When eating is a burden

For many people, eating is a source of pleasure – but for those affected by ARFID (avoidant/restrictive food intake disorder), it is often linked to anxiety, stress or disgust. The disorder is characterised by the rejection of certain foods, often due to their smell, texture, or a fear of choking or vomiting. A marked lack of interest in eating can also be a key feature. Unlike other eating disorders such as anorexia nervosa, ARFID is not driven by a desire to lose weight. Nevertheless, the risk of malnutrition and related health complications is similarly high.

The team led by Dr Ricarda Schmidt and Professor Anja Hilbert has been researching ARFID for several years at the University of Leipzig Medical Center. One of their key contributions is the development of a diagnostic interview now used worldwide to identify the disorder. “Our latest findings show that ARFID can also affect adults with higher body weight – although the symptoms may differ in some respects. These patients require specific diagnostic tools and tailored treatment strategies,” says Dr Ricarda Schmidt, senior author of the study.

In the current study, 369 adults participated in an online survey, with a subset additionally completing a clinical interview. This approach allowed the researchers to assess both self-reported symptoms and formal diagnoses, and to analyse them in relation to body weight and other health indicators. The results showed that 34 per cent of adults with ARFID had an elevated body weight. Compared with those with low body weight, this group was more likely to display selective eating patterns, experience greater everyday impairment, and face an increased risk of metabolic disorders. One particularly striking finding was that all participants with higher body weight reported psychosocial impairments – compared  with 65 per cent of those with lower body weight.

Many higher-weight participants also reported significant concerns about their body shape and weight  – a finding that has received little attention to date. Yet in clinical settings, such concerns are often misinterpreted. “ARFID frequently goes unrecognised in people with higher body weight, because their weight-related concerns are mistakenly viewed as signs of other eating disorders or simply attributed to dieting,” explains Dr Schmidt. As a result, accurate diagnosis is often missed – with potentially serious consequences for treatment and care, she warns. To address this gap, diagnostic procedures must be revised and healthcare professionals better trained to recognise ARFID across all weight categories. Existing screening tools should be expanded to include indicators that are not dependent on body weight. The authors also recommend adapting treatment approaches – both psychotherapeutically and pharmacologically – to meet the specific needs of this group.

“With these findings, we are helping to close a significant research gap and broaden the understanding of this disorder to include a population that has largely been overlooked,” says Dr Schmidt, a researcher in behavioural medicine. Follow-up studies on the causes and treatment of ARFID are already underway at the University of Leipzig Medical Center.