Speaker 1: This episode includes discussion of eating disorders. We know these
Speaker 1: topics can be sensitive and even triggering. Please take care
Speaker 1: of yourself and feel free to pause or skip if
Speaker 1: you need to. If you or someone you love is
Speaker 1: struggling with an eating disorder, support is available in the
Speaker 1: US by calling or texting nine eight eight, or by
Speaker 1: visiting Nationaleatingdisorders dot org for resources.
Speaker 2: I'm TT and I'm Zachiah.
Speaker 1: And this is Dope Labs. Welcome to Dope Labs, a
Speaker 1: weekly podcast that mixes hardcore science with pop culture and
Speaker 1: a healthy dose of friendship. In today's lab, we're talking
Speaker 1: about something that hits close to home for many families,
Speaker 1: avoidant restrictive food intake disorder.
Speaker 2: Or our fit. That's right.
Speaker 3: For years, when we heard about someone who was a
Speaker 3: picky eater, it often felt like it was brushed off.
Speaker 3: It's just a phase or a personality quirk. But now
Speaker 3: there's growing awareness that for some this is a serious
Speaker 3: medical condition, and so ourfit is a relatively newer diagnosis,
Speaker 3: and it's important to understand that it differs significantly from
Speaker 3: typical picky eating.
Speaker 2: Right.
Speaker 1: URFID can have serious health and social impacts. We know
Speaker 1: that it often co occurs with other mental health conditions,
Speaker 1: and treatment for our FID is also much more intensive
Speaker 1: and requires a team approach, so a lot of folks
Speaker 1: to help you out, unlike just trying to encourage a
Speaker 1: child to eat their veggies. You know.
Speaker 2: Yeah, it's way more than that.
Speaker 3: And the conversation around our FID is gaining a lot
Speaker 3: more visibility, and part of that is thanks to personal
Speaker 3: stories that have been shared publicly, like that of reality
Speaker 3: TV star Emily Simpson discussing her son's diagnosis. But perhaps
Speaker 3: one of the most compelling and widely shared stories that
Speaker 3: has immerged on social media recently has been from Hannah
Speaker 3: bringing a new face to this disorder.
Speaker 1: Yes, I originally stumbled on Hannah's TikTok page and she's
Speaker 1: this really adorable little girl who was trying different foods.
Speaker 1: And it's not like, oh, I'm trying sushi or I'm
Speaker 1: trying snails for the first time. It was basic things
Speaker 1: like oh, I'm going to try watermelon or I'm going
Speaker 1: to try cheese. And it really was surprising to me
Speaker 1: because I'd never seen anything like this before.
Speaker 2: Yeah, you put Hannah on the map for me.
Speaker 3: You shared her profile on Instagram because you know, I
Speaker 3: don't have a TikTok, and she has an account and it's.
Speaker 2: Called my r fit Life.
Speaker 1: In each video, Hannah is bravely sampling a single food
Speaker 1: and rates it on a scale from one to ten.
Speaker 1: She always pushes herself to eat at least three bites
Speaker 1: before saying she doesn't want to eat something anymore.
Speaker 2: Sometimes there's tears.
Speaker 1: Sometimes she is really pleasantly surprised and is able to
Speaker 1: add foods to her safe list.
Speaker 3: And really her honesty and sharing this struck a nerve
Speaker 3: online and it was incredible for me to see, right,
Speaker 3: because I had no awareness of arfit, and within just
Speaker 3: six months her account exploded to like one point four
Speaker 3: million followers. Yes, and I think this is a beautiful
Speaker 3: example of science communication, right because we're seeing a personal story, yes,
Speaker 3: and we're seeing how on platforms like social media it
Speaker 3: can create a powerful wave of awareness and community for folks.
Speaker 1: Yes. So to help us dive deeper into the science
Speaker 1: and human experience of our fit, we're joined by doctor
Speaker 1: Jessica Body, who works at the Pearlman's School of Medicine
Speaker 1: at the University of Pennsylvania. I am always on TikTok
Speaker 1: or Instagram chronically, and there was a few videos that
Speaker 1: had popped up on my feeds with this young girl
Speaker 1: and she was talking about how she was going to
Speaker 1: be trying like cheese for the first time, or trying
Speaker 1: a pickle for the first time in her life, or
Speaker 1: trying wheat bread.
Speaker 2: And I was like, what's happening. I don't get it.
Speaker 1: And so I looked at the hashtags, and one of
Speaker 1: the hashtags was ARFED, and so I clicked on it,
Speaker 1: and then I was introduced to this whole world of
Speaker 1: folks that are struggling with this avoidant restrictive food intake disorder.
Speaker 1: And so it really just piqued my interest because it
Speaker 1: seems like it's mostly very, very small kids that are
Speaker 1: dealing with this, and so I thought it would be
Speaker 1: helpful kind of shine a light in this a little
Speaker 1: bit of a dark corner that people may not know exist,
Speaker 1: and if they do know it exists, to help them
Speaker 1: understand how this comes to be.
Speaker 4: Yep, great, really relevant question.
Speaker 5: I think if you pulled any parent at like a
Speaker 5: playground or a school, they would all spark a conversation
Speaker 5: about picky eating among their kids. Yeah, so it's like
Speaker 5: both common and then, Yet this arfied name sounds like
Speaker 5: a bug right, sounds like something. Where did this name
Speaker 5: come from? And it's relatively new, so it didn't get
Speaker 5: introduced in the Diagnostics Just manual until twenty thirteen, which
Speaker 5: is fairly new for an eating disorder, and it is
Speaker 5: housed in the same category as bolimia and anorexia. But
Speaker 5: for most folks with ARFID, it's an anxious experience to
Speaker 5: be presented with a new food. It's really tough to
Speaker 5: see her eating those foods, and she really looks anxious
Speaker 5: and uncomfortable, partially disgusted, a little bit gaggy at times,
Speaker 5: so quite brave that she's recording it, quite brave that
Speaker 5: she's doing that exposure work. And it really is the
Speaker 5: recommended treatment for our FID. So I think people wonder,
Speaker 5: is my kid just picky? Is my kid having this
Speaker 5: ARFID experience? Where is this diagnosis coming from? And I
Speaker 5: think it's so new even though it's been around for
Speaker 5: more than ten years, pediatricians are still getting new information
Speaker 5: about it and starting to recognize the severity of some
Speaker 5: kids with picky eating.
Speaker 4: So I think if it's sort of like picky eating.
Speaker 5: Like an umbrella term right, you could talk about all
Speaker 5: people with ARFIT or picky eaters, but not all picky
Speaker 5: eaters meet criteria for our FA. There's probably a spectrum there,
Speaker 5: just like with somebody who's afraid of flying on airplanes. Right,
Speaker 5: you could say, oh, I'm a terrible fly er, I
Speaker 5: hate to fly, but you get on airplanes and you
Speaker 5: kind of white knuckle through it all the way up
Speaker 5: to people who are crying and having panic attacks, or
Speaker 5: people who will say I won't even book a flight.
Speaker 4: Like same with picky eating.
Speaker 5: You could have kiddos who need a lot of nudging
Speaker 5: to eat their vegetables, like you got to finish that
Speaker 5: before we have dessert, or you need to eat your
Speaker 5: fruit before we go play. Kids who respond to that
Speaker 5: contingency might be mildly picky, but they can get some
Speaker 5: eating off the ground. Right. Parents are successfully getting those
Speaker 5: bites in. I think there's parents at the playground who
Speaker 5: are getting advice from other picky parents and they're like, oh,
Speaker 5: you know, just.
Speaker 4: Set out a veggie tray.
Speaker 5: They'll graze on it, they'll eat what they want, just
Speaker 5: keep offering it. And the parents of the kids with
Speaker 5: ARFID are thinking to them like, that's pie in the sky.
Speaker 5: There's no way my kid's going anywhere near that cucumber.
Speaker 5: It's not going to happen, And so I think there's
Speaker 5: this level of frustration. And even when they take these
Speaker 5: kids to the pediatrician and they say they're really picky,
Speaker 5: sometimes the pediatrician is looking at their weight saying their
Speaker 5: BMIs pretty typical, or they've stayed on their trajectory the
Speaker 5: whole time, and they're not expressing a lot of concern,
Speaker 5: which makes parents sort of walk away saying, either it's
Speaker 5: not that big of a deal, or I'm sensing something
Speaker 5: that's not quite right. They're not eating things from food groups.
Speaker 5: They're really struggling. Every night's of battle to try to
Speaker 5: get them to eat the foods that the rest of
Speaker 5: the family is eating, and they feel really invalidated. So
Speaker 5: the diagnosis is great that it's now in there, and
Speaker 5: we're starting to see more clinicians and pediatricians starting to
Speaker 5: represent that diagnosis in the eating disorder space, but treatment
Speaker 5: is sort of still like trickling through, and we're trying
Speaker 5: to get more and more families aware of what the
Speaker 5: treatment options are, which is exactly what Hannah Arfit and
Speaker 5: Handle is trying to do she's trying to show how
Speaker 5: she's doing exposure therapy.
Speaker 2: Wow.
Speaker 3: You know when you think about ten years, you could
Speaker 3: think like, oh, well that's a long time everybody should
Speaker 3: have a handle on this.
Speaker 2: But I think you.
Speaker 3: Raised such a great point about how things may present
Speaker 3: across different cases. That makes maybe progress and being able
Speaker 3: to quickly recognize things that could make it difficult. At
Speaker 3: what point does picky eating cross the line into our
Speaker 3: fit territory? So, even if you're a pediatrician is not informed,
Speaker 3: are there specific red flags that parents or even if
Speaker 3: they're pediatricians listening to this, that they should be looking
Speaker 3: for to inform their diagnosing.
Speaker 4: Yeah, definitely.
Speaker 5: Some of the main red flags that easily get you
Speaker 5: the ur FO diagnosis, or that you're so limited in
Speaker 5: what you eat or so avoidant or so restrictive in
Speaker 5: what you eat that you have a weight loss or
Speaker 5: a growth deficiency. So pediatricians can see this really easily
Speaker 5: on the growth charts. They can say, well, she was
Speaker 5: at twenty fifth percentile when she was like an infinittaller.
Speaker 4: Now she's sort of fallen off the growth curve.
Speaker 5: So things like failure to thrive or failure to meet
Speaker 5: those needs in gain and growth could be a huge flag.
Speaker 4: However, when we did our research, a.
Speaker 5: Colleague of mine, Catherine Dollsguard, who big shout out for
Speaker 5: doing the Picky Eating program at the Children's Hospital of
Speaker 5: Philadelphia for many years. When we looked at the data
Speaker 5: on the picky eating group, the BMI was actually quite high,
Speaker 5: and I kept asking, like, is that right we should
Speaker 5: this number?
Speaker 4: Is that the right?
Speaker 5: What happens with kids with pig eating is that they
Speaker 5: end up having a bimodal distribution, meaning that there's kids
Speaker 5: that are actually low weight underweight, but there's also kids
Speaker 5: that are in the overweight obese category because they're eating
Speaker 5: breakfast foods and pastas and goldfish crackers and snacking all day, right,
Speaker 5: because that's the limited food set that they're able to eat.
Speaker 5: So just weight alone isn't enough to sort of look
Speaker 5: at whether a kid is picky or significantly picky. So
Speaker 5: things like nutritional deficiencies can be assessed for and we
Speaker 5: ask pediatricians to sort of run some panels on kiddos
Speaker 5: that we're about to start an outpatient therapy to make
Speaker 5: sure they're not missing anything, because you could have a
Speaker 5: carb loving kiddo who's like at risk for rickets and scurvy. Right,
Speaker 5: they're not getting enough ingredients, and so we like to
Speaker 5: see kids with a protein that they're able to eat,
Speaker 5: an animal food of some type, and some sort of
Speaker 5: fortified carb. Then we feel a little bit better that
Speaker 5: they're not as much risk for nutritional deficiencies. But even
Speaker 5: like that weight is not necessarily the red flag. We
Speaker 5: might need to get them in and get some blood
Speaker 5: work done or some testing if a parent is concerned
Speaker 5: they're not getting enough of various food groups. The nice
Speaker 5: thing about the ARPHID criteria that was written in by
Speaker 5: the people who developed the diagnostic criteria is that you
Speaker 5: can meet criteria for ARFID just on interference with what
Speaker 5: they call psychosocial functioning, meaning like, is it a pain
Speaker 5: to feed this kiddo? Is it hard to take them
Speaker 5: lunch to school? Is it hard for them to eat
Speaker 5: at restaurants? Is it hard to travel?
Speaker 4: Because we have to.
Speaker 5: Track the restaurants that have the foods that they'll eat.
Speaker 5: But parents will know, am I making separate meals for
Speaker 5: this kiddo? Am I bending over backwards to pick off
Speaker 5: specs and retoast the toast that got to burn, right, Like,
Speaker 5: it's difficult for a parent and they know that it is,
Speaker 5: so it honors that difficulty.
Speaker 4: In having that added to the criteria.
Speaker 5: I think if you have a kiddo you're really struggling
Speaker 5: to get them to eat across food groups or expand
Speaker 5: their diet or eat what your other typical eating kiddo
Speaker 5: will eat, then you can actually meet criteria just based
Speaker 5: on that interference alone.
Speaker 2: Wow.
Speaker 1: I mean, I think that that's really great to have
Speaker 1: that type of nuance when we're talking about something like this,
Speaker 1: which is a very sensitive topic for a lot of people.
Speaker 1: You talk a little bit about how URFID a new
Speaker 1: diagnosis within the last you know, ten years, you said
Speaker 1: that it came to be. Can you talk about in
Speaker 1: the world of eating disorders, can you explain why OURFID
Speaker 1: was recognized as a distinct condition and what makes it
Speaker 1: different from older well known eating disorders like anorexia or bolimia.
Speaker 5: Great question, And when we have a person in our
Speaker 5: office that we're assessing for URFID, we ask questions that
Speaker 5: to rule out those other conditions, because it's really important
Speaker 5: to make sure that we are identifying what we think
Speaker 5: we're identifying the treatment's going to differ based on whether
Speaker 5: someone meets criteria for URFID or anorexia, So super important
Speaker 5: to get that nuance right. And I should mention we
Speaker 5: talked about URFID presenting in kids. We see the teens
Speaker 5: and adults as well. There's an arfid Andrew as well
Speaker 5: all over Instagram doing the adult version.
Speaker 4: Of these exposures.
Speaker 5: And if we had someone like him in our office
Speaker 5: and we're asking questions like what's behind the food avoid
Speaker 5: or the food aversion.
Speaker 4: If it's not because of shape or weight like.
Speaker 5: We would expect to see in anorexia, we're more confident
Speaker 5: that it's more about the aversion to the food itself.
Speaker 5: Within our FID, we think that there's probably subtypes of
Speaker 5: folks with our FID. So just like we would ask
Speaker 5: questions about binge eating or bingeting history, weight and shape
Speaker 5: concerns in anorexia, we can ask some specific questions to
Speaker 5: see even what subtype of our FOD someone might have.
Speaker 5: So we see a subset of kids, teens and adults
Speaker 5: who just historically have had a lack of interest in eating.
Speaker 5: They're like the opposite of a foodie. So and it's
Speaker 5: a shame when you have a foody in a household.
Speaker 5: They don't always understand what it's like to have these
Speaker 5: like low appetite food apathy kinds of people, because they're like,
Speaker 5: what do you mean you don't appreciate a good stake,
Speaker 5: and like they just don't get it. But these books
Speaker 5: sometimes they have a history of just never really having
Speaker 5: a strong hunger Q, never having a strong interest in
Speaker 5: the varieties and flavors of food.
Speaker 4: It just falls flat.
Speaker 5: Sometimes it can come from a history of having discomfort
Speaker 5: when eating. We see kids with like chronic history of constipation,
Speaker 5: or folks that have had a lot of GI ups
Speaker 5: and downs or IBD where eating actually has a history
Speaker 5: of causing them some discomfort and pain, and that sort
Speaker 5: of association over time creates this learned fear of eating
Speaker 5: or disinterest in eating, because it just never feels the
Speaker 5: typical experience of somebody who's eating feels you feel hungry,
Speaker 5: you grab something to eat, you feel the food is
Speaker 5: delicious and rewarding, and it reinforces that I should do
Speaker 5: that again when I get a hunger Q. For folks
Speaker 5: with ourfait, they might not necessarily get that strong sensation
Speaker 5: of hunger and the reward from eating.
Speaker 4: So they're sort of tapped out of that entire system.
Speaker 5: And when you add that fear layer on top of it,
Speaker 5: if their history, say you were lactose intolerant, but you
Speaker 5: wasn't recognized for a long time. Anytime you look at milk,
Speaker 5: it might sort of have this like, oh, yeah, I
Speaker 5: didn't feel great.
Speaker 4: The last time.
Speaker 5: Might have that milkshake, so it's not feeling as interesting
Speaker 5: to me. So there's that category of folks with arfod.
Speaker 5: Then you get folks who are really sensory bothered by food,
Speaker 5: so things like mushi textures, soft textures. If you think
Speaker 5: of like a bowl of blueberries and a bowl of
Speaker 5: goldfish crackers.
Speaker 4: Every goldfish cracker is.
Speaker 5: Very predictable in applewl, a bowl of blueberries super unpredictable, like.
Speaker 4: The squashy mushy one.
Speaker 5: The really our one, the really tart one, the release
Speaker 5: like it's a mixed bag. So in terms of it
Speaker 5: coming from this place of anxiety, I'm going to get
Speaker 5: a lot less of anxiety eating that predictable, crunchy, sort
Speaker 5: of smooth carb versus this really unpredictable set of experiences
Speaker 5: with typically fruits, vegetables, and meats. So those sensory kiddos,
Speaker 5: I think they're really sensitive. So those types of things,
Speaker 5: we hear stories all the time, like a chicken nugget
Speaker 5: manufacturer changed their recipe and now my kiddo won't eat
Speaker 5: it anymore. Or we change toasters and now we keep
Speaker 5: burning these slight specks.
Speaker 4: On the pizza.
Speaker 5: Now my kid won't eat it anymore. So they're super
Speaker 5: sensory sensitive and they're really in tune with that. And
Speaker 5: then the last type of folks with our fad that
Speaker 5: we will ask more about when we have these folks
Speaker 5: in our offices are people with folks that have a
Speaker 5: fear of choking or vomiting or gagging on the food.
Speaker 4: So the way I like to think about this is if.
Speaker 5: We were in Thailand together and we were walking around
Speaker 5: open air market and there's skewers of crickets and scorpions
Speaker 5: and meal worm burgers, and a guide says these are great,
Speaker 5: like this is a delicacy here, you gotta try it.
Speaker 5: I don't know about you, guy, but if you were
Speaker 5: offered a skewer of crickets, your reaction might not be
Speaker 5: as positive, even if the person is saying they're great.
Speaker 5: They're delicious, everyone loves them. Our reactions might be I
Speaker 5: don't know if that texture will go down well. I
Speaker 5: don't know if I would vomit or gag. I don't
Speaker 5: know what that would do to my GI system. We
Speaker 5: would have the same sort of reaction that a picky
Speaker 5: eater would have to like a slice of pizza.
Speaker 4: So you get that category too.
Speaker 5: So when people are coming into offices, we're asking do
Speaker 5: you have any of these other subtypes and can we
Speaker 5: rule out some of those other bigeating disorder or anrexia.
Speaker 2: Tit and I just talked about this. I ate something recently.
Speaker 3: It did not treat me well, and we were texting
Speaker 3: each other and she says, I hate when food betrays me.
Speaker 2: That's what she wrote to me.
Speaker 3: And I can't imagine what it must feel like to
Speaker 3: have all of these things betray you. I think about
Speaker 3: how much of our day to day life. I'm just
Speaker 3: thinking about if I were scrolling on Instagram or what
Speaker 3: as I see on television. Food is everywhere. I'm curious
Speaker 3: about some of the psychosocial impacts. How does arfit affect
Speaker 3: someone's social life or friendships. And we've talked a little
Speaker 3: bit about family dynamics. But I'm particularly interested for teens
Speaker 3: and adults. You know, as food is such a central
Speaker 3: social nexus for all of us, what does that look like.
Speaker 5: Yeah, the amount of shame and anxiety that people with
Speaker 5: our fit experience in those spaces is really strong, and
Speaker 5: I think for some people it leads. There's this misnomer
Speaker 5: in picky eating that kids will grow out of it, right,
Speaker 5: And I think it comes from the fact that a
Speaker 5: lot of kids do so some of those like nudge
Speaker 5: to eat your vegetable. Folks with mild picky eating do
Speaker 5: grow out of some of those rigidities. And when the
Speaker 5: folks that are sort of getting passed in the toddler years,
Speaker 5: elementary school years, middle school years and they haven't expanded
Speaker 5: their diet, I've had teens say I'm so embarrassed by
Speaker 5: my toddler lunch. Right, I have an apple sauce pouch
Speaker 5: and a peanut butter sandwich and I've been doing this
Speaker 5: since I was five. They're embarrassed. And now I have
Speaker 5: some adults on my caseload. They talk about going to
Speaker 5: restaurants and having panic attacks. Someone had I think onion
Speaker 5: put on her salad and she went to the bathroom
Speaker 5: and cried full panic attack.
Speaker 4: And cried, and she's feeling like I know this.
Speaker 5: Cognitively, I know this shouldn't be such a big deal,
Speaker 5: but physically it's like the cricket on the plate. It's
Speaker 5: like it's such an anxiety response and so embarrassing to
Speaker 5: feel that way and to have to then advocate for
Speaker 5: kind of clos have the salad remade without onions, or
Speaker 5: to be facing the consequence of eating something aversive in public,
Speaker 5: which is the other part of that fear. I think
Speaker 5: people worry about social judgment for making faces or for
Speaker 5: struggling to eat something.
Speaker 4: What if I gag or choke in front of somebody as.
Speaker 5: I'm trying to get down a new food, because imagine,
Speaker 5: like it one thing to eat crickets with your friends,
Speaker 5: it would be another to like be in a job
Speaker 5: interview and be expected to sort of keep this food down.
Speaker 5: So the amount of anxiety that people are experiencing is
Speaker 5: quite high, the good news being that it does respond
Speaker 5: well to graduated treatment. So I think for some folks
Speaker 5: who are motivated enough, that's where that's where some of
Speaker 5: that interference can be turned into a motivator, because it
Speaker 5: can be the thing that makes me try to Okay, fine, fine,
Speaker 5: I'll try to down the crickets, which for them could
Speaker 5: be like I'll try to eat a salad in front
Speaker 5: of my work colleagues, because that's always offered at the
Speaker 5: beginning of a business meal, you know. And so with
Speaker 5: some graduated practice, people can do well looking at least
Speaker 5: more tolerant of those foods. So our motto is that
Speaker 5: you get more comfortable being uncomfortable.
Speaker 4: And you can even see it in Hannah Arfid's video.
Speaker 5: She showed one recently of like she's eating honeydew melon
Speaker 5: for the very first time. She's almost in tears. She's like,
Speaker 5: this is awful. It tastes like cucumber. It's really disgusting.
Speaker 5: They show her a year later she hasn't even tried
Speaker 5: honeydew melon that much in the intermediary year, and she
Speaker 5: says she's eating it. She's eating it pretty quickly, and
Speaker 5: she's like, it's not great, it's not my favorite. But
Speaker 5: you can tell what the intermediary factor is that she's
Speaker 5: gotten better at eating things she doesn't like. So for
Speaker 5: a lot of parents, we have them take liking off
Speaker 5: the table altogether. So the immediate thing when a picky
Speaker 5: eater tries something new is to say, okay, so did
Speaker 5: you like it? And all parents follow victim to this, right,
Speaker 5: did you like it? I usually try to get people
Speaker 5: out of it because it's a double bind. If I
Speaker 5: say yes a picky eater who has ten foods or
Speaker 5: something really restricted, the parent's going to go out and
Speaker 5: buy Pasco sized portions of that and they're going to
Speaker 5: be like, so saye. Saying yes is like, Ooh, I
Speaker 5: don't know that I want to commit to that. So
Speaker 5: the urge is to say no. And then saying no
Speaker 5: means that I've signed up for my parent not only
Speaker 5: not presenting it again, because I've sort of trained them
Speaker 5: in this avoidance cycle, but then I've identified I'm not
Speaker 5: a person that eats honeydew melon. I'm not a person
Speaker 5: who eats those granola bars and it stays stuck. So
Speaker 5: I tried to get parents out of the liking dilemma. Altogether,
Speaker 5: you can tell by their face whether they like it
Speaker 5: or not, and in the treatment, it's not the goal anyway.
Speaker 5: The goal is actually to get you practice eating things
Speaker 5: that you don't like. So instead my response is, oh,
Speaker 5: I know that one was a tough one. Keep going,
Speaker 5: you got this, keep those bites down, and if they
Speaker 5: kind of seem like they like it, then there's like
Speaker 5: the thought that we could keep gradually introducing it, not
Speaker 5: costco size introducing it.
Speaker 1: I'm definitely one of those parents who does that where
Speaker 1: I'm like, oh, he likes it, get We're going to
Speaker 1: eat it every day. That's what we're eating every day.
Speaker 2: And then he gets sick of it, and I'm like,
Speaker 2: uh oh, but we have more. So now we're.
Speaker 1: Eating blackberries for the next few days just to get
Speaker 1: through it before they we have to throw them all
Speaker 1: in the trash.
Speaker 2: Yeah.
Speaker 1: When I think of people who have this disorder, we
Speaker 1: don't exist in a vacuum. There's so many other things
Speaker 1: that are going on out And you were talking about
Speaker 1: the anxiety and the fear and the shame that's wrapped
Speaker 1: up in all of this, and it started to get
Speaker 1: me thinking about how having this type of disorder and
Speaker 1: other types of disorders like anxiety, how that could impact
Speaker 1: a person, and how the overlay of these multiple complicated
Speaker 1: diagnoses can really interfere with each other and sometimes hold
Speaker 1: someone back. There was some research that suggested that our
Speaker 1: fit often coexists with conditions like autism, ADHD or anxiety.
Speaker 1: Can you talk about how these overlaps complicate diagnosis and
Speaker 1: treatment and what should a parent and clinicians be aware of.
Speaker 5: We see comorbidity across those diagnoses, and there's actually a
Speaker 5: good amount of meta analyzes out now that sort of
Speaker 5: have done that number crunching. It's the norm for there
Speaker 5: to be an eating disorder among folks with autism, or
Speaker 5: at least eating interference. It's so common for those kiddos
Speaker 5: to struggle, ARFID being one subtype of how that can
Speaker 5: present sensory preferences and some of the nonverbal kiddos having
Speaker 5: difficulty describing what's hard about a food.
Speaker 4: So that's the norm.
Speaker 5: The good news is across all of those comorbidities is
Speaker 5: that the interventions work well for all of those kids.
Speaker 5: So there's been quite a few pilot studies of eating
Speaker 5: interventions for kids with autism and ARFID, and they look
Speaker 5: great when they're responding to that slow graduated food introduction.
Speaker 5: So a parent will typically give up giving a food
Speaker 5: after three to five rejections, but the data suggests that
Speaker 5: even for folks without sensory sensitivities. You need at least
Speaker 5: ten to fifteen tries of a food to even start
Speaker 5: to accept it into this is safe a poison berry,
Speaker 5: it's a safe food.
Speaker 4: To eat category.
Speaker 5: So getting those folks with autism to do multiple tries
Speaker 5: it can take a big behavioral motivational reward lift for
Speaker 5: parents to do it, but I think for the kiddos
Speaker 5: that have more significant eating interference, it's worth it. And
Speaker 5: the protocol works the same in kiddos with autism, So
Speaker 5: that's the good news. And then there's other comorbidities where
Speaker 5: the actual anxiety condition might have to be addressed first.
Speaker 5: So someone who has choking phobia or vomit phobia, not
Speaker 5: eating is part of that picture, but they might need
Speaker 5: specific exposures that address the choking fear or the vomit fear.
Speaker 5: We have a lovely set of vomit exposures that involve
Speaker 5: photos and pictures and videos and sensation you know, spitting
Speaker 5: into the toilet, gagging with your duke brush that get
Speaker 5: that kiddo all the way ready to eat non preferred
Speaker 5: foods because the fear of vomiting might be just part
Speaker 5: of that, or the fear of getting so full that
Speaker 5: I threw up might just be part of that. We
Speaker 5: also see a decent chunk of OCD comorbidity with harfit
Speaker 5: and picky eating. We often with OCD try to get
Speaker 5: to the core fear of what is what am I
Speaker 5: afraid it is that the contamination of the food. Is
Speaker 5: it that the food touched my brother who's contaminated. We
Speaker 5: had a kiddo recently who said, I'm afraid of root
Speaker 5: vegetables because they grow in the ground, and you don't
Speaker 5: know what kind of contaminant they could have absorbed by
Speaker 5: growing in the ground. Right, So there you have to
Speaker 5: kind of get to the underlying logic, start doing exposures
Speaker 5: that address the absurdity of that OCD and throw in
Speaker 5: some eating exposures on top of that.
Speaker 4: So it just complicates the picture. But luckily the treatment's
Speaker 4: very much the same.
Speaker 2: That root vegetable when I don't know, it doesn't feel
Speaker 2: absurd to me.
Speaker 1: I have a quick follow up question because I'm a
Speaker 1: two year old who eats what I feel like, eats
Speaker 1: everything except except vegetables. He did eat them when he
Speaker 1: was a very very small baby. For a parent who
Speaker 1: feels like, oh my child is refusing this type of food,
Speaker 1: Could you give like an age range where you should
Speaker 1: start really paying strong attention and can you talk with
Speaker 1: a little bit more granularity when it comes to the
Speaker 1: plate when we present it.
Speaker 5: I think everybody feels that who's parented a toddler before,
Speaker 5: and what you're hitting on is actually really developmentally normative.
Speaker 5: So I wouldn't be worried yet, because what happens in
Speaker 5: evolutionary terms is that when we go from infant breastfeeding
Speaker 5: and into the early pures, kids are pretty non specific
Speaker 5: and might be sort of dictated by what they were
Speaker 5: fed in utero. So we see moms who are eating
Speaker 5: spicy foods, their kids are more tolerant of spicy foods.
Speaker 5: Moms who are drinking bitter coffee during pregnancy, their kids
Speaker 5: are more tolerant of bitter food. So there's been some
Speaker 5: breast milk research from the Monell Center and Philly that's
Speaker 5: confirmed some of those findings. So, but those early pures
Speaker 5: are often pretty widely accepted. So he was eating like
Speaker 5: braccli puree and all the weird green bean smelling pures.
Speaker 5: What happens when kiddos get to age one or two,
Speaker 5: they start to walk and so evolutionarily, this was a
Speaker 5: dangerous time period because these kiddos could walk off and
Speaker 5: eat fistfuls of poison berries, So human development fascinating. We
Speaker 5: were able to sort of queue these kids to say,
Speaker 5: maybe you should be cautious with how much you're putting
Speaker 5: in your mouth when you're one to two, and you
Speaker 5: should make sure that it's not too bitter. So things
Speaker 5: like veggies, which are quite bitter, spark that like, but
Speaker 5: is it a poison berry concern for these kids? And
Speaker 5: so it's normal for across the spectrum those little walkers
Speaker 5: to start to look more picky. So it's up to
Speaker 5: parents to sort of keep pushing the contingencies. And you're
Speaker 5: right on track for thinking like, how do I get
Speaker 5: him to reapproach These bitter foods are the ones that
Speaker 5: just have that slimy I mean, carrots can be too
Speaker 5: crunchy or too hard to chew down. These things that
Speaker 5: have unusual presentations that might be less predictable than the
Speaker 5: goldfish cracker or more bitter than some of the other
Speaker 5: foods that they eat. So in the what to do category,
Speaker 5: it's funny I joked about the veggie plate before because
Speaker 5: the severe picky eaters won't do it. But in typical development,
Speaker 5: when we can catch kids when they're hungry, the veggie
Speaker 5: plate is an awesome strategy. So something like the kids
Speaker 5: coming home, they want a snack, you know they're gunning
Speaker 5: for like the granola bars and the mini bites, and like,
Speaker 5: you know that that's what they want. We can put
Speaker 5: a contingency in place. Certainly you can have mini bites
Speaker 5: just as soon as you eat these three carrot bytes,
Speaker 5: and we could start with something that's like the least
Speaker 5: aversive of those things.
Speaker 4: We get them really accustomed to.
Speaker 5: Every time I ask for one of those snacks during
Speaker 5: the hungry period, Mom sets out the apple tray with
Speaker 5: the carrots on it, and I know, I sort of
Speaker 5: graze on that before I'm able to get the real thing.
Speaker 4: There's a book called French Kids Eat Everything.
Speaker 5: I Love for like a guide through that, because it's
Speaker 5: essentially it is about offering and modeling and having those opportunities,
Speaker 5: but it has to hit when they're hungry, and for
Speaker 5: some kids they might need more of a nudge than
Speaker 5: just having it out. So for my four year old,
Speaker 5: I was a picky eater when I was little. There's
Speaker 5: a high genetic load for picky eating. I passed it
Speaker 5: on to my four year old. Despite being a picky
Speaker 5: eating expert, I have to give him a ton of
Speaker 5: nudges to get him eating some of these veggies.
Speaker 4: And so nudge is meaning we.
Speaker 5: Might have to have a specific cucumber eating party which
Speaker 5: he's doing his bites and he's getting a reward afterwards.
Speaker 4: How that's set up for parents can really differ.
Speaker 5: So it could be like the full round of cucumber
Speaker 5: has to be eaten and then we can go pick
Speaker 5: out a Pokemon card from your bin.
Speaker 4: It could be points towards something. It could be.
Speaker 5: Special time with parents, which is free and lovely, but
Speaker 5: the heavier lift of the reward might have to happen
Speaker 5: if just setting out the food isn't that interesting. Screen
Speaker 5: time is also lovely for this, So pushing pause on
Speaker 5: a show and saying, oh, finish your cucumber bite and
Speaker 5: then we can push play again.
Speaker 4: That's how we do it in some of the feeding clinics.
Speaker 5: So even the feeding clinic over at Chop will do
Speaker 5: very specific bite for bite rewards. Like we are sitting
Speaker 5: across from the kiddo, we put the piece of carry
Speaker 5: it down. We say eat your bytes, and then we
Speaker 5: can play. As soon as they're chewing, we get back
Speaker 5: into playing whatever little toy or game we're playing with.
Speaker 4: The next bite gets set out.
Speaker 5: If they're refusing, we sort of turn our attention away
Speaker 5: and wait for them to do the bites and then
Speaker 5: we go back to reinforcing the eating with playing in
Speaker 5: that way, So there's some strategies you can start to employ.
Speaker 4: Again.
Speaker 5: The folks with really significant ARPD will laugh at you
Speaker 5: for saying my kid won't eat for a Pokemon card.
Speaker 4: But that's a different protocol.
Speaker 1: Yeah, we.
Speaker 3: See ourfit kind of gaining popularity and people are talking
Speaker 3: about it. I'm curious about how you see social media
Speaker 3: as a tool for people with ARFIT. Do you think
Speaker 3: it's helpful or does it add pressure or is there
Speaker 3: any kind of stigma.
Speaker 5: I think it helps a lot because I think people
Speaker 5: there is like a scoffing with what do you mean
Speaker 5: you don't like that food? Or I think if I
Speaker 5: asked everybody, are there certain foods you don't like? I
Speaker 5: think a lot of people would have a few. And
Speaker 5: even when we look at the you see sort of
Speaker 5: distressed ratings of people's foods. You probably have a pretty
Speaker 5: average rating for most foods, and then there's a spike
Speaker 5: around something like tomato, cucumber. These are like commonly hated
Speaker 5: foods or like cilantro, right is the funny one out right,
Speaker 5: And so there's this really strong dislike for those types
Speaker 5: of foods, and people think they understand what it means
Speaker 5: to not like a food. And I think that's the risk,
Speaker 5: right that if you start dating someone and they're like
Speaker 5: kind of picky, you think I get that because I
Speaker 5: don't like cilantro, But you either muscle through it or
Speaker 5: you just don't order it. And so that's a simple
Speaker 5: solution for someone without our FID. For someone with URFID,
Speaker 5: they're like, my everyday meals are tricky because of this,
Speaker 5: and powering through it is a lot harder for me
Speaker 5: than it is for you. So it's it's almost like
Speaker 5: the semblance of understanding that gets us in trouble a
Speaker 5: little bit there. And I think social media when they're
Speaker 5: showing someone like Arfid Andrew who's gagging and like he's
Speaker 5: just eating cheese right right, He's eating, you know, and
Speaker 5: a banana for the first time, and it looks really
Speaker 5: distressing to him. I think that's helpful to sort of
Speaker 5: see it's not just your run of the mill aversion
Speaker 5: to something. He's really struggling with the sensory experience or
Speaker 5: the taste experience, and it's different for him. So social
Speaker 5: media can be helpful there. I think there's also we
Speaker 5: mentioned it being multidisciplinary. I think there's multiple influencers out
Speaker 5: there that are now speaking to the platform.
Speaker 4: Which is great.
Speaker 5: So you have speech pathologists who are talking about how
Speaker 5: to like quickly quickly chew the food and get it down,
Speaker 5: or manipulate the food in your mouth so that you
Speaker 5: can swallow it quickly. Some folks work with occupational therapists
Speaker 5: because they can help you sort of touch the squishy blueberry.
Speaker 5: And kids who are super super avoidant who would throw
Speaker 5: a tantrum if a blueberry is anywhere in sight, they
Speaker 5: can start doing ot with those folks and start touching blueberries,
Speaker 5: smelling blueberries, et cetera. We tend to see the best
Speaker 5: symptom relief when we get full bites to happen, so
Speaker 5: like touching and playing with foods will only give us
Speaker 5: so much symptom relief. But like you mentioned, getting someone
Speaker 5: with a psychologist, a licensed professional counselor, or a social
Speaker 5: work er. Somebody can do graduated food exposures. That's going
Speaker 5: to be great. I think the more people who are
Speaker 5: out on the platform advertising that or talking about how
Speaker 5: they are therapeutically helping people get through, that's great. The
Speaker 5: folks that are showing their food bites I think are
Speaker 5: the bravest, right.
Speaker 4: They're both being vulnerable.
Speaker 5: In those moments eating those foods, being able to be
Speaker 5: how could you not like cheese? How could you have
Speaker 5: that reaction to cheese? They're at the whim of all
Speaker 5: the comments, and I think they're also modeling for what
Speaker 5: parents can sort of expect to sort of get out
Speaker 5: of an exposure protocol, both that it's hard at first
Speaker 5: and then like with Arf and Hannah, she's looking awesome.
Speaker 5: She's looking much more tolerant of foods than ever before.
Speaker 1: Yeah. I think one of the great things about one
Speaker 1: highlighting this disorder that people might not know much about
Speaker 1: and the experience of it on social media is that
Speaker 1: it shows that one these folks exists. It gives them
Speaker 1: a voice, and then it also shows that there is
Speaker 1: life like during your struggle in life after you're struggling
Speaker 1: and the process of living a life, a full life,
Speaker 1: even though you have this disorder that you're working through.
Speaker 1: It really humanizes folks and it really helps with people's
Speaker 1: understanding and empathy. So the next time maybe you sit
Speaker 1: down with a friend who is picking tomatoes out of
Speaker 1: their burger or sending it back and asking for a
Speaker 1: fresh one, maybe you'll before you say, oh my gosh,
Speaker 1: that's ridiculous, you say, okay, yeah, I've seen people with
Speaker 1: similar types of aversions to types of food, and so
Speaker 1: you won't comment on it, or you say if they're
Speaker 1: feeling like I can't eat this, you're encouraging like, hey,
Speaker 1: it's okay, you can send it back, ask them to
Speaker 1: make you a new one. You could say you're allergic
Speaker 1: or something like that, so that they, you know, really
Speaker 1: come back with something fresh. And that's one of the
Speaker 1: things that I've really loved about watching Hannah and some
Speaker 1: of these other kids that deal with it, is that
Speaker 1: even with my own child, I'm not I don't feel
Speaker 1: like I pressure him so much to like, you have
Speaker 1: to eat this, you have to eat this, because I'm like,
Speaker 1: you know, it might be a wrong dislike and I
Speaker 1: don't want to traumatize. I don't want him the negative
Speaker 1: association with sitting down and having dinner with his parents.
Speaker 1: And so that's one of the things that I love.
Speaker 1: Prior to social media, I know that there was probably
Speaker 1: some common miss or even still now common misconceptions that
Speaker 1: you want cleared up about our FID, whether it's among
Speaker 1: parents or teachers or even healthcare professionals. Can you talk
Speaker 1: about some of those misconceptions and kind of like where
Speaker 1: they come from and clear them up for us?
Speaker 4: Yeah?
Speaker 5: Sure, I think you tapped into one, which is sort
Speaker 5: of like that tussle between do I force them to
Speaker 5: eat this? How do you even force somebody to eat something?
Speaker 5: Are we like to clear the plate kind of family or.
Speaker 4: Are we not? And that struggle?
Speaker 5: So how do I advocate for their independence and that
Speaker 5: this might be one of those foods that spikes dislike
Speaker 5: for them or like you often get a one parent
Speaker 5: in the household who says, like, I don't know, just
Speaker 5: tell them to eat it, like the put the foot down, punish,
Speaker 5: go the harsh way path And really it's not glamorous.
Speaker 4: It's this day in day out. We gotta be.
Speaker 5: Practicing foods just like you would have with a kid
Speaker 5: with diabetes, right, sorry, dude. Other kids don't have to
Speaker 5: do the blood stuff that we do or the insulin
Speaker 5: stuff that we do, but you have a condition that
Speaker 5: makes things different. We have to stick to this protocol,
Speaker 5: and no one likes that. Even teeth brushing, right, We
Speaker 5: don't say would you like to brush your teeth tonight?
Speaker 4: Would you like to do that?
Speaker 5: We know it's aversive, but we also know that you
Speaker 5: can do it, so we try to apply that level
Speaker 5: of confidence to the protocol. And then parents sort of
Speaker 5: get in their groove, and once they start seeing games,
Speaker 5: they get really happy with the protocol. And then we
Speaker 5: get all the pictures of like kids eating crab legs.
Speaker 1: And one of the things that you've brought up that
Speaker 1: I thought was spot on was just about the each
Speaker 1: house has its own culture, yes, and creating a culture
Speaker 1: inside of your house so that kids understand, because I
Speaker 1: think me and my husband we grew up with two
Speaker 1: different cultures inside of our houses. His house was the
Speaker 1: clean plate club was a big thing. You clean your
Speaker 1: it's like you're part of the clean plate club. But
Speaker 1: in my house, it was like eat until you're full
Speaker 1: if you don't want anymore. You stop eating and if
Speaker 1: there's stuff left over, that's okay. And it was never
Speaker 1: a big deal. When we started dating and I had
Speaker 1: food left on my plate, He'd be like, you're not
Speaker 1: gonna be in the clean plate club and I was like,
Speaker 1: I don't know.
Speaker 2: What that is, and why should I care? Like I'm full?
Speaker 1: And so I think that culture that we had in
Speaker 1: our separate houses, bringing that into our house and trying
Speaker 1: to find a new culture that works for our home
Speaker 1: with these things in mind arms us with the terminology,
Speaker 1: with the mindset that we need to create a healthy
Speaker 1: food culture, whether it's you know, our child eats everything
Speaker 1: or our child is really struggling with different textures, but
Speaker 1: just knowing that we can set the tone and that
Speaker 1: none of this is permanent and we can really help
Speaker 1: mold them into having a better relationship with food. I mean,
Speaker 1: all of this has been really illuminating and just so
Speaker 1: how even if you don't have a child who's suffering
Speaker 1: from a specific disorder, having that in mind, those tools
Speaker 1: can help you in your household. It can help you
Speaker 1: with lots of different things, like if you have a
Speaker 1: child that you feel likes have too much screen time,
Speaker 1: or if you have a child that you that is
Speaker 1: struggling with anything. Really, all of this is so it's.
Speaker 4: Like creating a bravery culture.
Speaker 5: And I have a friend who says, like, anxiety plus
Speaker 5: bravery equals confidence, and that's really what we're aiming for it.
Speaker 5: So I often say, if anybody's going to kill a
Speaker 5: reward program or an exposure program, it's the parent because
Speaker 5: we're so busy and trying to sort of manage so
Speaker 5: many things. But if we can do this mundane day
Speaker 5: in day out, we're doing.
Speaker 4: This brave stuff.
Speaker 5: It creates a culture of achievement from bravery rather than
Speaker 5: from luck or from just that I happen to like
Speaker 5: this food. It comes from this place of oh, I
Speaker 5: don't like that food yet, but if I keep working
Speaker 5: at it, I can create some practice and confidence for myself.
Speaker 5: It's how I want kids to approach academics and social
Speaker 5: appearances that are reverse and world in general.
Speaker 4: So totally true.
Speaker 1: That's perfect.
Speaker 3: This lab has been such an eye opener for me
Speaker 3: tt me too, Me too. We've talked about the importance
Speaker 3: of food in society and culture, and we've even covered
Speaker 3: food accessibility when it comes to like urban planning and
Speaker 3: food deserts. However, I don't think we've stopped to really
Speaker 3: address the lack of accessibility to so much of our
Speaker 3: society through the lens of eating disorders.
Speaker 1: Oh my gosh, it's such a good point, and it
Speaker 1: really makes me look at all of our past episodes
Speaker 1: a little bit differently. It's really difficult to navigate, and
Speaker 1: we learn just a little bit about various factors that
Speaker 1: are at play, and this is a reminder that we
Speaker 1: could all be a kinder. We could be more empathetic,
Speaker 1: Like when we notice little things, we can say, oh,
Speaker 1: this person might be struggling. We can be more tolerant
Speaker 1: and more understanding about what people might be going through.
Speaker 1: It's such an important lesson to learn and something that
Speaker 1: we need to really be conscious about in like actively
Speaker 1: practicing in our day to day lives to just tell ourselves,
Speaker 1: I don't know what this person is going through, I
Speaker 1: don't know what they're thinking in their minds, I don't
Speaker 1: know what's going on in their households, and taking that
Speaker 1: into account into every interaction that we have. Yeah, And
Speaker 1: I really feel like if you can't do that at
Speaker 1: a minimum, practice mine of your business. And I think
Speaker 1: that's the polite Southern way to say it, I would
Speaker 1: say something else, Oh my goodness, bless her heart.
Speaker 3: To learn more about therapy for pickie eating, or to
Speaker 3: join a parenting group, it www dot Doctorjessica Bodi dot com.
Speaker 3: You can find that link in our show description, along
Speaker 3: with links to Arford, Hannah and Arfred Andrew accounts.
Speaker 1: You can find us on X and Instagram at Dope
Speaker 1: Labs podcast, tt.
Speaker 2: Is on X and Instagram at dr Underscore t Sho.
Speaker 1: And you can find Takiya at Z said So.
Speaker 2: Dope Labs is a production of Lemonada Media.
Speaker 1: O Senior supervising producer is Kristin Lapour and our associate
Speaker 1: producer is Isara Savez.
Speaker 3: Dope Labs is sound design edited and mixed by James Farber.
Speaker 3: Leimonada Media's Vice President of Partnerships and Production is Jackie Danziger.
Speaker 3: Executive producer from iHeart podcast is Katrina Norvil. Marketing lead
Speaker 3: is Alison Kanter.
Speaker 1: Original music composed and produced by Taka Yatsuzawa and Alex
Speaker 1: suji Ura, with additional music by Elijah Harvey. Dope Labs
Speaker 1: is executive produced by us T T show Dia and
Speaker 1: Kiah Wattley