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is severe adult picky eating an “eating disorder,” and “should” it matter?

Posted by on Dec 3, 2010 in Blog Posts | 10 comments

It’s time to throw out the kale that has been sitting on my counter in a cup of water this week (after wilting in the fridge.) It has been judging me. It scolded me from the shelf at the market. “I am a super food! You should be eating more of me!” I popped it in my cart and brought it home to live out it’s fate.*

As I worked this week with an adult on her concerns around her picky eating, she told me how she “should” be eating fish and that was one of her treatment goals. So my client has to deal with her own voice (I guess we all have it to some degree) along with the chorus of voices her whole life that have shamed and guilted her about her eating; who told her she “should” eat this, or that, or she was doing it wrong while not only not supporting,  but actively undermining her learning around food.

The idea of the adult picky eater as one suffering from an eating disorder has been hot in the news. Do the eating patterns of selective adults cause major problems in their lives? Yes. But is it the same biological process that we see in the thirteen-year-old who begins her first diet only a few weeks later to be in the full-throes of anorexia nervosa? Does it need to be?

The selective adults I have heard from have shared a feeding history that is complex, difficult and fraught with anxiety. Yes, there is likely something about many of these folks that made them more of a challenge with feeding.  In the article, Ellyn Satter says  “Everyone has got something and everyone has to learn to cope. And children need to learn to deal with their predilections.”  (Feeding often plays a large role in selective eating and even children with concerns like reflux or sensory issues can mature well with eating and are not doomed to  an “eating disorder.” The ‘nurture’ part of this equation must be considered, and as a culture, as physicians and health care providers we do a terrible job overall supporting parents with feeding challenges. Back to adults…)

The stories I hear from adult selective eaters describe screaming at meals over who is eating what,  escaping meals altogether and eating out for years to avoid being home,  not being supported or exposed to a variety of foods, kids vomiting at the table and being forced to eat the vomit, or parents fighting openly, punishing, shaming, rewarding… (This is not a scientific review, and I’m sure there are adult selective eaters who have a different story.)

Am I qualified to proclaim this is or isn’t an “eating disorder?” Probably not.

Am I happy if it helps people access treatment? Yes.

Would I like to see parents of children with feeding challenges get amazing support so they can optimize feeding no matter what the concern is? Yes.

Am I concerned that the treatment many will access won’t help and will bring on further shame? (Like the parents who call me because their child “failed” the feeding clinic?) Yes.

Does the label of an eating disorder help or harm healing? Does it stigmatize and make the situation into a more powerful external process? I don’t know.

Is there a higher prevalence of coexisting conditions like anxiety or OCD that needs to be addressed? I don’t know, but this needs to be explored.

And then the therapist in the article says, “We don’t yet know how much they can be pushed …”     Which gets me back to “should.”
Here is the crux of the problem, if adults are being “pushed,” whether by a professional or a feeding group or themselves to smell, touch, eat a food- if they have to “force” themselves to eat something they will likely fail. For many, their past history with feeding, the trauma, the “you are not OK, you cannot be trusted” with this all comes back and there they are at the table with stress levels off the charts. Food= fight or flight.  My friend said it well,  familiar foods “mean safety.”

Long-term sustainable change does not come from a place of shame, guilt or “shoulds,” it comes about when the changes are themselves rewarding. When the change makes you feel better from the inside out.  Will forcing herself to eat fish make my client feel better? No. Will learning to come to the table and feel calm there, and recognizing that she did the best she could, and learning to feel good, first about the food she IS eating, make her feel better? Yes. Will that open the door for more change? We hope so. Will it be a slow process? Yes, and that’s OK.

How to begin? First, I encouraged my clients to banish should from the vocabulary around food. I encouraged them to give themselves permission to eat what tastes good as we work on healing the relationship with eating, as we work around decreasing the anxiety that is at the table after years of stress around food. But, I had to chuckle this week as I shared my own should food wilting on my counter.

Should is a taste-killer. Should is the worst word there is if you are trying to heal your eating or help your child learn to eat. Should makes us think something will taste bad. It makes us want to rebel and push back. Someone pushing you doesn’t make you feel safe.  Forcing yourself to eat something because you should is not going to heal you. (I am referring here to selective eating, not eating disorders with malnutrition and restriction.) It is not going to make you like new foods. (Is it?)

We eat foods first because they taste good. If we can tap into that pleasure around food, approach the relationship with food from a point of kindness, curiosity, patience, work to rid that relationship of anxiety and conflict, perhaps there will be a space for tasting foods and discovering some that actually taste OK, and even taste pretty good.

And maybe you’ll find out that you don’t like crunchy textures, or fish, or stews with mixed textures. Maybe you’ll find out that you perhaps are more cautious, or a “super-taster” or find your mouth feels different with starchy foods. But, until you make peace with the table and what you are eating now, there isn’t really any room for discovery.

A reader writes in response to a comment about adult picky eating. She has done some considerable work around this issue. Note that while she makes vegetables and is regular about providing opportunities, she still gives herself permission not to eat vegetables, and is finding out that sometimes she even “craves” them…

I too (and my husband) are learning how to eat vegetables now, and we’re considerably older than you.  Progress comes in fits and starts.  I make myself prepare veggies every day, but that doesn’t mean I have to eat them.  I usually do, because once I’ve gone to the effort… but sometimes the effort is minimal, like with a basic green salad.  I also stay in my comfort zone with veggies and only once a week or sometimes once every two weeks try something new.  And every so often, I’ll have a craving for a vegetable, which is still a foreign experience for me.  I’ve been at this for a little over a year.  I’ve been very focused on being patient with myself and so far as I am able, treat my veggie hating brain like a child separate from myself.

I would LOVE to hear your thoughts on this. I really struggled with this post. I still haven’t wrapped my brain around all of this in terms of the eating disorder diagnosis. Are you someone that has learned to like foods by forcing yourself? Did it not work? Share whatever comes up, again I want to learn from you!

*I acknowledge the privilege I have that I can do this, and contemplate throwing food away and know this will be hard for some to get over.

p.s. I also know I will get recipes now from readers who love kale, who prepare it and enjoy it regularly. The only way I have found that I enjoy it is in a rich and hearty veggie soup, but that’s not what I feel like cooking. I also once almost sliced my finger off with my new Santoku knife while I chopped a bunch of kale :)

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10 Comments

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  1. Red Pomegranate

    Along the same lines, what are your thoughts about strict dietary “choices” such as veganism, trad foods or raw foods? I’m a vegetarian myself but I have found that my ED nicely hijacks my vegetarianism making my restrictions “noble” so I have chosen instead to be a “flexitarian” and I eat fish and sometimes poultry (red meat is still hard for me but I’m trying to try it!) I see folks who see one trend after another as the end-all-be-all for “health” when really it just looks like disordered eating. It’s especially wearisome to hear friends of mine tout it as healthful merely because “it’s how our ancestors ate”, when our ancestors were probably able and needed to eat a ton of animal protein because of how hard they worked physically! Any thoughts?

    • katja

      It’s great that you are in tune enough to know that for you it was a nice way for ED to get in. I like your flexibility, which to me is a hallmark of competent eating. I think rigid eating is a red flag. I do see folks careening from one fad to the other. The term for what you describe is “orthorexia,” right? It can be wearisome. I think one can be a vegetarian and have balance and good nutrition, but it can be a slippery slope. And, for kids, it is hard and takes a lot of attention to nourish a vegetarian well. I do see a worrying trend with parents who are “orthorexic” and it is really hard for children who are learning to eat. If there are no “carbs” in the house, children often struggle with learning to handle foods. Everything becomes the forbidden food. I am having my nutritionist address the phrase I am hearing a lot where folks say, “X, Y orZ leaches nutrients out of your body.” It’s worrisome anytime people cross out or refuse to eat whole groups of food. It certainly warrants asking more questions.

  2. Jess

    I think there are many, many adults who have disordered aspects to their eating, but I think there is a spectrum in terms of how disruptive it is to their health and happiness. I mean, I regard the national obsession with forbidden foods, body image and weight and its effects, particularly on women, to be deeply dysfunctional. Many adult women I know have “should” foods, but almost all of them struggle with “shouldn’t” foods that are discussed in terms of sin and repentance (crazy when you think about it), and it’s something they think about every day, every time they decide what they’re going to eat. Even if a person seems to be a “good eater” in terms of what they actually take in, if that person is obsessing over food choices, is that healthy? It may not be a full-blown, life-destroying eating disorder, but emotional issues around eating do affect a lot of people’s sense of well being.

    The eating issues you bring up in your post are, for many of us, a microcosm of larger life issues. The big “SHOULD” is something most of us hear in our head about our careers, our families, how we spend our spare time…personally, I think the word should be banished from a lot of areas of life, not just eating!

    • katja

      Jesse. I totally agree that it is a continuum, and it fascinates me where we decide to draw the line in terms of the clinical definition which has HUGE implications for how it is dealt with, treated, researched etc…
      A couple of thoughts on why labels matter.
      Why don’t we nail down a definition of “normal” eating? (I like Satters. http://www.ellynsatter.com/what-is-normal-eating-i-62.html)
      The reason we need to define “normal” is that studies around feeding and eating have a “control” group that in my mind is not “normal” but rather abnormal, on that continuum. So, if we want to study a feeding clinic therapeutic outcome, we should compare it with best practice feeding,not our cultural norm…
      Second, many of the “experts” I have heard over the years on nutrition, childhood feeding practices etc don’t seem to have their own eating under control. it’s hard for me to accept someone as an expert who is on Weight Watchers or makes constant comments about her weight, dieting etc… Many of those who are making policy, instructing health care providers, doing research are themselves not competent eaters. It would be like having a professor in the math department who can’t do algebra, or is it?
      Just a few thoughts…

  3. Kate

    I’ve been giving this post a lot of thought. As an adult, one only has to change how they eat, how picky they are, etc, if they want to. If they want to go through life eating the same eight foods day in and day out, that’s their business. I think they are missing out on a lot, but obviously I don’t know their story or their obstacles, so I don’t judge.

    I felt like I *HAD* to change how limited my palate was, for oh, so many reasons. I was more open to trying new foods than my husband and before Ellyn Satter, I wasn’t very careful about introducing new foods with comfortable foods and was often not successful. I also have a perfectionist tendency that if I made the effort to prepare food, I had failed, not only did I fail myself, but my husband as well (that’s my opinion, not my husbands). A failure not only in the kitchen, but in planning, and wasting money, it was a very bad feeling.

    However, using Ellyn Satter’s methods and a lot of the information I have learned here and on similar sites, I’ve changed not only how I introduce new foods, but accepting that not every meal is not going to be a winner. And that’s okay.

    We have friends that I would describe as very adventurous eaters and chefs and when they invite us for dinner, we always accept. But before we go, my husband and I discuss how to best prepare for the meal, for instance, if it’s something that really freaks us out, we’ll eat a small meal beforehand so we’re not so full that we won’t try the main dish, but that way we won’t be reliant on their food to sustain us through the whole night. And that seems to work out for us really well, though as we become more and more adventurous, we eat smaller and smaller pre-meals and just roll with whatever comes. (Some of our issues are food insecurity, anxiety that’s lessening each day.)

    Basically, what I’m trying to say is that if you decide you want to change how you approach food, you need to respect your needs and take care of your needs so that with every step you feel safe (you also need to help your partner feel safe, like Twistie does). It doesn’t matter what other people think.

    • katja

      i love this. thank you. “you need to respect your needs and take care of your needs so that with every step you feel safe (you also need to help your partner feel safe, like Twistie does). It doesn’t matter what other people think.”

  4. sandrad

    Hmm, I think it must depend on degree. I mean how picky is picky? How distressed is the adult about thier eating? If there is an OCD element would not OCD be an adequate diagnosis? I suspect that a lot of picky eaters would be quite content if not for pressure from the people around them, in that case whose behaviour should change?

    • katja

      great point on who’s behavior should change. I think it’s amazing how much people feel they have the right to comment on what others are or aren’t eating. Maybe if people didn’t feel so scrutinized, they would feel a little more at ease and perhaps safe to try and reject or try and like a food.

  5. katja

    He’s lucky to have you, and so are we here at the FFD blog. THANK YOU FOR SHARING YOUR JOURNEY! I imagine it will be an inspiration to others…

  6. Twistie

    Mr. Twistie is a very picky eater. Food is one of the few aspects of my life where I’m pretty adventurous. It’s a challenge.

    Over the years I’ve learned that Mr. Twistie’s issues revolve quite a bit around autonomy. His mother wanted him to grow up big and strong, so she made huge amounts of food for him and then lost it completely if he didn’t finish every bite. Consequently, he’s got huge guilt issues around food and a mental script that if he doesn’t finish every single bite, something bad will happen. And I will admit I’ve done a LOT of complaining over the years about how I don’t get to eat the foods I love because he won’t even think about trying them.

    About two years ago, I gave up fighting him. I still skew the meals in directions I know he likes and don’t try to eat any creature that wasn’t a cow, pig, chicken, or turkey when it was alive (and this is kind of a biggie for me because my favorite meats are lamb and fish) when he’s dining at home. Still, I’m quietly expanding his horizons. I don’t lie to him about what I’ve made, but I let him know he’s free to try things out or not as he pleases.

    Two years ago, the only vegetables he would eat were: carrots, spinach (raw only), potatoes, green beans, tomatoes (in limited amounts), radishes (in salad), daikon (which I actually don’t care for), avocados, cabbage, and onions. That got boring really, really quickly.

    But since I took the pressure off, he’s tried and found he could eat: broccoli, kale (not often, and only in certain ways, but he’ll eat it), turnips, broccoli rabe, broccolini (he loves this), cooked spinach, and he even ate a little cauliflower once!

    Okay, it doesn’t look like much, but it’s made my life so much better I can’t even express it. The really amazing part is that he recently didn’t finish off a huge pot of soup I made and didn’t apologize when there was some left over.

    Disorder or not, I have no idea. All I know is that with a lot of patience Mr. Twistie is finally starting to deal with food in a more healthful and peaceful way. That’s worth everything to me.

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