What Is the Best Treatment for ARFID?
As a provider, you know that noticing changes in your patient’s behavior is crucial to providing proper care. Perhaps you’ve recently come across a patient who shows a lack of appetite or little interest in food. Maybe they’re restricting the amount or type of foods they eat, but it doesn’t appear tied to any body image concerns. Perhaps your patient has always been a picky eater and has not “outgrown” this behavior as they have aged. You might also have noticed physical symptoms like significant weight loss, slow growth or delayed puberty, or signs of malnutrition such as anemia or vitamin deficiencies.
These symptoms could be signs of an eating disorder called Avoidant/Restrictive Food Intake Disorder (ARFID). While not as well known as other eating disorders, ARFID is just as serious and valid as anorexia, bulimia, and binge eating disorder. Each diagnosis requires its own unique treatment plan and ARFID is no different.
If you recognize the signs of ARFID and refer your patient to a specialty eating disorder treatment center like The Emily Program, you may be wondering what happens next. Gain some insight into ARFID and how it is treated at The Emily Program so you can continue to support your patients through their healing journey.
What Is ARFID?
ARFID (Avoidant/Restrictive Food Intake Disorder) is characterized by a disturbance in eating or feeding behaviors that results in significant weight loss (or growth slowing/failure to grow as expected), nutritional deficiency, and/or dependence on tube feeds or supplements. Patients with ARFID can also present with a great impact on their daily lives—especially with social events that involve eating. Because ARFID often involves significant weight loss and nutritional deficiency, it can be confused with anorexia nervosa, but patients with ARFID typically do not have a desire for thinness or obsessive thoughts about body image.
People of any age, race, gender, socioeconomic status, sexuality, ability, or size can have ARFID, but children and young adolescents are most frequently affected. ARFID also commonly co-occurs with other mental health conditions, including anxiety disorders and obsessive-compulsive disorder (OCD).
Although ARFID can develop in anyone, certain segments of the population have a heightened risk. Those with a higher chance of developing ARFID include:
- Those on the autism spectrum
- Those with ADHD
- Those with internet gaming disorder
- Those with mood or anxiety disorders
Now that you have more of a grasp on what this illness entails—along with who’s the most susceptible—you may be wondering, “What does ARFID treatment look like at The Emily Program?”
How Does The Emily Program Treat ARFID?
Once your patient has completed The Emily Program’s eating disorder assessment and is indeed diagnosed with an eating disorder, they will be admitted to one of our treatment centers at the recommended level of care. Your patient’s multidisciplinary team will then create an individualized treatment plan that takes into account their specific needs and the overall physical and emotional issues that commonly occur with ARFID (e.g., malnourishment, trying new foods that are not their preferred foods, stunted growth, etc.).
ARFID-specific treatment goals can include:
- Correcting nutritional deficiencies that may have arisen due to the limited list of preferred foods typically consumed by people with ARFID
- Achieving or maintaining a healthy weight by increasing volume and regularity of food intake as well as increasing variety of accepted foods
- Developing coping skills to identify and manage emotions surrounding fear foods and any other eating disorder behavior triggers
- Increasing comfort in social situations (e.g., eating out with friends or at a family member’s home) to engage in experiences without the limitations of ARFID
To reach those goals, ARFID treatment at The Emily Program includes:
- Informational session with the care team, family, and patient. The care team conducts an assessment with your patient and their family (or community of support). This assessment covers the onset of the eating disorder, growth charts and nutritional status, preferred foods, sensory sensitivities, any choking incidences, and more, providing the treatment team with the information they need to create a personalized treatment plan.
- Education on ARFID. Treatment for ARFID at The Emily Program includes psychoeducation for both your patient and their family. These educational sessions empower both with the knowledge, skills, and support they need to overcome the challenges of ARFID.
- Specialized ARFID programming. Programming that addresses the issues specific to ARFID is essential to a successful recovery. The following topics are covered either in individual or group settings:
- Food Discovery. In food discovery sessions with their therapist and dietitian, your patient will uncover their comfort levels with different types of food by ranking them in a food hierarchy, including the foods they are most comfortable and uncomfortable with. After this, they’ll be encouraged to try new foods. The goal of food discovery is to make eating fun and have clients push themselves one step beyond what they think they can do.
- Body Awareness. Our clients with ARFID dive into the topic of body awareness (versus body image) with their therapist. Through body awareness, your patient will discover the purpose of emotions, where emotions are felt in the body, and how to express those emotions. They will also learn about nutrition and body functions and mindfulness.
- Enriched Exposure Therapy. This method of therapy includes culinary experiences to help our ARFID clients become more comfortable in the kitchen and dining spaces. There is no pressure to eat or taste food in this group—it is more about being in the room and experiencing the smells of food.
- Socialization groups. Socialization groups—including social skills groups, group meals, and restaurant and therapeutic outings—are designed to develop and practice social interaction, problem-solving, and coping skills, as well as nurture the skills necessary for participating in social and community settings that involve food.
Recovery Is Possible
Providers are often on the front lines when it comes to eating disorder identification and intervention. You have the opportunity to notice the signs and screen your patients for eating disorders like ARFID. With the proper tools, providers like you can connect those struggling in silence to the life-changing journey to recovery.
ABOUT THE AUTHOR
Anna Tanner, MD, FAAP, FSAHM, CEDS-S
Dr. Anna B. Tanner (she/her) is Vice President of Child and Adolescent Medicine for Accanto Health, the parent company of The Emily Program, Veritas Collaborative, and Gather Behavioral Health. In this role, she has the opportunity to help our youngest patients access treatment across our system with age-appropriate medical care. She works with our child and adolescent medical sites across The Emily Program and Veritas Collaborative brands and also enjoys providing direct care to patients at Veritas’ Atlanta facility.
Dr. Tanner is driven to provide research-based medicine to our youngest patients and is passionate about preventing the long-term effects of eating disorders in children and adolescents. Medical complications in eating disorders are often treated through an age-neutral lens, yet children and adolescents have unique medical complications related to growth and development.
Dr. Tanner is a board-certified pediatrician who has specialized in the care of complicated adolescent patients, in particular patients with eating disorders, for almost 25 years. Dr. Tanner completed medical school and residency at Vanderbilt University and then remained there to serve on the Pediatrics faculty in the Division of Young Adult and Adolescent Medicine.
Dr. Tanner has been very involved in advocacy and education efforts and serves on national and international committees for eating disorders education. She speaks frequently across the United States on the Medical Complications of Eating Disorders, especially as they affect children and young adolescents, and contributed a book chapter on that topic in the 4th edition of Dr. Philip S. Mehler’s Eating Disorders: A Comprehensive Guide to Medical Care and Complications.
Dr. Tanner currently serves as an Adjunct Assistant Professor of Pediatrics for Emory University School of Medicine and Morehouse School of Medicine. She is co-chair of the Academy of Eating Disorders (AED) Medical Care Standards Committee and a member of the International Association of Eating Disorders Professionals (IAEDP) Curriculum Committee. Dr. Tanner is a Fellow in the Society for Adolescent Health and Medicine (SAHM), a Certified Eating Disorder Specialist and a Certified Eating Disorders Supervisor. She has been named by Atlanta magazine as a “Top Doctor” every year from 2013 to 2023 and named by Castle Connelly as an Exceptional Woman in Medicine and one of America’s Most Honored Doctors.