Avoidant Restrictive Food Intake Disorder (ARFID) Simple Suggestions Series – Strategies to aid you in adding new foods

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. It’s a good idea to think about your motivation – your reason why. This can help you to keep pushing forwards when it feels scary. Reasons why change is important are different for everyone. It might be so that you can join in with friends and family more or to have more food choices, so you feel less panic if your safe foods aren’t available. There are no wrong answers – the right answers are the reasons that makes sense to you. Your reasons why can change over time too. So, it’s helpful to keep checking in with yourself about what you are doing and why.
2. Some people prefer to work through new food challenges on their own. For others it can be helpful to have some support. This could be from a family member or a friend. Or it may be from a helpful online community, or a healthcare professional that you trust.
3. Finding where to start can feel dauting and overwhelming. One starting point could be to write yourself a ‘traffic-light’ list. This means writing a list of ‘green foods’ (food I could eat now), ‘amber foods’ (food I could try) and ‘red foods’ (food I cannot try yet). Also consider different ways the same food can be prepared e.g., raw, stir -fried, mashed, roasted. They all taste different.
   
   After writing your list:
   • Rate how much worry you think you will experience for each of your ‘amber foods’. Use a scale along 0-10 (0 = no worry, 5 = quite worried, 10 = very worried)
   • Rearrange the ‘amber foods’ list into a ranked order with the lowest worry score at the top.
   • Start your food exposures with the easiest food on your list. Never start with the hardest, or with the ‘red foods’.

4. If you struggle with a list because all foods feel like they are either very safe or very unsafe, then it might be helpful to use of a food chaining approach.
   
   Food chaining is the process of thinking about foods that are like the ones you are currently eating. For example, a round rich tea biscuit is like a round cream cracker. Chaining foods together like this can help us find new foods that don’t feel too different. Doing this can be hard if you’ve eaten the same foods for a very long time and don’t know of many other foods available. If this is the case, try asking a trusted person for their ideas of what could be a very close match to your usual foods. Remember though, they are only suggestions – you are in control of which you try and when.
5. Consider different ways of buying foods e. g frozen, raw or ready-cooked. It may be easier to buy something and cook it yourself, or easier to buy it ready-cooked. For some individuals mixing a tiny amount of new food into an accepted food will help. For example, trying a new jam on just one corner of a slice of toast spread with your usual jam.
6. Remember that picking up a new food and trying it is still positive progress even if very little is eaten.
   
   Food exposure doesn’t only mean eating food. Sitting at the same table with a new food is an experience of food exposure. For many people having a challenging food on their plate or in the same room as them is positive progress.
7. Try not to feel disheartened if progress feels very slow – change does take a long time. Repetition is key. Keeping a diary can be helpful to remind you that you have made progress. It can also be helpful to rate how much worry you feel with each of your new food exposures. You can use a scale of 0-10 to do this (0 = no worry, 5 = quite worried, 10 = very worried).
8. Remember that repetition of trying foods if you didn’t like the first time is important. It can take many exposures (tries) before a food becomes familiar. Only familiar food will feel safe. Consistent and structured repetition is the key to accepting any new foods. By completing a record of your worry, you should see that the worry score comes down over time until it feels safe.
   
   Try not to dismiss a food first time. Anxiety can affect how food tastes. Try not to decide about taste until your anxiety is much lower.
9. Try not to reduce the amount of ‘safe foods’ (green foods) that you are eating to accommodate new foods. This is more likely to make you feel hungry and lead to a negative new-food experience. Instead, have planned food challenges separate from mealtimes. Keep your safe foods the same amount and frequency as usual to give you the energy you need. Then, introduce the new foods away from mealtimes. Do this in small amounts until they become familiar. They can then be included in your usual intake as regular foods.
10. Think about your preferred food environment. Keeping other aspects as safe as possible can be helpful and avoids changing too many things at once. This could mean adjusting the lights, using distractions, or finding a quiet space. It could also mean eating at the same time, sitting in the same seat, or eating with familiar crockery.
11. Once a new food has been introduced, keep including it in your regular foods. Although unintentional, it’s very easy for foods you thought you were comfortable with to slip back out of your diet again.

For more advice and tools to support your journey please visit: www.bebodypositive.org.uk. For more information on developing your ideal meal environment, please visit: PEACEpathway.org.uk

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