A review of two new eating disorders

In a recent review published in NutrientsIn this study, researchers review existing data on two new eating disorders (EADs) including avoidant/restrictive food intake (ARFID) and atypical anorexia nervosa (AN).

Stady: Pitfalls and Risks of the ‘New Eating Disorders’: Let the Expert Talk! Image credit: Tero Vesalainen/Shutterstock.com


Cardiovascular diseases are characterized by impaired ability to digest or absorb food and have significant effects on mental and physical health. In the post-coronavirus 2019 (COVID-19) period, an increased incidence of EAD has been observed at younger ages, particularly of partial or indeterminate (NOS) types, with atypical clinical presentations among male and female children.

Many EAD patients have limited access to treatment. In fact, the majority of cases of EAD are undiagnosed and therefore untreated, leading to chronic disorders with long-term medical, social, and psychological implications. An improved understanding of EADs could subsequently enable early identification of these disorders and prompt treatment.

In the current review, the researchers provide evidence for the diagnosis and management of novel EADs such as ARFID and atypical AN for pediatric health professionals.

Atypical anorexia nervosa

Atypical anorexia nervosa is characterized by an altered body image without any significant weight loss or normal body weight. As a result, the diagnosis and treatment of atypical anorexia nervosa is often delayed. History of obesity and initiation of a weight-loss diet, along with improved self-image and positive reinforcement from families, are important clues for diagnosing the condition.

Atypical anorexia usually develops during adolescence, but it may also appear in younger individuals, especially those with comorbid psychiatric illnesses. The most common comorbidities include depression, obsessive-compulsive disorder (OCD), and suicidal ideation/self-harm.

Family therapy is considered a first-line treatment, after which psychopharmacological methods can be recommended. The studies reported no differences in physical appearance in the clinical presentation of atypical anorexia nervosa, except for decreased leukocyte counts.

Premature babies and children with craniofacial diseases or genetic syndromes are at increased risk of developing atypical anorexia nervosa.

Avoidance/restrictive eating disorder

Avoidant/restrictive eating disorders are characterized by altered eating or feeding habits with consequent unmet nutritional and energy requirements, as well as impaired growth and development. This condition is associated with significant weight loss, nutritional deficiencies, requirements for oral and parenteral supplementation, and psychosocial dysfunction.

The main clinical features of avoidant/specific food intake antagonists include food limitation due to apparent lack of interest in food, avoidance of food items due to their color, shape, or packaging, and food avoidance due to phobic symptoms, such as postchoking attacks.

Avoidant/restrictive eating disorders usually appear in early childhood and peak at two to six years of age. Prevalence estimates among school-age and older children range from 14% to 50% and 7% to 27%, respectively.

The most common symptoms include reduced portion size, avoidance of certain nutrients, early satiety history, and nausea. Avoidant/specific eating disorder patients typically have generalized anxiety, obsessive-compulsive disorder, or autism spectrum disorders.

Usually, but not always, ARFIDs are present with low body weight. This condition may also lead to an inability to self-feed, resulting in difficulties with weight gain and delayed growth.

The most effective management approaches include family-based therapies, cognitive behavioral therapy, and food chaining. Psychiatric treatments such as selective serotonin reuptake inhibitors (SSRIs) have also been used with limited success.

Nutritional interventions, involving initially increasing the intake of the child’s preferred food, followed by oral nutritional supplementation (ONS), can restore nutritional deficiencies. In unresponsive cases, patients should be referred to artificial feeding care centers to provide combined enteral and parenteral nutrition to the child under the care of a neuropsychiatrist and a pediatrician.


EADs can significantly hinder children’s growth and development; Therefore, these cases must be identified and treated as soon as possible. Warning signs of cardiovascular disease include consumption of only a particular food by a child, most calories eaten come from liquids, a child is easily distracted during meals, a child eats food items hidden in other foods, and meals that last more than 30 minutes. .

Excessive concerns about body shape and weight, decreased total food consumption or intake of specific nutrients, verbal fears of weight gain, compulsive exercise with increased anxiety of not being able to accomplish tasks, and feelings of shame/guilt during meals may also indicate the possibility of EAD.

NSAIDs and atypical anorexia nervosa can present with malignant onset during early childhood. As a result, these conditions may go undiagnosed and lead to severe malnutrition and psychosocial disorders over time, in addition to psychiatric illnesses that may require multidisciplinary treatment. Management may include pediatricians, gastroenterologists, nutritionists, neuropsychologists, and speech therapists.

Differential diagnoses include gastroesophageal reflux disease, food allergies, swallowing difficulties, and malabsorption-related disorders such as cystic fibrosis, celiac disease, and inflammatory bowel disease (IBD). Regular check-ups should include taking a detailed nutritional history and checking for feeding difficulties, low body weight, poor growth and development, and psychosocial abnormalities, including clinical evaluations for feeding disorders such as scurvy and beriberi.

Educating parents and children to raise awareness of the Environment Agency – Abu Dhabi is also crucial in the effective management of these cases.

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