It’s Not Just “Fussy” Eating: Raising Awareness of ARFID

The 4.5% of children and teenagers* labelled as “persistent picky eaters” could have an undiagnosed eating disorder, according to NHS experts.

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder unlike Anorexia Nervosa or Bulimia because individuals are not concerned about their body image or trying to lose weight. There is currently no solid data for how many people in the UK have ARFID as it is very often conflated with “fussy” eating. However, in a systematic review** of 30 studies, the estimated prevalence of ARFID in child and adolescent samples ranged between 0.3% and 15.5%.

ARFID is characterised by a limited range of food intake by eating only “safe” foods and avoiding entire food types, leading to difficulty meeting nutritional and energy needs, weight loss and health problems. This can be for reasons including sensory sensitivity, fear of negative consequences from eating, and/or a low interest in eating.

With Eating Disorder Awareness Week currently underway, the NHS-backed psychoeducational website, Be Body Positive, is urging parents, carers and health professionals to find out more about ARFID, listen to people’s stories with empathy, to offer support and avoid judgement. Be Body Positive, which is in partnership with Barnardo’s, also encourages people who have concerns to seek support from their GP should they have any concerns about diet and nutrition.

NHS specialist eating disorder dietitian, Paola Falcoskihas developed self-guided modules on ARFID for Be Body Positive. These include evidence-based resources from Cognitive Behavioural Therapy (CBT) and Exposure Therapy, as well as resources for parents, carers, schools, and health professionals.

Paola said: "ARFID is a complex eating disorder that requires a multifaceted approach to treatment, but recovery is possible. People deserve the right support in navigating their journey towards recovery."

Tahlia David, who had eating difficulties since childhood, was finally diagnosed with ARFID when she was 20 years old. Tahlia's experience with ARFID began at a very young age, but like many others, she was initially dismissed as a “fussy” eater before eventually being misdiagnosed with Anorexia Nervosa as a teenager due to significant weight loss.

For Tahlia, the impact of ARFID extends far beyond the dinner table to emotional, psychological and physical symptoms which make day-to-day life difficult. Tahlia has an above-average sense of smell and taste; she finds certain textures fear-provoking; she can’t eat different foods if they are together on her plate and she has an intense fear of food poisoning which causes distress and nausea long after mealtimes. This has impacted on Tahila’s social life and, as she was misdiagnosed as a teenager, she missed out on vital treatment earlier, when her symptoms were less severe and her physical and mental health were less impacted.

Tahlia said: "Growing up, I felt misunderstood and isolated because of my eating habits. It wasn't until I was properly diagnosed at 20 that I understood why I struggled with eating. Knowing that ARFID exists has been a validating experience, connecting me with a community of people who share similar challenges."

Tahlia's story highlights the importance of ARFID awareness, particularly in educational and medical settings where early intervention can make a significant difference in treatment outcomes. 

Tahila added: "Schools and GPs should be more aware of ARFID and other eating disorders that develop early. Words and attitudes matter.”

For further information and resources, connect with Be Body Positive on Instagram, TikTok (@bebodypositive_nhs), or X, previously Twitter (@BBP_NHS), or visit the official website www.bebodypositive.org.uk.

Follow Tahlia's journey @tahliapaiged on X and stay tuned for her upcoming blog on www.bebodypositive.org.uk

References
 *Cardona Cano S, Tiemeier H, Van Hoeken D, et al. Trajectories of picky eating during childhood: a general population study. The International Journal of Eating Disorders. 2015;48(6):570–579.
**Sanchez-Cerezo, J., Nagularaj, L., Gledhill, J., & Nicholls, D. (2023). Whatdo we know about the epidemiology of avoidant/restrictive foodintake disorder in children and adolescents? A systematic review ofthe literature. European Eating Disorders Review, 31(2), 226–246.