What Is ARFID? When Restrictive Eating Goes Beyond Picky

Is it picky eating or something deeper? Unpacking ARFID with RD Kristen Nyampong
Diabetes Digital Podcast by Food Heaven
0:00
Is it picky eating or something deeper?
Welcome back to another episode of the Diabetes Digital Podcast.
And today, we’re unpacking Avoidant or Restrictive Food Intake disorder, also known as ARFID, with our one and only registered dietitian, Kristen Nyampong.
0:17
You may have never heard of ARFID before, but it’s getting more attention lately.
Even New York Magazine ran a recent cover story on this type of eating disorder.
And what makes ARFID unique is that it’s not about dieting or body image.
It’s a type of eating disorder that is characterized by someone avoiding or restricting food for reasons that have nothing to do with weight or shape.
0:39
Things like sensory sensitivities, fear of choking or vomiting, or general lack of interest in food.
And it can even go deeper than that.
Some people develop ARPIT after a traumatic event around eating, like choking or food poisoning.
Others struggle with anxiety, OCD traits, or medical trauma that makes trying new foods feel impossible.
0:59
It can even lead to nutrient deficiencies, fatigue, and social isolation.
Yet it’s often mistaken for picky eating.
Also, when we look at ARFID through a cultural lens, the gaps in understanding get even bigger.
In bipod communities, for example, ARFID is often missed, mislabeled, or misunderstood, and cultural foods get pathologized.
1:20
Family dynamics are overlooked, and care often isn’t trauma informed.
So in this episode, Kristen breaks down what ARFID really looks like, how it’s often missed, and why it can show up differently across cultures.
We will also talk about how to expand food variety without pressure or shame, navigate family dynamics if you are a loved one is living with ARFID and how do it provide care through a trauma informed weight inclusive lens.
1:47
Our guest today is Kristen Nyampong, who is a registered dietitian at Diabetes Digital based in the Dallas Fort Worth area.
She practices through a trauma informed weight inclusive lens and helps teens and adults heal their relationship with food and body image.
Before joining our team, Kristen worked in an eating disorder treatment clinic supporting clients through recovery from ARFIT, anorexia and binge eating.
2:09
At Diabetes Digital, which is our practice, she specializes in disorder, eating, type 2 diabetes, pre diabetes and PCOS.
Yes, we are so excited to talk to Kristen today.
We’re going to be talking about strategies that help clients, especially younger clients to expand their food variety without pressure.
2:28
Also how to approach family dynamics because it can get very tense especially between parent and child when trying to introduce new foods into the plate.
So we’re going to talk about strategies that parents can implement in the home, also exposure therapy, what that means and how parents can implement that working alongside their therapist if they have one, and their dietitian.
2:53
Also going to touch on strategies that dietitians can implement if they come across someone that has ARFID and how to distinguish, like is it ARFID or is it really selective eating?
So this episode has so many gems.
It’s going to be so helpful, especially if you know someone that has really restrictive eating habits that might potentially have our fit.
3:16
So make sure that you listen until the very end, and we are going to jump right in.
Welcome to the Diabetes Digital podcast.
I’m Wendy.
And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.
Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes.
3:36
And pre diabetes.
Visit diabetesdigital.co.co to book your first appointment.
We accept insurance and offer affordable self pay options.
Now let’s get into today’s episode.
So Kristen, we are so excited to have you.
3:52
Welcome to the podcast.
Hi, thanks for having me.
Hey, Kristen.
So we thought that we could kick off the conversation by you telling us a little bit about how you got into this line of work.
Like I was saying, it’s not as common to see black dietitians who are doing disordered eating work.
4:10
So what got you interested in that?
Yeah, that’s a great question.
So I was in college and going through my own things when it came to a lot of disordered eating and continuing to heal my relationship with food.
And at first when I wanted to do dietetics, I wanted to do like plant based eating or I think I was also interested in pregnancy.
4:35
But once I was really focused on like, healing my relationship with food, I noticed that I had a story worth sharing with people, and I wanted to support people through disordered eating, specifically within the bipoc community and especially with Black women.
4:51
I know you say you have a story you wanted to share.
Are you comfortable sharing that story on this podcast?
Yeah, sure.
So a lot of my own disordered eating happened in middle school.
There is like some research to support that when black women are feeling like they’re almost like contesting with like acculturation and being in a white dominant society that it does kind of push them towards adopting like a thin ideal.
5:20
And I think with my own like internalized racism that I had and I was like healing from and trying to like see myself and kind of like the beauty ideal.
I was thinking that I had to be smaller.
And so I was adopting a lot of unhealthy sort of practices like counting my calories, not really eating throughout the day.
5:44
And I was literally like 12 or 13 when I was doing it.
Which when I think about it, it’s like really sad that at such a young age, I was so like aware of being in my body and a negative way.
And as I was coming more into accepting myself as a Black woman and seeing more people who looked like me, also, this was like the early 2000s, so there weren’t many people that looked like us, I started to appreciate the generations before me and their food practices that have helped me stay alive and my own family alive.
6:22
And it made me kind of heal my own relationship with food and body.
And I mean, that’s like a, it’s a fluid sort of thing.
It doesn’t kind of just happen all at once.
Yeah, thank you so much for sharing that.
I didn’t know about that, but I could definitely relate.
6:38
Yeah.
Especially being another black woman, it’s it can be hard because almost we have like two different ideals because we live like in this culture, in this media that is more Eurocentric.
But then the same time some of our culture has other ideals as well on top of that.
6:57
Like I’m just thinking of Cardi B and what did she say in this new album?
Something about like, my booty has 50 inches or something.
And it’s just like she’s like, that was like the that was the flex like, and my booty got 50 inches.
And so it’s like, OK, like then it’s all these other, you know, we we all know that Cardi has had that booty surgically enhanced.
7:18
So it gets tricky.
Now I want to get into like jump straight into disordered eating and what it looks like.
I know you work with a lot of our patients who do have disordered eating, and you actually used to work at an eating disorder clinic as well, which is why you have such a unique experience.
7:36
How do you typically see it show up with the patients that you work with?
Yeah.
So I like to think of disordered eating as like a step before an eating disorder.
And so it’s often the case when someone’s intake is not severely impacted by rules, beliefs or even like some rigidity that they may hold, but it’s still a bit compromised.
7:57
And so most people who do have disordered eating.
And so a lot of people in our society actually do hold disordered eating.
It’s often fad diets.
It’s overall just rules when it comes to eating, like thinking that like all your food needs to come from Whole Foods to be considered healthy or like no carbs after 2.
8:18
Also, like I’m seeing a lot of people like having this like big obsession with protein now and so that can become disordered.
But the difference highly between a disordered eating and an eating disorder is that a person can still obtain most of their macro nutrients.
8:34
They’re not like severely under or overfeeding themselves.
And and the level of care that we work in and outpatient, we I mostly do see disordered eating.
I wouldn’t work with somebody who is very compromised in this level of care because they would need something very highly structured with a higher level of care.
8:55
And with people with diabetes, we’ll see them wanting to, like, eliminate sugar, like, totally.
Or I’ll even hear some patients say like, oh, yeah, I like, I had a weekend and like, I was eating like a lot of sugar and foods that were fried.
9:10
And so I feel like I have to get on a juice or cleanse.
And so that’s kind of another form of disordered eating.
And it is disordered eating is just very highly normalized in the black community.
It’s like we don’t even put like a name on it.
Yeah, it’s so interesting because.
9:27
I.
Meet with different doctors for diabetes digital for referrals.
And I think it is very normal in the black community to have disordered eating even at like the medical level ’cause it can very much.
9:43
I think people are wanting to relate with me as a dietitian and like, oh, like saying things like, oh, they shouldn’t be eating this or oh that, or I tell them to cut out this and I’m thinking like, Oh dear, give us those patients and don’t say anything please.
But there are so many different types of eating disorders, like within the, you know, disorder eating umbrella.
10:05
One of those in particular is called ARFID, which I think is getting a lot more popularity these days.
I sent to the dietitian group chat at diabetes did fill this New York magazine article that was really long but excellent about ARFID, which stands for avoidant restrictive food intake disorder.
10:24
And essentially it is when people aren’t trying to restrict their food to like control their weight or shape, but more so they avoid or restrict foods.
Typically.
From my experience, I haven’t had that much experience with ARFID, but like the couple patients I’ve had, it’s like they had a traumatic experience where maybe they threw up in front of the class in second grade.
10:48
And then from there they will never eat like foods that aren’t packaged because then they can control like they know the ingredients and that they’re safe.
So having said that, I know that you specialize in ARFID.
You even did an in service for our dietitians on this topic.
You have patients with this.
11:04
How do BIPOC patients present in that subcategory?
Yeah, I often feel like BIPOC individuals who do have ARFID are just thought of at an early age for just being like a super picky eater.
11:20
It’s like not necessarily like a thing.
Like it’s almost like white children get that ability to like have it be a thing or like their mothers go like, Oh my God, we must like find someone to like help correct this, but not necessarily for, especially because it does like happen a lot when someone’s growing up.
11:38
So it doesn’t necessarily happen like when they’re younger.
But yeah, I feel that it comes with just picky eating, but it’s more than that.
So there’s like 3 distinct sort of characteristics when it comes to ARFID.
There are sensory versions, which is like maybe not wanting to eat red foods because it reminds you of something like gross or foods of a certain color because it feels like you should.
12:04
Food shouldn’t look that way.
A lack of interest in food.
So just like I will often hear people say like, yeah, like it’s just something I have to do.
It’s not something that I’m necessarily, like, interested in doing.
And then fear of an adverse consequence, which is what you just said before, which is like, yeah, I threw up one time when I was in middle school and it was so traumatic.
12:26
Like I am not going to eat foods from this family or this type of food again because it was like a really horrible sort of experience.
And the way to that we sometimes see it present with people who do have like insulin sensitivity or diabetes is that when cuz people with AFID go through like eating is always difficult.
12:49
But then there’s some moments when it’s especially difficult.
And then they do rely on their safe foods a lot more.
And some of these safe foods do have more carbs, sugar or salt.
And so that can sometimes lead to them having a higher A1C when they’re in this really difficult period with eating and that’s all they’re eating.
13:08
And then as they see it attributed in their labs.
Is there any intersection with ARFID and autism?
Because I’ve seen similar restriction happen in kids that have autism where it’s like very carb forward or just like the very intense restriction around certain food groups.
13:30
Have you seen that?
Yeah, yeah, there is definitely an association between ARFID and autism, autism spectrum disorder.
It’s actually, like, especially common in the neurodivergent population.
Like a lot of the research was on boys who do have ASD and ARFID, and they noticed that with autism, like, they did have this more selective eating pattern.
13:56
And again, like, it wasn’t associated with like, body image issues, but it was still to the point where their food intake was so, like, severely impacted and they weren’t getting the nutrients that they needed.
Their vitamin D was low.
They’re losing significant weight.
14:11
They weren’t growing.
And so, yeah, there is that association.
When I used to work in Pediatrics, I always got referrals for picky eating.
It was like every single day.
And how do you distinguish?
14:26
Because I’m sure there’s like even parents listening where it’s like, Oh my kid.
I mean everyone always asks me as a dietitian, even friends, family like hey, he only eats 5 things like when is it quote picky eating?
And I know that there’s, like, issues with that term where it should, you know, we should not label the kids picky eating.
14:44
And we’ve had episodes about this.
But how do we know when it goes from that in a child to, like, we should be more concerned because I do know, like, yeah, when kids are younger, they tend to.
They’re still exploring and it can take time.
Yeah.
That’s a really good question.
And so ARFID is often more than just picky eating.
15:04
It is a condition where someone is so selective or fearful that their nutritional health is severely impacted.
And so once a parent probably sees that, Oh, my child does not mean growth markers or my child now has vitamin DB12 deficiency, that they’re not eating enough or that literally everything that they eat has to be cooked in a very certain way, it is more severe than just picky eating.
15:35
Often times two kids with picky eating, after being around the food a certain period of time, touching food, interacting with food, they can decide to start eating it and they can like, we’ll often hear like, oh, they like they grew out of it.
15:53
But AFID like is not really something that somebody grows out of.
Like they carry it with them through like their adult years.
Yeah.
And I see that parents get really frustrated.
I’ve seen this especially with, like, immigrant parents where they’re just like, really blaming the child.
16:11
They’re kind of like, force feeding them and hoping that that will help.
I know you said that this is something that usually continues on to adulthood.
So is it something that it’s like someone just has to learn to live with or like are there things that can help with introducing new foods into the plate?
16:34
They really want their kid to get better and they’re trying to introduce them to new foods.
But when it comes to exposure, that’s kind of what that is, introducing somebody to new foods because of the surgery that they’re holding and needs to be done with consent from the person who is being exposed to those foods.
16:54
And so if a child does not want to eat new foods and you’re trying and they’re just not giving, it could be helpful then to add more nutrition to the foods that they already are comfortable with.
And so if they’re comfortable with like peanut butter and Jelly sandwiches, then maybe adding a little bit more peanut butter to the sandwiches so that they get more fat and more protein from it, continuing to buy their bread.
17:21
But maybe you’re also giving them some supplements on the side too, so that they are getting their vitamin D or whatever it is that they are being deficient in.
And so if they’re not giving you that consent, then you can add more nutrition to their plates through supplements.
17:40
There are a lot of supplements to that are gummy form that have flavor in them that can be more acceptable for a child or a person with ARFID.
And then if they are, you know, possibly interested in getting more care, then it would be helpful to connect them with an ARFID specialist like through dietitian and like a therapist.
17:59
Yeah, I know that you mentioned that you also see teens, and I would imagine that that is like a huge population for our ARFID and even children as well.
How do you approach family dynamics?
Because I know that there’s parents who are probably freaking out like, Oh my gosh, it’s not eating anything.
18:19
It’s probably causes a lot of stress at dinnertime, like having to cook different meals if the child is not growing according to growth charge.
Like how do you deal with the the family dynamic side of things?
Yeah, that’s a really great question.
When it comes to working with families, often times when a family comes to a clinic or a form of care, either outpatient private practice or a highly structured PHP or IOP program, that’s when people are there for like 6 hours or 4 hours at a time and it is like a program.
18:54
They’re being taught specific groups and they have therapy.
They have a dietitian if it’s an eating disorder program.
When a parent comes to get care, they’re really familiar with it.
I actually had one mom who was like, I was doing all this research because she just stopped eating her.
19:13
Her daughter started getting really fearful of acid reflux to the point where she wasn’t drinking water and she wasn’t eating.
And she was like, you know, I was telling the doctor.
The doctor was like, yeah, like, she’s fine.
Like, because she wasn’t like, not meeting her growth charts that much.
19:29
And so they were like, yeah, just don’t worry about it.
But she kept doing so much research, and that’s how she came across ARFID.
And so when a parent comes to a form of care, at that time, they’re really tired and they just want their child to get better.
19:44
They are more willing to want to go through care with a team, and it’s easier than to work with them.
I haven’t really worked with a family that I have told them that their child has ARFID.
It’s mostly like they know that their child has ARFID and now they want to get care.
20:03
And so now they’re more familiar with the diagnosis.
And so typically these families are families that, you know, maybe do have the time to also like research what’s kind of going on with their child like.
The families that were in the clinic weren’t necessarily working class families.
20:20
And so there’s just also much more research and advocacy that needs to be gone about for pediatricians to be aware of what to do when they notice that a child is not gaining weight.
But it’s not because of any disorder body image issue.
20:37
Are there any communication techniques that you have found to be helpful that parents can implement, especially with younger children?
Because I feel like for adolescents, you can talk to them and they have more of an understanding of like, OK, this is how this can impact my health.
But I think for younger children, like, they might not be able to wrap their head around it as much.
20:57
So any strategies for just like helping to improve the communication for younger kids?
When it comes to younger kids, that can be difficult because, yeah, like they’re maybe fighting with you.
21:13
They’re not really interested and they don’t get it right.
One of the sort of feeding methods that I have seen, Ellen Sater feeding methods, which is pretty much like getting a ton of food on the table.
21:29
Like the parent decides what sort of food they want to put on the table and the child then decides what they want to eat.
And so that is more of like almost like an intuitive eating approach where, you know, you are guiding their nutrition, but you’re not forcing them to intake it.
21:46
And so a lot of the times when it comes to treatment for our fed, I think that should be a model that needs to be followed.
Is that the person that is the one that’s going through this really difficult thing, which to us does not seem like it’s difficult to them is very difficult, decides how the paste and the types of foods and the methods that they’re approaching when it comes to eating?
22:13
Yeah, also the New York Magazine article I thought was really good, just showing the behind the scenes of what a family deals with.
And there was one child in the story that had ARFID and I can’t there’s they talked to a bunch, but I just remember this one family where they tried everything, nothing worked.
22:33
And then they just like stopped putting the pressure.
And then finally one day the kid was like, I forget what it was, but like, oh, I want to have, I don’t know, some caviar.
It wasn’t but.
And then they were like, you know, and they’re to each other like, Oh my God, is this for real?
22:48
Like, what?
But then to the kid, they are just like, oh, OK, yeah, sure.
So And that seemed to work.
So have you seen that too?
Like just not putting so much pressure on the situation.
Yeah, I think when kids don’t have so much pressure and their parents aren’t so worried and you’re mostly coming with like exposure therapy.
23:09
One of the methods that we use in our fit that I actually started using here because we do have another dietitian on the team, Lauren, who works in the eating disorder clinic, is food chaining.
And so food chaining is his preferred sort of therapy where you slowly introduce a person with our fit to more foods by basing it off of foods that they’re already consuming or are more safe.
23:34
And so let’s say, you know, you want your child to eat more red foods and they’re eating like Hot Cheetos, for example.
Like Hot Cheetos is the first food and then it goes spreads off to maybe like having a different form of like a spicy chip or something of that sort until you’re able to have them eat.
23:53
Like if the preferred end of the at the end the chain was like strawberries, then it would be like it would then gradually sort to increase in moisture.
And so when it comes to using food chaining, the person you know, obviously is guiding it and also to like hopefully they’re working with the team.
24:13
I would ideally want somebody with ARFID to be working with their own dietitian and therapist because that kind of takes away the pressure from the parent and puts it then so onto a person that is outside of their family circle.
24:30
And so they’re able to work with somebody who, you know, has a specialization and the experience in it.
And they also feel like they don’t have to perform to make their parent happy or whatever.
They’re not necessarily making us happy in therapy.
We’re telling them, you know, like you’re the one that we’re here for you.
24:48
And so, you know, we’re going to stop wherever you kind of want to stop, but we are going to try to introduce you to a couple more food so that you are able to have more nutrition.
And for dietitians who might encounter a person with ARFID, what is the best protocol if there aren’t really many resources for referring out?
25:11
Because I remember when I was working at a family clinic, I’m pretty sure I came across a few patients who had ARFID and it was also challenging because they were Spanish speaking.
So it was like already it was hard referring out to like disordered eating or eating disorder center or just like pediatric center.
25:32
But then the added layer was someone who spoke Spanish.
But it was a challenge, just like at baseline to find someone who had that specialty.
So in that case, do you recommend that the dietitian do the best that they can and keep seeing the the family or what is the proper protocol for that?
25:55
Yeah, that’s a really good, great question.
When it comes to giving more resources to a family, I think that is the thing, like giving more resources to the family.
Maybe you’re finding resources that are also like in their preferred language.
26:11
There’s so many different ARFED parent groups online and there’s also different like support groups that people can join for discounted rates.
And I think finding more resources, connecting them to more people that are aware of what to do when it comes to our fed.
26:29
And then for the dietitian, one of the first things that I like to do that I think any dietitian can start doing is do like red light green food and it has yellow foods too in it.
And Reds are the foods that are like big nose, like you cannot consume.
Greens are the foods that are very much so safe.
26:45
And then yellows are the foods that are like iffy.
Like I often will see eggs on yellow.
And that makes sense because eggs like can be made in so many different ways.
There’s different types of dishes with eggs.
And so they can start, you know, with kind of writing down, First off, what are these go foods and fear foods?
27:07
And they can just pretty much kind of their buys them by just adding more nutrition kind of again to like the foods that they’re more comfortable with eating.
And then seeing later on if they can get more specialized care because there is some education that the provider would need to do to just be more familiar with like our Fed and the way it presents.
27:31
Yeah, It sounds like the main thing that I’m hearing from you is just not having judgment.
I’m sure it must feel like such a safe place for a client to land where they might feel like, Oh my gosh, something’s wrong with me or no one’s going to understand.
But just to have that person understand and not push them too far, you know, more than they want to be pushed.
27:51
I think it’s amazing.
And yeah, instead of saying like disordered or whatever, it’s like, I think you said something like difficult period with food.
I just feel like that would be that would put people in a more calm place.
So I want to turn the tables to you and tell people how they can work with you.
28:09
Do you have an ideal client that you like to see at Diabetes Digital?
Give us all the tea.
Yeah.
So at Diabetes Digital, I don’t necessarily work with a ton of families and little kids.
I mostly work with teenagers.
I think the youngest I saw was like early teenager.
28:29
That’s more so Jessica’s kind of like area.
She’s another one of our dietitians, but I do.
Mostly another Jessica.
Yeah.
Jessica’s damn everybody.
Jessica’s like, don’t send me your kids.
And that’s what.
28:45
We’re not going.
To do we have.
Yeah, we have another Jessica.
I love it.
He has love children and so I mostly do work with adults at our practice.
And honestly, some of them don’t come in with ARFID.
29:03
Like I don’t see a ton of ARFID as much as I did before because they kind of just came in and they were like, yeah, I really want to lower my AU and C And then but then it’s kind of the language that they’re using often times that makes me kind of know if someone has an eating disorder or not.
29:19
You know, how are they talking about food?
How are they describing food?
If they’re using a lot of like language, like they’re talking about like an insect or something, then that would make me kind of like start like my brain will start dinging be like, oh, like this could be somebody with a selective, more selective eating pattern.
29:38
And then if it’s like they’re not really eating because of these like fears or this event that really happened or they’re just not interested in that kind of would make my brain start digging more of like, oh, this person possibly has our fed as dietitians, we can’t diagnose ARFID, but I sometimes will if it feels safe, like tell them like, hey, like have you ever heard of ARFID And you know, hearing kind of what they have to say.
30:03
And then from there, sort of like sharing what it is, you know, kind of like the three sort of subtypes that are associated with ARFID.
And then if they would be interested in possibly like introducing their diet more like, since I’ll hear people be like, I don’t want to continue to live like this, Like it’s, I feel really like limited here.
30:24
And so I’m like, oh, would you be interested in possibly like expanding your diet and exposing yourself to more foods?
And those are things that we can do like through telehealth, we can do live exposures kind of together.
And before even a person would eat a food, you ex, you tell have them be around it, you have them touch it, you have them interact, interact with it, that sort of makes them feel more comfortable when it comes to the thought of actually eating it.
30:50
And so, yeah, if you do kind of notice that you have selective eating patterns, so you can come and fill out the diabetes digital.co slash quiz form on our website.
And yeah, put it down on your intake form and I would love to meet you.
31:08
Amazing.
Thank you so much, Kristen.
It was such a pleasure.
Thanks for joining us for today’s episode.
If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit us at diabetesdigital.co.
31:25
Also, if you found our conversation helpful, do us a favor and rate and review this podcast on iTunes, plus share with someone who might find this helpful.
You can also connect with us on Instagram at Diabetes Digital dot.
Co and TuneIn every Wednesday for practical, inclusive and culturally humble diabetes insights.
31:45
We’ll catch you later.
Bye.
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