This is what Heather Hill eats: French fries, pasta with butter or marinara sauce, vegetarian pizza, cooked broccoli, corn on the cob and cakes and cookies without nuts.
And what she doesn't eat? Pretty much anything else.
Ms. Hill is what you might call a picky eater. But she isn't a child. She's a 39-year-old mother of three who runs her own business in Raleigh, N.C. She says she is unable to eat other foods. "When I was younger it was cute," Ms. Hill says. "Now it's embarrassing."
People like Ms. Hill have long puzzled clinicians and medical experts because their behaviors don't fit the definition of a traditional eating disorder, in which people aim to achieve a certain body weight. But picky eaters' diets can be so limited that their food preferences interfere with their social and professional relationships, which is one of the hallmarks of a true disorder. Ms. Hill says she lies to her friends about what she eats and avoids parties and business lunches. And although she tries to hide her pickiness from her children, she frequently worries they will acquire her eating habits.
Now, health experts are seeking to get a better sense of the range of people's food restrictions and how it affects their lives. The first national public registry of picky eating, launched last week by researchers at Duke University and the University of Pittsburgh, will allow people to log in and report on their unusual eating preferences and habits. Doctors also hope the effort will spur the development of improved treatment techniques for adult picky eaters. (The registry can be found online at eatingdisorders.mc.duke.edu. On the right side of the page, click on the Finicky Eating in Adults study link.)
Major eating disorders such as anorexia and bulimia are well known. There's also evidence of other types of adult eating disorders, including binge-eating syndrome, in which individuals are unable to stop themselves from consuming excessive amounts of food, and night-eating syndrome, where people get out of bed to eat in their sleep. But medical professionals say little is known about the extent and causes of picky eating in adults. One online support group for adult picky eaters claims to have about 1,400 active members.
Doctors once thought only kids were picky eaters, and that they would grow out of it. Now, however, a taskforce studying how to categorize eating disorders for the new version of the Diagnostic and Statistical Manual of Mental Disorders, due out in 2013, is considering recognizing for the first time a disorder to be called "selective eating" that could apply to adults as well as children. The DSM, a common psychiatric reference book, would currently lump picky eaters into a classification of eating disorder "not otherwise specified," a catchall category for people who don't meet the criteria for a major disorder.
Unlike people with anorexia or bulimia, picky eaters don't seem to make food choices based on calorie content. They aren't necessarily skinny or obsessed with looking a certain way. Researchers don't know yet what drives the behavior, but they say textures and smell can account for a picky eater's limited diet. Some will only eat foods with one consistent texture or one taste, leading some medical experts to speculate that picky eaters have some obsessive-compulsive tendencies. Doctors worry that over the long term such eating habits could lead to nutritional deficiencies linked to health concerns, including bone and heart problems.
Picky eaters tend to gravitate to certain foods, including blander products that are often white or pale colored, like plain pasta or cheese pizza. For reasons that aren't clear, almost all adult picky eaters like French fries and often chicken fingers, health experts say.
Amber Scott, of Enon, Ohio, has eaten only about 10 different foods since she was 3 years old. She describes foods that don't appeal to her as if they are inedible objects. "You wouldn't put a handful of grass in your mouth and chew it up," says the 29-year-old. "I feel the same way about spaghetti." It isn't as much the flavor as it is the texture and the way her body reacts to a new food, she says. When she tried eating an apricot last fall, her stomach churned. "I really wanted to like it, but my body wouldn't let me," she says.
Ms. Scott, a writer, is planning to move to Los Angeles and is "terrified" of having to sit through networking dinners. Like many picky eaters, she says most of her friends don't know about her tendencies because she tries to avoid social situations that involve eating. She has looked for help in the past but says she couldn't find a therapist who appeared to understand her condition, and has stopped searching.
Bob Krause, 63, of Virginia Beach, Va., runs an online support site called PickyEatingAdults.com that has 1,400 active members. From age 5 or 6 he thought of himself as a "social leper," who would avoid sleepovers because of his restricted eating habits. Even now, he has a rule that he will not go to someone's house before 7:30 pm in order to avoid any chance of being invited to eat dinner.
Nancy Zucker, director of the Duke Center for Eating Disorders, is part of the team launching the picky-eating registry. She says that when adults come to her for treatment, she first helps them work on assertiveness skills—ways to tell people what they need in order to live with the habits. Then they work to study patterns in eating habits and systematically try new foods. The treatment is "amazingly successful" in kids, but in adults it is too early to say how effective it is, she says.
Ms. Hill, of Raleigh, N.C., says she decided to seek treatment at Duke to help keep her children from developing similar eating habits. So far, only her oldest, 5-year-old Sarah, exhibits pickiness, despite Ms. Hill's attempts to hide her behavior. She says she never eats a meal with her kids. Instead, she has a snack while they eat and has a larger meal later.
Ms. Hill says she is so worried about her daughter's eating habits that she begins sweating and getting anxious if Sarah doesn't eat much at breakfast. She starts bargaining with Sarah about taking one more bite and has tried to use a food chart to encourage her daughter to eat more.
Ms. Hill describes her own habits as inconvenient and limiting to her life. To get around eating with friends, she tells them she is fasting or has already eaten. Two Thanksgivings ago, when visiting her husband's family, she avoided dinner by hanging out with the kids in another room, she says. Putting a foreign food into her mouth, like a bite of pepperoni pizza instead of cheese pizza, is like a "shock to my system," Ms. Hill says. Her brain immediately "freezes up" and doesn't let her think she might enjoy the food, she says.
Ms. Hill says she has no known physical health problems. Her therapist at Duke told her she might have some symptoms of attention-deficit disorder, she says. Since beginning treatment, Ms. Hill says she is starting to see how some of the social aspects of not eating have affected her personality, such as worrying if people are judging her. But she isn't sure she will actually make any eating changes or try new foods. "I know it's not a matter of wanting to, it's that you can't," she says.