Dietitian Rebecca Tilden Featured on Merrit Elizabeth Recovery

Dietitian Rebecca tilden Featured on Meritt Elizabeth Recovery

Registered dietitian, eating disorder expert, and ARFID specialist, Rebecca Tilden MCN, RD, LD, CEDS, was recently interviewed by a local eating disorder recovery coach Merrit Elizabeth discussing Avoidant Restrictive Food Intake Disorder also known as ARFID.

You’ve been diagnosed with ARFID, now what? Tips from registered dietitian rebecca tilden.

The article discusses the ARFID treatment process, who is included in the ARFID treatment team, how to support a loved one struggling with ARFID and what nutrition counseling and therapy look like for someone struggling with ARFID. To read the full article please click below.

Avoidant Restrictive Food Intake (ARFID) is widely misunderstood, and often referred to as “picky-eating” But it’s more than that. Registered Dietitian and Certified Eating Disorder Specialist Rebecca Tilden of the highly esteemed Dallas Nutritional Counseling team is here to share more about this eating disorder and how you can recover.

Before joining Dallas Nutritional Counseling, Rebecca worked at Eating Recovery Center in Plano with patients across multiple levels of care. She practices from an anti-diet, weight-inclusive lens. Rebecca works with all eating disorders, and has experience working with children as young as 5 years old. She values each client’s unique experience and strives to make all clients feel safe and heard.

What does the typical ARFID treatment team and treatment plan look like?

The treatment team usually looks pretty similar to your standard eating disorder team, but there might be a few additions. Of course, there’s a dietitian, therapist, physician, psychiatrist. But often with ARFID, especially if it’s a pediatric patient, there might be an occupational therapist or a speech-language pathologist that gets involved too because there can sometimes be cases where there might be a physical malformation or challenge in the mouth that we need to work around in order to help that patient. So that’s not in every case, but occasionally, that can be really beneficial.

I have had multiple patients who present with ARFID symptoms, and we eventually get them to see one of those other clinicians. And that clinician is actually able to identify that there’s something else going on that’s impacting their eating, and that can sometimes really resolve what’s going on. So treatment plan for ARFID, I think in overall structure, also can look similar to the other eating disorders treatment plan, but there are a lot more variations in what those look like as we get into details.

For example, usually with ARFID, we start off by first looking at whether they are getting enough volume of food. So that is usually the first place that I approach a treatment plan is by making sure are they getting enough food to either sustain their body’s needs or if it’s a child or adolescent, sustain appropriate growth. After volume, I then look at variety, and variety tends to be dictated more by the client’s goals.

Some clients want to greatly expand the variety of foods that they are currently eating, and others may have different goals where they are maybe looking to have their food choices be a bit more flexible, but they’re not really looking to expand quite as far as other patients. So when we get into variety, I let the patient guide that.

Do they want to be able to try lots of new foods with reduced anxiety, or are they really just looking to be able to maybe have a staple food that they can eat at most restaurants out? And when we start looking at variety, that often can include some exposure therapy, which is with food, it’s a form of exposure-response and prevention, and we can do that in a variety of different ways.

Usually, exposure therapy for food involves all five senses. So we will customize that to whatever the patient needs. Some patients have different sensory needs. Some have very strong sensory reactions from specific senses to foods.

Others may be a little bit more general. So the exposure therapy is really tailored again to that patient. Usually, it involves trying the same thing a repeated amount of times so that they can work on reducing that anxiety response that happens to the food. Sometimes exposure therapy will happen in session, sometimes outside of sessions. Again, this depends on the patient’s preference.

As a registered dietitian, how do you support clients with ARFID? Do you have anything to add to that last part?

Volume and variety of food are two of the big ways I can help support. Some of the other things that a dietitian does in supporting a patient with ARFID is overall kind of within volume and variety, making sure that they’re meeting nutritional needs. And with ARFID, that may mean that we’re looking at if we need to use different supplements or vitamins to help meet those nutritional needs.

Or, do we need to figure out some more creative ways to meet those needs? For example, some ARFID patients might meet a lot of their vitamin and mineral needs with fortified foods, which would be a lot of our flour-based products, or other packaged goods that have vitamins and minerals added. Those might help our patients actually meet their needs.

And so we can get kind of creative there. Dietitians also help with figuring out if there are different accommodations needed at mealtimes to help this patient thrive. So thinking again about some of the sensory sensitivities that ARFID patients may have, it can be helpful to have different accommodations at meal times where we help reduce that sensory reaction.

For example, some patients are really sensitive to the sound of others chewing or may be very sensitive to really strong smells. And so we can help kind of figure out, okay, how do we work with that in the context of the family meal or whatever that patient’s meal time looks like. And the other thing dietitians can help a lot with is education about ARFID, not only for the patient but for their whole support system.

I think, like any eating disorder, that support system is so important to help that patient make the progress that they need to make. So we can help educate and I think there’s just there’s a high learning curve with ARFID. So it’s it’s helpful to get all of those support people on board.

How can you support a loved one with ARFID at meal times?

I think that when I was thinking through this, the number one thing that came to mind is just to ask your loved one what kind of support they need because what each person needs varies so so much. I think that can be the most helpful thing–just asking. A lot of my patients, especially patients with ARFID, might feel unsure about asking others for support because they don’t want to be a burden or they don’t want people to go out of their way for support. 

So I think as a loved one, taking that initiative and asking them yourself can be really freeing for the patient. I think a lot of the time that support could look like having some of that person’s preferred foods available. It might look like accommodating some of those sensory needs, or it could just look like support.

Maybe they just need words of encouragement or other forms of support during mealtime.

What are some of your favorite coping strategies for people with ARFID?

I think number one, and this is where it’s really helpful to have a therapist on the team as well, is to have the toolkit of grounding skills that you can use at mealtimes or when you’re eating when anxiety is increasing because of the food. Some of the grounding skills that I think can be really universal and helpful for many patients are things like box breathing or just rhythmic deep breathing. Also, 5-4-3-2-1 where they’re increasing their awareness of their surroundings and pulling themselves back into the present and out of that anxiety. 

Grounding skills are going to vary from person to person, but each person having that individualized little toolkit they can pull from to help reduce anxiety is helpful. And therapists can, of course, help individualize and build that for that patient. And from a nutrition perspective, two of the things that I think are most helpful in making sure we’re getting enough volume and variety is simplifying how we look at meals.

So this is similar to how we teach any patient how to look at meals. I think of meals as a combination of protein, carbohydrates, and dietary fat. I think that can be beneficial for ARFID patients to think about meals in that equation and not to worry about the meal being cohesive, more to think about, “Okay. Do I have some kind of source of each of these nutrients?”

Sometimes depending on someone’s preferred foods, it can be really challenging to always make a cohesive meal or it may be a difficult day where a cohesive meal just isn’t possible. But we can at least think about, “Okay. Let’s try to at least get all of these elements using my preferred foods.” That can be helpful to increase variety and volume.

I think in addition to that, one of my favorite strategies for ARFID is to really get creative with supplementation. I know often when we think of the idea of supplementation, we’re thinking of protein shakes, various powders, or additives. And some ARFID patients like those. 

Some do not, especially if there’s an increased sensitivity to taste or texture, those can be really challenging. So I like to get creative in thinking about supplementation–how can we use even preferred foods as a form of supplement? So for example, if someone is comfortable with peanut butter, are there ways that we can maybe work in peanut butter in multiple places throughout the day in their meals and snacks as kind of a form of supplement to help them get the volume of nutrients that they need?

Are there any words of inspiration that you might offer to someone struggling with ARFID?

There’s kind of two things that pop to mind for me here. One is that ARFID is more than just picky eating. That is a sentiment that I hear often, especially among patients who may come to see me not long after they’ve been diagnosed with ARFID, or they may have just learned what ARFID is and realized that that really resonates with them. I think there’s there can be stigma sometimes around picky eating and ARFID. 

And I would encourage anyone with ARFID to remember that ARFID is categorized as an eating disorder for a reason. It is a multidimensional, very complex condition that has many different factors contributing to it. It is not a it’s not a matter of willpower.

It’s not a matter of desire. So know that it is not at all anything that is indicative of failure or some shortcoming on your behalf. Also, know that there are many trained professionals that can help and that there is hope for treatment.

If you want to change the way that you are eating, there are specialized clinicians that can help. I think the second thing that I would want to say too is that there’s no one right way to eat. Even among those with ARFID, there’s not one specific way that eating is going to look like after treatment or during treatment. 

There’s no right way for anyone to eat. And so I would encourage all those who want to seek help to go ahead and do so and be open and communicate what they’re looking for because there’s no one way that eating has to look like. And you never have to do something that you’re uncomfortable with.

If you or someone you know is struggling with an eating disorder or disordered eating and want to work with one of our dietitians please reach out to our office via the contact page or schedule an appointment online.

Registered dietitian, eating disorder expert, and ARFID specialist, Rebecca Tilden MCN, RD, LD, CEDS, was recently interviewed by a local eating disorder recovery coach Merrit Elizabeth discussing Avoidant Restrictive Food Intake Disorder also known as ARFID.