Fueling Wellness: Overcoming Common Diet Challenges in Autism
Overview: This article explores common unhealthy outcomes in the autistic community and steps on how to avoid those outcomes by establishing a diet baseline, fostering healthy mealtime routines, steps to expand a sensitive palate, and use of food consequences and rewards.
Eating healthy food is one of the most important and effective ways that we humans can care for ourselves. Sadly, diet is often an overlooked component to good mental health. This oversight is even more prevalent in the autistic community due to how frequently autistic individuals struggle with food textures, tastes, and varieties, as well as with setting cooking and eating routines. Given the primacy of food and nutrition in all our lives, diet is a great place to start the wellness process for autistic individuals.
Unhealthy Outcomes
I know from personal experience that bad days too often result in bad food choices. (Seriously, when I come home stressed, the junk food runs for cover!). While eating comfort food is a common problem for many people, it can be even more dire for autistics. Research shows that autistic people are more likely to seek out energy-dense, nutrient-deficient food, and less likely to eat fresh fruit, vegetables, and whole grains than their non-autistic peers (Hill et al. 2015). At a certain point “comfort-food” can become their only food, and that is where a small problem becomes dangerous.
An all-too-common scenario is that parents, school professionals, and other caregivers become stressed when a child refuses to eat certain foods. Autistic kids are often labeled as “picky eaters” who will “stubbornly” only eat certain food as if it is conscious choice (Craido et al. 2018). However, an autistic person’s “pickiness” is just as likely to be caused by sensitivity to a food’s texture or flavor, or with the setting or presentation of the meal. Too often, “pickiness” will lead to caregivers opting to avoid the fight and provide comfortable foods rationalizing that it’s better that the child eat “something” rather than nothing. This process contributes significantly to the fact that 30% of autistic American children were medically categorized as obese in 2019 (Christensen et al., 2019). Unhealthy food intake is further compounded by the fact that autistic kids are less likely to participate in physical activities like sports and exercise than their non-autistic peers (Hill et al., 2015), and that they are often dealing with medication side effects that can cause weight gain (Craido et al., 2018).
In addition, it is not uncommon for neurotypical caregivers who do not understand the genesis of the autistic child’s eating struggles to punish or demean the child for their eating habits and food choices thereby inadvertently reinforcing the idea that food and eating is stressful. This can in turn push autistic young people further towards their safe foods and thus exacerbate potential health issues.
Establishing Baseline
Eating well is a goal that most every parent and individual should embrace. But as so many of us know, that is much easier said than done. Luckily, there are steps that we can take to improve dietary deficiencies. The first step that a caregiver and/or autistic person should take is identify the foods they like and why they like them. Are the foods salty or sweet? Hot or cold? Crunchy or soft? If they could have any food item, what would it be and why? The goal is to establish a list of “safe foods” that can be utilized when other options are completely unpalatable.
Next, create a list of the foods or presentations that are problematic. What isn’t liked? What flavors, textures, temperatures, colors, or combinations are most off putting? Is it acceptable if different food items touch, or is it best if each dish is kept separate? These items can be explored in the “Safe Foods” personal development tool that accompanies this article.
Finally, it is important to examine environmental conditions that may impact mealtime. Are there particular times of day that are better? What room, lighting, chair, cutlery, dishes, clothing or other items help or hinder a successful meal? These items are often considered inconsequential, but they can interfere with an autistic person’s ability to feel comfortable at mealtime.
Creating Healthy Eating Habits
Healthy eating – consuming foods that are high in proteins, fats, vitamins, minerals, and antioxidants – has been shown to improve the mental health as well as the physical health of autistic individuals (Egan et al., 2013). This mind/body benefit, which is applicable to all humans, reinforces the importance of fostering healthy eating habits for the entire family. Again, easier said than done and although developing a healthy diet is very individualized, there are basic steps that can help all of us to develop healthy eating routines.
Establish mindset and setting routines
Identify the times, lighting, clothing, furniture, and dinner wear that are most conducive to eating. Try to use them as consistently as possible.
Establish “meal music” or other comforting sounds or, lack thereof, that can consistently be played and correlated with mealtime.
If you/your family member prefer that food items don’t touch, consider using smaller, separate plates or invest in a set of divided plates and maybe even separate flatware for each item.
Establish a routine of implementing an enjoyable activity prior to mealtime so that everyone is calm coming into the meal.
Avoid screens or other unnecessary distractions at the table.
Meal and Menu Consistency
Plan and discuss meal menus ahead of time to build awareness and allow preparation for the introduction of new flavors or foods.
Try to keep some days/meals consistent to establish routine and comfort. Think “Macaroni Monday” or “Salad Saturday.”
Offer a healthy “safe food” at every meal. Maybe every meal has blueberries, a special salad, a shake, or anything that is healthy and that you or your family member will enjoy.
Expanding Diets Over Time
One major impediment to healthy eating is breaking out of unhealthy habits. It becomes routine to order take out, pick up fast food, or make the same old comfort meal. Everyone gets stuck in food ruts, but this can be especially difficult for autistic individuals and families to break out of. Nadon et al (2011)’s research shows that breaking these routines is best done slowly and deliberately. It is important to follow the healthy habits and steps that were discussed above and then move on to these additional steps that move you and your family closer to the goal of adding the foods that are “not yet safe.”
Introduce Slowly
Identify a food, texture, flavor, temperature or other characteristic that is disliked and provide it in small amounts with other foods that are safe and comfortable. Try to select a food item that has just one of the “disliked” characteristics (just texture or just flavor) at a time to not overwhelm.
Try to introduce new foods in ways that are as palatable as possible. For example: if a flavor and texture are at issue, manipulate the food to change the texture to something that is more comfortable. You may steam and blend carrots, freeze grapes, finely chop or mince onions so that they are imperceptible, etc. The goal is to get a comfortable texture, so that the only objection or issue is the uncomfortable flavor.
Introducing a new food item does not necessarily mean eating it. Gradual exposure to the food by having it on the plate, putting it on a fork, smelling it, kissing it, and licking it can all eventually lead to trying the food. An introduction may happen over days or weeks of progressively doing more with the food.
Food Progression
Food progression is when you expose unfamiliar new foods with “safe food” and then gradually remove the safe food and only eat the new food. This can happen as two separate dishes or by adding the new ingredient into a “safe food.”
Combining foods can be as simple as adding peas to pasta, mushrooms to pizza, or fresh fruit to ice cream. If added in small quantities at first the combinations will hopefully result in trying the new food. After the new food becomes familiar and safe in combination you can move toward offering the new foods on their own.
Here is an example of a slow food progression:
Boxed mac and cheese > homemade mac and cheese > homemade fettuccine alfredo with macaroni noodles > homemade fettuccine with fettuccini noodles > homemade red cream sauce with spaghetti noodles > homemade spaghetti
Be Consistent in Adding New Food
It is often not enough to try a new food once. It can require exposing new foods up to 30 times before an autistic child will try it. Don’t give up on a food! If you keep at it your autistic family member will be more likely to come on board.
4. Sneak “not safe yet” food in safe food.
This is a complete sneak, you should provide a warning that there is something new in the safe food item, but you don’t have to identify what it is, just that there is something new in the meal. You may even want to turn it into a game and see if they can identify the new food. It is best not to sneak new food into a safe food without discussing it because you could erode trust in an important area. However, sometimes food aversion is alleviated if someone tries something and then realizes that it isn’t so bad. That is the goal here.
If done well, it is possible to sneak all sorts of healthy foods in other dishes. Blend spinach in a shake. Rice cauliflower and mix with potatoes. Mince carrots and add to the chili.
Just remember to talk to your child about it to not erode trust.
Food Consequences
Food can be stressful and overwhelming for both autistic people and their families. This is especially true when autistic people are picky and refuse to eat what has been prepared. Despite how easy it may be to give and take food, it is important to be cautious and intentional with food consequences.
Starve It Out Method
Sometimes parents approach new food by putting it out with the idea that their autistic child will eat when they get hungry. However, this model is not advised for multiple reasons.
Some autistic people may not attune to their body’s hunger cues and understand that they need to eat to alleviate them. They, and their food, may just sit there forever.
Sometimes the issue is less about the food and more about the environment or sensory overwhelm. Food sitting out may just exacerbate this issue.
Using Food as Rewards/Consequences
Food is an essential component to overall health and wellness. Using it as a reward or consequence can make eating and food more stressful than it needs to be. It also sets up preferred foods to be “special” and can lead to sneaking, binging, and reinforced dietary restriction.
Positive Reinforcement
It is important to acknowledge and celebrate progress with food. Providing rewards for trying and eating (or even smelling, touching, licking, etc.) new foods establishes that food is rewarding and beneficial.
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