Psychopathology in Adults with Co-occurring Avoidant/Restrictive Food Intake Disorder (ARFID) and Higher Weight

Introduction: Avoidant/restrictive food intake disorder (ARFID) occurs in individuals across all weight ranges and age groups. While previous studies primarily focused on children and individuals with underweight, research on ARFID in adults with higher weight is virtually non-existent. Therefore, this study aimed to examine whether adults with (1) ARFID symptoms and (2) ARFID diagnosis differ clinically based on weight status (underweight, normal weight, overweight/obesity). Methods: Adults from the population participated in an online survey and optional clinical interview to verify ARFID diagnostic criteria. Data from 369 adults with ARFID symptoms (online survey) and 77 adults with ARFID diagnosis (interview) were analyzed. Results: Overweight/obesity was present in 34% of the online (30 ± 9 years, 77% female) and 39% of the interview sample (29 ± 8 years, 62% female). Adults with both ARFID symptoms and ARFID diagnosis and overweight/obesity showed less lack of interest in eating, higher eating disorder psychopathology, and more metabolic comorbidities compared to those with underweight or normal weight. Additionally, adults with ARFID and overweight/obesity exhibited more psychosocial impairment than those with underweight (100% vs. 65%), but no weight loss due to restricted food intake. There were no group differences in terms of food neophobia, smell and texture sensitivities, and depressive symptoms. Conclusion: This study provides a first detailed analysis of ARFID in adults as a function of weight status, emphasizing its relevance for diagnosis and treatment of ARFID. Future longitudinal studies are needed to explore the role of ARFID in the development and management of higher weight.