Hospital course of underweight youth with ARFID treated with a meal‐based behavioral protocol in an inpatient‐partial hospitalization program for eating disorders

Abstract

Objective Information on nutritional rehabilitation for underweight patients with avoidant/restrictive food intake disorder (ARFID) is scarce. This study characterized hospitalized youth with ARFID treated in an inpatient (IP)‐partial hospitalization behavioral eating disorders (EDs) program employing an exclusively meal‐based rapid refeeding protocol and compared weight restoration outcomes to those of patients with anorexia nervosa (AN). Method Data from retrospective chart review of consecutive underweight admissions (N = 275; age 11–26 years) with ARFID (n = 27) were compared to those with AN (n = 248) on clinical features, reason for discharge, and weight restoration variables. For patients with ARFID, presenting phenomenology was further characterized by detailed chart review. Results At admission, 53% of patients with ARFID were vomiting regularly. The predominant ARFID subtype was ARFID‐aversive, with close to a third being mixed subtype. Gastrointestinal (GI) symptomatology (81.5%) was the most commonly endorsed reason for restriction. A third had undergone unsuccessful parenteral or enteral tube feeding. Patients with ARFID were more likely male, had higher admission BMI, and slower IP weight gain (1.36 kg /week vs 1.92) compared to patients with AN. Fewer patients with ARFID transitioned to the partial hospitalization program, although the proportion discharged for clinical improvement did not differ and both groups had a mean program discharge BMI >18.5. Discussion GI symptoms appear a common contributor to restrictive eating amongst hospitalized youth with ARFID. Despite a slightly lower rate of IP weight gain, clinical improvement and weight restoration at discharge were similar for patients with ARFID compared to AN.

Avoidant/restrictive food intake disorder: Psychopathological similarities and differences in comparison to anorexia nervosa and the general population

“…In our study, patients with ARFID had significantly more antecedents in their medical and psychiatric histories. It is congruent with literature revised referring to a greater medical risk found in young people with ARFID (Becker et al, 2019;Bryson et al, 2018;Coglan & Otasowie, 2019;Fitzgerald & Frankum, 2017;Makhzoumi et al, 2019;Norris et al, 2016;Zia et al, 2017;Zimmerman & Fisher, 2017). Some of these physical and mental conditions may be in turn a risk factor in developing ARFID.…”

<p>An Inpatient Observational Study: Characteristics And Outcomes Of Avoidant/Restrictive Food Intake Disorder (ARFID) In Children And Adolescents In Japan</p>

“…Compared to the patients in similar studies,18,29,30 our ARFID patients exhibited a poorer weight status, younger age, and a shorter time to hospitalization. Nevertheless, 10 (77.0%) of the 13 patients in ARFID group achieved a full recovery after discharge.…”

Cognitive‐behavioral therapy for avoidant/restrictive food intake disorder: Feasibility, acceptability, and proof‐of‐concept for children and adolescents

“…Only three small randomized controlled trials have been published, and all have focused on young children ages 13 months to 12 years (Lock et al, 2019a; Sharp et al, 2016; Sharp et al, 2017). Published research on the treatment of older children and adolescents is limited to retrospective chart reviews (Bryson, Scipioni, Essayli, Mahoney, & Ornstein, 2018; Makhzoumi et al, 2019), case studies (Thomas, Brigham, Sally, Hazen, & Eddy, 2017), and case series (Dumont, Jansen, Kroes, de Haan, & Mulkens, 2019; Rienecke, Drayton, Richmond, & Mammel, 2020). A growing number of reports have highlighted the potential application of cognitive‐behavioral (Görmez, Kılıç, & Kırpınar, 2018; Steen & Wade, 2018; Zucker et al, 2019), family‐based (Eckhardt, Martell, Lowe, Le Grange, & Ehrenreich‐May, 2019; Lock et al, 2019; Rienecke et al, 2020; Spettigue, Norris, Santos, & Obeid, 2018), and parent‐management (Dahlsgaard & Bodie, 2019) approaches.…”