The prevalence and burden of avoidant/restrictive food intake disorder (ARFID) symptoms in the adult general population of the UK and USA

Introduction

Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding and eating disorder characterized by avoidant/restrictive eating behaviors that lead to medical and/or functional impairments. While ARFID is increasingly recognized within pediatric populations and specialist clinics, data on its prevalence and burden within the adult general population remain sparse. We sought to address this knowledge gap.

Methods

We conducted a population-based internet survey with predefined demographic quotas across the UK and USA. The survey included the Nine-Item ARFID Screen (NIAS), the Rome IV diagnostic questionnaire for disorders of gut-brain interaction (e.g., irritable bowel syndrome, functional dyspepsia), and questions regarding demographics, body mass index, somatic symptoms, anxiety and depression, quality of life, and healthcare utilization.

Results

Among 4002 participants (mean age 47.1 years, 50% female), 26.0% screened positive for ARFID. Prevalence was significantly higher in females versus males (29.6% vs. 22.1%, OR 1.48, 95% CI 1.28–1.71) and varied by age: 18–39 years (31.6%), 40–64 years (25.0%), and ≥ 65 years (16.1%; p < 0.001). Participants with a positive ARFID screen demonstrated significantly higher rates of underweight status, disorders of gut-brain interaction, mood disturbances, somatic symptoms, reduced mental and physical quality of life, and increased healthcare utilization compared to unaffected individuals. Increasing severity of ARFID correlated with greater general health impairment (all p < 0.001).

Conclusion

A positive ARFID screen is common within the adult general population, affecting 1-in-4 people, and associated with a substantial health burden. Increased awareness of ARFID will facilitate clinical service provision and guide future research.