As a practice dedicated to eating disorders, it’s common for clients, families and colleagues to assume we treat the more known disorders of Anorexia, Bulimia, Binge Eating Disorder, and OSFED. Although Integrated Eating does work with clients with these diagnoses, more and more we are referred clients reporting ARFID symptoms. New to the term? Join the club.

ARFID - Avoidant Restrictive Food Intake Disorder is a newer diagnosis added to the list of “official” diagnoses for disordered eating. Previously ARFID was referred to as “Selective Eating DIsorder”. While there may be similarities between ARFID and other restrictive type eating disorders, the biggest difference is that ARFID does not involve thoughts or behaviors related to being thin, or feelings around body size. There is zero motivation to look a certain way, in fact, many with ARFID are hoping and motivated to resume adequate body size, shape or weight.

Typically, those who are dealing with ARFID do not consume enough nutrition to grow (for younger children) or function day to day. Older clients might experience weight changes (typically weight loss). Individuals may present with moderate to intense aversions to foods and sometimes phobias related to food, vomiting or stomach aches. ARFID can cause disruptions in school, daily life or the workplace. With it being a newer diagnosis, research is becoming increasingly helpful as we learn how to navigate the condition and treat it with the right support. Here’s a peek at some of the newest information out there.

A study out of Japan published in 2019 took a look at those hospitalized with ARFID vs. traditional Anorexia (Kurotori et al, 2019). Main differences included age and family history of mental disorders. On average those with ARFID were 10 years of age vs 13 years, and had a 46.2% reported family history of mental disease (vs 17.7% of those with Anorexia). This highlights the importance to monitor those at a younger age for signs and symptoms of ARFID.

Often, parents and sometimes providers blame “picky eating” for selective choices or texture preferences. Here’s a gentle reminder to always dig for more information. Even more important, is to screen for family history during conversations with families and clients. Let’s remind ourselves (and to practicing pediatricians) that those with family history of mental diagnoses might need some extra care!

Another study published just last year by Becker and colleagues, found that those with ARFID tended to have higher weight status, or higher BMIs than those with Anorexia. This may be helpful when screening or working with families, in not using weight or “normal” weight to rule out ARFID. This highlights what our community continues to emphasize, someone’s weight or size is never the whole picture.

In 2019, Harshman and colleagues were the first to analyze dietary records of those with ARFID compared to those without. Those with ARFID were found to have a much higher refined diet and consumed more added sugar. They also had a lower intake of protein, vegetables, Vitamin K and B12 specifically. These results highlight the importance of a dietitian in the care of those

with ARFID - to help make up and delicately treat those with insufficient intake. A Registered Dietitian can play a vital role on the care team by analyzing food logs and supplementing appropriately.

Summarizing the existing research in the community on ARFID, only helps our practice adapt for the clients we work with. We continue to learn and grow as we work with our clients- no matter where on the eating disorder spectrum they are presenting.

References:

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770555/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886540/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191972/