WEBVTT - ARFID is More than Picky Eating - Lab 108 0:00:00.760 --> 0:00:04.920 This episode includes discussion of eating disorders. We know these 0:00:04.960 --> 0:00:08.680 topics can be sensitive and even triggering. Please take care 0:00:08.720 --> 0:00:11.680 of yourself and feel free to pause or skip if 0:00:11.720 --> 0:00:14.079 you need to. If you or someone you love is 0:00:14.120 --> 0:00:17.400 struggling with an eating disorder, support is available in the 0:00:17.520 --> 0:00:20.640 US by calling or texting nine eight eight, or by 0:00:20.720 --> 0:00:26.800 visiting Nationaleatingdisorders dot org for resources. 0:00:28.080 --> 0:00:29.840 I'm TT and I'm Zachiah. 0:00:29.880 --> 0:00:37.040 And this is Dope Labs. Welcome to Dope Labs, a 0:00:37.040 --> 0:00:40.479 weekly podcast that mixes hardcore science with pop culture and 0:00:40.520 --> 0:00:47.920 a healthy dose of friendship. In today's lab, we're talking 0:00:48.000 --> 0:00:50.920 about something that hits close to home for many families, 0:00:51.360 --> 0:00:54.560 avoidant restrictive food intake disorder. 0:00:54.280 --> 0:00:55.960 Or our fit. That's right. 0:00:56.240 --> 0:00:58.440 For years, when we heard about someone who was a 0:00:58.480 --> 0:01:01.240 picky eater, it often felt like it was brushed off. 0:01:01.280 --> 0:01:04.120 It's just a phase or a personality quirk. But now 0:01:04.200 --> 0:01:07.400 there's growing awareness that for some this is a serious 0:01:07.440 --> 0:01:11.039 medical condition, and so ourfit is a relatively newer diagnosis, 0:01:11.080 --> 0:01:15.000 and it's important to understand that it differs significantly from 0:01:15.000 --> 0:01:15.959 typical picky eating. 0:01:16.160 --> 0:01:16.399 Right. 0:01:16.840 --> 0:01:20.360 URFID can have serious health and social impacts. We know 0:01:20.400 --> 0:01:23.559 that it often co occurs with other mental health conditions, 0:01:23.840 --> 0:01:26.679 and treatment for our FID is also much more intensive 0:01:26.760 --> 0:01:29.880 and requires a team approach, so a lot of folks 0:01:29.959 --> 0:01:32.760 to help you out, unlike just trying to encourage a 0:01:32.800 --> 0:01:34.560 child to eat their veggies. You know. 0:01:35.040 --> 0:01:36.160 Yeah, it's way more than that. 0:01:36.560 --> 0:01:39.200 And the conversation around our FID is gaining a lot 0:01:39.240 --> 0:01:42.600 more visibility, and part of that is thanks to personal 0:01:42.640 --> 0:01:45.840 stories that have been shared publicly, like that of reality 0:01:45.880 --> 0:01:50.440 TV star Emily Simpson discussing her son's diagnosis. But perhaps 0:01:50.840 --> 0:01:53.480 one of the most compelling and widely shared stories that 0:01:53.480 --> 0:01:57.480 has immerged on social media recently has been from Hannah 0:01:57.560 --> 0:01:59.320 bringing a new face to this disorder. 0:01:59.440 --> 0:02:03.880 Yes, I originally stumbled on Hannah's TikTok page and she's 0:02:03.920 --> 0:02:08.880 this really adorable little girl who was trying different foods. 0:02:08.919 --> 0:02:12.040 And it's not like, oh, I'm trying sushi or I'm 0:02:12.080 --> 0:02:15.480 trying snails for the first time. It was basic things 0:02:15.520 --> 0:02:18.640 like oh, I'm going to try watermelon or I'm going 0:02:18.680 --> 0:02:21.079 to try cheese. And it really was surprising to me 0:02:21.120 --> 0:02:24.080 because I'd never seen anything like this before. 0:02:24.320 --> 0:02:26.040 Yeah, you put Hannah on the map for me. 0:02:26.280 --> 0:02:29.000 You shared her profile on Instagram because you know, I 0:02:29.000 --> 0:02:32.120 don't have a TikTok, and she has an account and it's. 0:02:32.000 --> 0:02:33.359 Called my r fit Life. 0:02:34.040 --> 0:02:39.160 In each video, Hannah is bravely sampling a single food 0:02:39.760 --> 0:02:41.839 and rates it on a scale from one to ten. 0:02:42.320 --> 0:02:45.760 She always pushes herself to eat at least three bites 0:02:45.800 --> 0:02:48.440 before saying she doesn't want to eat something anymore. 0:02:49.000 --> 0:02:50.399 Sometimes there's tears. 0:02:51.000 --> 0:02:54.600 Sometimes she is really pleasantly surprised and is able to 0:02:54.600 --> 0:02:56.320 add foods to her safe list. 0:02:56.560 --> 0:02:59.760 And really her honesty and sharing this struck a nerve 0:02:59.760 --> 0:03:03.200 online and it was incredible for me to see, right, 0:03:03.240 --> 0:03:06.920 because I had no awareness of arfit, and within just 0:03:06.960 --> 0:03:09.399 six months her account exploded to like one point four 0:03:09.400 --> 0:03:13.720 million followers. Yes, and I think this is a beautiful 0:03:13.760 --> 0:03:18.160 example of science communication, right because we're seeing a personal story, yes, 0:03:18.320 --> 0:03:20.440 and we're seeing how on platforms like social media it 0:03:20.440 --> 0:03:23.919 can create a powerful wave of awareness and community for folks. 0:03:24.120 --> 0:03:26.440 Yes. So to help us dive deeper into the science 0:03:26.520 --> 0:03:29.880 and human experience of our fit, we're joined by doctor 0:03:30.000 --> 0:03:33.440 Jessica Body, who works at the Pearlman's School of Medicine 0:03:33.480 --> 0:03:42.400 at the University of Pennsylvania. I am always on TikTok 0:03:42.560 --> 0:03:47.560 or Instagram chronically, and there was a few videos that 0:03:47.600 --> 0:03:51.600 had popped up on my feeds with this young girl 0:03:51.720 --> 0:03:55.120 and she was talking about how she was going to 0:03:55.160 --> 0:03:59.000 be trying like cheese for the first time, or trying 0:03:59.080 --> 0:04:01.240 a pickle for the first time in her life, or 0:04:01.360 --> 0:04:03.240 trying wheat bread. 0:04:03.400 --> 0:04:05.880 And I was like, what's happening. I don't get it. 0:04:05.920 --> 0:04:08.320 And so I looked at the hashtags, and one of 0:04:08.320 --> 0:04:11.600 the hashtags was ARFED, and so I clicked on it, 0:04:11.640 --> 0:04:13.880 and then I was introduced to this whole world of 0:04:14.440 --> 0:04:19.080 folks that are struggling with this avoidant restrictive food intake disorder. 0:04:19.640 --> 0:04:22.839 And so it really just piqued my interest because it 0:04:22.880 --> 0:04:25.840 seems like it's mostly very, very small kids that are 0:04:25.880 --> 0:04:28.080 dealing with this, and so I thought it would be 0:04:28.160 --> 0:04:30.679 helpful kind of shine a light in this a little 0:04:30.680 --> 0:04:32.800 bit of a dark corner that people may not know exist, 0:04:32.839 --> 0:04:35.040 and if they do know it exists, to help them 0:04:35.200 --> 0:04:37.120 understand how this comes to be. 0:04:37.480 --> 0:04:39.679 Yep, great, really relevant question. 0:04:39.720 --> 0:04:41.960 I think if you pulled any parent at like a 0:04:42.000 --> 0:04:45.600 playground or a school, they would all spark a conversation 0:04:45.640 --> 0:04:49.200 about picky eating among their kids. Yeah, so it's like 0:04:49.360 --> 0:04:52.560 both common and then, Yet this arfied name sounds like 0:04:52.560 --> 0:04:55.320 a bug right, sounds like something. Where did this name 0:04:55.360 --> 0:04:58.280 come from? And it's relatively new, so it didn't get 0:04:58.320 --> 0:05:01.719 introduced in the Diagnostics Just manual until twenty thirteen, which 0:05:01.760 --> 0:05:04.480 is fairly new for an eating disorder, and it is 0:05:04.680 --> 0:05:08.279 housed in the same category as bolimia and anorexia. But 0:05:08.400 --> 0:05:12.120 for most folks with ARFID, it's an anxious experience to 0:05:12.160 --> 0:05:14.240 be presented with a new food. It's really tough to 0:05:14.240 --> 0:05:18.120 see her eating those foods, and she really looks anxious 0:05:18.160 --> 0:05:21.679 and uncomfortable, partially disgusted, a little bit gaggy at times, 0:05:21.720 --> 0:05:24.560 so quite brave that she's recording it, quite brave that 0:05:24.640 --> 0:05:27.279 she's doing that exposure work. And it really is the 0:05:27.320 --> 0:05:31.599 recommended treatment for our FID. So I think people wonder, 0:05:31.720 --> 0:05:35.240 is my kid just picky? Is my kid having this 0:05:35.600 --> 0:05:39.400 ARFID experience? Where is this diagnosis coming from? And I 0:05:39.400 --> 0:05:41.920 think it's so new even though it's been around for 0:05:41.960 --> 0:05:45.279 more than ten years, pediatricians are still getting new information 0:05:46.000 --> 0:05:49.279 about it and starting to recognize the severity of some 0:05:49.480 --> 0:05:50.760 kids with picky eating. 0:05:51.000 --> 0:05:53.120 So I think if it's sort of like picky eating. 0:05:52.960 --> 0:05:55.800 Like an umbrella term right, you could talk about all 0:05:55.800 --> 0:05:57.960 people with ARFIT or picky eaters, but not all picky 0:05:58.000 --> 0:06:01.640 eaters meet criteria for our FA. There's probably a spectrum there, 0:06:02.120 --> 0:06:04.600 just like with somebody who's afraid of flying on airplanes. Right, 0:06:04.600 --> 0:06:06.120 you could say, oh, I'm a terrible fly er, I 0:06:06.120 --> 0:06:07.840 hate to fly, but you get on airplanes and you 0:06:07.920 --> 0:06:09.560 kind of white knuckle through it all the way up 0:06:09.600 --> 0:06:11.480 to people who are crying and having panic attacks, or 0:06:11.520 --> 0:06:13.120 people who will say I won't even book a flight. 0:06:13.240 --> 0:06:14.280 Like same with picky eating. 0:06:14.279 --> 0:06:16.760 You could have kiddos who need a lot of nudging 0:06:16.800 --> 0:06:18.839 to eat their vegetables, like you got to finish that 0:06:18.960 --> 0:06:20.719 before we have dessert, or you need to eat your 0:06:20.720 --> 0:06:23.840 fruit before we go play. Kids who respond to that 0:06:23.880 --> 0:06:27.560 contingency might be mildly picky, but they can get some 0:06:27.720 --> 0:06:30.520 eating off the ground. Right. Parents are successfully getting those 0:06:30.520 --> 0:06:33.640 bites in. I think there's parents at the playground who 0:06:33.640 --> 0:06:36.080 are getting advice from other picky parents and they're like, oh, 0:06:36.120 --> 0:06:36.640 you know, just. 0:06:36.600 --> 0:06:37.680 Set out a veggie tray. 0:06:37.800 --> 0:06:40.560 They'll graze on it, they'll eat what they want, just 0:06:40.640 --> 0:06:43.159 keep offering it. And the parents of the kids with 0:06:43.279 --> 0:06:45.880 ARFID are thinking to them like, that's pie in the sky. 0:06:45.920 --> 0:06:48.080 There's no way my kid's going anywhere near that cucumber. 0:06:48.400 --> 0:06:51.279 It's not going to happen, And so I think there's 0:06:51.279 --> 0:06:53.720 this level of frustration. And even when they take these 0:06:53.800 --> 0:06:55.719 kids to the pediatrician and they say they're really picky, 0:06:56.240 --> 0:06:59.000 sometimes the pediatrician is looking at their weight saying their 0:06:59.000 --> 0:07:02.120 BMIs pretty typical, or they've stayed on their trajectory the 0:07:02.160 --> 0:07:04.120 whole time, and they're not expressing a lot of concern, 0:07:04.160 --> 0:07:06.560 which makes parents sort of walk away saying, either it's 0:07:06.600 --> 0:07:09.479 not that big of a deal, or I'm sensing something 0:07:09.520 --> 0:07:11.800 that's not quite right. They're not eating things from food groups. 0:07:11.840 --> 0:07:14.640 They're really struggling. Every night's of battle to try to 0:07:14.680 --> 0:07:16.080 get them to eat the foods that the rest of 0:07:16.160 --> 0:07:18.640 the family is eating, and they feel really invalidated. So 0:07:18.800 --> 0:07:21.200 the diagnosis is great that it's now in there, and 0:07:21.240 --> 0:07:25.000 we're starting to see more clinicians and pediatricians starting to 0:07:25.120 --> 0:07:29.480 represent that diagnosis in the eating disorder space, but treatment 0:07:29.520 --> 0:07:32.240 is sort of still like trickling through, and we're trying 0:07:32.280 --> 0:07:34.800 to get more and more families aware of what the 0:07:34.800 --> 0:07:37.840 treatment options are, which is exactly what Hannah Arfit and 0:07:37.920 --> 0:07:39.920 Handle is trying to do she's trying to show how 0:07:39.920 --> 0:07:41.360 she's doing exposure therapy. 0:07:42.200 --> 0:07:42.560 Wow. 0:07:42.640 --> 0:07:44.960 You know when you think about ten years, you could 0:07:44.960 --> 0:07:47.239 think like, oh, well that's a long time everybody should 0:07:47.240 --> 0:07:47.960 have a handle on this. 0:07:48.120 --> 0:07:48.640 But I think you. 0:07:48.680 --> 0:07:51.480 Raised such a great point about how things may present 0:07:51.880 --> 0:07:56.160 across different cases. That makes maybe progress and being able 0:07:56.160 --> 0:07:59.160 to quickly recognize things that could make it difficult. At 0:07:59.200 --> 0:08:02.920 what point does picky eating cross the line into our 0:08:02.960 --> 0:08:07.400 fit territory? So, even if you're a pediatrician is not informed, 0:08:07.800 --> 0:08:10.640 are there specific red flags that parents or even if 0:08:10.640 --> 0:08:13.400 they're pediatricians listening to this, that they should be looking 0:08:13.480 --> 0:08:16.040 for to inform their diagnosing. 0:08:16.560 --> 0:08:17.280 Yeah, definitely. 0:08:17.440 --> 0:08:20.240 Some of the main red flags that easily get you 0:08:20.400 --> 0:08:23.280 the ur FO diagnosis, or that you're so limited in 0:08:23.320 --> 0:08:25.400 what you eat or so avoidant or so restrictive in 0:08:25.440 --> 0:08:28.120 what you eat that you have a weight loss or 0:08:28.400 --> 0:08:31.320 a growth deficiency. So pediatricians can see this really easily 0:08:31.360 --> 0:08:33.240 on the growth charts. They can say, well, she was 0:08:33.280 --> 0:08:35.920 at twenty fifth percentile when she was like an infinittaller. 0:08:36.040 --> 0:08:38.360 Now she's sort of fallen off the growth curve. 0:08:38.720 --> 0:08:41.079 So things like failure to thrive or failure to meet 0:08:41.120 --> 0:08:44.640 those needs in gain and growth could be a huge flag. 0:08:44.720 --> 0:08:47.000 However, when we did our research, a. 0:08:46.960 --> 0:08:49.560 Colleague of mine, Catherine Dollsguard, who big shout out for 0:08:49.600 --> 0:08:51.959 doing the Picky Eating program at the Children's Hospital of 0:08:51.960 --> 0:08:54.920 Philadelphia for many years. When we looked at the data 0:08:55.000 --> 0:08:58.040 on the picky eating group, the BMI was actually quite high, 0:08:58.120 --> 0:08:59.920 and I kept asking, like, is that right we should 0:09:00.200 --> 0:09:00.640 this number? 0:09:01.120 --> 0:09:01.679 Is that the right? 0:09:02.320 --> 0:09:03.920 What happens with kids with pig eating is that they 0:09:04.000 --> 0:09:06.760 end up having a bimodal distribution, meaning that there's kids 0:09:06.800 --> 0:09:09.680 that are actually low weight underweight, but there's also kids 0:09:09.679 --> 0:09:11.880 that are in the overweight obese category because they're eating 0:09:11.920 --> 0:09:15.800 breakfast foods and pastas and goldfish crackers and snacking all day, right, 0:09:15.800 --> 0:09:18.680 because that's the limited food set that they're able to eat. 0:09:19.040 --> 0:09:21.880 So just weight alone isn't enough to sort of look 0:09:21.920 --> 0:09:25.160 at whether a kid is picky or significantly picky. So 0:09:25.480 --> 0:09:28.320 things like nutritional deficiencies can be assessed for and we 0:09:28.360 --> 0:09:31.559 ask pediatricians to sort of run some panels on kiddos 0:09:31.559 --> 0:09:33.720 that we're about to start an outpatient therapy to make 0:09:33.800 --> 0:09:35.960 sure they're not missing anything, because you could have a 0:09:36.000 --> 0:09:39.920 carb loving kiddo who's like at risk for rickets and scurvy. Right, 0:09:39.920 --> 0:09:42.920 they're not getting enough ingredients, and so we like to 0:09:42.920 --> 0:09:44.800 see kids with a protein that they're able to eat, 0:09:44.800 --> 0:09:46.880 an animal food of some type, and some sort of 0:09:46.920 --> 0:09:49.120 fortified carb. Then we feel a little bit better that 0:09:49.160 --> 0:09:52.760 they're not as much risk for nutritional deficiencies. But even 0:09:52.840 --> 0:09:55.640 like that weight is not necessarily the red flag. We 0:09:55.720 --> 0:09:57.319 might need to get them in and get some blood 0:09:57.320 --> 0:09:59.320 work done or some testing if a parent is concerned 0:09:59.320 --> 0:10:02.560 they're not getting enough of various food groups. The nice 0:10:02.600 --> 0:10:04.920 thing about the ARPHID criteria that was written in by 0:10:04.920 --> 0:10:08.800 the people who developed the diagnostic criteria is that you 0:10:08.840 --> 0:10:12.680 can meet criteria for ARFID just on interference with what 0:10:12.720 --> 0:10:15.400 they call psychosocial functioning, meaning like, is it a pain 0:10:15.480 --> 0:10:17.920 to feed this kiddo? Is it hard to take them 0:10:18.080 --> 0:10:19.720 lunch to school? Is it hard for them to eat 0:10:19.720 --> 0:10:21.640 at restaurants? Is it hard to travel? 0:10:21.640 --> 0:10:22.319 Because we have to. 0:10:22.320 --> 0:10:24.760 Track the restaurants that have the foods that they'll eat. 0:10:25.000 --> 0:10:27.400 But parents will know, am I making separate meals for 0:10:27.440 --> 0:10:30.400 this kiddo? Am I bending over backwards to pick off 0:10:30.400 --> 0:10:33.600 specs and retoast the toast that got to burn, right, Like, 0:10:33.640 --> 0:10:36.200 it's difficult for a parent and they know that it is, 0:10:36.280 --> 0:10:38.679 so it honors that difficulty. 0:10:38.200 --> 0:10:40.079 In having that added to the criteria. 0:10:40.280 --> 0:10:42.160 I think if you have a kiddo you're really struggling 0:10:42.200 --> 0:10:45.320 to get them to eat across food groups or expand 0:10:45.400 --> 0:10:48.520 their diet or eat what your other typical eating kiddo 0:10:48.600 --> 0:10:52.160 will eat, then you can actually meet criteria just based 0:10:52.200 --> 0:10:53.360 on that interference alone. 0:10:54.640 --> 0:10:55.000 Wow. 0:10:55.240 --> 0:10:56.920 I mean, I think that that's really great to have 0:10:57.000 --> 0:10:59.520 that type of nuance when we're talking about something like this, 0:10:59.559 --> 0:11:02.080 which is a very sensitive topic for a lot of people. 0:11:02.679 --> 0:11:07.240 You talk a little bit about how URFID a new 0:11:08.000 --> 0:11:10.800 diagnosis within the last you know, ten years, you said 0:11:10.840 --> 0:11:13.560 that it came to be. Can you talk about in 0:11:13.600 --> 0:11:16.960 the world of eating disorders, can you explain why OURFID 0:11:17.000 --> 0:11:20.280 was recognized as a distinct condition and what makes it 0:11:20.400 --> 0:11:25.040 different from older well known eating disorders like anorexia or bolimia. 0:11:25.600 --> 0:11:28.000 Great question, And when we have a person in our 0:11:28.000 --> 0:11:31.400 office that we're assessing for URFID, we ask questions that 0:11:31.520 --> 0:11:34.000 to rule out those other conditions, because it's really important 0:11:34.000 --> 0:11:36.319 to make sure that we are identifying what we think 0:11:36.320 --> 0:11:38.680 we're identifying the treatment's going to differ based on whether 0:11:38.720 --> 0:11:42.160 someone meets criteria for URFID or anorexia, So super important 0:11:42.160 --> 0:11:44.880 to get that nuance right. And I should mention we 0:11:44.960 --> 0:11:47.240 talked about URFID presenting in kids. We see the teens 0:11:47.280 --> 0:11:50.520 and adults as well. There's an arfid Andrew as well 0:11:51.000 --> 0:11:53.400 all over Instagram doing the adult version. 0:11:53.200 --> 0:11:54.120 Of these exposures. 0:11:54.240 --> 0:11:56.079 And if we had someone like him in our office 0:11:56.080 --> 0:11:59.880 and we're asking questions like what's behind the food avoid 0:12:00.200 --> 0:12:01.040 or the food aversion. 0:12:01.320 --> 0:12:03.559 If it's not because of shape or weight like. 0:12:03.520 --> 0:12:06.439 We would expect to see in anorexia, we're more confident 0:12:06.520 --> 0:12:09.600 that it's more about the aversion to the food itself. 0:12:10.240 --> 0:12:13.240 Within our FID, we think that there's probably subtypes of 0:12:13.400 --> 0:12:16.400 folks with our FID. So just like we would ask 0:12:16.559 --> 0:12:19.880 questions about binge eating or bingeting history, weight and shape 0:12:19.880 --> 0:12:22.800 concerns in anorexia, we can ask some specific questions to 0:12:22.840 --> 0:12:25.440 see even what subtype of our FOD someone might have. 0:12:25.840 --> 0:12:28.120 So we see a subset of kids, teens and adults 0:12:28.160 --> 0:12:30.959 who just historically have had a lack of interest in eating. 0:12:31.040 --> 0:12:33.960 They're like the opposite of a foodie. So and it's 0:12:34.000 --> 0:12:35.600 a shame when you have a foody in a household. 0:12:35.640 --> 0:12:37.800 They don't always understand what it's like to have these 0:12:37.920 --> 0:12:41.400 like low appetite food apathy kinds of people, because they're like, 0:12:41.400 --> 0:12:43.320 what do you mean you don't appreciate a good stake, 0:12:43.559 --> 0:12:46.480 and like they just don't get it. But these books 0:12:46.559 --> 0:12:48.720 sometimes they have a history of just never really having 0:12:48.720 --> 0:12:52.360 a strong hunger Q, never having a strong interest in 0:12:52.400 --> 0:12:54.199 the varieties and flavors of food. 0:12:54.240 --> 0:12:55.400 It just falls flat. 0:12:55.679 --> 0:12:58.800 Sometimes it can come from a history of having discomfort 0:12:58.800 --> 0:13:02.240 when eating. We see kids with like chronic history of constipation, 0:13:02.800 --> 0:13:04.440 or folks that have had a lot of GI ups 0:13:04.440 --> 0:13:08.120 and downs or IBD where eating actually has a history 0:13:08.120 --> 0:13:10.880 of causing them some discomfort and pain, and that sort 0:13:10.880 --> 0:13:14.440 of association over time creates this learned fear of eating 0:13:14.880 --> 0:13:17.800 or disinterest in eating, because it just never feels the 0:13:17.880 --> 0:13:21.079 typical experience of somebody who's eating feels you feel hungry, 0:13:21.320 --> 0:13:23.920 you grab something to eat, you feel the food is 0:13:23.960 --> 0:13:28.080 delicious and rewarding, and it reinforces that I should do 0:13:28.120 --> 0:13:30.240 that again when I get a hunger Q. For folks 0:13:30.280 --> 0:13:33.640 with ourfait, they might not necessarily get that strong sensation 0:13:33.760 --> 0:13:36.120 of hunger and the reward from eating. 0:13:35.920 --> 0:13:38.120 So they're sort of tapped out of that entire system. 0:13:38.440 --> 0:13:40.559 And when you add that fear layer on top of it, 0:13:40.679 --> 0:13:42.880 if their history, say you were lactose intolerant, but you 0:13:43.120 --> 0:13:45.920 wasn't recognized for a long time. Anytime you look at milk, 0:13:45.960 --> 0:13:47.559 it might sort of have this like, oh, yeah, I 0:13:47.600 --> 0:13:48.559 didn't feel great. 0:13:48.400 --> 0:13:49.000 The last time. 0:13:49.120 --> 0:13:52.199 Might have that milkshake, so it's not feeling as interesting 0:13:52.240 --> 0:13:54.760 to me. So there's that category of folks with arfod. 0:13:54.840 --> 0:13:58.080 Then you get folks who are really sensory bothered by food, 0:13:58.200 --> 0:14:01.920 so things like mushi textures, soft textures. If you think 0:14:01.960 --> 0:14:03.400 of like a bowl of blueberries and a bowl of 0:14:03.400 --> 0:14:04.400 goldfish crackers. 0:14:04.880 --> 0:14:06.360 Every goldfish cracker is. 0:14:06.400 --> 0:14:11.080 Very predictable in applewl, a bowl of blueberries super unpredictable, like. 0:14:13.320 --> 0:14:14.720 The squashy mushy one. 0:14:14.600 --> 0:14:16.800 The really our one, the really tart one, the release 0:14:17.200 --> 0:14:19.880 like it's a mixed bag. So in terms of it 0:14:20.080 --> 0:14:22.000 coming from this place of anxiety, I'm going to get 0:14:22.000 --> 0:14:25.520 a lot less of anxiety eating that predictable, crunchy, sort 0:14:25.520 --> 0:14:29.720 of smooth carb versus this really unpredictable set of experiences 0:14:29.760 --> 0:14:33.960 with typically fruits, vegetables, and meats. So those sensory kiddos, 0:14:34.280 --> 0:14:36.480 I think they're really sensitive. So those types of things, 0:14:36.520 --> 0:14:38.720 we hear stories all the time, like a chicken nugget 0:14:38.720 --> 0:14:41.920 manufacturer changed their recipe and now my kiddo won't eat 0:14:41.960 --> 0:14:44.880 it anymore. Or we change toasters and now we keep 0:14:44.920 --> 0:14:47.920 burning these slight specks. 0:14:47.520 --> 0:14:48.600 On the pizza. 0:14:48.680 --> 0:14:50.680 Now my kid won't eat it anymore. So they're super 0:14:50.720 --> 0:14:54.480 sensory sensitive and they're really in tune with that. And 0:14:54.480 --> 0:14:56.320 then the last type of folks with our fad that 0:14:56.320 --> 0:14:58.720 we will ask more about when we have these folks 0:14:58.760 --> 0:15:02.600 in our offices are people with folks that have a 0:15:02.640 --> 0:15:06.000 fear of choking or vomiting or gagging on the food. 0:15:06.080 --> 0:15:08.040 So the way I like to think about this is if. 0:15:07.920 --> 0:15:10.360 We were in Thailand together and we were walking around 0:15:10.880 --> 0:15:14.960 open air market and there's skewers of crickets and scorpions 0:15:15.080 --> 0:15:18.880 and meal worm burgers, and a guide says these are great, 0:15:18.960 --> 0:15:21.040 like this is a delicacy here, you gotta try it. 0:15:21.280 --> 0:15:22.720 I don't know about you, guy, but if you were 0:15:22.760 --> 0:15:26.360 offered a skewer of crickets, your reaction might not be 0:15:26.440 --> 0:15:28.640 as positive, even if the person is saying they're great. 0:15:28.680 --> 0:15:32.440 They're delicious, everyone loves them. Our reactions might be I 0:15:32.440 --> 0:15:35.040 don't know if that texture will go down well. I 0:15:35.080 --> 0:15:37.080 don't know if I would vomit or gag. I don't 0:15:37.080 --> 0:15:38.880 know what that would do to my GI system. We 0:15:38.920 --> 0:15:40.960 would have the same sort of reaction that a picky 0:15:41.000 --> 0:15:44.120 eater would have to like a slice of pizza. 0:15:44.200 --> 0:15:45.760 So you get that category too. 0:15:45.760 --> 0:15:48.080 So when people are coming into offices, we're asking do 0:15:48.160 --> 0:15:52.160 you have any of these other subtypes and can we 0:15:52.240 --> 0:16:25.080 rule out some of those other bigeating disorder or anrexia. 0:16:10.720 --> 0:16:13.160 Tit and I just talked about this. I ate something recently. 0:16:13.200 --> 0:16:15.760 It did not treat me well, and we were texting 0:16:15.800 --> 0:16:20.200 each other and she says, I hate when food betrays me. 0:16:20.840 --> 0:16:21.800 That's what she wrote to me. 0:16:22.320 --> 0:16:25.280 And I can't imagine what it must feel like to 0:16:25.360 --> 0:16:28.160 have all of these things betray you. I think about 0:16:28.520 --> 0:16:31.160 how much of our day to day life. I'm just 0:16:31.160 --> 0:16:34.000 thinking about if I were scrolling on Instagram or what 0:16:34.200 --> 0:16:37.680 as I see on television. Food is everywhere. I'm curious 0:16:37.680 --> 0:16:42.760 about some of the psychosocial impacts. How does arfit affect 0:16:43.040 --> 0:16:46.080 someone's social life or friendships. And we've talked a little 0:16:46.080 --> 0:16:49.040 bit about family dynamics. But I'm particularly interested for teens 0:16:49.040 --> 0:16:51.800 and adults. You know, as food is such a central 0:16:51.880 --> 0:16:55.640 social nexus for all of us, what does that look like. 0:16:56.160 --> 0:16:59.840 Yeah, the amount of shame and anxiety that people with 0:17:00.040 --> 0:17:04.040 our fit experience in those spaces is really strong, and 0:17:04.119 --> 0:17:07.040 I think for some people it leads. There's this misnomer 0:17:07.200 --> 0:17:10.600 in picky eating that kids will grow out of it, right, 0:17:10.640 --> 0:17:12.280 And I think it comes from the fact that a 0:17:12.280 --> 0:17:15.280 lot of kids do so some of those like nudge 0:17:15.320 --> 0:17:18.480 to eat your vegetable. Folks with mild picky eating do 0:17:18.680 --> 0:17:21.439 grow out of some of those rigidities. And when the 0:17:21.480 --> 0:17:25.320 folks that are sort of getting passed in the toddler years, 0:17:25.720 --> 0:17:28.600 elementary school years, middle school years and they haven't expanded 0:17:28.600 --> 0:17:31.120 their diet, I've had teens say I'm so embarrassed by 0:17:31.160 --> 0:17:34.160 my toddler lunch. Right, I have an apple sauce pouch 0:17:34.160 --> 0:17:36.560 and a peanut butter sandwich and I've been doing this 0:17:36.640 --> 0:17:39.320 since I was five. They're embarrassed. And now I have 0:17:39.440 --> 0:17:41.399 some adults on my caseload. They talk about going to 0:17:41.440 --> 0:17:44.840 restaurants and having panic attacks. Someone had I think onion 0:17:44.880 --> 0:17:46.920 put on her salad and she went to the bathroom 0:17:46.960 --> 0:17:49.080 and cried full panic attack. 0:17:48.800 --> 0:17:51.200 And cried, and she's feeling like I know this. 0:17:51.320 --> 0:17:54.000 Cognitively, I know this shouldn't be such a big deal, 0:17:54.359 --> 0:17:56.520 but physically it's like the cricket on the plate. It's 0:17:56.560 --> 0:18:00.679 like it's such an anxiety response and so embarrassing to 0:18:00.680 --> 0:18:02.960 feel that way and to have to then advocate for 0:18:03.520 --> 0:18:06.320 kind of clos have the salad remade without onions, or 0:18:06.359 --> 0:18:09.120 to be facing the consequence of eating something aversive in public, 0:18:09.160 --> 0:18:10.800 which is the other part of that fear. I think 0:18:10.840 --> 0:18:13.639 people worry about social judgment for making faces or for 0:18:13.720 --> 0:18:14.960 struggling to eat something. 0:18:15.200 --> 0:18:18.080 What if I gag or choke in front of somebody as. 0:18:17.880 --> 0:18:19.919 I'm trying to get down a new food, because imagine, 0:18:19.920 --> 0:18:21.840 like it one thing to eat crickets with your friends, 0:18:21.880 --> 0:18:23.760 it would be another to like be in a job 0:18:23.800 --> 0:18:27.520 interview and be expected to sort of keep this food down. 0:18:27.560 --> 0:18:30.200 So the amount of anxiety that people are experiencing is 0:18:30.280 --> 0:18:33.080 quite high, the good news being that it does respond 0:18:33.160 --> 0:18:36.680 well to graduated treatment. So I think for some folks 0:18:36.680 --> 0:18:39.560 who are motivated enough, that's where that's where some of 0:18:39.600 --> 0:18:44.359 that interference can be turned into a motivator, because it 0:18:44.400 --> 0:18:47.080 can be the thing that makes me try to Okay, fine, fine, 0:18:47.119 --> 0:18:50.600 I'll try to down the crickets, which for them could 0:18:50.640 --> 0:18:52.520 be like I'll try to eat a salad in front 0:18:52.600 --> 0:18:55.240 of my work colleagues, because that's always offered at the 0:18:55.240 --> 0:18:58.680 beginning of a business meal, you know. And so with 0:18:58.720 --> 0:19:01.840 some graduated practice, people can do well looking at least 0:19:01.880 --> 0:19:04.399 more tolerant of those foods. So our motto is that 0:19:04.440 --> 0:19:06.480 you get more comfortable being uncomfortable. 0:19:06.760 --> 0:19:09.080 And you can even see it in Hannah Arfid's video. 0:19:09.160 --> 0:19:11.800 She showed one recently of like she's eating honeydew melon 0:19:12.160 --> 0:19:14.439 for the very first time. She's almost in tears. She's like, 0:19:14.440 --> 0:19:17.080 this is awful. It tastes like cucumber. It's really disgusting. 0:19:17.200 --> 0:19:19.439 They show her a year later she hasn't even tried 0:19:19.480 --> 0:19:23.200