At Duke Health, researchers conducted a study on a generation of people who struggled with food avoidance before it was formally recognized as an eating disorder known as Avoidant/Restrictive Food Intake Disorder (ARFID) in 2013.
The findings, which were published today in the International Journal of Eating Disorders, are intended to help families and behavioral health professionals create best practices for dealing with extreme food aversions, according to the researchers.
Picky eating is diagnosed as ARFID when it is severe. Weight loss and nutritional inadequacies are common symptoms of the illness, which can also lead to social and emotional issues when mealtimes become a cause of embarrassment, friction, and/or conflict.
“It’s not surprising that positive approaches were favored, but it is surprising how overwhelming that position was among this group of adults,” said the authors of the study.
“It is robust confirmation for what had been out there in the literature and reinforces the concept that children feeling forced or pressured to eat is not helpful.”
The study began more than a decade ago, at a time when extreme food avoidance was becoming more well-known and research on the disorder was scarce. The online poll was designed to better understand the perspectives and experiences of adults who self-identify as contemporary picky eaters.
The study included more than 19,200 respondents, with 75% being female and 25% being male, and 89 percent being white. Respondents were asked to describe food presentation tactics used by their parents or caregivers that were beneficial or ineffective in boosting dietary diversity.
Based on the degree of impairment caused by food avoidance, survey participants were characterized as having an ARFID diagnosis or not having an ARFID diagnosis. ARFID was diagnosed in those who reported severe weight loss, nutritional deficit, interference with job functioning, and/or difficulties with social connections as a result of eating disorders.
The logistical problem of interpreting the story answers from such a large group of people was overcome by the use of powerful artificial intelligence systems.
The researchers employed an algorithm to analyze the meaning and/or sentiment of survey responses to define them as helpful or not helpful, using a computational tool to characterize the perceived helpfulness of parent feeding practices.
“From a technical perspective, this study used an AI application that understands language, not just words and sentences, but concepts of paragraphs, which was imperative here,” said the study authors.
“By getting the positive and negative emotions, it enables us to analyze the comprehensive memories of nearly 20,000 people.”
The researchers discovered that a positive emotional context is mentioned in 39 percent of the themes about helpful strategies, such as using food to teach cultural or nutritional lessons, being flexible about food, providing plenty of safe foods, assisting with food preparation, or presenting foods from specific food groups.
40 percent of the helpful comments mentioned the necessity of having a system in place when it comes to preparing meals. In order to distinguish between feeling “forced” and being requested to do something, it’s important to have expectations surrounding eating that are clearly established.
While positive and encouraging tactics were seen to be effective in improving attitudes about food and reducing social discomfort associated with eating, many adults still suffered with some form of avoidance or restriction. Despite their children’s food avoidance extending into adulthood, parents are seen as having a beneficial impact, according to the study.
According to the researchers, several foods were obviously aversive, not just unpleasant, to survey participants. If they were forced to eat such meal, they were likely to feel even more confined and forced to do something horrible.
“To our knowledge, there is no published research that identifies effective feeding strategies for those with ARFID.”
“Figuring out the best way to feed a child with severe food avoidance can be exhausting and stressful for parents, so providing guidance is essential to improve the social and emotional eating environment for their children and reduce the distress that both parents and children have at mealtimes,” they concluded.
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