Avoidant restrictive food intake disorder isn't just "picky eating"
We’re conditioned to believe that being thin means, health-wise and otherwise, we’re doing something right. A skinny body and "normal" body mass index (or BMI) are often accepted as evidence of baseline wellness, even though, medically speaking, we know that isn’t true. We know that in the United States, around a third of the people designated as "obese" by BMI metrics, and more than half of “overweight” people, are actually metabolically healthy. We also know that the BMI is a questionable framework in general.
The idea that a thin body is a healthy body is persistently harmful, no matter what pops up when you step on the scale, because it obscures real health problems that aren’t tied to weight. 25-year-old Jade Youngman, who described her diet to the Daily Mail as “pizza, plain pasta, [fries] and chicken nuggets,” said even though she falls within the “normal” weight range ascribed to her by the BMI, she lives with an eating disorder that impacts her life, called avoidant restrictive food intake disorder (ARFID, for short).
ARFID tends to develop out of childhood picky eating, and is often found in people with anxiety or autism spectrum disorders, according to the National Eating Disorder Association. Symptoms of ARFID include extreme limitations on foods consumed based on texture or taste, fear of choking or vomiting, phobic reactions to certain food items (like fruits or vegetables), and a lack of concern surrounding body image or weight gain. Notably, people with ARFID also tend to fall within the normal range in terms of body weight, despite lack of nutritious intake.
Healthcare professionals often overlook this eating disorder due to a lack of weight fluctuation. Youngman told the Daily Mail that doctors and acquaintances alike tend to brush off her concerns about her restrictive diet, and her social circle doesn’t always take her disorder seriously, either.
“It feels like people are very judgmental,” Youngman said. “Because I do not look obese or really thin, they think it can't be possible that I have an eating disorder.” She also said she’s been unable to get doctors to run more extensive tests on her, despite the fact that she is iron deficient and reports trouble with wakefulness. “Doctors don't seem to recognize my problems as a medical condition, so are not testing me for anything,” she said. “They just say at some point I will need to change my diet.” It’s hard to imagine someone who is outside of the normal weight range, on either end of the weight spectrum, receiving the same assurances.
This ignorance can lead to disaster: In the past year, two teenagers living with ARFID in the UK have lost their vision after living on diets of fries, chips, and white bread. One 18-year-old went blind in his left eye, and a 19-year-old dropped out of college after losing his vision, according to the Daily Mail. The cause: nutritional optic neuropathy due to dietary deficiencies.
Not everyone whose diet isn’t up to nutritional standards is living with ARFID. Food phobia is ARFID’s primary characteristic, so people in food deserts who experience symptoms of nutritional deficiency don’t automatically fall under its umbrella, although research has shown that people who experience food insecurity are more likely to display eating disorder pathology.
Despite growing awareness of how harmful eating disorders are and how many people they impact (demographically, anyone and everyone!): As long as a skinny body is enough to fool doctors into handing patients a clean bill of health, it’s definitely worth taking a nutrient-deficient diet, and the pathologies it could center around, very seriously.