Chuck E. Cheese serves pizza, not broccoli. The business plan developed in the late 70’s capitalizes on the fact that at a young age, many children are picky eaters. If Chuck E. Cheese developed a new plan to serve broccoli or other foods commonly refused by children, families may find themselves in a scene commonly found at homes: families gathered around a table, with the younger children loudly protesting the contents on their plate.
Many kids are picky eaters at a young age and parents frequently go through the frustration of dealing with a “picky eater.” In fact, pediatricians report that it is one of parents’ most commonly cited concerns. Picky eating is simply the norm for many children and families. While this behavior can be very frustrating for parents, it is normative for children to refuse certain groups of food or types of foods. A recent review in Current Opinions in Psychiatry estimates the prevalence of picky eating to be somewhere between 14% and 50% in early childhood. The majority of children are the pickiest around age 2, this gradually declines by their 6th birthday.
What does “normative” picky eating looking like?
Normative picky eating most commonly includes:
In addition, parents often notice picky eaters eating more slowing and children complaining about the texture of certain foods. For example, picky eaters often prefer foods that are smooth, such as bananas, or complain about foods that are very crunchy, such as broccoli. This sensitivity to texture is referred to as tactile sensitivity.
Currently, experts are unsure what exactly causes picky eating. Parents sometimes hear that individuals may be predisposed to picky eating, indicating a potential genetic or biological risk, but the cause is likely to be a combination of both genes and the environment.
Normal development of picky eating can shift from “normative” to “concern” when children have an overalllack of interest in eating or refusing many foods. Additionally, concern may be warranted when children are hung-up on certain details of food such as the shape, texture, or taste, or when they develop fears and worries around specific foods groups.
The updated classification and diagnostic tool used across North America for the treatment of mental health, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V), now recognizes clinical pickyeating, and offers health care providers with clear guidelines for diagnosis. The new diagnosis, Avoidant/Restrictive Food Intake Disorder (ARFID), describes children who persistently refuse groups of foods or have very limited food choices. For example, a child may ONLY eat products with little-to-no color such as bread, pasta, or rice. In addition, to be diagnosed, this pattern of eating needs to be coupled with health consequences such as weight loss, inadequate growth, or not developing in a way that would be expected. Many children with ARFID are also diagnosed with “failure to thrive,” meaning that these children are not even on the developmental growth charts. This pattern of very limited food intake often leads to challenges outside of food as well, such as general anxiety around eating with others or discussing food with friends and family.It is important to note that picky eating and ARFID are not synonymous terms.
What does “clinically significant” picky eating look like?
Meet Sophia: Sophia is an 11-year-old girl who loves Taylor Swift, sleepovers, and anything glittery and pink. Her parents describe her as a “social butterfly;” she has lots of friends, in all different friend groups. When asked to describe herself, Sophia happily rattles off a host of positive personality traits: “I am funny, kind, pretty, smart and a good friend.” Her favorite subject is reading and her least favorite subject is lunch. Yes, unlike most kids, Sophia hates lunch. In fact, Sophia refuses to eat lunch at school because all of the foods “taste horrible.”
Sophia’s diet is limited to Goldfish, pretzels, McDonalds Chicken Nuggets and lemon hard candy. She refuses to eat any food in the presence of ketchup, which makes school lunch particularly challenging. In most situations, Sophia is described as a very outgoing and social child, except at lunch. During lunch, Sophia does not talk to her friends or eat any foods because she is so worried about the foods around her or appearing “weird” in front of her friends. In fact, Sophia has never eaten lunch at school.
Growing up, Sophia’s parents noted that she was a picky eater. She often refused milk and most baby food. She has been referred to multiple eating disorder specialists, gastroenterologists, allergists, and dietitians. Her fears surrounding food have increased over the years, and she continues to refuse new foods. She frequently complains of headaches and a lack of energy.
At 11 years old, Sophia is severely malnourished and underweight. Sophia wants to gain weight. In fact, Sophia would love to eat around her friends and family. She has no fear of weight gain and no body image disturbance, unlike most individuals with other eating disorders.
This description illustrates the behaviors described in the new diagnostic category, Avoidant and Restrictive Food Intake Disorder (ARFID). While many children may go through normative stages of picky eating, sometimes called “food tantrums,” ARFID is not just about picky eating. It is a complex pattern of picky eating that requires treatment to address both the medical and psychological aspects of the disorder. Most importantly, if left untreated, children and teens may be left with serious long-term complications.
How Parents Can Help
While picky eating can be very challenging and frustrating for parents, there are some ways parents can help.
1) Be a role model.
Children observe and notice everything, including what their parents eat. Studies have shown that the food preferences of 2 and 3 year-olds are related to foods that their mother like, dislike, or avoid. Try to express excitement around new foods or to not avoid specific food groups.
2) Exercise patience and persistence.
Giving up when a child continues to refuse a type of food may feel like a short-term solution, but studies have shown that introducing more foods takes many repeated tries. Offering new foods each night needs to be repeated, between 5 and 10 times, before a child may take the first bite. Although it may not work for all foods, studies show that children will eventually learn to like some new foods.
3) Make a wide variety of foods available.
Instead of cooking a limited variety of meals or only purchasing certain foods, provide a wide variety of foods. Be sure to make a wide variety of foods easily available for kids to try out on their own time.
4) Don’t force it.
Make sure to offer new foods, but try not to pressure your child to eat them. Forcing your child to eat certain foods will only cause more stress for you and your child. Try serving some new foods at dinner, along with foods your child enjoys. Or see if you can incorporate new ingredients into their favorite foods. Encourage your child to try everything you serve. In addition, you may want to try out a “one-bite rule;” every child must try at least one bite of the foods on their plates.
5) Offer rewards, not punishments.
Research has consistently shown that children are more likely to change or alter behavior if you offer rewards. When building rewards into trying new foods, it is important to create rules that are non-food related. Children should not view eating vegetables as a chore. For example, broccoli should not be necessary for a brownie. Rewards might be spending extra special time with mom or dad or a getting a few extra minutes playing outside.
6) Early intervention is key.
When you start to notice your child restricting certain foods or limiting food groups, early intervention is key. Early improvements have lasting consequences. On the other hand, once children become picky eaters, it is more difficult to change these patterns and behaviors.
Parents can take early steps if they are concerned that picky eating has become more than just “annoying.”
It may be scary to think that picky eating may not end, or that it could lead to other challenges such as anxiety and avoidance of social situations. However, recognizing the signs and symptoms of the disorder early is important. The new ARFID diagnosis will allow children and adults who deal with extreme anxiety around food to find treatment options. Treatment for ARFID will typically include psychological interventions, nutritional advice or intervention, and correspondence with medical experts. The goal of treatment will be to minimize any physical or nutritional complications as well as anxiety around eating and trying new foods.
While the official diagnosis for ARFID is new, the behaviors associated with the diagnosis are not. Below are a few ways to help evaluate the context surrounding your child’s picky eating to determine whether their picky eating is normative or if they could be showing signs of more troubled disordered eating:
Remember that while ARFID is classified as an eating disorder, it differs from other eating disorders in that the eating difficulties are not related to concerns with body weight and shape. There is also NO evidence that parents are to blame for ARFID, or any other eating disorders for that matter. Rather, parents are often best positioned to help their children recover.
For additional information and support, contact the National Eating Disorders Association Helpline at 1.800.931.2237.
Lauren Breithaupt, M.A.
George Mason University
Dear Beckett, Sophie & Sammy,
This is a special week for your momma and a lot of other people too. It’s a week where people speak up about a sickness that is very serious, but sometimes not talked about very much. You know I’m a psychotherapist (I know, I know, emphasis on psycho) and that I help people with eating disorders. I haven’t talked to you much about my work because it can be pretty hard to understand. When I come home tired, you make me smile as you remind me of your idea of what I do: “You just sit and talk to people all day! What’s so hard about that?” Daddy’s work is much easier for us to see as we can drive by the houses and businesses he has helped build. My work must seem sort of invisible when all you see is an office with comfy furniture.
Since you guys are getting a little older, I wanted to tell you something that’s important about me. For seven years I had an eating disorder. I was very sick for a long time, mostly when I was in college, but I’m all better now. When I married daddy I was slowly getting healthier every day. Finally, I had something way bigger than my eating disorder to help motivate me – I wanted to be a mom.
You see, I had been praying real hard to be a momma. It was my biggest dream since I was a little girl. I told my third grade class on ‘Career Day’ that when I was all grown up, I wanted to be a mom. When asked in graduate school what I planned to do with my degree, I pretty much answered the same way. I don’t think anybody was looking for that response, but it didn’t matter to me, because being your mom is my true calling (the thing I was meant to do while I’m here on earth). But I was really scared that, because I had been sick for so long, maybe my body wouldn’t work right anymore and that my dream might not come true. I promised myself that if I was able to get pregnant, I would lay down my eating disorder and fight as hard as I could, once and for all, to stay well for you guys and for myself.
Want to know something really special?? The day I found out I was pregnant with Beckett, I committed to that big promise that I had secretly carried around in my heart. I’ve kept the promise for thirteen years and I’m really proud of myself for that, because it means I can really be here for you.
Even though it was hard being sick for so long, something beautiful came from it. I learned that I have another very important calling that’s really meaningful to me. When I was sick, I had a hard time finding anyone to help me who really understood how to do so; eating disorders are tricky to heal. I wanted that to be different, even if only in a small way for other people. So daddy and I moved to the same college town where I was sick, and now, I help a lot of other college students get better. Every day I feel so lucky and blessed that I get to be your momma AND that I help other people get well.
I’ve made some new promises along the way. Some of them may seem silly, but oh well, you know I’m kind of silly.
1. You will never hear me order a ‘Skinny Latte’ from Starbucks. It’s just too stupid to say out loud and brings up unnecessary questions.
2. When you want to order pizza and have a picnic in the living room, I will be the first to get it all set up and eat with you. Always. Because pizza is delicious!
3. If you want to throw on swimsuits on the first warm day of summer and run through the sprinkler in our front yard, I’ll do it with you! I don’t feel the need to hide my body anymore. In fact, I’m really proud of the body I have. It helped me grow and feed you!
4. You will never hear me complain about the way my body looks. The way I feel in my body and how I talk about it has an even bigger impact on you than what I say to you about your body. I wish more moms knew this – maybe they would talk more lovingly about themselves.
5. I refuse to be the mom who orders a salad, “Oh, and could you hold the croutons and cheese and put the dressing on the side?” (If salads like this feel really nourishing and satisfying to you, great! For me, a salad like this would feel restrictive.) Nor will I ever go on a cleanse, a detox, or a diet. I spent SEVEN long years doing that, and it’s so NOT FUN! What I eat communicates a lot more to you than what I feed you.
6. We will talk about what ‘sometimes’ foods are and what ‘always’ foods are and you will know the difference. I added this as a new promise when you came home and told me one of your friends said that McDonald’s makes people fat and you didn’t want to eat there anymore. Wait, what?? Sometimes as a mom, you have to do some deprogramming because other people and the media don’t always convey the truth. There is no restaurant, or food for that matter, that can ‘make you fat.’
7. I promise to show you that it’s important to move your body in ways that are fun and feel good to YOU. I won’t spend my time running away from myself in the form of over-exercising. It’s way more fun to play with the three of you anyway! But when you are upset that I’m leaving to go to yoga, I want you to know that it’s important for me to love and take care of my body, just as I love and take care of yours.
8. I will share with you what a powerful messenger your body is and encourage you to listen to it – like when it tells you to rest when you are sick or hurt and how hard it fights to get well, all on its own. Our bodies are really cool that way!
9. I made another new promise as we pull through the carpool line after school and I heard, “Mom, what does it mean to have a six-pack?” (And yes, I needed to take a minute before we talked about this, because I was so upset that elementary-aged kids even have these conversations). You will be surrounded in this lifetime by conversations about weight and shape. It’s important for you to remember that we all have unique body types and comparing ourselves to others (really in any way) just doesn’t feel good. So, I promise to teach you how to turn the conversation away from this kind of talk, and move on to topics that relate to your friends’ insides, rather than focusing on their outsides. Doesn’t that sound more fun?
10. We are going to talk a lot about how we mess up – every day. All of us. It’s just part of life. We need to get cozy with the idea of imperfection! Most importantly, I want YOU to know, in your heart, how wonderful, special, and amazing you are – because I’ve learned it’s not enough for me to think that about you, you need to believe it too.
So, my sweet loves, those are some of the promises I hold in my heart so I could stay better and to help protect you from this illness. I’m not going to get it right all the time. And that’s okay, too. I never promised to be a perfect mother. I figured out as I got better that there really is no such thing as perfect. But then I had each of you, and wondered if that was really true. As I got to know you, I realized that much like me, you are perfectly imperfect.
I’m so grateful that I have the three of you and that I’m all BEDR (pronounced better and stands for Beautifully Eating Disorder Recovered)!
Love you with my whole heart,
by Angie Viets, LCPC
Angie owns her own private practice in Lawrence, Kansas and treats adults struggling with the following concerns: eating disorders, mood & anxiety, or simply . . . life! To learn more about Angie and her practice, visit her website.
This is for anyone who feels as if an eating disorder has taken over their life or a life that they love. If anything, I hope to encourage those who feel as if they’re stuck in a hopeless place and to assure them that there is always a way out.
Three years ago, the girl that I once was stood in the shower contemplating her purpose. She looked down and saw nothing – nothing but the gift of life fading away. She spent days in solitude questioning if the world had more to offer her than her appearance. She was constantly praised for her thin, athletic figure. Meanwhile, she was held hostage in her own body, chained to her rigid routine that she was tricked into thinking kept her from drowning. Yet it was pulling her deeper. Deep down, she wanted more for her life. The days passed, each the same as the one before, and she grew cold, tired, and weak. Her family remained silent. They did notice the changes in her behavior and in her physical appearance, but they too praised her for her for what they labeled a “healthy” lifestyle. They failed to see the truth – the truth that she was dying. She was alone in her war. When she finally hit her rock bottom, she knew that she had two choices: to fade away or to give up control, choosing life.
She chose life. She accepted help, took small steps, and stayed faithful to the guidance of professionals. Her days no longer looked the same. Nothing became easier. Rather, each day was a new battle to conquer. Controlling her intake and her physical appearance became less and less important as she got to know the girl inside of her – a girl who was made for more. That girl today is ME. I am whole. I am renewed. I am healed. I am liberated from my dark past and free to explore a new future. Throughout my recovery, my hope came from the boys and girls, the men and women who would one day need to know my story. I stayed the course of recovery, and today I walk in freedom. But I am not done with my eating disorder. It is a part of me, and it will always be a part of me. I embrace the trials that I faced as a part of my story that has only just begun.
Family and friends can and should play a huge role in the recovery process. It’s important to walk hand-in-hand with a loved one through this time, to help care for their hurting heart. Unfortunately I did not have my mother or father’s encouragement through my toughest years in my eating disorder. This did, however, motivate me to seek professional help. My treatment team was incredible; they saved me. I’m so thankful for the care and guidance I received, but I cannot help but think that if my family had had a greater understanding about what I was going through, I would have entered treatment sooner, perhaps saving me from at least some of what I endured. Knowing how to communicate with empathy with someone who is suffering from an eating disorder is critical. Having people in my life who understood my struggles, who truly cared, who listened without judgement, and who treated me like they would anyone else helped me to find a safe place to heal. While fighting for my life, I learned to become stronger than my eating disorder.
For those of you who feel like an eating disorder is taking over your life or a life that you love, let me finish with this: “Don’t let the enemy win a battle that you never had a chance to fight” (George S. Patton). Take on the challenge of recovery. I promise that it’s worth it. There is freedom in the healing process. And with healing comes life. I am healed, I am free, and I urge you to allow yourself or to give someone you know who is struggling the push they need to start on their own path to recovery so that they may too experience what it means to truly live.
Visit the National Eating Disorders Association website for more information about eating disorders and to seek help.
by Nikki Budreau
Senior, Olathe Northwest High School (Olathe, KS)
“I want to lose weight.”
The thing I hear the most from my clients is their desire to be accepted and loved. But that’s not how they’re saying it. It’s the whisper that I hear beneath their body hatred.
Sadly, we have been told our whole lives that our acceptability depends on our appearance, primarily thinness. It starts at such a young age. Kids are bullied about their weight. Well-meaning doctors and parents tell kids to lose weight. Mothers go on diets with their daughters. The fashion industry tailors clothes to the thin ideal, a body type that only approximately 5% of people can naturally achieve. Magazines, social media, TV, and movies show us images of thin, ripped, and toned celebrities – the underlying message that we must look this way to be considered beautiful. Weight bias is everywhere. It’s no wonder people walk around worrying about their weight.
And then there’s the fruitless pursuit of thinness. Studies show that attempting to lose weight (i.e. dieting, whether it’s a formal diet program or just your own attempt to lose it) might temporarily work, but that 95% of people regain the weight they lost, often plus some. Then comes the self-deprecation and sense of failure. As if you did something wrong – when the diet was never going to work in the first place, at least not for the long-term.
Consider the common behaviors of a person who is on a diet:
Is this the type of person you want to hang out with? Someone who is so distracted that being present in the moment is nearly impossible? If the underlying goal of losing weight is to be loved and accepted, the behaviors that it takes to get there pull you in the opposite direction, leaving you disconnected.
Imagine a world where there’s a radical shift from our current thinking, and body diversity is accepted, thus there’s no need for dieting. What would you do with the time and energy you’ve put into controlling your eating? Perhaps that time could be used toward loving yourself and others.
So when I hear someone say, “I want to lose weight,” what I really hear is, “I want to be loved.”
By Katy Harvey, MS, RD, LD
Katy works as a Registered Dietitian at InSight Counseling in Overland Park, Kansas. She is passionate about helping others find peace with food. To read more from Katy, click here.
It seems as if everywhere we look we’re bombarded by reminders – sometimes obvious and sometimes subtle – that our bodies aren’t good enough, that we’re not good enough. These reminders come in many forms: tips for slimming down that are shared among friends, Internet articles advertising the latest strategies to help you cut carbs or eat clean, devices that are marketed to consumers to use to count their steps and to monitor and rigidly control their exercise, and magazine headlines and television shows that perpetuate the notion that being heavy is the worst possible outcome for our lives. Do you see anything missing from this list of culprits? Gyms. Gyms are among the worst offenders in terms of triggering body dissatisfaction. Here are three of their sly, yet simple tactics to keep us disliking our bodies and to keep us coming back for more.
1. Displaying images of perfectly toned, slim, scantily clad women and strong, sinewy men. You’ve seen them – the men featured are as lean as can be, hairless, with chiseled abs and bulging biceps, effortlessly pumping out 45-pound dumbbell curls. Similarly, women are pictured wearing sports bras and Spandex shorts, with smooth, sun-kissed skin, make-up, not a hair out of place, and not a bead of sweat on their brow as they pedal to nowhere. Sometimes these images are accompanied by a quote of some sort, like “Strive for progress, not perfection.” Interestingly, however, these images portray what most of us see as perfection.
When I go to the gym, I look nothing like what is described above, and generally neither does anyone else. These images do not depict reality. Rather, images like these contribute to “gymtimidation” and they perpetuate the drive for perfection in our culture. Gyms are for everyone – people of all shapes and sizes and varying degrees of fitness. And exercise is not one-size-fits-all. Yet these images suggest otherwise.
You certainly don’t have to fit within the narrow constructs of our culture’s definition of perfection in order to step foot inside a gym or to start an exercise program. And achieving “perfection” certainly should not be your ultimate goal when it comes to fitness. Furthermore, exercise itself doesn’t have to look this way or that way. Exercise can be whatever we want it to be, as long as we’re moving our bodies. And it doesn’t even have to occur in a gym! Exercise can occur anywhere. And it should be fun. And sustainable. And free of judgement.
2. Posting signage suggesting that excuses are not tolerated. It’s generally acceptable to skip out on a day at the gym when we’re overly sore, tired, or ill. Right? Well what about this? Your close friend is in town for just a few short hours overlapping your Zumba® class, and you have no other time to sneak in a workout that day. What do you do?
a. Tell your friend that you have plans and attend your Zumba® class as usual.
b. Skip Zumba® to grab a bite to eat with your friend, and spend the whole evening beating yourself up.
c. Skip Zumba® to have dinner with your friend; you can go to Zumba® class again later this week.
The best answer? Option c. But is this an excuse? If you view exercise as something that is a part of your life, but that is not the most important part of your life, then no. For some, exercise is inflexible and compulsive – their life revolves around exercise as opposed to the other way around. Setting out to never miss a day at the gym is unrealistic. Furthermore, the “never miss a workout” mentality is unhealthy. “No excuses!” messaging tends to induce feelings of guilt and shame and to propagate an all-or-nothing approach to exercise that is the opposite of healthy.
3. Using language that portrays exercise as way of punishing our bodies. I’m sure you’ve seen these too – motivational posters that read “No pain, no gain!” Or promotional signs for a new fitness class called “15 Minute Booty-Blaster.” Or a sign in the retail area of the gym amidst the nutritional supplements that reads, “Fight belly fat today!” The fitness industry is guilty of using language that not only places value on appearance over health but that also implies that our bodies are inherently bad and that we need to punish them – as if having anything other than a totally flat mid-section is a mortal sin. In an effort to inspire and motivate us, they’re encouraging us to hate ourselves. And they’re succeeding.
We should not apologize for our bodies. Rather, we should celebrate our bodies. As opposed to punishing our bodies through exercise, we should engage in exercise that we truly enjoy and that makes us feel good. And this looks different for everyone. Exercise as a way to give back to your body. After all, exercise comes along with countless benefits that have nothing to do with aesthetics.
The next time you visit your gym, take a few moments to look a little closer at what is posted on the walls and printed on signage. What messages is your gym sending to you and the other guests? How are they keeping their customers and drawing new ones in? Are they encouraging self-compassion or are they contributing to guests’ body dissatisfaction and self-hate?
by Jessica Lee Betts, MS, RD, LD
REbeL Program Director