Wednesday, July 07, 2010

picky, picky

a new eating disorder?

picky-eater staple: the all-american grilled cheese

in pediatrics, one of the more challenging topics to broach at a clinic visit is nutrition. i am not kidding when i say that in my resident primary care clinic, it was the exception rather than the rule to have a patient on the healthy area of the weight-for-age or BMI growth curve.

not all of my patients were overweight -- oh no, i had plenty of failure-to-thrive kids on my panel to balance things out. interestingly, one thing that both groups tended to have in common was pickiness. older adolescents would proudly admit this outright ("i don't eat green things"), while parents of toddlers often expressed frustration about their kids' unwillingness to tolerate even carefully shrouded vegetables in their meals.

i came across this wall street journal article and learned that apparently, this doesn't always end in adulthood!

taken from the article, here is one adult's 'typical day' of eating:

processed to the max, and OH what a lonely existence to always avoid eating with friends!

the article refers to this sort of rigidity as 'a new eating disorder' called selective eating. i don't know -- sometimes i wonder about the medicalization of certain traits which seem to stem more from environment. then again, i certainly could see how being this limited would be detrimental (both health-wise and psychologically) and might warrant treatment, so maybe the label would be a good thing.

i grew up eating tofu and homemade whole wheat bread. my parents DID accuse my sister and me of pickiness at times, but i think it was more wanting to eat what 'normal' kids had. they never prepped a special 'kids dinner' for us; until the ridiculously busy high school years, there was one meal served and really no alternatives. i may have groused back then, but to this day i'll try almost anything as long as i'm not ethically opposed to it.

i hope to do the same when we have kids -- but of course it IS different with every kid and you never know how things are going to play out!

were you a picky eater growing up? how about now?

do you think this should be classified as 'disorder' or is it just a product of our society?

if you have kids, what kind of strategies do you use to avoid this picky fate?

into the swing of things
for anyone curious, my first day 'on the pager' went just fine! it turned out not to be a terribly busy day (NO new consults - just follow-ups) so i had plenty of time to get eveything done. there is so much to learn, though! i tried to treat every page i got with a question as a chance to look up something new. maybe after a few months of this i'll actually feel like i know something about pediatric endocrinology . . .



workout: 5 miles with 2 @ tempo.
miles 0-1.5: 9:12/mi
miles 1.5 - 3.5: 8:12/mi average
miles 3.5 - 5: 9:08/mi


cooking: did not happen.

HP update: i have one day left to focus on my current resolution of keeping work and play separate. while i haven't been perfectly adherent to my resolution, just having it out there has made me more aware when i think about checking my non-work email or (horrors!) facebook at work or opening up our hospital lab system to check on things randomly in the evening at home.

i think this is okay -- after all, there is a time and a place for taking breaks during work, and if done sparingly, it can be a nice reward for a longer period of focused productivity. but doing so consciously and with intention is the way to go. i'll be continuing to work on this throughout the month but will add on another goal tomorrow!


  1. Anonymous7:37 AM

    Yes nutrition is always a tricky topic when working with kids - as a Registered Dietitian even I get stumped with how to handle it sometimes! Since you're in the pediatric world, I'd recommend reading Ellyn Satter's books. Do you have a local RD in a clinic that you can refer patients to? But thank you for at least talking about nutrition/weight - too many MDs leave it out altogether!

  2. That typical meal makes me sad b/c it's so true! sounds like what most of my co-workers and probably friends eat. blech! I was pretty picky growing up, but my parents always encouraged me to eat healthy and would take us to farms to pick our own veggies, which of course made us want to eat them. I think learning where your food came from helps you eat better. Now I LOVE veggies! :)

  3. I didn't really eat vegetables when I was a kid, but in my defense the only ones my mom ever made came out of a can. Blech. There are certain foods I really really don't like (olives!), but for the most part the things I didn't like as a kid, I've retried again as an adult and liked.

    As for picky eating as a disorder- I could see it in the extreme- but in my limited experience it seems that a lot of kids are just picky.

  4. Albert and I are DETERMINED not to let Miles be a picky eater. I can't even believe the number of adults that I work with that are extremely picky eaters. It really annoys me and I DON'T think parents should make special kids meals. I don't even want Miles to order off of the kids menu at restaurants.

    I also struggle with the work/play thing - hence reading your blog at work and ALWAYS checking my blackberry at home. Good luck with your HP!

  5. Coincidental - I read that article about 2 minutes before I read your post. I generally like it when people from the triangle area (Heather Hill) make national news, but I like it even more when it's for good things :-/

    My original reaction was, "no way, I'm not picky at all", but after thinking a little, despite the fact that I can eat and enjoy the taste of almost anything, I choose to be a pescatarian, and a lot of people consider that to be being picky, which annoys me, since it's not about the taste, it's about the way the meat was raised. I could keep ranting in run-on sentences, but I think I'll just write a post about it, so thanks for the inspiration :)

    I do think it should be classified as a disorder. I think if people heard their problem was a legitimate disorder, they'd be more likely to get help. If more people needed help, best practices for helping people would be developed and taught to health professionals, and the process would be easier for everyone. I may change my mind about this in 20 minutes, but that sounds good to me for now.

  6. Anonymous11:01 AM

    omg i was the WORST picky eater ever. and i think i still am to a certain degree although i'm more willing to try something.

    i think it's a product of our society because, from what i see around me, parents give in too easily to the things their kids want. i totally see it in my family where my mom will just order pizza because she doesn't want to "fight" my younger siblings who don't want to eat something healthy that she makes

  7. It's funny you posted on this topic, because my boyfriend is SUCH a picky eater. I never thought of this as something to be called a 'disorder' though. He just doesn't like certain tastes and textures. We wouldn't call someone who disliked only spinach disordered, or even someone who disliked three types of vegetables. So where would the line be? Perhaps someone who is experience serious quality of life issues (e.g. can't go out to restaurants or eat with friends) then perhaps it could be diagnosable... but I'm not sure.

  8. People call me a picky eater now, but I'm really not. I just don't like fast food and fried stuff and things of that sort.

  9. I'm not really a picky eater, there are things that I simply will not eat, like.. I HATE olives with a passion, one olive on a pizza and it literally ruins the entire thing for me. A friend of mine is a so annoying with her food, she won't eat out at all and at home she eats the SAME thing ever single day, white rice and a peice of chicken and for lunch she ALWAYS has crackers and cheese and then she wonders why she can't get in better shape, it's pretty frustrating lol. Grilled cheese and tomatoe soup on a stormy day is the BEST combo ever though lol : )

  10. I was a really, really picky eater growing up. The only thing I wanted to eat were noodles, sweet potatoes, fried stuff. I didn't even like sweets or meat. I'm glad I've lost my pickiness, though. I think pickiness can be combated from an early age, but it gets harder if you've had it for many many years.

    Oh, and it really seems like there are ALL sorts of eating disorders! There's another one called pregorexia...pregnant ladies with weird eating habits.

  11. I was a terribly picky eater when I was little, but I have no idea why. I often just wasn't hungry (really, no eating disorder or anything, but I rarely remember being hungry when I was younger). I would eat cucumbers, vanilla yogurt, apples, rice, Honey Nut Cheerios, and salami sandwiches on rye bread. I went through a phase where I HATED red meat, and sometimes I wouldn't even eat chicken. This wasn't for lack of my parents exposing me to new foods, but I just didn't like a lot of foods and I wasn't hungry!

    That being said, I eat a wide variety of foods now and turned out just fine. My (twin) sister, who was less picky than I was, is now more picky, and I definitely eat healthier. I don't know if this is all a fate of environment or genetics, but kids in general tend to be picky, although I don't know how to solve that!

  12. I was a very picky kid and gradually grew out of it. I think most people do and it could only be classified as an eating disorder in extreme cases like the one in your post.

  13. i was really picky when i was younger (refused to eat tomato sauce on my pasta, didn't like pizza, didn't eat a lot of vegetables) but i'm pretty much un-picky now. i'll eat anything as long as it's not moving. still, i don't go out of my way to eat certain things (condiments on sandwiches, for example). if/when i have kids they will eat EVERYTHING.

  14. atilla7:36 PM

    I'm picky....anything I can pick up I'll eat

  15. I actually do not remember either Sarah or her sister being picky at all, and it is true that I made only one dinner each night. I think that parents that cater to their children's pickiness do them a disservice. Assuming the meals are healthy, there should be no reason (unless, of course there are real allergies involved)for making a multitude of different things. Sarah and her sister could tell you that I started them on plain unsweetened yogurt when they were babies, somethng that most adults will not eat.

    This a complicated topic, however. I like every vegetable and guess that that is true or mostly true of Sarah and her sister, but is that something we inherited, or was it the nutrition nurturing that we received?

    Another point is that picky eater adults most likely do not feed their children food that they, themselves, will not eat, thus continuing the picky eater cycle. Like everything else, parents need to be good role models for their children if their children are going to acquire good habits.

    - Mom

  16. I read that same article! Nancy Zucker, who is quoted in the article, was one of my favorite professors in my time at Duke. She told us some crazy stories of picky eaters like you described in your post.

  17. I'm not even slightly picky, mostly because I just love to eat. My kids are moderately picky, on par with the average kid, I think. The decision I've had to make is whether I want to have them enjoy eating or whether our "eating table" will become a battlefield. I think that a family dinner table has so many benefits in terms of both food and family bonding that I elected more for the former than the latter. I do make two meals some nights (the kids' meal being fairly simple), but the rule is that they at least have to try one bite of everything on our plates. Several times, after 3-4 small bites at separate meals, they discover they like it. Happened last night with broccoli and I did quite the little victory dance (can't believe I'm admitting to that!). The kids didn't feel forced or criticized and we still had a good outcome. There are lots of things we do as parents that we thought we wouldn't do, like two meals, but overall, I'm pretty pleased with how the monsters are turning out (and we do let them order from the kids' menu at restaurants, when we're brave enough to take all of them out!).

  18. I'm adding a few things because pickiness in my kids is something I had to come to terms with, so I've thought a lot about it. I struggle with the idea of whether you can "let" or "not let" your kids be picky eaters (@denise). Sometimes kids just _are_ and you have to work with it. As I said above, my personal choice is to not have food be a battle because it can be such a joy and can turn into such a problem. My second was initially a wonderful eater and would gobble everything put in front of her. Around 15 months, though, that changed without anything precipitating it that we could identify. We continued to give her healthy, varied choices, but she would only take a few things. Short of forcibly opening her mouth, shoving in the food, and making her swallow, there was nothing to do. If there's anything we've learned from parenting three small children, it's that flexibility is key. We could be anxious about it, but we're kind of low-key parents and just rolled with it (we're certainly not perfect, but try to pick battles carefully). Now, she and her brother cleared her plate of broccoli, homemade applesause, and pork cutlets. I never would have pictured that 6 months ago, but I'm happy.

    I read an awesome article by a food editor of one of the major newspapers (wish I could remember her name or link to the article) about this issue. Her son was extraordinarily picky, despite the number of options you would guess only a food editor in a big city could offer. They were both miserable until they bonded over a glazed donut from one particular store. I think about this every time I talk to the family of a picky child.

  19. I guess I'm lucky b/c my son tries most everything at least once. I introduced him to fruits and veggies as his first foods, though, not rice cereal. I had read that avocado is a better first food than rice and I went with it. He loved it. From there, I just expanded on what I gave him. maybe that's why he'll try new things? I also don't make special meals for him. If he doesn't like what I serve for dinner, he's more or less out of luck.

  20. molly and happy: you both definitely sound like you know what you are talking about! as someone in peds AND future parent, i really appreciate your experienced perspectives!

    molly also you are my hero with 3 at this point. YOU AMAZE ME!