Selective eating

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Selective eating, also known as picky eating, is a variety of behaviors whereby people are highly selective in what they eat and do not eat. Selective eating is common in younger children [1] and can also sometimes be seen in adults. [2]

Contents

There is no generally accepted definition of selective eating, [3] [4] which can make it difficult to study this behavior. [5] Selective eating can be conceptualized as two separate constructs: picky eating and food neophobia. [4] Picky eaters reject both novel and familiar food whereas food neophobic people are thought to reject unfamiliar foods specifically. [6] Selective eating can be associated with rejecting mixed or lumpy foods. [7] It can also be associated with sensory sensitivity. [8]

Estimates of the prevalence of selective eating vary due to measuring instruments, age of sample, or population sample. [5] However, studies suggest that feeding problems occur in about 80% of children with intellectual and development disabilities, and in about 25-45% of typically developing children. [9] Consequently, a proportion of selective eaters continue into adulthood with similar eating patterns as during childhood. [10]  

Selective eating in children is a common concern for parents, as it may lead to nutritional inadequacies and mealtime struggles. [3] While many cases of selective eating tend to diminish with age, [4] some individuals continue to exhibit discerning eating habits into adulthood, which can impact their overall health and well-being.

There is debate as to whether selective eating represents an eating disorder or is related to eating disorders. [11] Some extreme forms of selective eating are recognized as psychiatric disorders such as avoidant/restrictive food intake disorder (ARFID), or proposed psychological disorders such as orthorexia nervosa.

Causes and contributing factors

The etiology of selective eating is not well understood [9] but can be broadly explained through nature and nurture. Nature typically refers to genetic predispositions, which play a significant role in the development of selective eating behaviors. The ability to taste certain bitter thiourea compounds, such as 6-n-propylthiouracil (PROP) and phenylthiocarbamide (PTC), is genetically determined. PROP tasters tend to have more food dislikes due to heightened sensitivity to bitter compounds. As a result, they’re at higher risk of developing selective eating patterns. [12] Additionally, several studies provide evidence that food neophobia is highly heritable. A study conducted on over 5000 twin pairs and their parents found a neophobia heritability estimate of 0.78, although about 25% of phenotypic variation was accounted for by environmental factors. [3]  

Environmental influences during early life also shape selective eating behaviors. The impact of early experiences with flavor, both in utero and via breastfeeding, plays a crucial role in shaping food preferences later in life. Fetuses are exposed to the flavors present in the mother's diet through the amniotic fluid, leading to heightened preferences for those flavors postnatally. Breastfeeding further influences flavor preferences, as flavors from the mother's diet are transmitted through breast milk. Infants exposed to various flavors through breastfeeding demonstrate increased acceptance of those flavors during weaning. During weaning, the timing and variety of foods introduced influence children's readiness to consume new and varied foods. [12] Parenting style and feeding practices further influence children's food behaviors. Cole et al’s (2017) systematic review cites several studies indicating that negative, non-responsive feeding styles are positively associated with selective eating. Across these studies, high warmth authoritative parenting was reported as being the most beneficial for implementing healthy eating habits. [13] Lastly, the food environment at home, encompassing food availability and exposure to novel foods, significantly influences children’s food preferences and behaviors. Children exposed to a greater variety of foods at home tend to consume more fruits and vegetables. However, it’s important to note that some families will struggle to provide their children with varied healthy food options due to socioeconomic restrictions or food insecurity. [14]  

Ultimately, various factors interact to shape each child’s eating behaviours and food preferences. Early experiences including exposure to flavors in utero and via breastmilk, interact with genetic differences in flavor perception to establish food preferences. Nurture elements such as exposure to different tastes and parental feeding practices can modify feeding behaviors.  Conversely, a child's innate preferences, behaviors, and temperament can influence nurture elements. Research indicates that children who are sensitive to sensory stimuli may be less likely to model their parents' fruit and vegetable consumption, highlighting the bidirectional nature of picky eating. Further research is needed to fully understand the intricate interactions between these factors and their relation to selective eating. [12]

Implications

Family conflict

Selective eating often causes conflict within the family. [10] Studies have reported impairment in family functioning with both moderate and severe selective eating. [15] Parents of selective eaters commonly report that their children consume a restricted range of foods; require food prepared in particular ways; express strong preferences and aversions towards food and throw tantrums when these are denied. This often leads parents to providing meals for their children that are different from the rest of the family. Selective eating may also be a significant source of concern for parents as it may prompt physician visits and potentially spark conflict between parents regarding how to manage their child's eating behavior. [16]

Physical health

Selective eating is characterised by a restricted diet. Restricted diet can have a concerning impact on growth and development. [17] Studies show it is associated with poor physical health through nutritional deficiencies including low intakes of iron and zinc as these are associated with low intakes of fruit, vegetables, and meat. [18] Also, lower intakes of vitamin C, vitamin E, folate, and fiber has been noted, which may lead to a weakened immune response and digestive problems. [19]

Studies have shown mixed findings regarding the relationship between selective eating and being at risk of being underweight or overweight. A 1997 study of a group of selective eaters (aged 4–14) found that "a significant minority has poor growth or weight gain." [2] Yet, this observation could be attributed to their broadened interpretation of selective eating and the inclusion of much younger children. There remains little evidence for a consistent effect of being a selective eater on growth trajectories. [18] Further research is needed to investigate the effects of selective eating on brain development and metabolism. [17]

Psychosocial symptoms

Selective eating is linked to eating psychopathology and psychosocial dysfunction. [7] This includes both internalizing (e.g., anxiety, depression) and externalizing (e.g., attention deficit hyperactivity disorder) psychopathology. Both moderate and severe levels of selective eating are associated with psychopathological symptoms, and the severity of these symptoms tends to worsen with more severe selective eating. [15]

Selective eaters tend to show social avoidance, although it's unclear whether this is a result of selective eating behavior or simply reflects a primary social skills deficit. The extent of social avoidance varies but one case study of a 9-year-old boy identifies the impact of selective eating specifically. He missed lunch at school so found it difficult to make friends. It affected how long he could stay at his friend's house. It prevented the whole family from going on visits and this family tension was exacerbated as his dad would get cross and go off with his brothers. [17]

Diagnosis

Assessment of selective eating varies due to the lack of universal definition. Considering the complex etiology of selective eating, assessment (and later treatment) ideally should be carried out by an interdisciplinary team of professionals. [9]

One of the most common ways of measuring selective eating is using scales. Selective eating can be measured with a list heuristic, where the number of foods that the person rejects on a standard list is counted. [2] When investigating selective eating in children, parental report tends to be the most common tool of measurement. Two commonly used questionnaires include the Child Eating Behavior Questionnaire Food Fussiness subscale (CEBQ FF) [20] and the Food Neophobia Scale (FNS). These questionnaires have undergone validation against weight-for-age-z score or child body mass index z-score (BMIz), with greater selective eating being negatively correlated with BMIz or weight-for-age z-score. However, a limitation of such scales is that they either rely on individuals to self-identify as selective eaters [21] or rely on parental report which may be biased. Parents may struggle to accurately gauge the extent to which their child's eating habits differ from typical behavior for children, or they may find that their perception of their child's eating behavior is influenced by their own concerns regarding eating and feeding habits. [5]

Therefore, it can be helpful to validate selective eating scales against observational measures. There are a range of ways to conduct observational assessments of selective eating behavior. One study tested participants individually and told them that they were participating in a study of the relation between mood and taste perception. They were presented with various types of cookies and asked to rate them along various dimensions and told to eat as many as they wanted as fresh cookies would be baked for each participant. Following the taste test, participants completed a packet of surveys including dietary restraint scales as well as distractor scales (e.g. mood measures). Each of the plates was weighed before and after participant arrival to provide an unobtrusive measure of total caloric intake. [22]

Extreme forms of selective eating have been recognized as eating disorders, mainly avoidant/restrictive food intake disorder (ARFID). These should be assessed through diagnosis. The DSM-5 includes a 'feeding and eating disorders' section and covers several diagnoses that may be related to selective eating. [23]

See also

Related Research Articles

Orthorexia nervosa is a proposed eating disorder characterized by an excessive preoccupation with eating healthy food. The term was introduced in 1997 by American physician Steven Bratman, who suggested that some people's dietary restrictions intended to promote health may paradoxically lead to unhealthy consequences, such as social isolation, anxiety, loss of ability to eat in a natural, intuitive manner, reduced interest in the full range of other healthy human activities, and, in rare cases, severe malnutrition or even death.

<span class="mw-page-title-main">Appetite</span> Desire to eat food

Appetite is the desire to eat food items, usually due to hunger. Appealing foods can stimulate appetite even when hunger is absent, although appetite can be greatly reduced by satiety. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the digestive tract, adipose tissue and the brain. Appetite has a relationship with every individual's behavior. Appetitive behaviour also known as approach behaviour, and consummatory behaviour, are the only processes that involve energy intake, whereas all other behaviours affect the release of energy. When stressed, appetite levels may increase and result in an increase of food intake. Decreased desire to eat is termed anorexia, while polyphagia is increased eating. Dysregulation of appetite contributes to ARFID, anorexia nervosa, bulimia nervosa, cachexia, overeating, and binge eating disorder.

Neophobia is the fear of anything new, especially a persistent and abnormal fear. In its milder form, it can manifest as the unwillingness to try new things or break from routine. In the context of children the term is generally used to indicate a tendency to reject unknown or novel foods. Food neophobia, as it may be referred to, is an important concern in pediatric psychology.

A food craving is an intense desire to consume a specific food, and is different from normal hunger. It may or may not be related to specific hunger, the drive to consume particular nutrients that is well-studied in animals. In studies of food cravings, chocolate and chocolate confectioneries almost always top the list of foods people say they crave; this craving is referred to as chocoholism. The craving of non-food items as food is called pica.

Baby-led weaning is an approach to adding complementary foods to a baby's diet of breast milk or formula. BLW facilitates oral motor development and strongly focuses on the family meal, while maintaining eating as a positive, interactive experience. Baby-led weaning allows babies to control their solid food consumption by "self-feeding" from the start of their experience with food.

Avoidant/restrictive food intake disorder (ARFID) is a feeding or eating disorder in which individuals significantly limit the volume or variety of foods they consume, causing malnutrition, weight loss, or psychosocial problems. Unlike eating disorders such as anorexia nervosa and bulimia, body image disturbance is not a root cause. Individuals with ARFID may have trouble eating due to the sensory characteristics of food, executive dysfunction, fears of choking or vomiting, low appetite, or a combination of these factors. While ARFID is most often associated with low weight, ARFID occurs across the whole weight spectrum.

<span class="mw-page-title-main">Palatability</span>

Palatability is the hedonic reward provided by foods or drinks that are agreeable to the "palate", which often varies relative to the homeostatic satisfaction of nutritional and/or water needs. The palatability of a dish or beverage, unlike its flavor or taste, varies with the state of an individual: it is lower after consumption and higher when deprived. It has increasingly been appreciated that this can create a hunger that is independent of homeostatic needs.

Hunger is a sensation that motivates the consumption of food. The sensation of hunger typically manifests after only a few hours without eating and is generally considered to be unpleasant. Satiety occurs between 5 and 20 minutes after eating. There are several theories about how the feeling of hunger arises. The desire to eat food, or appetite, is another sensation experienced with regard to eating.

Research into food choice investigates how people select the food they eat. An interdisciplinary topic, food choice comprises psychological and sociological aspects, economic issues and sensory aspects.

<span class="mw-page-title-main">Social class differences in food consumption</span>

Social class differences in food consumption refers to how the quantity and quality of food varies according to a person's social status or position in the social hierarchy. Various disciplines, including social, psychological, nutritional, and public health sciences, have examined this topic. Social class can be examined according to defining factors — education, income, or occupational status — or subjective components, like perceived rank in society. The food represents a demarcation line for the elites, a "social marker", throughout the history of the humanity.

Satiety value is the degree at which food gives a human the feeling of satiety per calorie. The concept of the Satiety Value and Satiety Index was developed by Australian researcher and doctor, Susanna Holt. Highest satiety value is expected when the food that remains in the stomach for a longer period produces greatest functional activity of the organ. Limiting the food intake after reaching the satiety value helps reduce obesity problems.

Emotional eating, also known as stress eating and emotional overeating, is defined as the "propensity to eat in response to positive and negative emotions". While the term commonly refers to eating as a means of coping with negative emotions, it sometimes includes eating for positive emotions, such as overeating when celebrating an event or to enhance an already good mood.

Hedonic hunger or hedonic hyperphagia is the "drive to eat to obtain pleasure in the absence of an energy deficit". Particular foods may have a high "hedonic rating" or individuals may have increased susceptibility to environmental food cues. Weight loss programs may aim to control or to compensate for hedonic hunger. Therapeutic interventions may influence hedonic eating behavior.

Expected satiety is the amount of relief from hunger that is expected from a particular food. It is closely associated with expected satiation which refers to the immediate fullness that a food is expected to generate.

The psychology of eating meat is an area of study seeking to illuminate the confluence of morality, emotions, cognition, and personality characteristics in the phenomenon of the consumption of meat. Research into the psychological and cultural factors of meat-eating suggests correlations with masculinity, support for hierarchical values, and reduced openness to experience. Because meat eating is widely practiced but is sometimes associated with ambivalence, it has been used as a case study in moral psychology to illustrate theories of cognitive dissonance and moral disengagement. Research into the consumer psychology of meat is relevant to meat industry marketing, as well as for advocates of reduced meat consumption.

Leann L. Birch was an American developmental psychologist, best known for her research on children's eating behaviors.

Caroline Christine Horwath is a New Zealand nutritional scientist and professor in the Department of Human Nutrition at the University of Otago.

Food psychology is the psychological study of how people choose the food they eat, along with food and eating behaviors. Food psychology is an applied psychology, using existing psychological methods and findings to understand food choice and eating behaviors. Factors studied by food psychology include food cravings, sensory experiences of food, perceptions of food security and food safety, price, available product information such as nutrition labeling and the purchasing environment. Food psychology also encompasses broader sociocultural factors such as cultural perspectives on food, public awareness of "what constitutes a sustainable diet", and food marketing including "food fraud" where ingredients are intentionally motivated for economic gain as opposed to nutritional value. These factors are considered to interact with each other along with an individual's history of food choices to form new food choices and eating behaviors.

<span class="mw-page-title-main">Intuitive eating</span> Approach to food

Intuitive eating is an approach to eating that focuses on the body's response to cues of hunger and satisfaction. It aims to foster a positive relationship with food as opposed to pursuing "weight control". Additionally, intuitive eating aims to change users' views about dieting, health, and wellness, instilling a more holistic approach. It also helps to create a positive attitude and relationship towards food, physical activity, and the body.

The Food Cravings Questionnaires (FCQs) are among the most widely used self-report questionnaires for measuring food craving. They were developed by Antonio Cepeda-Benito and colleagues in 2000. For the 39-item trait version (FCQ-T), respondents indicate how frequently each statement is true for them in general on a six-point scale with 1 = never/not applicable, 2 = rarely, 3 = sometimes, 4 = often, 5 = usually, and 6 = always. For the 15-item state version (FCQ-S), respondents indicate the extent to which they agree with each statement right now, at this very moment, on a five-point scale with 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree.

References

  1. ↑ Walton, Kathryn; Kuczynski, Leon; Haycraft, Emma; Breen, Andrea; Haines, Jess (2017). "Time to re-think picky eating?: A relational approach to understanding picky eating". International Journal of Behavioral Nutrition and Physical Activity. 14 (1): 62. doi: 10.1186/s12966-017-0520-0 . PMC   5420103 . PMID   28476160.
  2. 1 2 3 Potts, Henry W.W.; Wardle, Jane (1998). "The List Heuristic for Studying Personality Correlates of Food Choice Behaviour: A Review and Results from Two Samples". Appetite. 30 (1): 79–92. doi:10.1006/appe.1997.0087. PMID   9584064. S2CID   23389215.
  3. 1 2 3 Taylor, Caroline M.; Emmett, Pauline M. (2019). "Picky eating in children: Causes and consequences". Proceedings of the Nutrition Society. 78 (2): 161–169. doi:10.1017/S0029665118002586. PMC   6398579 . PMID   30392488.
  4. 1 2 3 Cardona Cano, S.; Hoek, Hans W.; Bryant-Waugh, Rachel (2015). "Picky eating". Current Opinion in Psychiatry. 28 (6): 448–454. doi:10.1097/YCO.0000000000000194. PMID   26382157. S2CID   31066057.
  5. 1 2 3 Fernandez, Carmen; DeJesus, Jasmine M.; Miller, Alison L.; Appugliese, Danielle P.; Rosenblum, Katherine L.; Lumeng, Julie C.; Pesch, Megan H. (August 2018). "Selective eating behaviors in children: An observational validation of parental report measures". Appetite. 127: 163–170. doi:10.1016/j.appet.2018.04.028. ISSN   0195-6663. PMC   5994375 . PMID   29729326.
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  8. ↑ Wildes, Jennifer E.; Zucker, Nancy L.; Marcus, Marsha D. (2012). "Picky eating in adults: Results of a web-based survey". International Journal of Eating Disorders. 45 (4): 575–582. doi:10.1002/eat.20975. PMID   22331752.
  9. 1 2 3 Volkert, Valerie M.; Patel, Meeta R.; Peterson, Kathryn M. (2016), "Food Refusal and Selective Eating", Evidence-Based Practices in Behavioral Health, Cham: Springer International Publishing, pp. 137–161, doi:10.1007/978-3-319-27297-9_7, ISBN   978-3-319-27295-5
  10. 1 2 Van Tine, Meredith L.; McNicholas, Fiona; Safer, Debra L.; Agras, W. Stewart (August 2017). "Follow-up of selective eaters from childhood to adulthood". Eating Behaviors. 26: 61–65. doi:10.1016/j.eatbeh.2017.01.003. ISSN   1471-0153. PMID   28152419.
  11. ↑ Jacobi, Corinna; Schmitz, Gabriele; Agras, W. Stewart (2008). "Is picky eating an eating disorder?". International Journal of Eating Disorders. 41 (7): 626–634. doi:10.1002/eat.20545. PMID   18454484.
  12. 1 2 3 Patel, Meera D.; Donovan, Sharon M.; Lee, Soo-Yeun (2020-11-06). "Considering Nature and Nurture in the Etiology and Prevention of Picky Eating: A Narrative Review". Nutrients. 12 (11): 3409. doi: 10.3390/nu12113409 . ISSN   2072-6643. PMC   7694604 . PMID   33171966.
  13. ↑ Cole, Natasha Chong; An, Ruopeng; Lee, Soo-Yeun; Donovan, Sharon M (2017-05-23). "Correlates of picky eating and food neophobia in young children: a systematic review and meta-analysis". Nutrition Reviews. 75 (7): 516–532. doi:10.1093/nutrit/nux024. ISSN   0029-6643. PMID   28535257.
  14. ↑ Best, Maisy; Papies, Esther K. (September 2019). "Lower socioeconomic status is associated with higher intended consumption from oversized portions of unhealthy food" (PDF). Appetite. 140: 255–268. doi:10.1016/j.appet.2019.05.009. ISSN   0195-6663. PMID   31082447.
  15. 1 2 "Psychological and Psychosocial Impairment in Preschoolers With Selective Eating". Pediatrics. 136 (3): X19. 2015-08-03. doi:10.1542/peds.2014-2386d. ISSN   0031-4005.
  16. ↑ Mascola, Anthony J.; Bryson, Susan W.; Agras, W. Stewart (December 2010). "Picky eating during childhood: A longitudinal study to age 11years". Eating Behaviors. 11 (4): 253–257. doi:10.1016/j.eatbeh.2010.05.006. ISSN   1471-0153. PMC   2943861 . PMID   20850060.
  17. 1 2 3 Nicholls, Dasha; Christie, Deborah; Randall, Louise; Lask, Bryan (April 2001). "Selective Eating: Symptom, Disorder or Normal Variant". Clinical Child Psychology and Psychiatry. 6 (2): 257–270. doi:10.1177/1359104501006002007. ISSN   1359-1045.
  18. 1 2 Taylor, Caroline M.; Emmett, Pauline M. (2018-11-05). "Picky eating in children: causes and consequences". Proceedings of the Nutrition Society. 78 (2): 161–169. doi:10.1017/s0029665118002586. ISSN   0029-6651. PMC   6398579 . PMID   30392488.
  19. ↑ Wolstenholme, Hazel; Kelly, Colette; Hennessy, Marita; Heary, Caroline (2020-01-03). "Childhood fussy/picky eating behaviours: a systematic review and synthesis of qualitative studies". International Journal of Behavioral Nutrition and Physical Activity. 17 (1): 2. doi: 10.1186/s12966-019-0899-x . ISSN   1479-5868. PMC   6942299 . PMID   31900163.
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  21. ↑ Ellis, Jordan M.; Galloway, Amy T.; Webb, Rose Mary; Martz, Denise M. (August 2017). "Measuring adult picky eating: The development of a multidimensional self-report instrument". Psychological Assessment. 29 (8): 955–966. doi:10.1037/pas0000387. ISSN   1939-134X. PMID   27643793.
  22. ↑ Stice, Eric; Fisher, Melissa; Lowe, Michael R. (2004). "Are Dietary Restraint Scales Valid Measures of Acute Dietary Restriction? Unobtrusive Observational Data Suggest Not". Psychological Assessment. 16 (1): 51–59. doi:10.1037/1040-3590.16.1.51. ISSN   1939-134X. PMID   15023092.
  23. ↑ Zimmerman, Jacqueline; Fisher, Martin (April 2017). "Avoidant/Restrictive Food Intake Disorder (ARFID)". Current Problems in Pediatric and Adolescent Health Care. 47 (4): 95–103. doi:10.1016/j.cppeds.2017.02.005. ISSN   1538-5442. PMID   28532967.
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