#602: Avoidant/Restrictive Food Intake Disorder (ARFID) – Megan Hellner, DrPH, RD & Katherine Hill, MD

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder diagnosis characterized by a persistent restriction or avoidance of food intake that results in clinically significant consequences (medical, nutritional, and/or psychosocial), but without the weight- and shape-driven psychopathology typical of anorexia nervosa and bulimia nervosa.

In this episode, Megan Hellner and Katherine Hill outline how ARFID presents across the lifespan, why it is frequently missed in routine healthcare, and what an evidence-informed assessment and treatment pathway can look like in practice.

A central theme is that ARFID is not synonymous with "picky eating" and not confined to any one body size. Patients may present at any point on the weight chart, including those who are weight-stable or in larger bodies, and the condition can begin in early childhood and persist into adulthood.

The episode also highlights ARFID in athletes and physically active people, where restricted dietary variety and/or low intake can contribute to low energy availability and RED-S-like presentations, sometimes without an obvious intent to lose weight.

• [03:48] Interview start
• [06:23] What is ARFID? DSM-5 definition vs "picky eating"
• [09:36] Clinical red flags: when restriction becomes a disorder
• [11:37] ARFID isn't always underweight: missed cases & diagnostic pitfalls
• [16:46] ARFID presentation profiles: low interest, sensory sensitivity, fear
• [18:59] Comorbidities & nutrition consequences
• [25:16] Evidence-based ARFID treatment
• [29:16] How to expand foods without pressure
• [32:28] Weight restoration, stabilization, and long-term maintenance
• [35:44] What research still needs
• [38:16] Differential diagnosis & referral

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