Journal Article Annotations
2024, 1st Quarter

Child and adolescent psychiatry/pediatrics

Annotations by Sneha Jadhav, MD
April, 2024

Prevalence, characteristics, and correlates of probable avoidant/restrictive food intake disorder among adult respondents to the National Eating Disorders Association online screen: a cross-sectional study.

PUBLICATION #1 — Child and adolescent psychiatry/pediatrics

Prevalence, characteristics, and correlates of probable avoidant/restrictive food intake disorder among adult respondents to the National Eating Disorders Association online screen: a cross-sectional study.

Laura D’Adamo, Lauren Smolar, Katherine N Balantekin, C Barr Taylor, Denise E Wilfley, Ellen E Fitzsimmons-Craft

Abstract: J Eat Disord. 2023 Dec 4;11(1):214. doi: 10.1186/s40337-023-00939-0.

Background:
Avoidant/restrictive food intake disorder (ARFID) is a serious, albeit under-researched, feeding or eating disorder. This exploratory study utilized data from adult respondents to the National Eating Disorders Association online eating disorder screen to validate items assessing the presence of ARFID and examine the prevalence, clinical characteristics, and correlates of a positive ARFID screen.

Methods:
Among 50,082 adult screen respondents between January 2022 and January 2023, the prevalence of a positive ARFID screen was calculated. Chi-square tests and t-tests compared demographics, eating disorder attitudes and behaviors, suicidal ideation, current eating disorder treatment status, and eating disorder treatment-seeking intentions between respondents with possible ARFID and other eating disorder diagnostic and risk categories. Clinical characteristics of respondents with possible ARFID were also examined.

Results:
2378 (4.7%) adult respondents screened positive for ARFID. Respondents with possible ARFID tended to be younger, male, and have lower household income, and were less likely to be White and more likely to be Hispanic/Latino than most other diagnostic/risk groups. They had lower weight/shape concerns and eating disorder behaviors than most other diagnoses and higher BMI than those with AN. 35% reported suicidal ideation, 47% reported intentions to seek treatment for an eating disorder, and 2% reported currently being in treatment. The most common clinical feature of ARFID was lack of interest in eating (80%), followed by food sensory avoidance (55%) and avoidance of food due to fear of aversive consequences (31%).

Conclusions:
Findings from this study indicated that ARFID was prevalent among adult screen respondents and more common among individuals who were younger, male, non-White, Hispanic, and lower income relative to those with other eating disorders, at risk for an eating disorder, or at low risk. Individuals with possible ARFID frequently reported suicidal ideation and were rarely in treatment for an eating disorder. Further research is urgently needed to improve advances in the assessment and treatment of ARFID and improve access to care in order to prevent prolonged illness duration.

Annotation

The finding:
Avoidant/resistrictive food intake disorder (ARFID) is a relatively new condition in our understanding of eating disorders. Research on ARFID is almost exclusively in children and adolescents but there is increasing awareness of prevalence in adults. This is a large-scale survey using a publicly available eating disorders screening tool (National Eating Disorders Association online screen) and had over fifty thousand adult respondents. Almost 5% of respondents screened positive for ARFID and were more likely to be younger, male, non-White, Hispanic and lower income relative to those with other eating disorders. They frequently (35%) reported suicidal ideation, had high intentions to seek treatment (47%) but were rarely in treatment (2%). The most commonly reported symptom was a lack of interest in eating followed by sensory avoidance and avoidance due to fear of aversive consequences.

Strength and weaknesses:
Strengths of the study include the large and diverse population included in the study, including socio-demographic factors such as income and including a range of eating disorders as well as at risk and low risk group. Weaknesses include using a screening tool that has not previously been validated, lack of clinical assessments before assigning ‘diagnoses’. There may be a selection bias since the data includes people who chose to respond to the survey. Since ARFID screening was offered only to individuals who did not meet criteria for other established eating disorders, the study may have missed more nuanced clinical presentations. The screening process did not include other psychopathology (mood, anxiety, developmental disorders) besides suicidal ideation. The screen did not address factors such as food insecurity and cultural food practices which are necessary exclusions during assessment of ARFID.

Relevance:
ARFID is considered to be a disorder of childhood onset with limited view of its stability or prognosis in adult life. As we recognize these symptoms in adults and as children with ARFID transition to adulthood, we will need awareness, effective screening and evidence-based treatment which is relevant for adults.