How to Build an Adult ARFID Safe Food List
Living with ARFID or selective eating can be tricky.
There might be a fine line between the desire for increased food options and variety and the pull of maintaining the status quo.
Sometimes, life situations like increased pressure or burnout result in times when food feels more limiting.
Hi! I’m Melinda Staehling, MS, CNS. I’m an Oregon-based Certified Nutrition Specialist and AuDHDer (autistic + ADHD).
I’m here to help ARFIDers and selective eaters feel more empowered in their food choices.
Let’s dive into an affirming approach to ARFID, followed by a closer look at one tool in the ARFID toolbox: creating ARFID-safe food lists.
CW: ARFID, eating disorder, emetophobia
I. Introduction: Understanding ARFID and the Role of Safe Foods
What is ARFID?
The textbook definition of Avoidant/Restrictive Food Intake Disorder (or ARFID, for short) is a mental health condition where people have a challenging time eating enough food to nourish their bodies, and/or have a tough time eating a wide range of foods or textures. They may only be able to eat a few specific “safe” foods.
Please note that just like with ADHD, autism, and other diagnoses in the DSM, the definition and language of ARFID works from a deficit model, and doesn’t consider strengths, which I think is very important.
ARFID often stems from sensory aversions (sensitivity to taste, feel, smell, or look of food), fear of consequences (e.g., choking, vomiting, stomach aches), or a lack of interest in food. While not listed in the DSM, ARFID can also stem from sensory overwhelm, a common challenge for neurodivergent folks like me and many of my clients.
ARFID is a relatively new diagnosis. It was only recognized as a unique diagnosis in 2013. I think this demonstrates how new ARFID is in terms of both treatment options and awareness.
Here’s a part of the current criteria for ARFID, straight from the manual. This includes the update in the DSM-5TR:
Significant weight loss (or failure to achieve expected weight gain or faltering growth in children, aka “falling off the growth charts”).
Significant nutritional deficiency (for example, iron deficiency is common).
Dependence on enteral feeding (tube feeding) or oral nutritional supplements.
Marked interference with psychosocial functioning (for example, not being able to join a dinner out because of food phobias and/or sensory overwhelm).
While ARFID is listed as a mental health condition, I think it is important to also acknowledge the physical effects, too. Many people with ARFID can experience regurgitation, weight loss, or nutrient deficiencies, all of which can affect physical health.
There’s one part about the DSM-5 that’s up for a lot of debate within the ARFID community, which has to do with body image. The DSM-5 states, “there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced,” and yet, there are plenty of ARFIDers out there who do experience body image distress.
ARFID as its own Unique Neurotype
Right from the jump, I believe an understanding of ARFID needs to come from ARFIDers (or FIDers, thanks to Kevin Jarvis for that phrase) themselves.
Just like with ADHD and autism, ARFID can also be understood as its own unique neurotype. I recommend reading this article by Shira Collings, MS, NCC (she/they) for more of that concept.
Before we get into safe foods lists, I want to take a second to say that healthcare professionals can make far more progress and build trust with our clients when we consider ARFID from an affirming approach, in the same way we think about ADHD and autism.
With an affirming approach to ARFID, we’re not trying to force a person into our neat version of what “healthy” is, or expose people to foods before or if they’re ready. We do, of course, want to reduce distress and find new ways of thinking, resourcing, and eating that align with your values and goals.
ARFID-Specific Challenges and Some Solutions:
For most ARFIDers, many food options can feel overwhelming and "unsafe.” That restaurant kale salad can feel on par with a surprise meeting with a black bear while hiking: get me OUT of here.
And, many ARFIDers also have experienced the pressure of exposure to new foods in a rushed or unresourced way, which can then backfire and stall progress. While it is helpful to have the ability to eat and tolerate a range of foods, we don’t want to create more tension by forcing the process too quickly.
One thing I want to emphasize is that we have strategies and tools available to help you with the more physical aspects of ARFID.
When we start to look for new ways to support, we find vitamins and (some) supplements, shakes, safe foods lists, and tube feeding when necessary.
We can also challenge our ideas around what “healthy” looks like.
Let’s really ask ourselves if a safe and selected foods list is currently working for you, and if your health parameters are OK.
Do we then need to be so concerned about eating the same foods repeatedly? Or, are we sort of feigning health and healthism here? These questions are, of course, highly individual.
The Power of an ARFID Safe Food List:
As an ARFID-affirming nutritionist, one of the first steps in supporting clients with ARFID is to help them create the beginnings of a safe food list.
This list can be a valuable tool to help you navigate your relationship with food.
II. What Exactly is a Safe Food List?
One way to support you with ARFID is by creating a list, or usually a series of lists. These are a compilation of safe, tolerated foods and beverages.
Food lists can be organized in various ways depending on your individual needs, such as by:
Preference - different types of foods, preferred brands
Textures and Tastes
Time or effort required to prepare the food
Easier or more challenging food days
Where the food may be consumed - a separate list for when you’re out of the house for a full day, or traveling.
Grocery store categories (e.g., produce, dairy, pantry).
Your food list is dynamic: It will change and evolve over time as your preferences and comfort levels shift.
III. Why Create a Safe Food List? The Benefits
Simplifies Decision-Making: Helps reduce anxiety and overwhelm when faced with food choices.
Provides Reminders: Acts as a quick reference for potential food options, especially during stressful times. I love to keep these lists visually handy, on the fridge or in the Notes app on the phone.
Facilitates Communication: A useful resource to share with caregivers or providers who support you around food.
Aids in Expansion: Serves as a starting point for strategically selecting and exploring new foods.
Supports Nutritional Goals: Helps you identify areas for increasing intake, consistency, and nutrients.
IV. Some Considerations When Building Your ARFID Safe Food List
Start with What You Already Eat: Begin by listing foods you’re currently consuming comfortably.
Assess Time and Effort: Consider the practicalities of preparing foods based on your energy levels and availability.
Recall Past Foods: Are there foods you might have eaten in the past but no longer do?
Define Your Nutritional Goals: Think about what success means to you, such as eating enough, eating consistently, or increasing specific nutrients or overall food variety.
Consider Preparation Variations: The same food can taste and feel different depending on how it's prepared (e.g., a fried potato is a different sensory experience from one that is mashed or roasted).
Acknowledge Yourself in the Present: What is your comfort level with different foods right now? And, what is your current health status, energy level, and overall state of well-being?
I think this last piece can be a helpful prompt when creating the following types of food lists. Here, with either the traffic light system or the spoon theory, we can make lists that support us today.
Implement a "Traffic-Light" System or “Spoon Theory” List:
🚦Green Foods: Foods you can eat now without significant worry or distress
🚦Yellow Foods: Foods you could try with some effort
🚦Red Foods: Foods you aren’t currently able to eat
OR
🥄 Low Spoons/energy - bars, shakes, fruit pouch
🥄🥄 Medium Spoons - frozen meals, nuggets
🥄🥄🥄 Higher Spoons - burgers, tacos, mashed potatoes
V. How to Use Your Safe Food List
FIRST STEP
Identify Your Personal "Reason Why": What is your goal for creating the list? Here are some options; you might have your own.
Grocery shopping. The list will help you avoid starting from scratch every time.
Reduce decision fatigue at snack and meal times. A safe food list can provide a quick reference of your available options. No need to carry all of this around in your brain.
Decrease overwhelm. When feeling overwhelm or low energy, the list can help you make choices.
Some of my clients use the Notes app on their phone and refer to their list multiple times a day. By keeping the list updated, they’re reminded of different options, even when they’re busy, on the road, or simply feel like they want a reminder and support.
NEXT STEPS
🤝 Seek Support: Working with a trusted person, whether it's a family member, friend, or healthcare professional, might feel supportive while implementing the list.
📒 Keep a Journal: Track foods you try, noting their taste, texture, and smell. This information can both serve as a reminder when energy is lower and guide you to other new foods that might be acceptable when the time is right.
🏠 Create a Preferred Food Environment: Keep other aspects of your meal environment as safe and sensory-appealing as possible to avoid changing too many things at once.
This might involve adjusting lighting, minimizing noise, using familiar plates and dishes, or listening to a familiar video or podcast.
🔗 Food Chaining: If and when you’re ready to introduce new foods, the food chaining technique involves finding foods that are very similar to those you already eat and slowly introducing them. For example, if you like a round cookie of one particular brand, you might try a new brand or variation on the flavor the next time.
The goal is to find foods with similar sensory qualities (taste, texture, smell).
📅 Practice Consistency: By checking back in with the list frequently and updating with new information, you’ll develop a tool that works for you.
VI. Important ARFID Reminders
ARFID and selective eating are not "picky eating": ARFID is a new condition in the DSM, is not widely known about by medical professionals, and is still in its infancy in terms of professional treatment.
Progress may be slow: Don't get disheartened if change feels gradual; any positive step in working with your current foods, or trying a new food, is progress.
Consider professional treatment: While there isn't just one "evidence-based" treatment for ARFID yet, ideas from therapies like Cognitive Behavioral Therapy (CBT) and food chaining approaches can be beneficial. Medication can also help reduce anxiety associated with eating "unsafe" foods.
VII. Find Support and Resources
Building a safe food list and expanding your diet with ARFID can be challenging, but you don't have to do it alone.
Here are some more resources:
💗 @KevindoesARFID (Instagram)
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While living with ARFID has its challenges, we can also view ARFID through an affirming, strengths-based approach.
If these ARFID safe food lists are feeling a bit overwhelming, and you would like some support by your side to work through this, book an Introductory Call, here.