Improving Gastroenterologists’ Awareness of Eating Disorders

Vol. 30 / No. 5 — Eating Disorders Review

Red flags include progressive food restriction and fear of food.

In a recent interview, gastroenterologist Kimberly N. Harer, MD, ScM, from the University of Michigan, Ann Arbor,  noted that disordered eating or an eating disorder can complicate the clinical picture of a patient with irritable bowel syndrome (IBS) and other gastrointestinal (GI) conditions (Gasteroenterol Hepatol[NY]. 2019; 15:280). She added that it is important to be aware when disordered eating habits shift from being a reasonable response to an underlying GI condition to pathologic behaviors that cause physical or psychosocial impairment.

Avoidant/restrictive food intake disorder (ARFID) is a good example, according to Dr. Harer.  Most of the research on ARFID, a condition first included in the DSM-5in 2013, has been done in pediatric and adolescent populations, and there is limited information about the role of ARFID among adult populations.  Dr. Harer and her colleagues conducted the largest study to date of the prevalence of ARFID among adult GI patients (Am J Gasterol. 2018; 113:S247). They found that 19% of patients from their adult outpatient GI clinic screened positive for ARFID. Furthermore, IBS patients were twice as likely as non-IBS patients to screen positive for ARFID.

According to Dr. Harer and colleagues, a helpful tool for screening for ARFID among adults with GI complaints is the 9-item ARFID screening questionnaire; this should, however, be only one part of the workup, according to the researchers.  Red flags include severe food restriction or lack of reintroduction of foods, fear of foods, weight loss, dependence on nutritional supplements or tube feeding, or differences between the clinical diagnosis and the degree of dietary restriction.  Clinicians treating patients for GI disorders should be aware that eating disorders and GI disorders occur concomitantly. Additional red flags include progressive food restriction in an already restrictive diet, body dysmorphia, or lack of concern about a severely restrictive diet or weight loss.