Understanding ARFID: A Dietitian’s Perspective

For some people, eating is not just a routine part of the day —bit can feel overwhelming, stressful, or even frightening. This is often the reality for individuals living with Avoidant/Restrictive Food Intake Disorder (ARFID), a lesser-known eating disorder that can have a significant impact on nutrition, growth, and overall wellbeing.

Unlike other eating disorders, ARFID is not driven by concerns about body weight or shape. Instead, it is often linked to low appetite, sensory sensitivities, or fear-based experiences around food. Despite this, the effects can be just as serious.

As dietitians, we are in a unique position to recognise the early signs of ARFID and provide practical, compassionate support. By working closely with individuals, families, and care teams, we can help turn what feels like an overwhelming challenge into small, manageable steps forward.

What is ARFID?

ARFID is an eating disorder where someone has ongoing difficulty eating enough food to meet their energy or nutrient needs. This can show up in different ways, and no two people experience it exactly the same.

Some people may have very little interest in food or feel full quickly, making it hard to eat enough throughout the day. Others experience strong sensory sensitivities — certain textures, smells, colours, or temperatures can feel intensely uncomfortable or even unbearable. For some, eating is linked to fear, especially if they have had a past experience like choking, vomiting, or ongoing digestive discomfort.

While ARFID is not about body image, it can still lead to significant nutritional concerns, including weight loss, nutrient deficiencies, or challenges with growth and development. That is why early support, particularly from a dietitian, can make such a meaningful difference.

How Does ARFID Present?

ARFID can look quite different from person to person, and its impact goes beyond just what someone eats.

You might notice a very limited range of “safe” foods, with strong resistance to trying anything new. For children, this can show up as slower growth or difficulty meeting expected milestones. Adults may struggle to maintain their weight or meet their nutritional needs.

Eating can also become a source of anxiety. Mealtimes — especially in social settings — may feel stressful or overwhelming, leading some people to avoid eating with others altogether. Over time, this can affect not just nutrition, but also social connection and overall quality of life.

ARFID often occurs alongside other conditions, such as anxiety or neurodivergence (including autism), which can shape how it presents and how best to support it.

Potential Risks

Nutritional Risks

When food intake is limited, the body may not get the nutrients it needs to function and grow.

This can lead to:

• Slower or faltering growth in children, or weight loss in adults

• Deficiencies in key nutrients that affect bones, skin, hair, and overall health

• Delays in physical development, including dental changes

• Low energy levels, fatigue, and difficulty concentrating
  

Psychosocial Risks

ARFID does not just affect physical health — it can also take a toll emotionally and socially.

Some individuals may experience:

• Lower self-confidence or self-esteem

• Anxiety around eating, particularly in front of others

• Avoidance of social situations involving food

• A reduced overall quality of life

How Dietitians Can Help

This is where dietitians can make a real difference. Our role is to translate nutrition science into practical, achievable strategies that work in everyday life — often as part of a broader care team.

Support might include:

Assessing nutritional risk:
Looking at dietary intake, growth patterns, and medical information to identify gaps and prioritise what matters most.

Supporting adequate intake:
Focusing on realistic ways to meet energy and nutrient needs, often by building on familiar “safe” foods. This might include gently fortifying preferred foods, introducing small changes alongside accepted options, or using oral nutrition supplements when needed.

For example, if a child mainly eats plain white bread and cheddar cheese, small adjustments — like trying a higher-fibre white loaf or a higher-protein cheese — can improve nutrition without making the food feel unfamiliar or overwhelming.

Working with families and carers:
Helping create structured, low-pressure mealtime environments. A helpful approach is dividing responsibility: caregivers provide the food, and the individual decides what and how much to eat.

Collaborating with the care team:
Working alongside psychologists, occupational therapists, and medical professionals to ensure nutrition strategies align with broader therapy goals.

Monitoring progress over time:
Tracking growth, adjusting strategies as needs change, and supporting transitions such as starting school, adolescence, or moving toward independent living.

A Compassionate, Practical Approach

Supporting someone with ARFID takes patience, flexibility, and a non-judgmental mindset. Progress is often gradual, and success isn’t just about expanding food variety — it is also about reducing anxiety, building confidence, and improving quality of life.

If you are supporting someone with ARFID, it is worth remembering that small steps really do matter. With the right support, positive change is possible — and it does not have to happen all at once.

Early dietetic input can make a meaningful difference, helping individuals and families navigate this complex journey with greater confidence and clarity.