SAN ANTONIO — While avoidant/restrictive food intake disorder has often been associated by clinicians with underlying psychiatric and eating disorders, data presented at the American College of Gastroenterology Meeting revealed lower body image concerns and increased frustration with not being able to eat among patients with the intake disorder.
According to Kimberly Harer, MD, ScM, from the University of Michigan, avoidant/restrictive food intake disorder (AFRID) is under-recognized and under-treated among GI patients, driven by a lack of awareness and limited evidence regarding its prevalence in the field of gastroenterology.
“Although this is a rapidly emerging area of interest, we are just beginning to understand the association between GI disease and ARFID,” Harer told Healio Gastroenterology and Liver Disease. “Our goal is to raise awareness of ARFID among gastroenterologists and primary care physicians while simultaneously working to understand the risk factors, clinical presentation, and treatment options for GI patients with ARFID. The patients are complex and challenging, and there is a large knowledge gap and clinical need to fill.”
AFRID is defined by a disturbance in eating or feeding that results in one or more of the following: substantial weight loss, nutritional deficiency, dependence on tube feeds or dietary supplements, or significant psychosocial interference.
Harer and colleagues retrospectively reviewed 223 patients referred for short-term GI behavioral health treatment, 28 of whom met the criteria for AFRID. Both those with and without AFRID were clinically indistinguishable by age, sex, BMI, GI diagnosis or symptom severity.
Patients with AFRID were less likely to use psychotropic medication (17.9% vs. 50%; P < .01) compared with those without AFRID. Based on the Irritable Bowel Syndrome Quality of Life scores, patients with AFRID also had higher health-related quality of life scores for body image (8.8 vs. 7.8; P = .03) and lower health-related quality of life scores for food avoidance scores (5.4 vs. 7.9; P < .01).
Following GI-directed behavioral health treatment, patients with AFRID had decreased improvement in overall IBS-QOL health-related quality of life scores and evidence of increased health worry compared with patients without ARIFD.
“These results challenge some of the commonly held assumptions regarding GI patients with ARFID,” Harer said in an interview. “The fact that ARFID patients did not have as robust a response to GI behavioral health treatment also raises the question regarding if more comprehensive psychological care or a multidisciplinary approach to ARFID treatment is needed. The saying ‘the eyes cannot see what the mind does not know’ fits the situation. ARFID is relatively new diagnosis, and many providers are unaware of ARFID or how it complicates the clinical presentation of GI patients.”
Harer concluded that dietary restriction among GI patients is often appropriate, but AFRID is when the dietary restriction has spiraled out of control and exceeds what is normally expected for patients, resulting in harm.
“It is crucial to understand that the ARFID-driven restriction we see in the GI population is due to a ‘fear of negative consequences’ that occurs in the setting of GI symptoms,” she said. “Patients are not classified as an ARFID patient or a GI patient, they are often both. GI patients who suffer with ARFID require continued GI symptom management in addition to psychological and nutrition therapies.” – Talitha Bennett
Harer K, et al. Avoidant/Restrictive Food Intake Disorder (ARFID) Among Adult Gastroenterology Behavioral Health Patients: Comparison of ARFID vs. Non-ARFID Patients. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.
Disclosures: Harer reports no relevant financial disclosures.