We’re thrilled to announce our latest venture: The Family Dinner Project Podcast! In each of our 30-minute episodes, Content Manager Bri DeRosa and Executive Director Dr. Anne Fishel will talk through tough topics related to family meals. Pull up a chair and grab a plate — we’re serving up real talk about family dinner! You can get caught up on older episodes here. 

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On this episode of The Family Dinner Project Podcast, Bri and Dr. Anne Fishel are joined by Dr. Evelyna Kambanis for a deep dive into the world of picky eating, ARFID, eating disorders, and more.

Dr. Evelyna Kambanis is a Clinical & Research Fellow at the Eating Disorders Clinical and Research Program at Massachusetts General Hospital. Her research and clinical interests focus on avoidant/restrictive food intake disorder (ARFID). She helps walk us through the differences between developmentally normal picky eating, which occurs in most children, and feeding issues that may signal a problem warranting medical help. Evelyna breaks down the clinical definition of ARFID — Avoidant Restrictive Food Intake Disorder — and how parents can tell when picky eating has become something more concerning. She also helps shed light on the possible red flags parents may see at the dinner table when a child has ARFID or is in danger of developing another type of eating disorder, such as anorexia.

As always, we end the episode with food, fun, and conversation suggestions to help families who may be dealing with ARFID, sensory sensitivities, and other types of feeding challenges at their family dinner tables. The Family Dinner Project’s Welcoming Table initiative has plenty of resources to help, but families are also encouraged to reach out with questions or concerns. Families dealing with extreme picky eating may also benefit from Evelyna’s suggested resource, The Picky Eaters Recovery Book.

Episode Transcript:

Bri DeRosa: Welcome back to The Family Dinner Project Podcast! I’m Bri DeRosa, and joining me as always is my colleague, Dr. Anne Fishel. 

Anne Fishel: Hello. Great to be with you in this fourth conversation. 

Bri DeRosa: Fantastic to have you back, Annie. Thanks for joining. And we also have today a very special guest. We have invited our friend and colleague, Dr. Evelyna Kambanis, who is a fellow at the Eating Disorders Clinical and Research Program at Mass General Hospital. And Evelyna’s research focuses primarily on Avoidant Restrictive Food Intake Disorder, or ARFID. So we are thrilled to have her with us today as we try to learn more about ARFID and how it differs from developmentally normal or expected picky eating.

And that’s our topic for today, families. We want to kind of dig into a little bit more the concerns that we often hear around, Is my child too picky? Are they pickier than normal? Should I be worried about their intake? Should I be worried about their trajectory in learning to eat a variety of foods? I’m gonna start by asking, kind of throwing this out to the group, picky eating is sort of a universal catch all phrase that parents can use to describe, I feel like a whole range of behaviors, right?

So Annie, can, can you start by helping us understand what actual picky eating looks like in kids? What is this sort of developmentally normal thing? And, and what should parents be looking for? 

Anne Fishel: Yes. Yeah. There is a developmental component for sure. When parents are asked, parents of preschoolers are asked, they estimate between 14 and 20 percent of parents report that their kids are often or always selective around food. And I would say it’s even a larger percentage. If you think about the lives of small children, and how little control they have, really, over their lives, food is one place where they can just say no, and push back on a Monday, and maybe say yes on a Tuesday. But, you know, maybe they’re going to be just choosing yellow foods for a while, because this is an area that, you know, as I say, they do have some control over.

I think there is a kind of a normalizing tone that I want to add to this discussion, that there are a lot of good reasons– evolutionary, developmental– where a lot of young kids might seem like they’re going to grow up to be picky eaters. But they, they might not. And often the ages before 2 are a great time for parents to introduce a lot of novel foods because picking this tends not to set in until about age 3. And then maybe opens up again around age eight. 

Bri DeRosa: That’s really helpful background, but I also think that’s really important for families to understand, is that, you know, people tend to think of kids as being, toddlers as being picky, and they’re a little bit more, I want to say, tolerant of that young childhood, early childhood picky phase, right?

Where you know, your kid is going through so much developmentally at that time. And they’re like, no, I will only go to preschool if I’m wearing my froggy rain boots. Right. And the eating just feels like a whole extension of that. I will only this week eat things that are shaped like dinosaurs. How dare you cut my sandwich like a dinosaur. I no longer eat that way. Right. And so parents kind of get, I think reassured by others that it’s okay if your kid is a little bit picky and a little bit wacky even around their food choices as toddlers, and they’re not as concerned about it. But then, you know, it does often come back up. As you said, grade school kids can re exhibit pickiness.

And I, I feel like in a lot of the kids that I have personally known, and kids that have been in my life, there’s sometimes a little bit of that peer pressure aspect to that too, right? They go to school, they’re eating in the cafeteria maybe for the first time, somebody makes a comment about their lunch, or something smells weird, or this is the cool thing to be eating and that’s not. And all of a sudden you get this thing where your child who you thought was moving out of that picky eating stage, suddenly is like right back in it, sometimes even more entrenched than they were before. Is there something that parents need to know about that stage or about the resurgence of selectivity in eating at any age that you really, you would like to impart right as we start the conversation?

Anne Fishel: Yeah. I mean, I think certainly at The Family Dinner Project, we have, you know, a bunch of strategies that we’ve found are helpful for families, and I’ll be really interested to see what Evelyna thinks about some of these– things like the nutritionist rule of 15, that kids like familiar food, so we encourage parents not to give up on offering a food even if it’s rejected a couple of times, to keep at it. Maybe 15 is a bit extreme, but to keep at it, because maybe after a while that food that seemed repulsive or just not to their liking will seem like kind of a, well, familiar friend. Why not try it? 

Or the idea of parents saying as little as possible about the food, you know, and certainly not things like, why don’t you have another bite or eat this and you can have dessert, you know, any of those comments tend to kind of backfire, but rather to encourage parents to eat with gusto and to say as little as possible about the food and to concentrate on other things.

So those are some of the strategies and, and to sort of, you know, make sure you offer foods that, you know, you’re at least one food that your kid really likes and maybe introduce a novel food with that comfort, familiar and comfortable food. So these are some of the strategies that seem helpful for kids of any age, but I guess, particularly elementary school age kids.

Bri DeRosa: Yeah, I think that’s, that’s so helpful. And I think that’s one of the reasons, right, why, why we always say things like, if you can do a build your own dinner, if you can set out a dinner where there are component parts and people have a little bit more choice and flexibility, so you’re not sitting there, you know, picking the little pieces of carrot out of the stew, right? That that makes things a little bit easier while they’re forming kind of their food preferences. And, and I do want to, we haven’t yet said, although I think it’s implied, everybody has food preferences, and respecting the fact that people have food preferences is part of living in a civilized society, right? You can, you can have a really positive family dinner where people like different things and that’s okay. It’s respectful. I think we, we tend to be okay with older people, with adults having food preferences. And we kind of have a sense of catastrophizing, sometimes, food preferences in children.

But it’s really okay. And they’ll figure out what they like as they grow, right? To your point. 

Anne Fishel: Right. 

Bri DeRosa: But, all of that by way of saying, that doesn’t mean that it’s always developmentally appropriate and that any degree of selectivity in eating at any age is necessarily just fine. And that we should never be concerned.

We know that there are places where picky eating, or learning to like different things, flips over into a place of, gee, maybe, maybe this is something that isn’t quite within the realm of what we expect. And so, Evelyna, I would love to invite you to help us start to sort this out. I know you focus a lot on ARFID, avoided restrictive food intake disorder.

And that’s a little bit of a new thing on the scene, I think, for a lot of parents. So I’d love it if you maybe would jump in and give us a little bit of an overview of what ARFID is, what does it look like, and how would a parent even know if this was something that they should have on their radar? 

Evelyna Kambanis: Yes, I’d be super happy to.

So ARFID was introduced in the psychiatric nomenclature in 2013. So actually even for, you know, clinicians and researchers, it is a relatively new diagnosis. ARFID, like you said, stands for avoidant restrictive food intake disorder. And that’s the primary feature, is avoidance or restriction of food intake by volume.

So not eating enough food or variety. So not eating a lot of different kinds of foods, or foods out of each of the primary food groups. It’s typically driven by one of three prototypical sort of motivations that we think about. The first is called sensory sensitivity, and this describes individuals who have sensitivities to the sensory properties of food, like texture, taste, or smell.

And we have fear of aversive consequences of eating, which describes individuals who’ve typically experienced a traumatic event related to their eating, such as choking or vomiting and learn to associate eating with that, that feared event. So, initially say, you know, they had choked on a piece of meat, for instance, although initially they might avoid eating meat due to fear of choking, then that fear might eventually generalize to all protein and over time, their eating might get less and less varied. 

And then finally, we have individuals who exhibit a lack of interest of in food or eating, which is kind of exactly like it sounds. Individuals who don’t drive much pleasure from eating, don’t have much of an appetite, and typically eat less than others do.

So those are the 3 motivations. So sensory sensitivity, fear of aversive consequences and lack of interest in food or eating, and these can co occur. So an individual with ARFID can present with 1, 2, or all 3 of these. And then the other thing that we want to see with ARFID is certain associated consequences. And this is how ARFID differs from picky eating, is it goes kind of a step beyond. 

So with ARFID, what we’re looking for is one of these four consequences. You can have more than one. The first is weight loss or failure to gain weight as expected. The second is nutritional deficiencies. The 3rd is dependence on supplemental feeding. So this might look like, you know, a child who only eats nutrition supplements or someone who requires tube feeding in order to meet their dietary needs. And then finally, we have perhaps what might be the most common, is psychosocial impairment. So the avoidant restrictive eating causes difficulties in multiple domains.

So, you know, arguments at home with the family dinner table, or not being able to go out to eat at certain restaurants because they don’t have food that the person will order, or only eating off of the, kids menu at certain restaurants, and things like that. And so one of those 4 consequences. 

And then finally, the kind of last thing to keep in mind about ARFID is that people with ARFID, in contrast to people with other eating disorders like anorexia nervosa and bulimia nervosa, you don’t have that disturbance of shape and weight component. So people with ARFID don’t care much about what their bodies look like, or they feel good and comfortable in their bodies. And there isn’t that desire to lose weight, as is common with some of the other eating disorders. 

And finally, I don’t think I mentioned this, but ARFID can occur across the weight spectrum. So you don’t have to be underweight to have ARFID, and it can occur at any age. So not just in kids, it can be up to adults as well. 

Bri DeRosa: I just learned, I don’t know, 12 different things. So thank you for that rundown. And one thing that I’m curious about, you know, it struck me as you were outlining all of this for us, that we do have on our website in our welcoming table initiatives, we do have some resources around sensory sensitivities and eating and how those you know, having sensory processing disorder, being on the autism spectrum, for example, those types of comorbidities might actually impact your family dinner time, right? Because of those sensory components of eating. 

It sounds to me like ARFID kind of shares a lot of characteristics with that particular concern that parents might be seeing. How, first of all, I guess my first question is, is ARFID, or can ARFID be co occurring with something like the autism spectrum or sensory processing disorders?

And secondly, how can a parent tease out the difference? 

Evelyna Kambanis: Both great questions. So yes, ARFID can definitely co occur with something like Autism Spectrum Disorder. And what we typically say with ARFID and overlapping autism is that in order to diagnose both, right, the feeding difficulty has to sort of surpass what would be typically expected of someone with autism.

So if ARFID requires its own separate treatment, then it’s more likely to be a frank ARFID diagnosis, as opposed to just sort of like a set of symptoms that are associated with that autism diagnosis. So absolutely possible to see both. And what you want to be looking for is, you know, those consequences that are associated with ARFID, the weight loss, nutritional supplements or nutritional deficiencies, rather dependence on supplemental feeding and psychosocial impairment to kind of ascertain whether or not that ARFID diagnosis goes above and beyond those typical sensory feeding difficulties that are associated with some developmental disorders.

Anne Fishel: Seems like the nutritional deficiency, the, the consequences of losing weight or being very low weight, and the behavioral consequences, a parent would observe, but the nutritional deficiencies might not come to a parent’s attention unless they had a workup or… 

Evelyna Kambanis: Definitely. And something that we hear parents commonly reporting is, you know, my kid only eats beige or gray foods. And you know, there isn’t much green on their plate. And that’s a scenario in which a parent might think, Hmm, I wonder, you know, if my child’s getting enough nutrients or vitamins, or conversely, someone might be taking a vitamin supplement. Like I know those Flintstone gummies are really common among kids with ARFID in particular.

And so oftentimes taking that gummy might be masking. And, and kind of looking for is even if those blood tests show no deficiencies and someone is taking that vitamin, it could potentially be correcting for what you might see otherwise. 

Anne Fishel: And Evelyna, is the treatment approach different depending on which of those motivations for the, for ARFID there is? I mean, if it’s motivated by an experience of having choked on meat, I’m thinking some kind of behavioral intervention or exposure therapy might be an approach. 

Evelyna Kambanis: Yeah, I’m so glad you asked this question. So they do differ. The common element across all is exposure. So exposure to the foods that the person you know, might not be eating.

So for the sensory sensitivity profile, we do what’s called systematic desensitization to novel foods. And what this looks like is, you know, patients will bring in five new foods that they’re going to be tasting in each session and, and complete the five steps, is what we call it in cognitive behavioral therapy for ARFID, where the patient neutrally describes the food by focusing on what it looks like, what it feels like, what it smells like, what it tastes like, and ultimately what the texture is like.

So those are the exposures that someone might expect. For the fear versus consequences profile, it’s a little different. Again, common element being exposure. They create a fear and avoidance hierarchy ranging from 0 to 100, 0 being food that causes no distress or impairment. So, for someone that choked on a piece of meat, for instance, 0 might be something super mushy that doesn’t really have a choking risk. So say, applesauce might be a 0, and 100 would potentially be the meat that they choked on, and they’d be responsible for completing the fear hierarchy from 0 to 100, kind of filling in what kinds of foods would represent each different level of distress with tasting it. And then we work up the fear hierarchy until we get to that most feared food.

And then, finally, for the lack of interest profile what we do is exposure to preferred or liked foods, to kind of have the conversation of, you know, what is it that you like about this food? And so that might even look like, you know, a patient who loves ice cream, but not much else. They bring in the ice cream and we do an exposure to the ice cream and talk about that.

We also do interoceptive exposures with a lack of interest profile to sort of accustom people to the feelings of fullness. Or like, even, you know, nausea after eating that might follow. So with the treatment for ARFID that we do in our clinic, again, that’s called Cognitive Behavioral Therapy for ARFID, and that was developed by our program co directors at the Eating Disorders Clinical and Research Program at Mass General.

We start with the primary mechanism that’s driving the ARFID, but if there’s more than one, we’ll do as many modules as are necessary to kind of target the full presentation of ARFID that we’re seeing. 

Bri DeRosa: So, I, I’m, I want to jump in here and just ask a very basic question because I want to be really clear with our listeners about some of this stuff sounds like, hey, we could try that at home.

We could, you know, try to desensitize our child to their fear foods at our family dinner table. And I’m, I kind of have the sense that while that might be okay for some kids who have a lower level sensory processing challenge, it might not be appropriate for a child with ARFID or with a more severe feeding issue.

So, can you speak to that? Should parents be trying this flying solo? And if not, who are the professionals? What types of doctors should they actually even be seeking out when they’re looking at trying to get a diagnosis, trying to treat this? 

Evelyna Kambanis: Yeah, another great question. So actually, our team recently published a self help manual that’s based on the cognitive behavioral therapy for ARFID that is, you can purchase on Amazon, it’s called The Picky Eater’s Recovery Book, and it’s oriented towards, you know, self help. So at home treatment for individuals with ARFID. I’ll add that it’s not necessarily a manual that’s designed for parents. It’s written for someone who has ARFID to be using. But of course, you know, the interventions are the same, and can be implemented by a parent who has a child with ARFID. 

What I would say is that oftentimes what we find is that, you know, people with ARFID will present a session with, say, these 5 new foods, and they’ll be willing to taste them in session, and sessions typically last 50 minutes. But trying those 5 new foods at home would probably take for some cases, not for all, a considerable amount of time. The person might not want to do it. They might have arguments with their family who are asking them to do it. So, oftentimes, it’s better to kind of do it in this confined 50 minute time period with someone else that’s not a family member, and where the person is perhaps more likely to engage in tasting the new foods and then work on practicing at home. 

So it might work, or it might be that, you know, perhaps like an additional individual is necessary to kind of facilitate this treatment. For the case of ARFID, I would recommend psychological evaluation in a feeding or eating disorders clinic, specifically one that has that expertise and treatment options available for ARFID.

Anne Fishel: Are pediatricians aware of ARFID kind of across the country? Would they pick it up and make the referral? Or is, does it, do you have to figure this out? 

Evelyna Kambanis: Hard to speak for everyone. I think increasingly pediatricians are becoming more and more aware of ARFID. You know, they are tuned to kind of assessing picky eating.

I’m not confident enough to say that everyone would make that referral, but I think we have had like many patients come in with, referrals from their pediatricians. 

Bri DeRosa: In addition to your work on ARFID, you also are an eating disorders practitioner. And there are, as you mentioned at the outset, beyond ARFID, there are other restrictive eating disorders and other non restrictive types of eating disorders.

And one of the things that we haven’t touched on yet is how parents might see changes in their child’s eating patterns, what their accepted foods look like at different points in their lifespan for different reasons, potentially. And when a parent might notice something that isn’t ARFID, isn’t a sensory based issue, isn’t one of these types of challenges, but maybe is a red flag for another type of eating disorder.

Can you speak at all to, you know, for example, lots of people come to us and say, hey, my 15 year old just suddenly decided she’s going vegan and gluten free. And I have some concerns about that. Can you speak at all to how parents might be able to discern what a perfectly developmentally reasonable change in asserting my eating habits might be, and what maybe warrants a little bit more reflection?

Evelyna Kambanis: Great question. I think this is really tricky. It’s a tricky, tricky area. So I think family mealtimes are, of course, a really important time in which parents might be able to notice that, notice signs and symptoms of an eating disorder that they might not otherwise be able to notice. So for instance, you know, if a family is sitting together and having dinner, they might be able to see that their son or daughter is limiting foods with gluten, limiting foods that have, you know, animal based products.

Whereas if this person is telling her parents or his parents that they’re buying breakfast and lunch in the school cafeteria, and then they’re eating dinner separately, there really is no opportunity to kind of observe these patterns. So I think in terms of signs and symptoms to be looking out for are, of course, food avoidance.

So at meal times, what this might look like is, you know, pushing food around on their plate without really eating much of it, claiming to be really full after taking only a few bites of food, saying that they don’t necessarily like what is served when it was previously perhaps a preferred food. And then, avoiding high calorie and high carbohydrate items altogether is another kind of like red flag that we might be looking for.

Portion control is another big one. So eating smaller portions compared to other family members, hiding food. Certain eating rituals that were not previously there, eating very slowly, cutting food into very small pieces. Having excuses and distractions for not eating, right? Like having to leave the dinner table to finish homework, or feeling really sick and not feeling very hungry.

And then another kind of big thing is emotional response. So when someone’s asked about their eating habits, if they become very defensive or anxious or irritable, that might be something to look out for. Whereas, you know, someone who might have chosen to go vegetarian for ethical reasons or animal rights reasons, whatever it might be, might be more willing to engage in that conversation and provide the rationale than someone who’s exhibiting restrictive eating and kind of using the vegetarian as an excuse, as a cover for what’s actually going on.

So, I do think it’s really tricky territory to navigate. I think observing behaviors, like parents know their children, they can notice that the behavior is a deviation from something that previously was occurring, and then engaging in these conversations, even though they might be difficult, is kind of the key thing to do. Coming from a point of, you know, compassion, you know, I noticed that you’re limiting vegetarian or non vegetarian and you know, gluten products. Can you share a little bit about me with me about why that may be, or what’s going on, or how we can support you?

I think the gluten one especially is one that kind of is more of a red flag, because why would you limit gluten if you don’t have an intolerance or sensitivity or celiac disease? Whereas the vegetarianism, vegan component is perhaps like, you know, more socially acceptable as something to do for different kinds of reasons. 

Anne Fishel: On a lighter note, I was just brought to a New Yorker cartoon to mind from years ago, which was two teenagers talking to each other. And one says to the other, at first I stopped eating meat for moral reasons. But then I did it just to annoy my parents.

Bri DeRosa: Everybody with a teenager right now is going, ugggghhhh, yeah. 

Anne Fishel: Actually, speaking about teenagers brings to mind developmental aspects to eating disorders. And I was wondering about, going back to ARFID, whether there’s an age range, which ARFID might appear. Or is it, you know, any age?

Evelyna Kambanis: Yeah, it’s tricky to say.

So typically with the sensory sensitivity and lack of interest profiles, they’re more chronic and longstanding. The fear of aversive consequences profile has a very acute and sudden onset following a traumatic event related to food or eating. So this one is kind of a little bit different than the other 2 in the, in the sense that it can literally happen overnight, right?

One day you might have not had a choking episode that involves meat, and then the next day you have it. And that’s kind of what’s going to lead to the development of ARFID. It’s very tricky in this population, because picky eating is so common and is, is a core feature of ARFID. It’s really tricky to ascertain when ARFID began.

So typically, you know, when you ask a patient with anorexia nervosa, how old were you when you developed anorexia, they’re going to very clearly be able to give you, you know, I was 12 when my coach said that I shouldn’t be eating this, this, and this foods, which kind of led me down the spiral. With ARFID, it’s so hard because the response that we very typically get is, oh, I’ve been a picky eater for as long as I can remember. And that’s kind of the important segue, right? Is to look out for when picky eating actually transitions to ARFID. So, it is hard to say. ARFID can occur at any age. And for most people with a sensory and lack of interest profiles, we do find that is more like a chronic course of illness.

Bri DeRosa: So, this has been an incredible conversation and I feel like we could go on forever. I just, I want to give a few kind of wrap up highlights to our listeners. It sounds like parents need to know a few things. One is, it’s developmentally normal for kids to be selective about their eating. It is developmentally normal for that to come back at different ages and stages. And it’s really okay for kids to assert different preferences and have even a fairly limited palate at different times. 

But what we want to be looking for are things like, first of all, a very restricted diet where entire categories of food groups are off the menu, or we eat fewer than, you know, five to 10 approved foods overall, or we’re losing weight. We are nutritionally deficient. We’re not thriving. We have a high kind of disgust profile around food or touching food or smelling food. And it’s something that bleeds over into really diminishing that child and family’s quality of life, inside the home and outside the home in any type of eating situation.

And that if you see these types of red flags and you are wondering, is my child maybe not just a typically picky eater? That you need to first seek medical help for that, and if your pediatrician is unable to refer you, you can be looking for a professional who is working in the domains of psychology, and feeding disorders, and eating disorders, and trying to find a fit there for your child and your family.

Do I have all of that right? 

Evelyna Kambanis: Oh, definitely. 

Bri DeRosa: Thank you. I know, I was like, how do I summarize this in a, in a key takeaway for our listeners so that if they only get this far in the episode, this is what they need to know.

So we’re going to wrap our episode now with food, fun, and conversation. Annie, I’m gonna kick it off with you. What is your food suggestion for today’s incredibly tricky– I feel like I’m putting you on the spot, because this is a very tricky one for a food suggestion. But lay it on us. 

Anne Fishel: Okay. I’m thinking of a build your own kind of food meal, and this could be one of many iterations. So it might look like a chicken rice soup, very plain, and there are many add ons. There’s crispy kale, there’s some cut up carrots, there’s some bean sprouts, maybe there’s some, I don’t know, some tomatoes, and each person throws in whatever they want, or, or not, but at least everybody is eating the same meal, which is great. And everybody, the child maybe who’s a picky eater, or has ARFID, is being exposed to some other food, so that’s, that’s good. Maybe a little bit in the exposure direction. 

And you know, that could be done with tacos. It could be done with crepes. There are lots of sort of simple build on starter foods where each person could customize what they’re having. 

Bri DeRosa: Yeah. It’s a great suggestion. I mean, you can even, you can use something that’s a typical safe food, like chicken nuggets even, to make a build your own salad bar, or a build your own chicken wrap, or you can make chicken nugget English muffin pizzas that are like little chicken parms, right?

And everybody can kind of touch their own and deal with their own. So it can be done with more sophisticated foods, and it can be done building off of extremely normative, safe foods for a lot of kids. So I love that suggestion, Annie.

Okay, I’m going to go ahead and do the fun, and for the fun component, I want to point people in the direction of the welcoming table resources on our website. I mentioned them earlier. We have some great games and activities on there for kids who do have kind of a more sensory avoidant profile with food. So you can do things like, we have a sensory table where we’ve broken it down with lots of different food based activities that they can do. 

So, some of them are messy, like smearing pudding or whipped cream. Some of them are dry, using oatmeal or rice, things like that. So depending on your child’s textural aversions and preferences, they can touch or not touch things that are more appropriate for them. We also have things like beet tattoos, where you can use a vegetable to make just a pretty heart shape on your skin, and you don’t have to, you know, eat the vegetable, or smell the vegetable, or do anything to the vegetable but do this very friendly activity.

So there are lots of different things like that that I think could be really useful for families when they’re trying to navigate how to help their child interact with food in a more neutral or enjoyable way.

Evelyna, I’d love to wrap with you. And can you give us a conversation idea that could really help families move forward with this?

Evelyna Kambanis: Yes, definitely. So I think one example might be, if you take an example of a food that a person is not eating and ask them how they would feel if they were asked to eat it. So for example, how might, how might it make you feel if I asked you to eat blank, right, to kind of get a sense of kind of emotional responses to eating a specific food, especially, you know, going back to the foods that don’t have gluten.

How would it make you feel if I made you eat a gluten cupcake? To kind of get into the emotions that might follow, I think, for older individuals. Another one might look like, what would you do if a friend were doing X, meaning, you know, limiting gluten and animal products? Like how, what, what might you talk to them about? To kind of get them thinking about externalizing it and thinking about other people.

And then as for a conversation starter with a doctor or pediatrician, I might just encourage parents to be fully forthcoming and up front saying that, you know, I’ve become more and more familiar with this diagnosis called ARFID. I was wondering, you know, if you were seeing signs and symptoms consistent with the diagnosis that I’ve observed, and if so, if we might put in a referral to a feeding or eating disorder specialist that might be able to help.

Bri DeRosa: Those are so useful. We have had such an incredible time with you, Evelyna. Thank you again for being with us and for teaching us so much. 

Evelyna Kambanis: Thank you so much for having me. This was awesome. 

Anne Fishel: Oh, it’s wonderful to have you. 

Bri DeRosa: All right, well, tune in next time for the Family Dinner Project podcast. In the meantime, if you have any additional questions about ARFID or eating disorders or any concerns about your child and family’s eating at all, please reach out to us.

You can contact us through our website, and we would love to hear from you, or you can even reach out to us on social media. We are active on Facebook, Instagram, X, and Threads. You can find us there to start a conversation as well. We don’t want anybody to navigate these questions alone.