Supportive strategies help 'picky eaters' deal with food aversions


Date:
November 11, 2021
Source:
Duke University Medical Center
Summary:
In a large national survey, adults who struggled with picky eating
habits as children overwhelmingly said they benefitted more from
positive and encouraging strategies their parents used than forceful
or coercive approaches.



FULL STORY ==========================================================================
In a large national survey, adults who struggled with picky eating habits
as children overwhelmingly said they benefitted more from positive and encouraging strategies their parents used than forceful or coercive
approaches.


==========================================================================
The research, led by a team at Duke Health, was conducted among a
generation of people who struggled with food avoidance before it was
identified in 2013 as a psychiatric condition called Avoidant/Restrictive
Food Intake Disorder (ARFID).

The researchers said their findings, appearing online Nov. 11 in the International Journal of Eating Disorders, provide guidance for both
families and behavioral health professionals for developing best practices
to deal with extreme food aversions.

When picky eating is severe, it is diagnosed as ARFID. The condition
is characterized by health problems such as weight loss and nutritional deficiencies and it can also lead to social and emotional problems when mealtimes become a source of shame, friction and/or conflict.

"It's not surprising that positive approaches were favored, but it
is surprising how overwhelming that position was among this group of
adults," said Nancy Zucker, Ph.D., professor in the Duke's Department
of Psychiatry & Behavioral Sciences. Zucker was co-senior author on the
study with Guillermo Sapiro, Ph.D., professor of electrical and computer engineering at Duke's Pratt School of Engineering.

Zucker, director of the Duke Center for Eating Disorders, said the
broad consensus is validation for the current treatment approach that emphasizes positive interactions: "It is robust confirmation for what
had been out there in the literature and reinforces the concept that
children feeling forced or pressured to eat is not helpful." The study
was launched more than a decade ago as severe food avoidance was gaining attention and research into the disorder was limited. The online survey
was aimed at adults who self-identified as current picky eaters to help understand their perceptions and experiences.



==========================================================================
More than 19,200 people were included in the survey; 75% were female and
25% were male, and 89% were white. Respondents were asked to describe
food presentation strategies used by their parents or caregivers that
they found to be helpful or not helpful in increasing food variety.

Survey participants were subsequently classified as either likely having
an ARFID diagnosis or not, based on their degree of impairment from food avoidance. Those who reported that eating problems led to significant
weight loss, nutritional deficiency, interference with job functioning
and/or interference with social relationships were categorized as likely
having ARFID.

Interpreting the narrative responses from the huge cohort of participants created a logistical challenge, which was solved with the application
of sophisticated artificial intelligence tools.

Using a computational tool to characterize the perceived helpfulness
of parent feeding strategies, the researchers applied an algorithm to
interpret the meaning and/or sentiment of survey responses to characterize
them as helpful or not helpful.

"From a technical perspective, this study used an AI application that understands language, not just words and sentences, but concepts of
paragraphs, which was imperative here," said J. Mati'as Di Martino,
Ph.D., co-lead author with doctoral student Young Kyung Kim. Both are in
Duke's Department of Electrical and Computer Engineering. "By getting the positive and negative emotions, it enables us to analyze the comprehensive memories of nearly 20,000 people." The researchers found that 39% of
the themes regarding helpful strategies mention a positive emotional
context, such as using food to teach cultural or nutritional lessons,
being flexible about the approach to food, providing plenty of safe
foods, helping with food preparation, or presenting foods from specific
food groups.



========================================================================== Forty percent of the helpful comments noted the importance of structure
around eating. Clearly defined expectations around eating were deemed
to be helpful in the context of distinguishing between feeling "forced"
vs. being asked 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. The researchers noted that parents are perceived
as having a positive impact despite their children's food avoidance
persisting into adulthood.

The researchers said survey participants clearly found some foods
aversive, not merely unpleasant. This likely intensified their feeling
of being trapped and made to do something disgusting if they were asked
to eat that food.

"To our knowledge, there is no published research that identifies
effective feeding strategies for those with ARFID," Zucker said. "Figuring
out the best way to feed a child with severe food avoidance can be
exhausting and stressful for parents, so providing guidance is essential
to improve the social and emotional eating environment for their children
and reduce the distress that both parents and children have at mealtimes."
In addition to Zucker, Sapiro, Di Martino and Kim, study authors include
Julia Nicholas, Alannah Rivera-Cancel, Jennifer E. Wildes and Marsha
D. Marcus.

The study received support from the National Institutes of Health (R01MH122370).

========================================================================== Story Source: Materials provided by Duke_University_Medical_Center. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Young Kyung Kim, J. Mati'as Di Martino, Julia Nicholas, Alannah
Rivera‐Cancel, Jennifer E. Wildes, Marsha D. Marcus, Guillermo
Sapiro, Nancy Zucker. Parent strategies for expanding food variety:
Reflections of 19,239 adults with symptoms of Avoidant/Restrictive
Food Intake Disorder. International Journal of Eating Disorders,
2021; DOI: 10.1002/eat.23639 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/11/211111130246.htm

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