Fussy eating or eating disorder?

 

Our eating behaviours are a reflection of the relationships we have with food. Moreover, our eating behaviours generally develop during early childhood years, such as the environment we grew up in and how we learnt to recognise food and huger cues. The tendency for an individual to overeat, undereat, or to be fussy around food has likely stemmed from their childhood and could be a contributing factor towards the development of an eating disorder later in life. Of course, it would be problematic to diagnose a person’s fussy eating behaviour as disordered eating without understanding the underlying causes of their food habits first – there are a multitude of contributing factors that influence and change our eating habits throughout our lifespan.

Fussy eating is a common occurrence in childhood and usually stems from parenting style and eating habits, cognitive ability, taste preferences, texture, and other sensory qualities. For most children, picky eating habits resolve as they get older. However, those with severe or persistent picky eating can go on to develop nutritional deficiencies, consequently hindering their physical and psychological development as well as create strain on social relationships (such as family/parental conflict and stress). When a child’s picky eating becomes severe, they may be diagnosed with a feeding disorder of infancy known as avoidant/restrictive food intake disorder (or ARFID) and can this persist throughout their lifespan4.

In a study by Mascola, Bryson, and Agras (2010) 13-22% of the children in the study sample were reported to be picky eaters. However, the researchers found that children with early onset eating problems recovered at a higher rate than those who developed picky eating habits later in childhood. Furthermore, over 50% of the children with picky eating habits recovered within a 2-year timespan irrespective of the age of onset1.

In another study conducted by Herle, De Stavola, and  Hübel (2020)  investigated the relationship between childhood fussy eating and the development of eating disorders into adolescence. The researchers studied 3 groups of children – overeating during childhood, low levels of undereating during childhood, and undereating during childhood. It was found that the children with low levels of undereating displayed appropriate eating behaviours into adolescence and were not considered to be at risk for patterns of disordered behaviour (such as restrictive food intake, over exercising, binging, and purging). However, the children that were considered to be fussy eaters, or under-eaters, where also found to be less likely to develop restrictive patterns of eating behaviours into adolescence. However, the researchers noted that this finding may have been a reflection of the small sample sized used in their study, and therefore warrants further in-depth investigation. In contrast, the researchers found that overeating in childhood posed 6-7% greater chance of the development binge eating disorder (BED) at 16 years. These findings highlight how the risk of overeating during childhood could foreshadow the development of eating disorders later in life. It could be argued that there is a correlation between higher BMI, body dissatisfaction, and the development of eating disorders (both binge and restrictive) into adolescence2.

It is also worth mentioning the eating behaviours of neuro-divergent individuals, such as those on the autistic spectrum (ASD). Statistics suggest that 46-75% of children with ASD experience feeding difficulties, and their experiences with food go beyond simply “fussy eating”. Research has identified that children and adults with ASD may experience the following challenges when it comes to feeding: food presentation, brand, utensils, as well as sensory issues (such as taste, texture, colour, and smell). With this information in mind, it could be argued that fussy eating in neuro-divergent people is not an issue relating to disordered eating, but rather a cognitive and sensory issue3.

So how do fussy eating and eating disorders differ?

The current blog entry has been a brief overview of fussy eating habits verses disordered eating behaviour. There is a distinct difference between developmentally appropriate picky eating, and persistent food refusal. As previously mentioned, picky eating commonly occurs in childhood, but generally resolves as the child grows older. However, children with severe picky eating habits, or ARFID, may experience some level of distress around food which may have been a consequence of a traumatic event, such as vomiting, illness, or choking. On the one hand, picky eaters, while their palate may not be broad, are still able to receive enough nutrients and maintain normal growth and development. On the other hand, individuals with ARFID are generally unable to obtain appropriate nutrients as a consequence of their eating behaviours. Furthermore, picky eaters experience and respond appropriately to hunger cues, whereas someone with an eating disorder may not consider food to be a priority4.

References

  1. Herle, M., De Stavola, B., Hübel, C., Abdulkadir, M., Ferreira, D.S., Loos, R.J., Bryant-Waugh, R., Bulik, C.M. and Micali, N., 2020. A longitudinal study of eating behaviours in childhood and later eating disorder behaviours and diagnoses. The British Journal of Psychiatry, 216(2), pp.113-119.
  2. Mascola, A.J., Bryson, S.W. and Agras, W.S., 2010. Picky eating during childhood: a longitudinal study to age 11 years. Eating behaviors, 11(4), pp.253-257.
  3. Rogers, L.G., Magill-Evans, J. and Rempel, G.R., 2012. Mothers’ challenges in feeding their children with autism spectrum disorder—Managing more than just picky eating. Journal of Developmental and Physical Disabilities, 24(1), pp.19-33.
  4. https://www.waldeneatingdisorders.com/blog/6-differences-between-picky-eating-and-avoidant-restrictive-food-intake-disorder-arfid/

This blog post was written by Ellie, one of our lovely volunteers at S.E.E.D!