"One common presentation of ARFID is a lack of interest in eating or food. Individuals with this type of ARFID often describe eating as a chore. They may forget to eat, rarely feel hungry, become full very quickly, or simply not enjoy food."
Avoidant/restrictive food intake disorder (ARFID) is an eating disorder that makes it difficult for people to eat enough food, or a wide enough variety of foods, to meet their nutritional needs.
While ARFID can affect both children and adults, it is often misunderstood and mistaken for typical picky eating.
In this Q&A, Mass General Brigham eating disorder experts Kamryn Eddy, PhD, Kendra Becker, PhD, and Jennifer Thomas, PhD, explain what ARFID is, how it can affect daily life, and what their latest research is revealing about the biological factors that may contribute to the disorder. They also discuss emerging treatments and why they are optimistic about the future of ARFID care.
What is avoidant/restrictive food intake disorder, and how does it differ from more commonly known eating disorders?
Avoidant/restrictive food intake disorder, or ARFID, is an eating disorder in which people eat too little food, too limited a variety of foods, or both. These eating patterns can lead to nutritional deficiencies, growth or health concerns, and challenges in everyday life.
People with ARFID are not restricting food because of concerns about weight, shape or body image. Instead, they may avoid foods because of low appetite, sensory sensitivities, fear of choking or vomiting, or other reasons.
What are some of the most common signs of ARFID, and what does the "lack of interest in eating or food" presentation look like? When should families seek help?
Picky eating is common in young children and is usually a normal part of development.
However, people with ARFID tend to have much more rigid eating patterns that can affect their health and daily lives. They may avoid certain foods, feel anxious about eating, or avoid social situations that involve food.
One common presentation of ARFID is a lack of interest in eating or food. Individuals with this type of ARFID often describe eating as a chore. They may forget to eat, rarely feel hungry, become full very quickly or simply not enjoy food.
Families should consider seeking professional help if eating patterns are leading to weight loss, poor growth, nutritional concerns, or problems at home, at school or in social situations.
Parents who are concerned should start by talking with their child's pediatrician.
Your research has explored biological factors involved in ARFID. What roles do hormones such as CCK and ghrelin play in appetite, hunger, and feelings of fullness?
Our bodies use hormones to help regulate hunger and fullness. Ghrelin is often called the “hunger hormone” because it helps signal that it's time to eat. CCK helps signal that we've had enough to eat and are feeling full.
Normally, ghrelin levels rise before meals and decrease afterward, while CCK levels increase after a meal to signal to the body that it is satisfied.
One of your studies found that young people with ARFID characterized by a lack of interest in eating had higher levels of CCK. Why is this finding important, and what could it mean for future treatment?
This finding aligns closely with what many patients tell us, which is that they rarely feel hungry or become full very quickly.
If their bodies are sending stronger fullness signals than usual, it may help explain why eating enough food can be difficult.
Understanding these biological factors gives us important clues about what may be contributing to ARFID and how we might better treat it in the future.
We also found that improvements in ARFID symptoms over time were linked to lower CCK levels and higher ghrelin levels.
While more research is needed, these findings could help guide the development of future treatments that target appetite and fullness signals.
Treatment for ARFID often requires a multidisciplinary approach. What are some of the biggest challenges clinicians face when helping patients expand their diets and improve their relationship with food?
People with ARFID do not choose to struggle with eating. Their eating patterns often make sense based on their biology and experiences with food.
At the same time, these patterns can lead to serious consequences, including poor nutrition and difficulties at school, work or in social situations.
Although recovery is possible, making changes can take time and effort.
One of the most important parts of treatment is partnership. Rather than telling patients exactly what foods they must eat, we work together to identify goals that matter most to them and gradually build confidence around eating.
Your recent pilot study examined a dietitian-led version of Cognitive Behavioral Therapy for ARFID (D-CBT-AR). What inspired the development of this approach, and how does it differ from traditional CBT-AR?
Dietitians are often among the first health professionals that people with eating concerns see, and they have extensive training in nutrition.
For this study, we partnered with dietitian Copeland Winten, PhD, to adapt CBT-AR so it could be delivered by specially trained dietitians.
The treatment follows the same core approach as traditional CBT-AR but includes additional nutrition-focused education and resources.
Our findings suggest that dietitians can be effectively trained to deliver D-CBT-AR, leading to meaningful improvements in ARFID symptoms and food variety.
Participants added a median of 26 new foods and showed significant improvements in their symptoms, which is encouraging because it may help expand access to specialized, evidence-based care for more patients.
Looking ahead, what do you see as the most promising directions for ARFID research and treatment, and what message would you like patients and families to take away from this work?
We are optimistic about the future of ARFID research and treatment.
Our team is currently conducting clinical trials in children, adolescents, and adults to continue improving care and expanding access to effective treatments.
We are also excited about new findings that are helping us better understand the biological factors involved in ARFID, which could lead to new treatment options in the future.
Most importantly, we want patients and families to know that ARFID is treatable.
We have seen many people make meaningful progress and improve their relationship with food.
If you or a loved one is struggling with ARFID, seeking help is an important first step, and there is reason for hope.
Subscribe to BenchMarks!
Subscribe to our monthly research newsletter and be the first to know what’s shaking in science at Mass General Brigham. From groundbreaking discoveries to the latest “you-heard-it-here-first” breakthroughs, we’ve got the updates that’ll keep your curiosity grooving.
Leave a Comment