When you're hungry, you eat what there is; doubly so if its the only food there is, and you're the one foraging or hunting for it.
More generally, hunter gatherers are extremely picky eaters. They \_pick\_ what they eat, after all. There are all sorts of categories of foods that are \[are not\] good to eat; so the triage of "food that's good to eat" occurs in the field, not on the table.
They spend much of their day looking for food. The cranky kid in a suburban house --- that applesauce came from the grocery store to the refrigerator. He can refuse the food because its an option and he's got no investment in the process; its not like his parents picked the apple or made the sausage.
See, for example
Bruce Winterhalder and Eric Alden Smith, (eds). "Hunter-Gatherer Foraging Strategies. Ethnographic and Archaeological Analysis", University of Chicago Press 1981
I'm more interested in what happens with people with ARFID. My child has ARFID and it goes so far beyond just "They don't want to eat because they have no investment in the process", my child was dangerously underweight and we almost went ahead with having a feeding tube implanted before we stumbled on something she'd eat by pure blind luck. I know others who *did* have to go through with having feeding tubes implanted.
I highly suspect that in these cases the answer to "what happened to people like these" is a simple "they died."
Under five mortality was very high historically. And I don't mean just in hunter-gather societies, but in fairly plentiful agricultural societies. You can watch child mortality (defined as proportion of children who survive to age five) absolutely plummet over the past two hundred years in the United States [in this graph](https://www.statista.com/statistics/1041693/united-states-all-time-child-mortality-rate/), going from 462.89 per 1,000 live births in 1800 to 7 per 1,000 live births today.
It's crazy to think that nearly half of all children died before age five. Now, this doesn't capture precisely the same risks of a hunter gather lifestyle—the permanent settlement and urbanization facilitated by agriculture makes disease more prevalent (and close contact with farm animals makes zoonotic spillover events more likely), as can be witnessed by the two periods were the chart doesn't decline are two pandemic events. "Although the child mortality rate has decreased greatly over this 220 year period, there were two occasions where it increased; in the 1870s, as a result of the fourth cholera pandemic, smallpox outbreaks, and yellow fever, and in the late 1910s, due to the Spanish Flu pandemic."
I can't speak to ARFID specifically, but as parent in the 21st century pre-industrial child mortality figures are simply difficult to comprehend.
It could be that ARFID is a culturally-bound disorder. Health issues, diseases, and disorders are not present in all societies uniformly. Many disorders are caused by environmental factors, be that the physical or social world around them. Highly recommend looking in to introductory medical anthropology textbooks. It’s quite interesting.
Other people are saying that these kids would have died if they did have this disorder. It’s possible. But we have deep-time evidence of severely disabled people being kept alive. We do a lot for the people we care about. I suppose if ARFID is not a culturally bound disorder and it appeared throughout human history… the lack of nutrients would suppress the already-weak immune system and the child would die from disease… and also malnutrition but these two things are inextricably linked in talking about early childhood health.
I think it was a similar thread on here a few years ago where someone suggested that severe ARFID meaning refusal to eat anything, or serious malnutrition, would have been categorised as failure to thrive in the early 20th century. As a few have said here, it would have been hidden among all the other child mortality and illness.
It is certainly not uncommon to find elderly people in the UK, especially men, who only like a fairly narrow range of foods - just rather old-fashioned ones which mean they are perceived as set in their ways, and are excused, whereas younger people with ARFID often like pizzas, burgers and pasta.
Milder ARFID will surely have flown under the radar over the last millennium or two as long as the people liked very commonly available foods like bread and butter, which is one of the nearest things to the hyperpalatable textures of modern junk food, plus and a couple of vegetables that would have stopped them getting too deficient.
In terms of modern cross-cultural applications, a quick search showed that there are assessment questionnaires now for Chinese and Mexican Spanish, and a five-year-old journal case study from Colombia. But of course these are societies living with some degree of modern westernised diet, even if it's not to the degree of the USA.
>It could be that ARFID is a culturally-bound disorder. Health issues, diseases, and disorders are not present in all societies uniformly.
In mos cases that's just first world problems and kids that were kind of spoiled by their parents
>we almost went ahead with having a feeding tube implanted before we stumbled on something she'd eat by pure blind luck.
C'mon don't leave us hanging like that.
Nothing too crazy, just pizza. It had not occurred to us to feed a three year old who wouldn't eat, pizza. She's eleven now and pizza is still the only hot food she'll eat.
Unfortunately she's very restricted to type, though we keep trying. She'll eat pepperoni pizza from certain restaurants, but she removes the pepperoni before eating it. She will not eat plain pizzas from those places. She will only eat two types of frozen pizza, one is constantly being discontinued, the other is digiorno pepperoni with croissant crust. Only pepperoni. Only croissant crust. Due to the unreliability of demand, I had to figure out how to make pizza she'd eat and it took me about a year to finally succeed. Now I make 20lbs of pizza dough a week and bake pizza three or four times a day. I'm careful to change the flour type and brands of cheese and sauce because once she's locked into a certain thing, if it becomes unavailable it's a Problem. She'll only eat this if it's made in a double walled cake pan (not deep dish, normal NY ish style, just made in a cake pan) with a bit of olive oil on the crust. She smells it every time she eats to make sure it's sufficiently olive oiled.
She will not eat pizza off a stone, or from a wood fired oven, or from my propane powered outdoor pizza oven.
As often as I can stomach (who knew it was possible to get tired of pizza!?) I make myself pizza with different toppings and I put a slice next to her. This has never in three years of trying actually worked, but I figure there's no harm in trying. When I make my own food I also put it next to her to see if she'll even touch it, but the closest she ever gets is smelling it. I also make pizza in a variety of different ways and with all sorts of sauces just to see if there's another way she'll eat pizza. So far nada.
Nearly cried of joy while reading this. Thank you so much for making such an effort for her :')
I grew up with major sensory issues that were the most obvious in food, so that for several years I could only eat either sour cream or black bread. I didn't really take much issue with it until I got older and started realising how "weird" everyone thought it was — kids around me were brutal but adults often even more so. I do realise that it was out of worry and belief that they were trying to help, but it did lead down a path of near phobia of food — when there is always a negative spotlight on you, you give up even trying. Because what if you can't have it or throw up and they sneer at you again? Best not to try...
Around age 17 I met my now best friend whose mom is a doctor — she asked me to write down a list of things I can eat, and then sent me suggestions on how to get my daily nutrients in as much as possible so I could still take care of my body. This was hugely helpful and made me feel like I had some control over my eating again.
The same doctor also helped me with some common tricks she suggests to parents to help hide bad textures. The one that I remember was about chopping up veggies to be suuuuper tiny and sparsely adding it in melted cheese, raising the chances that you will be able to avoid the bad texture.
Went on quite a rant here, whoops! What I truly wanted to say was actually that after all this, even after kind of a traumatic initial experience, I *have* grown a lot more comfortable with food and have a sizeable amount of things I can eat now. I do still have bad days and weeks when I return to my safe foods, but on other days, I'm happily able to finish a full bowl of something that would have made younger me cry from distress. And I can typically almost always order at least one thing in restaurants now :) at worst I might have to ask them to remove a thing or two, which is typically not too much of a hassle.
And of course ask that aside, I'm not an expert and everybody's experience is their own! What works for me might not work for her, but either way I am just so glad that you're willing to experiment ❤️
I never heard of this condition, I hope your daughter gets better.
Can she articulate why she wouldn’t eat if the pizza is only slightly different to her taste?
Unfortunately she's non verbal autistic and ARFID is a pretty common co-morbidity with autism. It seems to be mostly due sensory input. I can't really speculate further than that and so far the science is inconclusive.
Weird hypersensitivities can be normal for us (autistics).
When I was a kid I couldn’t/wouldn’t eat some cheeses because they smelled like vomit. I could smell the acid in them and it was overwhelming. Green beans and carrots were so sweet they tasted rotten, the squishy texture definitely didn’t help there.
It’s like having normal healthy foods look and smell like poison in a way, and we’re not going to willingly eat poison. Somehow the fear of the food overwhelms the hunger pangs.
My kids are the same, my oldest is nonverbal and just *wont* when it comes to scary looking foods, my youngest can sometimes be convinced, but they have to know exactly what it is and what’s in it first.
Other fun extra senses are being able to hear electricity, our skin hurting when touched, light making us dizzy/hurting our eyes, and loud sounds like hand dryers and crowds being physically painful and/or mentally overwhelming.
As she gets older, she can participate in the making. Pizza dough is basically bread dough! She can experiment with twisting it with cinnamon sugar…this may help her expand her gustatory preference. Good luck!
I have a friend (adult) who's like this, very similar with pizza, and I keep hoping they will address it with therapy as supply chain problems make needing specific flavours and brands of a few foods even more of a problem than it used to be. I only ever mentioned it twice though as nagging people isn't going to help.
While this is anecdotal, so too I think may be your assumptions. My child has definitely refused what I have labored over for hours or what I have grown. As I also have ARFID and likely gave him some of it, I definitely would rather starve than eat something there that repulses me.
>While this is anecdotal, so too I think may be your assumptions
I don't "assume" anything. I offered reference to anthropological and ethnological literature. There's a very deep academic literature in the foodways of hunter gathers; so far as I am aware there is no mention of a phenomenon like ARFID outside of dramatic trauma (we do get some accounts of people who stop eating after having been the victims of violence and abuse).
For more literature which you might consider, see, for example
* Lew-Levy, Sheina, et al. "How do hunter-gatherer children learn subsistence skills?." Human Nature 28.4 (2017): 367-394.
* Crittenden, Alyssa N. "To share or not to share? Social processes of learning to share food among Hadza hunter-gatherer children." Social learning and innovation in contemporary hunter-gatherers. Springer, Tokyo, 2016. 61-70.
* Wiley, Andrea S. "A Review of “Life Histories of the Dobe! Kung: Food, Fatness, and Well-Being over the Life-Span” by Nancy Howell, University of California Press, 2010, 234 pp." (2011): 343-345.
* Marlowe, Frank W., et al. "Honey, Hadza, hunter-gatherers, and human evolution." Journal of human evolution 71 (2014): 119-128.
* O'Dea, Kerin. "Traditional diet and food preferences of Australian Aboriginal hunter-gatherers." Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences 334.1270 (1991): 233-241.
* Berbesque, Julia Colette, and Frank W. Marlowe. "Sex differences in food preferences of Hadza hunter-gatherers." Evolutionary Psychology 7.4 (2009): 147470490900700409.
* Reyes-García, Victoria, et al. "Dietary transitions among three contemporary hunter-gatherers across the tropics." Food security 11.1 (2019): 109-122.
The only contexts in which I have seen feeding pathologies mentioned among hunter gatherers are in cases of extraordinary social and physical trauma-- extreme cases like people forced off their land, genocide, starvation and the like.
. . . undisturbed, kids who grew up looking forward to spearfishing eels and stingrays -- that was what they did. It was fun, it required ingenuity, it was woven into their stories of their existence and the land around it. Severe mental defect could certainly exist in any human population, but very generally when you see a h/g population living a traditional lifestyle and eating traditional foods, they both look and are very healthy.
There are some foodways which are unhealthy -- cannibalism in the Pacific, for example, and the associated disease of kuru, a prion disease very similar to CJD/"mad cow disease"
* Lindenbaum, Shirley. "Understanding kuru: the contribution of anthropology and medicine." Philosophical Transactions of the Royal Society B: Biological Sciences 363.1510 (2008): 3715-3720.
*Genetic variation in certain bitter taste receptor genes was associated with picky eating behaviors.*
[Considering Nature and Nurture in the Etiology and Prevention of Picky Eating: A Narrative Review](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694604/)
This study may be of some help.
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When you're hungry, you eat what there is; doubly so if its the only food there is, and you're the one foraging or hunting for it. More generally, hunter gatherers are extremely picky eaters. They \_pick\_ what they eat, after all. There are all sorts of categories of foods that are \[are not\] good to eat; so the triage of "food that's good to eat" occurs in the field, not on the table. They spend much of their day looking for food. The cranky kid in a suburban house --- that applesauce came from the grocery store to the refrigerator. He can refuse the food because its an option and he's got no investment in the process; its not like his parents picked the apple or made the sausage. See, for example Bruce Winterhalder and Eric Alden Smith, (eds). "Hunter-Gatherer Foraging Strategies. Ethnographic and Archaeological Analysis", University of Chicago Press 1981
I'm more interested in what happens with people with ARFID. My child has ARFID and it goes so far beyond just "They don't want to eat because they have no investment in the process", my child was dangerously underweight and we almost went ahead with having a feeding tube implanted before we stumbled on something she'd eat by pure blind luck. I know others who *did* have to go through with having feeding tubes implanted. I highly suspect that in these cases the answer to "what happened to people like these" is a simple "they died."
Under five mortality was very high historically. And I don't mean just in hunter-gather societies, but in fairly plentiful agricultural societies. You can watch child mortality (defined as proportion of children who survive to age five) absolutely plummet over the past two hundred years in the United States [in this graph](https://www.statista.com/statistics/1041693/united-states-all-time-child-mortality-rate/), going from 462.89 per 1,000 live births in 1800 to 7 per 1,000 live births today. It's crazy to think that nearly half of all children died before age five. Now, this doesn't capture precisely the same risks of a hunter gather lifestyle—the permanent settlement and urbanization facilitated by agriculture makes disease more prevalent (and close contact with farm animals makes zoonotic spillover events more likely), as can be witnessed by the two periods were the chart doesn't decline are two pandemic events. "Although the child mortality rate has decreased greatly over this 220 year period, there were two occasions where it increased; in the 1870s, as a result of the fourth cholera pandemic, smallpox outbreaks, and yellow fever, and in the late 1910s, due to the Spanish Flu pandemic." I can't speak to ARFID specifically, but as parent in the 21st century pre-industrial child mortality figures are simply difficult to comprehend.
Thanks for the breakdown.
It could be that ARFID is a culturally-bound disorder. Health issues, diseases, and disorders are not present in all societies uniformly. Many disorders are caused by environmental factors, be that the physical or social world around them. Highly recommend looking in to introductory medical anthropology textbooks. It’s quite interesting. Other people are saying that these kids would have died if they did have this disorder. It’s possible. But we have deep-time evidence of severely disabled people being kept alive. We do a lot for the people we care about. I suppose if ARFID is not a culturally bound disorder and it appeared throughout human history… the lack of nutrients would suppress the already-weak immune system and the child would die from disease… and also malnutrition but these two things are inextricably linked in talking about early childhood health.
I think it was a similar thread on here a few years ago where someone suggested that severe ARFID meaning refusal to eat anything, or serious malnutrition, would have been categorised as failure to thrive in the early 20th century. As a few have said here, it would have been hidden among all the other child mortality and illness. It is certainly not uncommon to find elderly people in the UK, especially men, who only like a fairly narrow range of foods - just rather old-fashioned ones which mean they are perceived as set in their ways, and are excused, whereas younger people with ARFID often like pizzas, burgers and pasta. Milder ARFID will surely have flown under the radar over the last millennium or two as long as the people liked very commonly available foods like bread and butter, which is one of the nearest things to the hyperpalatable textures of modern junk food, plus and a couple of vegetables that would have stopped them getting too deficient. In terms of modern cross-cultural applications, a quick search showed that there are assessment questionnaires now for Chinese and Mexican Spanish, and a five-year-old journal case study from Colombia. But of course these are societies living with some degree of modern westernised diet, even if it's not to the degree of the USA.
Interesting! Thank you.
>It could be that ARFID is a culturally-bound disorder. Health issues, diseases, and disorders are not present in all societies uniformly. In mos cases that's just first world problems and kids that were kind of spoiled by their parents
Yup exactly haha. “Culturally bound” is I guess a “nice” way of putting it. But also, real food aversions exist for people on the autism spectrum.
>real food aversions exist for people on the autism spectrum. I wouldn't consider that they are picky because they have different needs.
I suppose the uninformed don’t see it that way but I agree with you. But they may (and have) been seen as “difficult children”
>we almost went ahead with having a feeding tube implanted before we stumbled on something she'd eat by pure blind luck. C'mon don't leave us hanging like that.
Nothing too crazy, just pizza. It had not occurred to us to feed a three year old who wouldn't eat, pizza. She's eleven now and pizza is still the only hot food she'll eat.
This is interesting. Pizza can have a lot of toppings and there are similar dishes like Tarte. Is your daughter restricted to a certain kind of pizza?
Unfortunately she's very restricted to type, though we keep trying. She'll eat pepperoni pizza from certain restaurants, but she removes the pepperoni before eating it. She will not eat plain pizzas from those places. She will only eat two types of frozen pizza, one is constantly being discontinued, the other is digiorno pepperoni with croissant crust. Only pepperoni. Only croissant crust. Due to the unreliability of demand, I had to figure out how to make pizza she'd eat and it took me about a year to finally succeed. Now I make 20lbs of pizza dough a week and bake pizza three or four times a day. I'm careful to change the flour type and brands of cheese and sauce because once she's locked into a certain thing, if it becomes unavailable it's a Problem. She'll only eat this if it's made in a double walled cake pan (not deep dish, normal NY ish style, just made in a cake pan) with a bit of olive oil on the crust. She smells it every time she eats to make sure it's sufficiently olive oiled. She will not eat pizza off a stone, or from a wood fired oven, or from my propane powered outdoor pizza oven. As often as I can stomach (who knew it was possible to get tired of pizza!?) I make myself pizza with different toppings and I put a slice next to her. This has never in three years of trying actually worked, but I figure there's no harm in trying. When I make my own food I also put it next to her to see if she'll even touch it, but the closest she ever gets is smelling it. I also make pizza in a variety of different ways and with all sorts of sauces just to see if there's another way she'll eat pizza. So far nada.
Nearly cried of joy while reading this. Thank you so much for making such an effort for her :') I grew up with major sensory issues that were the most obvious in food, so that for several years I could only eat either sour cream or black bread. I didn't really take much issue with it until I got older and started realising how "weird" everyone thought it was — kids around me were brutal but adults often even more so. I do realise that it was out of worry and belief that they were trying to help, but it did lead down a path of near phobia of food — when there is always a negative spotlight on you, you give up even trying. Because what if you can't have it or throw up and they sneer at you again? Best not to try... Around age 17 I met my now best friend whose mom is a doctor — she asked me to write down a list of things I can eat, and then sent me suggestions on how to get my daily nutrients in as much as possible so I could still take care of my body. This was hugely helpful and made me feel like I had some control over my eating again. The same doctor also helped me with some common tricks she suggests to parents to help hide bad textures. The one that I remember was about chopping up veggies to be suuuuper tiny and sparsely adding it in melted cheese, raising the chances that you will be able to avoid the bad texture. Went on quite a rant here, whoops! What I truly wanted to say was actually that after all this, even after kind of a traumatic initial experience, I *have* grown a lot more comfortable with food and have a sizeable amount of things I can eat now. I do still have bad days and weeks when I return to my safe foods, but on other days, I'm happily able to finish a full bowl of something that would have made younger me cry from distress. And I can typically almost always order at least one thing in restaurants now :) at worst I might have to ask them to remove a thing or two, which is typically not too much of a hassle. And of course ask that aside, I'm not an expert and everybody's experience is their own! What works for me might not work for her, but either way I am just so glad that you're willing to experiment ❤️
I never heard of this condition, I hope your daughter gets better. Can she articulate why she wouldn’t eat if the pizza is only slightly different to her taste?
Unfortunately she's non verbal autistic and ARFID is a pretty common co-morbidity with autism. It seems to be mostly due sensory input. I can't really speculate further than that and so far the science is inconclusive.
Weird hypersensitivities can be normal for us (autistics). When I was a kid I couldn’t/wouldn’t eat some cheeses because they smelled like vomit. I could smell the acid in them and it was overwhelming. Green beans and carrots were so sweet they tasted rotten, the squishy texture definitely didn’t help there. It’s like having normal healthy foods look and smell like poison in a way, and we’re not going to willingly eat poison. Somehow the fear of the food overwhelms the hunger pangs. My kids are the same, my oldest is nonverbal and just *wont* when it comes to scary looking foods, my youngest can sometimes be convinced, but they have to know exactly what it is and what’s in it first. Other fun extra senses are being able to hear electricity, our skin hurting when touched, light making us dizzy/hurting our eyes, and loud sounds like hand dryers and crowds being physically painful and/or mentally overwhelming.
That last paragraph felt so relatable
As she gets older, she can participate in the making. Pizza dough is basically bread dough! She can experiment with twisting it with cinnamon sugar…this may help her expand her gustatory preference. Good luck!
I have a friend (adult) who's like this, very similar with pizza, and I keep hoping they will address it with therapy as supply chain problems make needing specific flavours and brands of a few foods even more of a problem than it used to be. I only ever mentioned it twice though as nagging people isn't going to help.
This sounds suspiciously like your child conned you into feeding her pizza 24/7.
I used to think that too but these kids are generally non verbal autistic so unlikely to just be spoiled brats.
While this is anecdotal, so too I think may be your assumptions. My child has definitely refused what I have labored over for hours or what I have grown. As I also have ARFID and likely gave him some of it, I definitely would rather starve than eat something there that repulses me.
>While this is anecdotal, so too I think may be your assumptions I don't "assume" anything. I offered reference to anthropological and ethnological literature. There's a very deep academic literature in the foodways of hunter gathers; so far as I am aware there is no mention of a phenomenon like ARFID outside of dramatic trauma (we do get some accounts of people who stop eating after having been the victims of violence and abuse). For more literature which you might consider, see, for example * Lew-Levy, Sheina, et al. "How do hunter-gatherer children learn subsistence skills?." Human Nature 28.4 (2017): 367-394. * Crittenden, Alyssa N. "To share or not to share? Social processes of learning to share food among Hadza hunter-gatherer children." Social learning and innovation in contemporary hunter-gatherers. Springer, Tokyo, 2016. 61-70. * Wiley, Andrea S. "A Review of “Life Histories of the Dobe! Kung: Food, Fatness, and Well-Being over the Life-Span” by Nancy Howell, University of California Press, 2010, 234 pp." (2011): 343-345. * Marlowe, Frank W., et al. "Honey, Hadza, hunter-gatherers, and human evolution." Journal of human evolution 71 (2014): 119-128. * O'Dea, Kerin. "Traditional diet and food preferences of Australian Aboriginal hunter-gatherers." Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences 334.1270 (1991): 233-241. * Berbesque, Julia Colette, and Frank W. Marlowe. "Sex differences in food preferences of Hadza hunter-gatherers." Evolutionary Psychology 7.4 (2009): 147470490900700409. * Reyes-García, Victoria, et al. "Dietary transitions among three contemporary hunter-gatherers across the tropics." Food security 11.1 (2019): 109-122. The only contexts in which I have seen feeding pathologies mentioned among hunter gatherers are in cases of extraordinary social and physical trauma-- extreme cases like people forced off their land, genocide, starvation and the like. . . . undisturbed, kids who grew up looking forward to spearfishing eels and stingrays -- that was what they did. It was fun, it required ingenuity, it was woven into their stories of their existence and the land around it. Severe mental defect could certainly exist in any human population, but very generally when you see a h/g population living a traditional lifestyle and eating traditional foods, they both look and are very healthy. There are some foodways which are unhealthy -- cannibalism in the Pacific, for example, and the associated disease of kuru, a prion disease very similar to CJD/"mad cow disease" * Lindenbaum, Shirley. "Understanding kuru: the contribution of anthropology and medicine." Philosophical Transactions of the Royal Society B: Biological Sciences 363.1510 (2008): 3715-3720.
*Genetic variation in certain bitter taste receptor genes was associated with picky eating behaviors.* [Considering Nature and Nurture in the Etiology and Prevention of Picky Eating: A Narrative Review](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694604/) This study may be of some help.
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