In a recent review published in Nutrients, researchers review existing data on two novel eating disorders (EADs) including avoidant/restrictive food intake disorder (ARFID) and atypical-type anorexia nervosa (AN).
Study: Pitfalls and Risks of “New Eating Disorders”: Let the Expert Speak! Image Credit: Tero Vesalainen / Shutterstock.com
EADs are characterized by impaired abilities to digest or absorb food and have considerable effects on psychosocial and physical health. In the post-coronavirus disease 2019 (COVID-19) period, an increased EAD incidence has been observed at younger ages, especially of partial or not otherwise specified (NOS) types, with atypical clinical presentations among male and female children.
Many EAD patients have limited treatment accessibility. In fact, the majority of EADs are undiagnosed and therefore untreated, thus resulting in chronic disorders with long-term medical, social, and psychiatric implications. Improving the understanding of EADs can subsequently enable the early identification and prompt treatment of these disorders.
In the present review, researchers present clues for diagnosing and managing novel EADs such as ARFID and atypical AN for pediatric health professionals.
Atypical anorexia nervosa
Atypical AN is characterized by a modified body image without any significant loss of weight or normal body weight. As a result, the diagnosis and treatment of atypical AN are often delayed. History of obesity and initiation of weight-loss diets, combined with improved self-image and positive reinforcements from families, are important clues to diagnose the condition.
Atypical AN typically develops during adolescence but may also arise in younger individuals, especially those with psychiatric comorbidities. The most frequently observed comorbidities include depression, obsessive-compulsive disorder (OCD), and suicidal/self-harm ideation.
Family-based therapy is considered first-line therapy, following which psychopharmacological approaches may be recommended. Studies have reported no differences in physical appearance in the clinical presentation of atypical AN, except for lower leukocyte counts.
Preterm infants and children with craniofacial pathology or genetic syndromes are at an increased risk of developing atypical AN.
Avoidant/restrictive food intake disorder
ARFIDs are characterized by altered eating or nutritional habits with resultant unmet nutritional and energy requirements, as well as impaired growth and development. This condition is associated with significant weight loss, nutritional deficits, supplementary oral and parenteral feeding requirements, and psychosocial dysfunction.
The main clinical features of ARFIDs include food limitation from an apparent disinterest in food, avoiding food items due to their color, shape, or packaging, and avoiding food due to phobic-type symptoms, such as post-choking episodes.
ARFIDs usually develop in early childhood and peak at two to six years of age. The prevalence estimates among school-aged and older children are 14% to 50% and 7% to 27%, respectively.
The most commonly observed symptoms include reduced portion size, avoidance of particular food items, history of early satiety, and nausea. ARFID patients usually suffer from generalized anxiety, OCD, or autism-spectrum diseases.
ARFIDs usually, but not always, present with low body weight. This condition may also lead to the inability to self-feed, with resultant weight gain difficulties and retarded growth.
The most effective management approaches include family-based therapies, cognitive-behavioral treatment, and food chaining. Psychopharmacological treatments such as selective serotonin reuptake inhibitors (SSRIs) have also been used with limited success.
Nutritional interventions, which initially involve increasing the intake of food preferred by the child, followed by oral nutritional supplementation (ONS), can restore nutritional deficiencies. In unresponsive cases, patients must be referred to artificial nutritional care centers to provide combined enteral and parenteral nutrition to the child under neuropsychiatrist and pediatrician care.
EADs can considerably impair the growth and development of children; therefore, these conditions must be identified and treated as early as possible. Warning signs for EADs include the consumption of only particular food by the child, the majority of caloric intake is from liquids, the child getting easily distracted during meals, the child eating food items hidden in other foods, and meals lasting for more than 30 minutes.
Excessive concerns over body shape and weight, reduced total food consumption or intake of particular food items, verbal concerns of an increase in weight, compulsive exercises with increased anxiety of inability to accomplish tasks, and feeling shame/guilt during meals may also indicate a potential EAD.
ARFIDs and atypical AN could present with an insidious onset during early childhood. As a result, these conditions may go undiagnosed and lead to severe malnutrition and psychosocial impairments with time, and coupled with psychiatric illnesses that may require multidisciplinary treatment. Management may include pediatricians, gastroenterologists, nutritionists, neuropsychiatrists, and speech therapists.
Differential diagnoses include gastroesophageal reflux diseases, food allergies, swallowing difficulties, and malabsorption-associated disorders such as cystic fibrosis, celiac disease, and inflammatory bowel disease (IBD). Regular check-ups must incorporate detailed dietary history taking and screening for feeding difficulties, low body weight, impairments in growth and development, and psychosocial dysfunction, including clinical assessments for nutritional disorders such as scurvy and Beriberi.
Parent and child education to increase EAD awareness is also critical in the effective management of these conditions.