Category: Eating Disorders
Picky eating (PE) is an eating behavior defined by rigid, perseverative eating and refusal to try new foods. PE is common across the lifespan, with an estimated 30-35% of adults endorsing some degree of pickiness (Kauer et al., 2015; Zickgraf et al., 2016). Severe PE can lead to symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID), an eating disorder, new to DSM-5, that is characterized by restrictive eating leading to compromised nutritional/energy intake. Along with PE, poor appetite and fear of negative consequences from eating can also lead to ARFID. A recent study reported an association between adult PE and reduced dietary variety, particularly for fruits and vegetables (FV). Participants who reported experiencing symptoms of ARFID due to their picky eating reported lower FV consumption than other picky eaters, who in turn reported lower consumption than non-picky eaters (Zickgraf & Schepps, 2016). The present study explores all three ARFID-associated eating behaviors (PE, appetite, and fear) as predictors of FV variety and consumption.
The present sample includes 450 adults recruited for ARFID-like eating difficulties (e.g., PE, poor appetite, vomit phobia, choking phobia, and digestive difficulties including IBS). Participants completed the nine-item ARFID screen, a three-factor measure of PE, appetite, and fear (Zickgraf & Ellis, submitted), and the ARFID Symptom Checklist, which aligns with DSM-5 diagnostic criteria and identifies likely ARFID diagnoses when elevated PE, appetite or fear is detected (Zickgraf, Franklin, & Rozin, 2016). Participants also responded to self-report measures of FV variety and daily intake (Zickgraf & Schepps, 2016), as well as the Eating Attitudes Test, a measure of weight concerns and compensatory behavior, controlled in all analyses.
Generalized linear modeling was used for all six analyses. ARFID diagnosis was positively related to FV intake (unstandardized β = .14). The independent relationships between the ARFID eating behaviors and FV intake were examined in a separate model; appetite (β = .02) and fear symptoms (β = .02) predicted higher intake, whereas the relationship between PE and intake was negative and significant (β = -.02). A different pattern of results emerged for variety, with ARFID diagnosis associated with reduced vegetable (β = -.06) and fruit (β = -.03) variety. In a separate set of models, appetite was unrelated to FV variety, whereas PE was negatively associated with both vegetable (β = -.04) and fruit (β = -.03) variety, and fear was positively associated with vegetable (β = .01) and fruit (β = .01) variety.
These findings provide further evidence to support the association between PE and FV intake. The other ARFID-like eating behaviors, low appetite and fear of negative consequences, are less consistently associated with FV. Individuals with ARFID may report eating from a restricted range of fruits and vegetables, but this appears to translate to reduced FV intake only when ARFID is characterized by PE behaviors. Clinicians should be aware of adult PE as a behavior that can lead to nutritional problems even at levels that are not significant enough to lead to a diagnosis of ARFID.
Hana Zickgraf– PhD Candidate in Clinical Psychology, Psychology Intern, University of Pennsylvania, Pennsylvania State University College of Medicine, Philadelphia, Pennsylvania