Acute and chronic physical risks in avoidant restrictive food intake disorder: findings from a national surveillance study

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PURPOSE: Avoidant restrictive food intake disorder (ARFID) is associated with acute and chronic physical health risks, but population-level data remain limited. METHODS: We analysed national surveillance data from 319 clinician-reported cases of ARFID among children aged 5-18 in the UK and Republic of Ireland over a 13-month period. Physical health variables at presentation were assessed using the Medical Emergencies in Eating Disorders medical risk criteria. Multivariable logistic regression models examined associations with acute medical risk and nutritional deficiencies. Longitudinal mixed-effects models were fitted to assess changes in height z-scores over time. RESULTS: Nearly a third (30.41%) of children met criteria for acute medical risk, although over two-thirds of those were classified based on weight criteria alone, while some children without low weight showed markers of compromise, including bradycardia and hypotension. Shorter symptom duration was associated with higher odds of identified acute risk. Nutritional deficiencies were common (51.1%), particularly iron and vitamin D. Longer symptom duration was associated with increased odds of deficiency, while individuals with the lack of interest subtype had lower odds compared with the combined subtype. Height trajectories remained stable over time, but many children presented with reduced height, and lower weight z-score at diagnosis was associated with shorter stature. CONCLUSION: Children with ARFID experience substantial physical health complications that may occur independently of weight status. Reliance on body mass index alone may obscure medical risk. Symptom duration and ARFID presentation may provide additional clinical indicators. Standardised, comprehensive physical assessment is needed to improve detection and care.

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