Avoidant Restrictive Food Intake Disorder (ARFID) Simple Suggestions Series – Creating your own ideal supportive mealtime

Produced in collaboration with:

• Bedfordshire and Luton Mental Health and Wellbeing Services provided by East London NHS Foundation Trust
• InsightEating and InsightHealth
• North East and North Cumbria Mental Health, Learning Disability and Autism Partnership

1. Anxiety around mealtimes can usually be reduced by considering your sensory sensitivities. This means thinking about how what you see, smell, touch, taste, and hear impacts how comfortable you are to eat. Think about the characteristics of both the food and the environment around you. You also have internal (interoceptive) sensory signals which are feelings inside your body like fullness, hunger, temperature or needing the toilet.
   
   Taken together, these are known as your ‘sensory profile’. Understanding what your sensory needs are helps you to understand how to tailor or create your ideal eating environment. It can also help you to develop your ideal strategies for challenging new foods.
2. Think about when meal/snack times feel most relaxed for you and try to practice that. This might mean keeping the same routine. For example, eating at the same time, in the same seat or with the same crockery. It might mean knowing that foods will be separate from one another. Or it may mean having a food plan and writing down which foods you will eat and when. Predictability often helps to reduce anxiety (worry).
3. Taking some of the focus off eating (during, before or after eating) can be a useful strategy. This is because it reduces the hypervigilance (anxiety). It can also reduce the physical feelings (interoception) associated with eating. Some examples can include listening to music, TV, podcasts, reading books, conversation, and using fidget toys, or puzzles. Breathing techniques such as abdominal breathing can also be helpful for some people.
   
   After identifying what is difficult about the eating environment, you can problem solve. For example, you could use ear plugs if you struggle with the sound of people eating or you could change your seat position to avoid looking at food. For some people it is more helpful to eat alone to reduce the sensory input from food smells, noises, and visuals. For others, eating together can be helpful and normalising. Ultimately, the best choice is the one that is the right fit for you.
4. Devising a meal schedule in advance can be helpful. This is best done with timings and with food types and quantities. It could also include specifics like certain brands. This helps to decrease worry and increase predictability and a sense of control. If you find that visual aids support this, then using pictures on your schedule could also be of benefit. Your meal schedule is your own – so be as creative as you like!
5. It is inevitable that at some point, planed food maybe be unachievable. This could be because the specific brand is unavailable, or the shop is unopen. One way to help manage this is to come up with a contingency plan that you find acceptable. Finding out which aspects would be the worst if altered is a good place to start. Alternatively, having a ‘safe meal’ which can always be on-hand can be a useful fail-safe. Having other options improves predictability over unpredictable events.
6. Sometimes, despite all your planning and preparation efforts, something can still go ‘wrong’. This often causes lots of arousal or emotion. This can also be the case if you need to move from Plan A to Plan B and didn’t want to. When this happens, having a toolkit of basic strategies to reduce arousal can be helpful. These will be different for each person. Try to think about what sensory input/strategies relaxes you and work with this. Some examples might include dimming the lights or finding a quiet space. It could mean using tactile objects like fidget toys or throwing a ball against a wall. Abdominal breathing and using strong/grounding smells (like essential oils) can also help.
7. An energy deficit means not having enough calories and/or losing weight. If you have an energy deficit, try to increase your safe foods portions over time. For example, this could mean trying to add one more chip to your plate each day/every few days. Nutritious fluids include options like milk, milkshakes, fruit juice, smoothies and hot chocolate. If these are tolerated, you could also try using these. They can be excellent snacks to take to college or work in discrete bottles like water bottles. Another option could be to eat more often than others (e.g. having lots of regular small snacks).
   
   Nutrition is key to keep your focus, attention, and concentration. Consuming nutrition little and often can help to reduce the feeling of fullness. This makes it a useful strategy for managing your energy needs.
8. Comments from family/friends/colleagues can be difficult. They can often add more pressure on to how you are feeling. A good strategy can be having some prompt answers ready. These are things like – ‘thank you for your concerns and I’m doing ok’ or ‘my clinician is aware and told me to do this’. Think about what words or phrases might work for you, and what you feel comfortable with saying. Having something pre-prepared can help you feel more in control.
9. Socialising whilst trying to complete a meal can feel terrible for some people. Others might find this a welcome distraction. Try to think about how these occasions can be adjusted to your needs. This helps to maximise your chances of success and reduce your feelings of anxiety. In some cases, the management of social and cultural eating might mean that you do not partake at all – and that is ok.
10. When at college or work, try to be familiar with places that you feel safe eating. Some settings have limited choices, for example there is only an open kitchen available. If you are limited in your choices, consider having helpful strategies to manage. Examples of this might include managing the smell by using an essential oil. Or managing noise by using ear plugs or noise cancelling headphones.

For more information on supporting an ideal eating environment please visit: PEACEpathway.org.uk

C.Ellison, RD, P.Falcoski, RD and U.Philpot (February 2024)