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

In this in-depth episode of Sigma Nutrition Radio, host Danny Lennon explores Avoidant/Restrictive Food Intake Disorder (ARFID), a lesser-known eating disorder that often goes undiagnosed due to its overlap with typical picky eating and lack of body image concerns. Dr. Megan Hellner and Dr. Katherine Hill, founders of AthleteMD and experts in eating disorders with a focus on athletes, provide a comprehensive overview of ARFID, emphasizing its three primary presentation types: low interest in eating, sensory sensitivity, and fear of aversive consequences like choking. They clarify that ARFID is not defined by weight loss but by clinically significant medical, nutritional, or psychosocial consequences, and highlight that it can affect individuals across all weight ranges—including those who are overweight or maintain normal weight due to a narrow food repertoire. The discussion underscores the importance of growth charts, medical monitoring, and multidisciplinary care involving dietitians, mental health professionals, and physicians. Evidence-based treatments like Family-Based Treatment (FBT) and Behavioral Therapy for ARFID (BBT-AR) are recommended, with a focus on gradual food chaining and meeting patients where they are, rather than imposing pressure to eat more. The episode also addresses diagnostic challenges, comorbidities like anxiety and neurodevelopmental conditions, and the risk of misdiagnosis as Relative Energy Deficiency in Sport (REDS). Both experts stress the need for increased awareness among healthcare providers and the importance of early intervention to prevent long-term consequences. The episode concludes with practical takeaways for clinicians and the public: recognizing ARFID through persistent eating difficulties that interfere with health, not just weight; using growth charts as a key diagnostic tool; and prioritizing multidisciplinary care. The hosts emphasize that ARFID is treatable, with recovery possible through patience, structured support, and normalization of eating patterns. They also call for more research on weight restoration, prevalence, and treatment response across different ARFID subtypes. For those seeking help, they recommend resources like the ARFID Collaborative, FEAT, and AthleteMD. Finally, both guests share a unifying message: cultivating body respect and prioritizing sleep and physical awareness are foundational to long-term well-being.