A large national survey found that adults who struggled with selective eating habits as children were more comfortable using positive and encouraging strategies than coercive or violent methods.
A Duke Health team conducted the study among those who been struggling with food avoidance. It was before it was recognized in 2013 as a mental illness, Avoidant/Restrictive Intake Disorder (ARFID).
Researchers reported their findings, published online Nov. 11 in the International Journal of Eating Disorders provide guidelines for families and health professionals to devise the most effective strategies for extreme food aversions.
ARFID is a diagnosis for severe picky eating. The condition is characterized by health issues like weight loss or nutritional deficiencies. It can also lead to emotional and social issues when mealtimes are an area of tension, shame, or friction.
It is not surprising that positive approaches were the most popular, but it is quite shocking how prevalent this view was in this group.
Nancy Zucker, Ph.D. Professor at Duke’s Department of Psychiatry and Behavioral Sciences
Zucker was a co-senior researcher in the study with Guillermo Sapiro (Ph.D.) who is a professor of electrical engineering at Duke’s Pratt School of Engineering.
Zucker, director of the Duke Center for Eating Disorders, said the broad consensus was a confirmation of the current treatment strategy that emphasizes positive interactions “It is robust confirmation for what was previously reported in the literature, and reinforces the notion that children being forced or pressured to eat is not helpful.”
The study was launched more than a decade ago when severe food avoidance was receiving attention, and research into the disorder was not extensive. The online survey was targeted at adults who self-described as current picky eaters to understand their views and experiences.
More than 19,200 respondents were included in the survey; 75% of them were female, 25% were male, and 89% were white. Respondents were asked to share food presentation strategies used by their parents or caregivers that they found to be helpful or not helpful in enhancing the variety of food available.
Based on the extent of impairment caused by food avoidance, survey participants were classified as having ARFID or not. People who claimed that eating disorders caused significant weight loss, nutritional deficiencies and/or impairment to job performance and/or disruption to social relationships were categorized as likely to have ARFID.
The task of interpreting the narrative responses from the huge cohort of participants created an issue with logistics, which was solved with the application of sophisticated artificial intelligence tools.
Researchers employed a computer program to assess the perceived value of strategies for feeding parents to determine their effectiveness. They then used an algorithm to interpret survey responses and classify them as helpful or ineffective.
“From technical standpoint, this study used an AI application that can understand language that includes more than words and sentences, but concepts of paragraphs. This was essential in this study,” said J. Matias Di Martino, Ph.D. co-author with doctoral student Young Kyung Kim. Both are from Duke’s Department of Electrical and Computer Engineering. “By analyzing both the positive and negative emotions, we are able to look at the entire memory of nearly 20 000 people.”
The study revealed that 39% of the themes regarding helpful strategies mention an emotional or positive context, such as using food to teach nutritional or cultural lessons, being flexible about the approach to food, providing plenty of safe foods, helping with the preparation of food, or presenting foods from specific food groups.
40% of the positive comments emphasized the importance of the structure of eating. Clear expectations about eating were considered to be beneficial in the context of separating between being “forced” and being required to do something.
While positive and encouraging strategies were perceived as helpful in improving attitudes towards food and minimizing social discomfort around eating, many adults still struggled with a degree of avoidance/restriction. Researchers found that parents have an impact on their children even when their children still avoid food.
The study participants clearly found some foods to be abrasive, not just unpleasant. This may have increased their sense of being trapped and made to do something disgusting in the event that they were forced to eat the food.
Zucker said that there isn’t any published research that suggests effective feeding strategies for patients with ARFID. “Figuring out the most effective way to feed a child with severe food aversion can be exhausting and stressful for parents, which is why providing guidance is vital to enhance the social and emotional eating environment for their children, and to reduce the distress that both parents and children feel during mealtimes.”
Kim, Y.K., et al. (2021) Parent strategies for expanding food variety Reflections of 19,239 adult with symptoms of Avoidant/Restrictive Intake Disorder. International Journal of Eating Disorders. doi.org/10.1002/eat.23639.
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