Moms and dads are often on a mission to contend with their picky little eaters, but a story out of the U.K. illustrates a food-related condition that's on a whole different level. And it has parents terrified.
According to The Independent and an article in the Annals of Internal Medicine, a now 19-year-old boy who refused to eat anything but processed food as a kid is now blind due to his poor diet. The foods he would eat: potato chips, fries, processed ham, white bread, and sausages. The teen has since been diagnosed with an eating disorder called Avoidant-Restrictive Food Intake Disorder (ARFID, previously called Selective Eating Disorder), in which sufferers only tolerate certain foods, and in turn, are at risk for serious conditions caused by nutritional deficiencies.
"He has no social life to speak of now," his mother said. "After leaving school he got into college to do a course in IT, but he had to give it up because he could not see or hear anything."
Cue panic for parents of finicky eaters everywhere, right? But while nutritional deficiencies are absolutely serious, the link between eating only processed foods and something as serious as irreversible eye damage deserves a closer look. We went to the experts to get their take on the risks and roots of a highly restrictive diet in children and teens.
A pediatrician says: Underlying conditions matter.
"ARFID is a type of eating disorder where the child has a very restrictive palate, and it causes nutritional deficiencies," notes Dyan Hes, M.D., medical director of Gramercy Pediatrics in New York.
But there's often more to the story than a straightforward ARFID diagnosis. According to the National Eating Disorders Association (NEDA), risk factors include:
Having autism spectrum conditions, ADHD, and intellectual disabilities
Being a child who doesn't outgrow normal picky eating, or in whom picky eating is severe
And a co-occurring anxiety disorder.
What Dr. Hes has seen in her own practice echoes this: "In the cases I have treated, all of the children have a co-morbidity of either anxiety or autism, sometimes both. If these diagnoses are not treated in conjunction with the nutritional aspect, there will be little success."
Dr. Hes points out that in the U.S., children 4 and older visit their pediatrician annually, and it is during these visits that an issue like ARFID would typically be caught early. "At this visit, it is the job of the provider to determine if the child is thriving," she notes. "If there is a concern, it is up to both the doctor and the parent to make a mutual decision for follow-up care."
She also notes that this peculiar case goes to show that a poor diet doesn't necessarily translate to obesity (just as obesity doesn't necessarily stem from a poor diet), because the boy didn't gain weight. "He has always been skinny so we had no weight concerns," his mom noted. "You hear about junk food and obesity all the time—but he was as thin as a rake."
As for the vision loss, Dr. Hes notes that lacking vitamin A might have contributed to the issue: "There were no fruits or vegetables in the diet," she says. "There was almost no protein and definitely no source of vitamin A, which leads to blindness. Vitamin A is found in green leafy vegetables, orange vegetables, eggs, and cantaloupe."
An ophthalmologist says: Getting enough vitamin B-12 is essential.
Howard R. Krauss, M.D., a surgical neuro-ophthalmologist at Providence Saint John’s Health Center in Santa Monica, California, notes that, according to the Annals of Internal Medicine article, the boy suffered vision loss at 17 but initially saw his general practitioner at 14. At that time, he was found to have anemia linked to low vitamin B-12. He was given dietary guidance and injections of B-12.
"By the time he was 17, he had stopped B-12 supplementation, and he hadn't changed his diet, and by then, he had suffered permanent damage to his vision," Dr. Krauss says. "B-12 is a critical element in the health of our nervous system, especially the health of the optic nerve."
In his own practice, Dr. Krauss has seen various people suffering from B-12 deficiency caused by a number of reasons, from alcoholism to gastric bypass without proper supplementation. "B-12 in its early stages will cause sluggishness," he notes. "As it progresses, it will cause peripheral neuropathy and permanent damage to the optic nerve."
Dr. Krauss emphasizes that what happened to the U.K. teen was not the result of junk food in and of itself; if the teen had eaten the same, aforementioned processed foods but an otherwise balanced diet, he wouldn't have suffered the same effect.
An eating disorder expert says: AFRID sufferers can suffer from increased malnutrition.
"Although cases like this have been uncommon, children and teens who are diagnosed with ARFID run the risk of nutritional deficiencies due to restriction of food groups," explains Jaclyn Macchione, MOT, OTR/L, an occupational therapist at The Renfrew Center of Philadelphia, who notes that the number of ARFID cases have increased since the diagnosis was added to the Diagnostic and Statistical Manual of Mental Disorders (5th edition) in 2013.
"Those diagnosed with ARFID can suffer from increased malnutrition, vitamin and mineral deficiencies, and a weakened immune system," Macchione says. "Malnutrition can impact hearing and vision. Since vitamins and minerals are found in all food groups, those experiencing severe picky eating should speak to a healthcare provider that specializes in eating disorders and ARFID. A healthcare provider can assess and address the child's nutrition status and other possible medical complications."
The Bottom Line
Whether you're dealing with a generally picky eater or a more serious case, parents and doctors need to work together to encourage a child to eat a well-rounded, nutritious diet.
You might do well to get creative with how you frame new foods. "Cauliflower is a good choice, because it is white," notes Dr. Hes. "I encourage whole grain-fortified breads and help parents find new recipes, even smoothies if we have to. I give supplements when needed and use Pediasure or Ensure if needed to provide essential nutrients for growth. Often these children do not grow, because of the lack of vitamin D and calcium in their diets."
Ultimately, diligence is key to avoiding the unnerving health consequences suffered by this teen. According to Dr. Krauss, "The take home message from this is that at some point, parents can not simply be tolerant of their child's peculiar eating habits, and they have to recognize that this could lead to significant health problems."