 5: in the household who says, like, I don't know, just

723
00:34:53,239 --> 00:34:56,160
Speaker 5: tell them to eat it, like the put the foot down, punish,

724
00:34:56,360 --> 00:34:59,719
Speaker 5: go the harsh way path And really it's not glamorous.

725
00:34:59,760 --> 00:35:01,719
Speaker 4: It's this day in day out. We gotta be.

726
00:35:01,800 --> 00:35:04,600
Speaker 5: Practicing foods just like you would have with a kid

727
00:35:04,600 --> 00:35:07,279
Speaker 5: with diabetes, right, sorry, dude. Other kids don't have to

728
00:35:07,280 --> 00:35:09,920
Speaker 5: do the blood stuff that we do or the insulin

729
00:35:10,360 --> 00:35:12,000
Speaker 5: stuff that we do, but you have a condition that

730
00:35:12,040 --> 00:35:14,360
Speaker 5: makes things different. We have to stick to this protocol,

731
00:35:14,360 --> 00:35:16,880
Speaker 5: and no one likes that. Even teeth brushing, right, We

732
00:35:16,920 --> 00:35:19,799
Speaker 5: don't say would you like to brush your teeth tonight?

733
00:35:20,280 --> 00:35:21,239
Speaker 4: Would you like to do that?

734
00:35:21,520 --> 00:35:23,360
Speaker 5: We know it's aversive, but we also know that you

735
00:35:23,400 --> 00:35:25,359
Speaker 5: can do it, so we try to apply that level

736
00:35:25,400 --> 00:35:28,000
Speaker 5: of confidence to the protocol. And then parents sort of

737
00:35:28,040 --> 00:35:30,600
Speaker 5: get in their groove, and once they start seeing games,

738
00:35:30,600 --> 00:35:33,520
Speaker 5: they get really happy with the protocol. And then we

739
00:35:33,560 --> 00:35:35,960
Speaker 5: get all the pictures of like kids eating crab legs.

740
00:35:35,960 --> 00:35:39,480
Speaker 1: And one of the things that you've brought up that

741
00:35:39,520 --> 00:35:42,719
Speaker 1: I thought was spot on was just about the each

742
00:35:42,760 --> 00:35:46,640
Speaker 1: house has its own culture, yes, and creating a culture

743
00:35:46,719 --> 00:35:49,920
Speaker 1: inside of your house so that kids understand, because I

744
00:35:49,960 --> 00:35:51,719
Speaker 1: think me and my husband we grew up with two

745
00:35:51,760 --> 00:35:56,239
Speaker 1: different cultures inside of our houses. His house was the

746
00:35:56,320 --> 00:35:59,839
Speaker 1: clean plate club was a big thing. You clean your

747
00:36:00,560 --> 00:36:03,400
Speaker 1: it's like you're part of the clean plate club. But

748
00:36:03,520 --> 00:36:05,719
Speaker 1: in my house, it was like eat until you're full

749
00:36:06,000 --> 00:36:08,279
Speaker 1: if you don't want anymore. You stop eating and if

750
00:36:08,320 --> 00:36:12,279
Speaker 1: there's stuff left over, that's okay. And it was never

751
00:36:12,320 --> 00:36:14,759
Speaker 1: a big deal. When we started dating and I had

752
00:36:14,760 --> 00:36:16,640
Speaker 1: food left on my plate, He'd be like, you're not

753
00:36:16,640 --> 00:36:18,200
Speaker 1: gonna be in the clean plate club and I was like,

754
00:36:18,880 --> 00:36:19,319
Speaker 1: I don't know.

755
00:36:19,280 --> 00:36:22,839
Speaker 2: What that is, and why should I care? Like I'm full?

756
00:36:23,000 --> 00:36:26,239
Speaker 1: And so I think that culture that we had in

757
00:36:26,280 --> 00:36:29,160
Speaker 1: our separate houses, bringing that into our house and trying

758
00:36:29,160 --> 00:36:31,360
Speaker 1: to find a new culture that works for our home

759
00:36:31,640 --> 00:36:34,919
Speaker 1: with these things in mind arms us with the terminology,

760
00:36:35,000 --> 00:36:37,200
Speaker 1: with the mindset that we need to create a healthy

761
00:36:37,239 --> 00:36:41,000
Speaker 1: food culture, whether it's you know, our child eats everything

762
00:36:41,160 --> 00:36:45,560
Speaker 1: or our child is really struggling with different textures, but

763
00:36:45,719 --> 00:36:49,120
Speaker 1: just knowing that we can set the tone and that

764
00:36:49,440 --> 00:36:52,040
Speaker 1: none of this is permanent and we can really help

765
00:36:52,239 --> 00:36:56,319
Speaker 1: mold them into having a better relationship with food. I mean,

766
00:36:56,480 --> 00:36:59,719
Speaker 1: all of this has been really illuminating and just so

767
00:36:59,760 --> 00:37:02,560
Speaker 1: how even if you don't have a child who's suffering

768
00:37:02,600 --> 00:37:06,600
Speaker 1: from a specific disorder, having that in mind, those tools

769
00:37:06,640 --> 00:37:08,600
Speaker 1: can help you in your household. It can help you

770
00:37:08,680 --> 00:37:10,440
Speaker 1: with lots of different things, like if you have a

771
00:37:10,520 --> 00:37:12,680
Speaker 1: child that you feel likes have too much screen time,

772
00:37:13,200 --> 00:37:15,040
Speaker 1: or if you have a child that you that is

773
00:37:15,080 --> 00:37:19,240
Speaker 1: struggling with anything. Really, all of this is so it's.

774
00:37:19,200 --> 00:37:21,680
Speaker 4: Like creating a bravery culture.

775
00:37:21,880 --> 00:37:24,240
Speaker 5: And I have a friend who says, like, anxiety plus

776
00:37:24,239 --> 00:37:27,279
Speaker 5: bravery equals confidence, and that's really what we're aiming for it.

777
00:37:27,400 --> 00:37:29,880
Speaker 5: So I often say, if anybody's going to kill a

778
00:37:29,920 --> 00:37:32,799
Speaker 5: reward program or an exposure program, it's the parent because

779
00:37:32,840 --> 00:37:35,319
Speaker 5: we're so busy and trying to sort of manage so

780
00:37:35,360 --> 00:37:37,960
Speaker 5: many things. But if we can do this mundane day

781
00:37:38,000 --> 00:37:39,360
Speaker 5: in day out, we're doing.

782
00:37:39,120 --> 00:37:40,040
Speaker 4: This brave stuff.

783
00:37:40,400 --> 00:37:44,200
Speaker 5: It creates a culture of achievement from bravery rather than

784
00:37:44,239 --> 00:37:47,360
Speaker 5: from luck or from just that I happen to like

785
00:37:47,440 --> 00:37:49,880
Speaker 5: this food. It comes from this place of oh, I

786
00:37:49,880 --> 00:37:52,400
Speaker 5: don't like that food yet, but if I keep working

787
00:37:52,400 --> 00:37:55,560
Speaker 5: at it, I can create some practice and confidence for myself.

788
00:37:55,600 --> 00:37:57,880
Speaker 5: It's how I want kids to approach academics and social

789
00:37:57,920 --> 00:38:00,640
Speaker 5: appearances that are reverse and world in general.

790
00:38:00,760 --> 00:38:01,759
Speaker 4: So totally true.

791
00:38:01,800 --> 00:38:05,840
Speaker 1: That's perfect.

792
00:38:07,280 --> 00:38:09,960
Speaker 3: This lab has been such an eye opener for me

793
00:38:10,120 --> 00:38:13,440
Speaker 3: tt me too, Me too. We've talked about the importance

794
00:38:13,440 --> 00:38:16,720
Speaker 3: of food in society and culture, and we've even covered

795
00:38:16,719 --> 00:38:19,680
Speaker 3: food accessibility when it comes to like urban planning and

796
00:38:19,760 --> 00:38:23,319
Speaker 3: food deserts. However, I don't think we've stopped to really

797
00:38:23,360 --> 00:38:26,120
Speaker 3: address the lack of accessibility to so much of our

798
00:38:26,160 --> 00:38:28,400
Speaker 3: society through the lens of eating disorders.

799
00:38:28,440 --> 00:38:30,680
Speaker 1: Oh my gosh, it's such a good point, and it

800
00:38:30,800 --> 00:38:33,600
Speaker 1: really makes me look at all of our past episodes

801
00:38:33,600 --> 00:38:36,840
Speaker 1: a little bit differently. It's really difficult to navigate, and

802
00:38:36,880 --> 00:38:40,160
Speaker 1: we learn just a little bit about various factors that

803
00:38:40,320 --> 00:38:43,120
Speaker 1: are at play, and this is a reminder that we

804
00:38:43,160 --> 00:38:45,680
Speaker 1: could all be a kinder. We could be more empathetic,

805
00:38:45,800 --> 00:38:48,240
Speaker 1: Like when we notice little things, we can say, oh,

806
00:38:48,360 --> 00:38:51,000
Speaker 1: this person might be struggling. We can be more tolerant

807
00:38:51,360 --> 00:38:55,040
Speaker 1: and more understanding about what people might be going through.

808
00:38:55,239 --> 00:38:58,680
Speaker 1: It's such an important lesson to learn and something that

809
00:38:58,719 --> 00:39:02,200
Speaker 1: we need to really be conscious about in like actively

810
00:39:02,600 --> 00:39:05,680
Speaker 1: practicing in our day to day lives to just tell ourselves,

811
00:39:05,760 --> 00:39:07,840
Speaker 1: I don't know what this person is going through, I

812
00:39:07,880 --> 00:39:09,799
Speaker 1: don't know what they're thinking in their minds, I don't

813
00:39:09,800 --> 00:39:12,840
Speaker 1: know what's going on in their households, and taking that

814
00:39:13,000 --> 00:39:16,520
Speaker 1: into account into every interaction that we have. Yeah, And

815
00:39:16,560 --> 00:39:18,520
Speaker 1: I really feel like if you can't do that at

816
00:39:18,560 --> 00:39:21,640
Speaker 1: a minimum, practice mine of your business. And I think

817
00:39:21,640 --> 00:39:23,439
Speaker 1: that's the polite Southern way to say it, I would

818
00:39:23,480 --> 00:39:28,359
Speaker 1: say something else, Oh my goodness, bless her heart.

819
00:39:30,280 --> 00:39:32,600
Speaker 3: To learn more about therapy for pickie eating, or to

820
00:39:32,680 --> 00:39:37,320
Speaker 3: join a parenting group, it www dot Doctorjessica Bodi dot com.

821
00:39:37,520 --> 00:39:39,760
Speaker 3: You can find that link in our show description, along

822
00:39:39,760 --> 00:39:44,160
Speaker 3: with links to Arford, Hannah and Arfred Andrew accounts.

823
00:39:45,920 --> 00:39:48,799
Speaker 1: You can find us on X and Instagram at Dope

824
00:39:48,880 --> 00:39:50,680
Speaker 1: Labs podcast, tt.

825
00:39:50,719 --> 00:39:54,400
Speaker 2: Is on X and Instagram at dr Underscore t Sho.

826
00:39:54,239 --> 00:39:56,840
Speaker 1: And you can find Takiya at Z said So.

827
00:39:57,239 --> 00:39:59,480
Speaker 2: Dope Labs is a production of Lemonada Media.

828
00:39:59,719 --> 00:40:04,360
Speaker 1: O Senior supervising producer is Kristin Lapour and our associate

829
00:40:04,400 --> 00:40:06,520
Speaker 1: producer is Isara Savez.

830
00:40:07,200 --> 00:40:10,920
Speaker 3: Dope Labs is sound design edited and mixed by James Farber.

831
00:40:11,600 --> 00:40:15,800
Speaker 3: Leimonada Media's Vice President of Partnerships and Production is Jackie Danziger.

832
00:40:16,480 --> 00:40:20,600
Speaker 3: Executive producer from iHeart podcast is Katrina Norvil. Marketing lead

833
00:40:20,800 --> 00:40:21,680
Speaker 3: is Alison Kanter.

834
00:40:22,400 --> 00:40:26,640
Speaker 1: Original music composed and produced by Taka Yatsuzawa and Alex

835
00:40:26,719 --> 00:40:31,760
Speaker 1: suji Ura, with additional music by Elijah Harvey. Dope Labs

836
00:40:31,800 --> 00:40:35,200
Speaker 1: is executive produced by us T T show Dia and

837
00:40:35,480 --> 00:40:36,120
Speaker 1: Kiah Wattley