What Is ARFID and How To Treat It with Grace Wong

Hola amigos! Welcome back!

Tune in as Grace Wong and David Orozco discuss a newly recognized eating disorder, ARFID.  ARFID stands for Aversive Restrictive Food Intake Disorder and professionals are just now starting to understand it.

Highlights of this episode:

• What is ARFID?
• Who is likely to develop ARFID
• Assumptions in eating disorders
• How trauma affects eating
• Treatment of ARFID

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Introducing Our Guest:

Grace is a registered dietitian in Canada specializes in feeding and eating disorders.  She has been practicing as a dietitian for over 17 years, primarily in eating disorders, pediatrics, and mental health.  Grace works with clients of all ages living with feeding and eating disorders through a developmental lens.  She is experienced in working with co-existing conditions such as attention-deficit/hyperactivity disorder, autism spectrum disorder, sensory-based challenges, complex medical conditions, addictions and trauma.  Besides her clinical practice, she provides training and supervision for professionals in Canada and overseas.  She has written and developed various professional guidelines and papers on ARFID.  Grace is currently working with a group of multidisciplinary colleagues in developing the Responsive Feeding Therapy framework and resources to support this therapy approach.

Episode Description: 

[13:50] Introducing Grace Wong, RDN

Grace works with children and adults with a variety of eating challenges. She does not claim to be an expert, only because there is so much more for everyone to explore and learn about the connection between the neurological state and feeding.

Since at least the 1970’s, eating challenges have been largely unexplained, except that there has always been a recognition that eating disorders is beyond physiology. Practitioners were unsure about proper diagnosis and providing interventions. Today, more and more research is being done to explore feeding challenges and eating disorders. The DSM-5 did include ARFID, Aversive Restrictive Food Intake Disorder, in the last update to give providers some awareness, but there is not prescription to follow. The DSM-5 can be vague and tricky for real life situations.

Why is eating difficult? What can we see and not see? Dietitians are trained to explore why the eating is not taking place, but dietitians cannot diagnosis an eating disorder.

A “limited diet” nutrition diagnosis is common in dietetics and is often connected to various sensory variations in people. Sometimes the crunch or environmental noise is very disrupting to sensitive individuals. Taste, texture, sound, smells, etc., can all be triggers for rejecting food or the act of eating. The sensory experience can be complicated by other experiences, like history or other medical conditions.

[26:31] Aversions to Eating

A history of vomiting, nausea, or other stressful events can lead to aversions with food and eating patterns. Many families have been pushed aside in care since there was no recognized diagnosis for these behaviors.

Body image can be compromised with eating disorders. Whether that is a man feeling too small or women being rewarded for being in small bodies or people in larger bodies being shamed for their eating patterns. This can interfere with social activities. Limited diet, low appetite, or aversion to foods are all flags for this diagnosis.

A journey can be unique, but themes are present in clinical experience. Grace helps clients work on food relationships and the process of food acceptance. There is a lot of timeline pressure for healthy eating, and this alarms parents to rush the child’s timeline, creating stress.  This stress is counterproductive to creating healthy eating habits.

[36:56] Trying New Things

Biological vulnerability refers to someone’s genetics and environment being triggers towards ARFID behaviors. That is not to say that parents and children are mirrors of each other. Some parents are adventurous while children are very conservative with food exploration. Grace helps parents through the pressure of feeding their child well. Parent guilt triggers pressure to feed the “right way.”  Guilt is amplified by public messages and social media content.

[46:18] Boys and Girls

ARFID is more common in males; however, more females seek treatment. David and Grace wonder how this plays out in non-binary or transgendered adults.

[51:00] Trauma and Eating

Grace and David acknowledge how a stressful eating environment can potentially influence mental and physical health in the long run. How will child survivors of political upheaval be eating as adults? What happens when a traumatized person is settled within another food environment? Do providers have enough recognition and tools to help marginalized populations?

[58:00] Large Bodies and ARFID

Body size does not have to do with the way we eat. This is a common misconception. The DSM-5 only recognizes underweight bodies as a qualifier. However, weight is not a needed criteria for the diagnosis. Unfortunately, the underweight criteria could be taken into a bias perspective for diagnosing people in other body sizes.

[1:02:27] No Standardized Treatment

While evidence-based research is important, Grace is skeptical we could ever create a standardized treatment plan for disordered eating that is highly personalized through the patient’s story. The most important part of Grace’s process is to peel apart the layers of a person’s “why.” She likes to remove stressors and barriers to give the person, child or adult, the best chance to make eating work for the client. Grace teases out what works for the client and what does not work for them. She works with family dynamics and immigrant transitions. The general goal is to evolve the client’s eating and improve their quality of life.

Links from This Episode: 

Grace Wong’s Contact: https://www.facebook.com/gracewongrd

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Chop the diet mentality; Fuel Your Body; and Nourish Your Soul!