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Have you ever wondered if those managing food allergies have higher rates of eating disorders (ED) or disordered eating patterns than those without food allergies?
While research has established that there are higher rates of eating disorders in those diagnosed with chronic conditions managed by dietary interventions such as diabetes and celiac disease, there isn't much research currently available about food allergies and eating disorders.
Which is why I was excited to see this article in the Journal of Allergy and Clinical Immunology In Practice, which offers a review of the incidence and/or prevalence of eating disorders in individuals with food allergies!
Here's a summary of what was found in this review about food allergies and eating disorders:
The review suggests that eating disorders, namely Avoidant Restrictive Food Intake Disorder (ARFID) and Anorexia Nervosa (AN) and/or Bulimia Nervosa (BN), may be common among individuals with IgE-mediated food allergy (FA) and eosinophilic esophagitis (EoE), with reported prevalence estimates ranging from 0.8% to 62.9% and varying due to a number of factors.
Previous literature suggests that food allergy is over-represented among individuals with eating disorders.
In a couple of cited studies, disordered eating patterns did not translate to meeting criteria for diagnosable eating disorders, and therefore, it is possible that the eating symptoms detected reflect helpful responses to managing food allergies.
Food allergies have also been associated with a range of disordered feeding behaviors including excessively limited diets, feeding aversions, and limited psychosocial functioning around food and meals.
Negative impacts of allergen avoidance on nutrition, growth, quality of life, and parental anxiety has been well described.
Individuals, including kids and teens, may resort to disordered eating behaviors as a maladaptive (problematic) way to gain control and assert independence from concerned parents.
Psychology referrals for eating problems such as monotonous or excessively restricted diets and food fear have been reported in up to 18% of children and adolescents with food allergy.
Avoidant Restrictive Food Intake Disorder (ARFID) is defined as someone who doesn't receive sufficient nutrition, which then takes a toll on bodily functioning. Oftentimes, the food avoidance is due to sensory issues and/or fear of uncomfortable bodily sensations or responses, such as choking, vomiting, or reacting. Those with ARFID would not meet criteria for other eating disorders. [Unlike other eating disorders, ARFID is not focused on issues with body image].
The prevalence of ARFID in children with IgE-mediated food allergy was 62.9%.
ARFID sometimes develops as a problematic anxiety management response for dealing with negative eating experiences and the fear or anxiety that eating will cause these negative experiences again.
Clinicians should be aware of signs of eating disorders and be prepared to refer to a multidisciplinary team with expertise in eating disorders for assessment and management.
There is a need to assess whether current eating disorder questionnaires are valid to use in those with food allergies, or whether modified versions are required in order to accurately distinguish between what level of food allergy avoidance is useful versus unhelpful.
Here are my thoughts and key takeaways from this insightful review:
When it comes to eating disorders and allergic conditions, think beyond just the body image-based eating disorders such as anorexia and bulimia.
Consider the impacts that food allergy management has on nutrition, but also on daily and psychosocial functioning, particularly relating to relationships with food and navigating meal times.
If eating-related struggles are developing, explore what's at the core of those struggles - discomfort when eating? Anxiety about eating? Avoidance of something feared, such as an uncomfortable sensation? Also explore any relatively recent traumatic food-related experiences and their potential impacts on the eating-related struggles.
Be aware of unhelpful relationships and patterns with food, as well as rigid thoughts about eating, and monitor your own and your child's actions in response to these things thoughts and patterns.
The line between adaptive (useful) and maladaptive (problematic) eating-focused behaviors can sometimes be hard to distinguish. For instance, is avoiding a whole category of food useful and necessary for safety, or is it considered an over-avoidance behavior in response to anxiety? The answer will likely come from exploring a variety of things, including your allergist's guidance, your risk tolerance levels, your ability to assess actual versus perceived allergen risks, your anxiety management style, and your previous reaction history. Therefore, discussing eating-related concerns with your allergist and healthcare team is incredibly important.
At the same time, don't assume that every less-than-ideal eating pattern or food struggle is a diagnosable eating disorder! If you are truly concerned that you or your child may be developing a worrisome eating pattern, don't turn to the internet for answers. Rather, discuss this with your allergist and healthcare team, who can do a proper evaluation and develop a workable plan with you.
What to do if you are concerned about your own or your child's eating patterns, or you're wondering about an eating disorder diagnosis:
Take notes. Write down specific behaviors, patterns, and thoughts you're noticing and how they're impacting functioning, nutrition, meal times, etc.
Discuss. Share these concerns and the notes you've taken with your allergist and primary care physician so they can help determine if there's a diagnosable eating disorder. Even if there isn't, this is a good place to start, as they can help you begin to address the unhelpful relationships and patterns with food.
Therapy. If you and/or your health care team feel you need additional support, reach out to a qualified licensed mental health care practitioner. Ideally, this would be a food allergy-informed therapist who is also trained in addressing eating disorders. However, sometimes it's hard to find therapists working in multiple specific niches like this (i.e. food allergy and eating disorders). This is especially true when trying to find a licensed therapist who understands food allergy and ARFID. If you're unable to find a "just right" therapist who ticks all the boxes for your needs, focus on finding one who is qualified to help you address the most important aspects (i.e. eating patterns, over-avoidance of food, etc.) and encourage them to collaborate with your allergist for the food allergy-specific aspects. When addressing eating disorders, including ARFID, you'll likely want to work with a multidisciplinary team, meaning health care practitioners from various fields, including medical, mental health, and dietary.