Adult picky eaters with symptoms of avoidant/restrictive food intake disorder: comparable distress and comorbidity but different eating behaviors compared to those with disordered eating symptoms

An Inpatient Observational Study: Characteristics And Outcomes Of Avoidant/Restrictive Food Intake Disorder (ARFID) In Children And Adolescents In Japan

PURPOSE

To determine the clinical characteristics and course of severe avoidant/restrictive food intake disorder (ARFID) in hospitalized children and adolescents and compare them with those of patients with restricting-type anorexia nervosa (R-AN).

PATIENTS AND METHODS

We conducted a retrospective chart review of inpatients diagnosed with ARFID or R-AN based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, at Jichi Children's Medical Center Tochigi between April 1, 2007 and March 31, 2017. We compared the characteristics of the ARFID and R-AN patients at admission, during hospitalization, and after discharge.

RESULTS

Both the ARFID (n=13) and R-AN (n=79) patients required hospitalization for their medically unstable state. The features of ARFID group included concern about the aversive consequences of eating and avoidance of eating due to sensory concerns. Significant differences were found at admission between ARFID and R-AN groups in age (10.7 vs 12.7 years), family history of mental disorders (46.2% vs 17.7%), comorbid developmental disorders (6 vs 3 cases), and the time from onset to admission (3.9 vs 6.3 months). The body weight status, % ideal body weight (%IBW), % expected body weight (%EBW), <75% IBW rate, and <75% EBW rate did not differ significantly between the two groups at admission or discharge. The duration of post-discharge outpatient follow-up treatment did not differ significantly between ARFID and R-AN groups (15.3 vs 18.4 months); however, ARFID group recovery rate was significantly higher than that of R-AN group (77% vs 43%). The reasons that the patients with ARFID had significantly better outcomes than the R-AN patients remain unclear. Compared to those in previous studies, the present patients were younger and demonstrated better outcomes. Our results indicate that the body weight status is similar between ARFID and R-AN patients, but the ARFID patients achieved better outcomes.

CONCLUSION

These findings suggest that early onset in childhood, early disease recognition, and early intervention are important factors for achieving better outcomes for patients with ARFID.

A functional description of adult picky eating using latent profile analysis

OBJECTIVE

Research has indicated that adult picky eating (PE) is associated with elevated psychosocial impairment and limited dietary variety and fruit and vegetable intake; however, research operationalizing PE behaviors is limited. Previous research identified a PE profile in children, marked by high food avoidance (satiety responsiveness, fussiness, and slow eating) and low food approach (food enjoyment and responsiveness) appetitive traits. The present study aimed to replicate a similar latent eating behavior profile in an adult sample.

METHODS

A sample of 1339 US adults recruited through Amazon's MTurk completed an online survey that included a modified self-report version of the Child Eating Behavior Questionnaire (CEBQ-A). Latent profile analysis was employed to identify eating profiles using the CEBQ-A subscales, ANCOVAs were employed to examine profile differences on various self-report measures, and eating profiles were compared across BMI classifications.

RESULTS

Analyses converged on a four-profile solution, and a picky eater profile that closely resembled the past child profile emerged. Participants in the picky eater profile (18.1%) scored higher on measures of adult PE and social eating anxiety compared to all other profiles, scored higher on eating-related impairment and depression than moderate eating profiles, and were more likely to be of normal weight.

DISCUSSION

A distinct adult PE profile was observed, indicating childhood PE and appetitive behaviors may carry over into adulthood. Research identifying meaningful groups of picky eaters will help to shed light on the conditions under which picky eating is a risk factor for significant psychosocial impairment or distress, or weight-related problems.

"It's always on the safe list": Investigating experiential accounts of picky eating adults

Previous research into severely restricted eating for reasons which are not cultural, medical, due to a lack of food or due to concerns about body image has focused predominantly on "picky/fussy eating" in children. Despite evidence that picky eating does continue into adulthood and recognition in the new diagnostic category Avoidant Restrictive Food Intake Disorder (ARFID) that problematically avoidant and restrictive patterns of eating affect people across the lifespan, relatively little is known about the challenges and consequences faced by older adolescents and adults. This research employs qualitative methods to explore the experience of living as an adult with picky eating behaviours. Semi-structured interviews were undertaken with thirteen adults who identify as picky eaters and eat a highly limited diet, as determined by a checklist food questionnaire. Data were analysed using interpretative phenomenological analysis (IPA). Two themes are presented in this paper: "Constructions of food" and "Motivators for and barriers to change". These themes show the importance of how individuals perceive food, their diet and themselves, and implications for clinical practice and future research in light of these findings are considered.

Picky eating - A risk factor for underweight in Finnish preadolescents

BACKGROUND

Picky eating (PE) is the most common cause of early-life feeding problems. However, the consequences of PE on food intake and weight development in general populations have not been established.

OBJECTIVES

This study aims to investigate the associations of PE and food neophobia (FN) with weight status in 5700 Finnish preadolescents. In addition, we described food consumption by PE/FN status.

MATERIAL AND METHODS

We utilised the Finnish Health in Teens (Fin-HIT) cohort of 9-12-year-old preadolescents, who were categorised as having PE and FN based on answers from parental questionnaires. Weight was categorised as underweight, normal weight, and overweight/obesity based on body mass index (BMI) according to IOTF age- and sex-specific cut-offs. Eating patterns were obtained with a 16-item food frequency questionnaire. Multinomial logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CIs).

RESULTS

The overall prevalence of PE and FN were 34% and 14%, respectively. PE was inversely associated with overweight/obesity (OR = 0.7; 95% CI 0.6-0.8) and led to a higher risk of underweight (OR = 2.0; 95% CI 1.7-2.4), while this was not observed with FN. Compared with preadolescents without PE/FN, those with PE/FN reported consuming unhealthy foods such as pizza, hamburgers/hot dogs, and salty snacks more frequently (p < 0.0038). By the same token, these preadolescents reported consuming healthy foods such as cooked vegetables, fresh vegetables/salad, fruit/berries, milk/soured milk, and dark bread less frequently.

CONCLUSIONS

Among Finnish preadolescents, only PE was associated with a higher risk for underweight and inversely with overweight/obesity. PE and FN were accompanied with unhealthy eating patterns. Management of PE in children may be explored as a potential strategy for improving healthy eating and avoiding underweight in preadolescents.

Picky eating and fruit and vegetable consumption in college students

Picky eating (PE) may be an important individual-level factor related to fruit and vegetable (F&V) consumption in adulthood. Past studies showing negative relationships between Adult PE and F&V servings and variety have been limited by measurement issues. The purpose of the present study was replicate these relationships in college students using a well-validated F&V screener and comprehensive measure of adult PE. 1219 college students completed an online survey which included measures of adult PE, F&V daily servings, F&V variety, and other eating behaviors. Partial correlations were calculated, controlling for demographic factors and traditional disordered eating behavior, between the variables of interest. Factor analysis was also utilized to confirm the factor structure of the Adult Picky Eating Questionnaire (APEQ) in a college sample. Partial correlations revealed significant negative relationships between PE and measures of F&V servings and variety. Factor analysis confirmed the utility of the APEQ in a college sample. College students who reported higher levels of PE behaviors and attitudes were more likely to eat less fruits and vegetables, and reported lower F&V variety. Given that F&V servings and variety are related to adequate nutrient intake, and greater F&V consumption is a protective factor against chronic disease risk, the rigid inflexible eating patterns associated with adult PE should be further explored in future research aimed at increasing F&V consumption.

Sensory sensitivity mediates the relationship between anxiety and picky eating in children/ adolescents ages 8-17, and in college undergraduates: A replication and age-upward extension

This study explores the relationships among anxiety, sensitivity to sensory stimuli, and picky eating (PE). An earlier study in 95 children ages 5-10 found that sensory sensitivity fully mediated the relationship between anxiety and picky eating. We replicated this finding in a sample of 158 children, ages 8-17, and in 813 young adult college students. As in the previous child sample, the relationship between anxiety and picky eating appears to be mediated by sensory sensitivity. This relationship extends into adolescence and young adulthood and holds even in a sample of children with obsessive-compulsive-spectrum and anxiety disorders. However, there may be developmental differences in the relationship between sensory sensitivity and PE; the magnitude of this relationship was significantly greater for children than young adults. Although there was a trend towards a stronger relationship in a subsample of young adults with high anxiety, the effect was still smaller than that observed in children, suggesting that this difference is developmental and not completely driven by higher anxiety in the child sample. Sensory sensitivity is a candidate mechanism of picky eating, although the cross-sectional nature of this study means that we cannot address whether it is an etiological or maintaining mechanism, or both. Implications for behavioral treatment of picky eating in clinically anxious and non-clinical samples are discussed.

Avoidant/restrictive food intake disorder: a new eating disorder diagnosis in the diagnostic and statistical manual 5

PURPOSE OF REVIEW

Avoidant/restrictive food intake disorder (ARFID) is a new eating disorder diagnosis in the 5th edition of the diagnostic and statistical manual (DSM-5), published in 2013. The purpose of this review is to describe the creation of ARFID as a diagnostic category, and to explain the DSM-5 diagnostic criteria; to demonstrate what is known thus far about the prevalence of ARFID and characteristics of patients with this disorder; to provide guidance to the pediatrician and other providers on making a diagnosis of ARFID; and to discuss evolving treatment approaches.

RECENT FINDINGS

Several studies have been published recently on the prevalence and characteristics of patients with ARFID. Research has just begun to focus on new assessment measures, approaches to treatment based on established therapies for other eating/psychiatric disorders, and short-term outcomes. Robust treatment studies are in development.

SUMMARY

The addition of ARFID to the DSM-5 has captured a category of patients with clinically significant restrictive eating, but without weight and shape concerns, who were poorly classified in the past. Future research is needed to further elucidate the presentation, characteristics, diagnostic instruments, and effective management.

Adult picky eaters with symptoms of avoidant/restrictive food intake disorder: comparable distress and comorbidity but different eating behaviors compared to those with disordered eating symptoms

BACKGROUND

One presentation of Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by picky eating, i.e., selective eating based on the sensory properties of food. The present study has two aims. The first is to describe distress and impairment in individuals with ARFID secondary to picky eating. The second is to determine whether eating behaviors hypothesized to be specific to picky eating can differentiate picky eaters with and without ARFID from typical eaters (e.g., individuals not reporting picky or disordered eating) and individuals who strongly endorse attitudes associated with anorexia and bulimia (eating disordered attitudes).

METHODS

Participants were recruited from Amazon's Mechanical Turk (N = 325) and an online support group for adult picky eaters (N = 81). Participants were grouped based on endorsement of picky eating, ARFID symptoms, and elevated eating disordered attitudes on the Eating Attitudes Test (EAT-26). The resulting four eating behavior groups were compared on measures of distress and impairment (e.g., anxiety/depression and, obsessive compulsive disorder symptoms, eating-related quality of life) and on measures of eating behaviors associated with picky eating (e.g., food neophobia, inflexibility about preparation and presentation of preferred foods, sensitivity to sensory stimuli, and eating from a very narrow range of foods). The groups were compared using one way ANOVA with post-hoc Tamhane's T2 tests.

RESULTS

On measures of distress and impairment, participants with ARFID reported higher scores than both typical eaters and picky eaters without ARFID, and comparable scores to those with disordered eating attitudes. Three of four measures of picky eating behavior, eating inflexibility, food neophobia, and eating from a range of 20 or fewer foods, distinguished picky eaters with and without ARFID form typical eaters and those with disordered eating attitudes. Picky eaters with ARFID reported greater food neophobia and eating inflexibility, and were more likely to eat from a narrow range of foods, compared to picky eaters without ARFID.

CONCLUSIONS

Adult picky eaters can be differentiated from those with symptoms of anorexia and bulimia by their stronger endorsement of food neophobia and inflexible eating behaviors, and by eating from a very narrow range of foods. Picky eaters with ARFID symptoms can be differentiated from picky eaters without these symptoms on the basis of these three eating behaviors, and by their higher endorsement of internalizing distress, OCD symptoms, and eating-related quality of life impairment. This study provides evidence that ARFID symptoms exist independently of symptoms of other eating disorders and are characterized by several distinct eating behaviors. In a clinical analogue sample of disordered eaters, ARFID symptoms were associated with distress and impairment at levels comparable to symptoms of anorexia and bulimia.