Hi Reader,

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 ED in those diagnosed with chronic conditions managed by dietary interventions such as diabetes and celiac disease, there isn't much research available about food allergy and ED.

Which is why I was excited to see this article which explores a review of the incidence and/or prevalence of eating disorders in individuals with food allergies!​
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Here's a brief summary of what was found with this review:

• The review suggests that EDs, namely Avoidant Restrictive Food Intake Disorder (ARFID) and Anorexia Nervosa (AN) and/or Bulimia Nervosa (BN), may be common among individuals with IgE-mediated FA and EoE, with reported prevalence estimates ranging from 0.8% to 62.9% and varying due to a number of factors.
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• Previous literature suggests that FA is over-represented among individuals with ED.
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• In a couple of cited studies, disordered eating patterns did not translate to meeting criteria for diagnosable EDs, and therefore, it is possible that the eating symptoms detected reflect helpful responses to managing FA.
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• FA has also been associated with a range of disordered feeding behaviors including excessively limited diets, feeding aversions, and limited psychosocial functioning around food and meals.
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• Negative impact of allergen avoidance on nutrition, growth, quality of life, and parental anxiety has been well described.
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• Individuals may resort to disordered eating behaviors as a maladaptive (problematic) way to gain control and assert independence from concerned parents.
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• 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 FA.
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• ​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 or fear of uncomfortable bodily sensations or responses, such as choking, vomiting, or reacting. Those with ARFID would not meet criteria for other EDs.
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• The prevalence of ARFID in children with IgE-mediated FA was 62.9%.
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• ARFID sometimes develops as an problematic anxiety management response for dealing with negative eating experiences and the fear or anxiety that eating will cause these negative experiences again.
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• Clinicians should be aware of signs of EDs and be prepared to refer to a multidisciplinary team with expertise in EDs for assessment and management.
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• There is a need to assess whether current ED questionnaires are valid to use in those with FA or whether modified versions are required in order to accurately distinguish between what level of FA avoidance is useful versus unhelpful.

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​So, what are my thoughts and key takeaways from this insightful review?

• When it comes to ED and allergic conditions, think beyond just the body image-based EDs such as anorexia and bulimia.
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• Consider the impacts food allergy management has on nutrition, but also on daily and psychosocial functioning, particularly around meal times.
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• If struggles with eating are developing, explore what's at the core of those struggles - discomfort when eating, anxiety about eating, avoidance of something feared?
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• Be aware of unhelpful relationship patterns with food and rigid thoughts about eating as they develop, and monitor your own and your child's actions in response to these things.
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• 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 an avoidance response to anxiety? The answer will likely come from exploring a variety of things, including your allergist's guidance, your risk tolerance levels, your anxiety management style, and your previous reaction history, so discussing eating-related concerns with your healthcare team is incredibly important.
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• At the same time, don't assume that every less-than-ideal eating pattern is a diagnosable ED! 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 healthcare team, who can do a proper evaluation and develop a workable plan with you.
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As I wrap up this week's FAC Corner email, I'll leave you with this thought:

When living with food allergy or other allergic conditions has you feeling down, remind yourself that we find our courage and bravery when get through hard things - and those feelings are absolute emotional wellness gold.

So glad to connect with you again! And as always, take good care of yourself - and each other.

Founder & CEO, The Food Allergy Counselor
Licensed Clinical Professional Counselor
AAAAI & ACAAI Allied Health Member

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DISCLAIMER: The information provided here is for educational purposes only and is not intended to replace the medical or mental healthcare advice of your own healthcare provider. By reading this email, the reader acknowledges that there is no therapist-patient relationship between them and the author(s). If you think you are observing a medical or mental health emergency, call 911 immediately.​
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