National Eating Disorders Awareness Week: Avoidant/Restrictive Food Intake Disorder

TRIGGER WARNING: The passage you are about to read contains content about eating disorder thoughts & behaviors.

It’s National Eating Disorders Awareness Week and we have partnered with Boston Children’s Hospital to play a part in spreading awareness and sharing knowledge for our community of clinicians. We spoke with Dr. Elana Bern and Dr. Tracy Richmond to learn more about a type of eating disorder, Avoidant/Restrictive Food Intake Disorder, and what PCPs can do to best help their patients with this condition.

Dr. Elana Bern is an attending physician in the Division of Gastroenterology, Hepatology and Nutrition at Boston Children’s Hospital. In addition to her work as a physician, Dr. Bern is the Founder and Co-Director of the ARFID Program at Boston Children’s, and an Assistant Professor of Pediatrics at Harvard Medical School.

Dr. Tracy Richmond is an attending physician in the Division of Adolescent/Young Adult Medicine at Boston Children’s Hospital. In addition to their work as a physician, Dr. Richmond is the Director of the Eating Disorder and STEP Programs, Co-Director of the ARFID Program at Boston Children’s, and an Assistant Professor of Pediatrics at Harvard Medical School.

What is Avoidant/Restrictive Food Intake Disorder (ARFID)? What are some signs/symptoms?

One type of eating disorder is Avoidant/Restrictive Food Intake Disorder (ARFID). Children and adolescents with ARFID may limit the amount and/or types of foods they eat; they may not eat enough calories or eat foods that contain all of the healthy nutrients needed for the body to grow properly. Patients with ARFID and their families may also experience stress around mealtimes.

If a child has ARFID, it means they have 1 or more of the following: 

  • they have major weight loss (or are not gaining weight/growing as expected)
  • they are not getting enough nutrients
  • they need enteral (tube) feeding or nutritional supplements
  • they’re not interested in the social aspects of eating and/or eating is stressful

Their challenges with eating are not due to having access to food or because of cultural beliefs, are not related to concerns about their weight/body shape, and are not fully explained by any medical condition or another mental disorder.

Are there any associated disorders in those with ARFID?

Patients with ARFID may have had a bad experience associated with eating, which has made them fearful to eat certain foods. In some cases, those with autism spectrum disorder are more likely to develop ARFID. While in other cases, children and adolescents with ARFID have anxiety.

What are the recommended/most effective treatments that PCPs can offer?

PCPs can obtain an accurate diet history and determine if the patient is eating enough calories and appropriate nutrients for proper growth. Identifying and treating underlying disorders that can trigger the onset of ARFID is also helpful; PCPs can consider referring to a specialist.

Additionally, they can provide supplements to the diet to support healthy growth and address concerns with multidisciplinary experts that care for patients with ARFID. Some helpful ARFID resources can be found here and here.

What does post-“treatment” look like?

Post-treatment in patients with ARFID means that they can have a healthy diet, both in calories and nutrients, to support growth. Furthermore, they can develop a positive relationship with food.

Anything else you are inclined to share with PCPs on identifying & managing ARFID?

ARFID is a chronic disease for which long-standing nutrient deficiencies can be subtle in presentation but associated with significant, sometimes irreversible morbidities. As PCPs are identifying and treating patients with ARFID having a heightened awareness is important in the care of these children and adolescents.

RubiconMD is proud to partner with Boston Children’s to support clinicians and patients. For more information, visit the Boston Children’s website.