The COVID-19 pandemic has created stress on our internal infrastructure, disrupting our food systems. Every time I go to the grocery store now, and see the empty and picked through shelves, I cannot help but think about my patients and other individuals struggling with or in recovery from an eating disorder. I think about the strain this may be causing in their day to day life. More so, I cannot help but think, “What are my patients with ARFID doing for food?”.

Many people are still unfamiliar with the diagnosis of ARFID – Avoidant/Restrictive Food Intake Disorder. Patients with ARFID have far more than picky eating, although this is what it may appear to be to untrained professionals and non-professionals alike. Instead, individuals with ARFID have trouble meeting their nutritional needs because they have concerns about the aversive consequences of eating or they avoid food based on sensory characteristics.

So, what does this look like in daily life? These are individuals who do not outgrow their selective eating habits in adolescence. They are often underweight and may be off track for growth compared to their genetic potential. For many of these patients, a disgust response to food starts early in childhood, even infancy or toddlerhood. Also, many individuals with ARFID seem to have a lack of interest in food or eating. This can present as rarely expressing hunger or getting full easily. Sometimes these patients will “drink” their calories, by sipping on sports drinks all day.

Because of these sensory issues, fears, and disgust – many of these patients will only have a few foods they will consume. Not only that, but those few foods can be very brand specific. For example, chicken nuggets may be one of the three foods they will regularly eat. But more than that, for these individuals it will be a specific brand. They must eat the exact same food, the same brands, day after day and meal after meal. When individuals with ARFID do not get enough to eat – they risk short-term and long-term medical issues including acute malnutrition and issues with growth and bone development.

Due to the COVID-19 pandemic, we are all seeing some disruptions in the way food is available throughout the United States. We also are aware that for some families, financial assistance may be needed to maintain adequate nourishment.

Here are some general tips for anyone dealing with tight budgets and limited purchasing options:

• Choose frozen options for fruits and vegetables
• Plan a menu ahead of shopping
• Look for sale items
• Cook at home
• Shop what is in season
• Buy in bulk when possible – freeze some for later
• Look for community food distribution opportunities

For families with a child or loved one with ARFID – here are some additional ideas from our team to manage this crisis:

• Enlist Your Community: Don’t hesitate to ask for assistance from your community of support. Tell friends, family, and neighbors about the specific foods and brands you are looking for – ask them to purchase these items when they see them available. This will help you to stay stocked up with fewer trips to the store.
• Try Curbside Pick Up or Delivery: If your family member with ARFID has a food on their shortlist of food choices from a local restaurant, see if they are still offering take out, curbside delivery, or even “touchless” delivery.
• Remember Supplements: Supplements, like Boost, Ensure, Carnation Instant Breakfast, and old-fashioned milkshakes can help support nutrition when meals are less than adequate in the short term. Consider keeping these options on hand for when choices are limited.
• Relax the Rules: If you have chicken nuggets, and nothing else in the house and it is time for breakfast – serve the chicken nuggets. At this time, maintaining an adequate volume of food should be a priority to avoid acute weight loss or slowed growth.
• Reach Out: If you or someone you love are having a hard time meeting your nutritional needs, please reach out. Receiving the right level of care at the right time is essential in creating a foundation for lasting recovery.

Anna B. Tanner, MD, FAAP, FSAHM, CEDS is the Vice President of Medical Services for Veritas Collaborative. She is a Board-Certified Pediatrician who has spent the last 20 years of her career working with complicated adolescent patients with a special emphasis on treating patients with eating disorders. Throughout the COVID-19 pandemic and beyond, Veritas Collaborative remains committed to their mission and vision – providing access to care for all individuals, their families, and communities of support. We are in this together – and together we are stronger. Contact Veritas at 855-875-5812. Please visit their website at www.veritascollaborative.com.