Treating ARFID with San Diego Eating Disorder Dietitian Maddie McClean, RD
Grappling with ARFID (avoidant restrictive food intake disorder) is really hard. Whether you struggle with ARFID yourself, or whether it’s one of your kiddos, there is SO much anxiety. You feel frustrated because food choices are limited. You may fear choking or vomiting. You struggle with how food looks or dislike how it feels in your mouth. Plus, you experience shame and embarrassment because you don’t eat the same as your peers. ARFID is incredibly complex, and not a lot of people really get it. One person who understands ARFID is San Diego eating disorder dietitian Maddie McClean, RD. She does amazing work helping folks of all ages get on the road to ARFID recovery.
How long have you been working in San Diego, California, as a dietitian?
I've been a dietitian here in San Diego for four years, and I was working in eating disorders for a year and a half prior to obtaining my license.
What prompted your interest in ARFID?
I actually didn't have a lot of exposure to working with ARFID in my role at a local treatment center, even though we had patients admitted with an ARFID diagnosis. My interest in ARFID stemmed from my interest in early childhood feeding behavior. Parents would reach out to us at the practice I'm now with, Nutrition Instincts, for help with their child's "picky eating," (many of which likely had undiagnosed ARFID) and it really opened my eyes to this population of people of ALL ages who have been isolated from care and often shamed for their eating habits. I began digging into the research and educating myself from there!
What is ARFID and how does it differ from other eating disorders?
ARFID is when people are extremely selective in their eating habits. Their selective or disturbed eating patterns extend beyond typical picky eating. Although it's similar to anorexia in that it may result in energy and nutritional deficiencies, there are significant differences requiring a completely altered treatment course than that of other eating disorders. ARFID is often accompanied by a fear of choking, sensory avoidance, slow or altered chewing and swallowing, and other disorders such as ADHD. Many parents of children or adults who have lived with ARFID for many years experience relief in discovering their life-long struggle with food and eating has a name and a course of treatment. ARFID isn't well-known to the medical field yet, and because of this children and adults have gone undiagnosed for far too long, often blamed for their "stubbornness" or "picky eating." Reducing shame around this is one of the first things we do in treatment.
What are some common nutrition challenges that you see in your San Diego clients with ARFID?
Many clients and parents actually come into their first session believing they are more nutritionally compromised than they are, and the first thing I often find myself doing is reassuring them that the body is resilient! It can withstand quite a bit, and although we want to get answers ASAP about nutritional status (from labs and clinical markers), I remind folks that they now have a member of their team whose sole job and purpose is to assess and manage nutritional status . . . ME! This typically releases a lot of stress and pressure right away. If a client is or becomes nutritionally compromised, we have protocols in place for addressing that. I work very closely with pediatricians and physicians to ensure we have the most up-to-date clinical picture—this includes labs, vitals checks, and nutritional assessments (frequency of these are determined by myself and the medical team).
What happens in a session with you with clients with ARFID?
In the beginning phases of working with a client or parents of a client, it's a lot of collecting information. I'll explore the client's own concerns and what their goals are (if age appropriate), assess sensory issues, assess the eating environment, work with parents to collect information on pregnancy, infancy, toddlerhood, and childhood; plus, so much more! As time goes on, we may set up specific food exposures, which look different for everyone. My priority is nutritional stability, so throughout the entire length of treatment we're working to establish and maintain a meal plan that meets the client's individual nutritional needs.
What do you wish parents/guardians knew about getting treatment for ARFID?
The biggest surprise to most parents and guardians is usually the pace of progress. Like with any eating disorder, ARFID work takes a lot of time and that can be hard on parents who have expectations of what "eating better" looks like for their child. Because of this, I spend a lot of time checking in with parents on how they are doing, validating their feelings and being the sounding board for their thoughts and emotions so that their child doesn't have to be. Kids and teens are more observant than we think, and they often take on their parent's stress as pressure to do better, which only slows things down. I work with parents to redefine what progress means and set very realistic goals.
How do you work with parents/guardians of kids and teens with ARFID?
In addition to helping parents set realistic goals and being an emotional support for them, I'll work with parents to develop plans to support their child/teen using objectives and roadmaps as I call them. Some may find it surprising that I might meet with a parent just as much or even more than meeting with their child/teen!
How can people work with you?
Go to the Nutrition Instincts website and sign up for a clarity call!
***PLUS, Maddie and I will be doing an INSTAGRAM LIVE on ARFID this Thursday, July 28th, from 12-1p Pacific time. Save up your questions and we will see you there!***
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Hey everyone, I really appreciate you reading my blog! Have a wonderful day. :)
Marianne 😊
It’s coming! The Ultimate Training to Break Free from the Binge Eating Cycle Join me LIVE via Zoom on Tuesday, September 13th, from 12-1p Pacific Time!
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If you want to move toward eating disorder recovery and find out more about eating disorder treatment, bulimia, ARFID, binge eating or other eating disorders in San Diego, check out the resources on my website, including previous blog posts and my guest-speaking gigs on podcasts.
You can find more information about me on Instagram @drmariannemiller, on my Facebook page, or on Twitter.