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\"Calories--too few or too many--are the source of health problems affecting billions of people in today's globalized world. Although calories are essential to human health and survival, they cannot be seen, smelled, or tasted. They are also hard to understand. In Why Calories Count, Marion Nestle and Malden Nesheim explain in clear and accessible language what calories are and how they work, both biologically and politically. As they take readers through the issues that are fundamental to our understanding of diet and food, weight gain, loss, and obesity, Nestle and Nesheim sort through a great deal of the misinformation put forth by food manufacturers and diet program promoters. They elucidate the political stakes and show how federal and corporate policies have come together to create an \"eat more\" environment. Finally, having armed readers with the necessary information to interpret food labels, evaluate diet claims, and understand evidence as presented in popular media, the authors offer some candid advice: Get organized. Eat less. Eat better. Move more. Get political\"--Provided by publisher.

differentiates avoidant/restrictive food intake disorder (ARFID) from other eating disorders (EDs) by a lack of overvaluation of body weight/shape driving restrictive eating. However, clinical observations and research demonstrate ARFID and shape/weight motivations sometimes co-occur. To inform classification, we: (1) derived profiles underlying restriction motivation and examined their validity and (2) described diagnostic characterizations of individuals in each profile to explore whether findings support current diagnostic schemes. We expected, consistent with , that profiles would comprise individuals endorsing solely ARFID or restraint (i.e. trying to eat less to control shape/weight) motivations. We applied latent profile analysis to 202 treatment-seeking individuals (ages 10-79 years [ = 26, s.d. = 14], 76% female) with ARFID or a non-ARFID ED, using the Nine-Item ARFID Screen (Picky, Appetite, and Fear subscales) and the Eating Disorder Examination-Questionnaire Restraint subscale as indicators. A 5-profile solution emerged: Restraint/ARFID-Mixed ( = 24; 8% [ = 2] with ARFID diagnosis); ARFID-2 (with Picky/Appetite; = 56; 82% ARFID); ARFID-3 (with Picky/Appetite/Fear; = 40; 68% ARFID); Restraint ( = 45; 11% ARFID); and Non-Endorsers ( = 37; 2% ARFID). Two profiles comprised individuals endorsing solely ARFID motivations (ARFID-2, ARFID-3) and one comprising solely restraint motivations (Restraint), consistent with . However, Restraint/ARFID-Mixed (92% non-ARFID ED diagnoses, comprising 18% of those with non-ARFID ED diagnoses in the full sample) endorsed ARFID restraint motivations. The heterogeneous profiles identified suggest ARFID and restraint motivations for dietary restriction may overlap somewhat and that individuals with non-ARFID EDs can also endorse high ARFID symptoms. Future research should clarify diagnostic boundaries between ARFID and non-ARFID EDs.

ObjectiveTo compare the clinical presentations, management and outcomes of avoidant/restrictive food intake disorder (ARFID) across paediatric and child and adolescent (C&A) psychiatric settings.Study designProspective surveillance study.MethodsData were collected during a 13-month prospective surveillance study of children and adolescents with ARFID in the UK and Republic of Ireland. Paediatricians reported cases via the British Paediatric Surveillance Unit and psychiatrists through the Child and Adolescent Psychiatry Surveillance System. A follow-up questionnaire was sent at 12 months after a case of ARFID was reported.Results319 cases were included, 189 from paediatricians and 130 from C&A psychiatrists. Patients presenting to paediatricians were younger (9.8 years vs 13.7 years), more often male (62.4% vs 43.1%), and had more chronic symptoms (80.4% vs 67.0%), selective eating (63.7% vs 46.6%) and comorbid autism (67.6% vs 50.0%) than to psychiatrists. Psychiatrists saw patients with more fear of aversive consequences from eating (13.1% vs 3.2%), weight loss (76.7% vs 65.0%) and comorbid anxiety (78.2% vs 47.4%). Patients presenting to paediatricians more often received medical monitoring (74.6% vs 53.1%), dietetic advice (83.1% vs 70.0%) and nutritional supplements (49.2% vs 30.0%). At follow-up, both cohorts improved in nutritional status. However, the psychiatric cohort improved more regarding disordered eating behaviours.ConclusionsThe presentation and management of ARFID differs across clinical settings. Findings suggest the need to develop clinical pathways for ARFID assessment and management across paediatrics and mental health. Our findings highlight the potential benefits of psychiatric input for some patients with ARFID.

Celiac disease (CeD) is an autoimmune disorder where adherence to a lifelong gluten-free diet (GFD) is the only available treatment. While this approach is rather effective, some patients experience ongoing symptoms, and this factor, along with the rigidity of the GFD, may predispose some to disordered eating behaviors, including Avoidant/Restrictive Food Intake Disorder (ARFID). ARFID is characterized by persistent food avoidance that is not driven by body image concerns, resulting in nutritional, psychological, and social impairment. This scoping literature review explores the emerging intersection between ARFID and CeD, examining prevalence, pathophysiology, clinical features, complications, and management strategies. Recent studies report that 14–57% of individuals with CeD may meet the criteria for ARFID, depending on the population and screening tools used. Factors contributing to ARFID in CeD may include ongoing gastrointestinal symptoms, anxiety over gluten exposure, negative conditioned responses to food, social challenges related to GFD adherence, and psychiatric co-morbidities. ARFID in CeD is associated with worsened nutritional deficiencies, anxiety, depression, and impaired social functioning, making the diagnosis of ARFID challenging due to symptom overlap with CeD and other psychiatric conditions. Management requires a multidisciplinary approach, including medical, nutritional, and psychological interventions. Routine screening, early intervention, and integrated care models may improve outcomes and quality of life.

Background Restrictive eating behaviors are common among patients with inflammatory bowel disease (IBD), which may may develop nutritional and/or quality of life impairments into avoidant/restrictive food intake disorder (ARFID). The objective of this study is to estimate the prevalence and characteristics of ARFID in Chinese patients with IBD, and to investigate the current perceptions and dietary behaviors of patients with and without ARFID. Methods A cross-sectional study was conducted in gastroenterology clinics of four tertiary hospitals in China. Patients with IBD were asked to complete a structured questionnaire including demographic characteristics, dietary attitudes and behaviors. The diagnosis of ARFID was established using Chinese version of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen questionnaire. Results A total of 483 patients with IBD completed the questionnaires, and 20.3% met clinical criteria for ARFID. The average score of ARFID was 21.9 (interquartile range = 17.0–26.0). Multivariable binary logistic regression results showed that patients with Crohn’s disease (OR = 0.483, 95%CI = 0.280–0.835; p  = 0.009), being in an active disease state (OR = 0.220, 95%CI = 0.123–0.392; p  < 0.001), holding dietary attitudes regarding symptom control (OR = 2.431, 95%CI = 1.299–4.548; p  = 0.005), and reporting a specific dietary history (OR = 27.158, 95%CI = 3.679-200.456; p  = 0.001) were significant more likely to suffer from ARFID. Conclusions ARFID is a common problem among patients with IBD. The incidence of ARFID is particularly high among patients with Crohn’s disease, during relapse, and those who hold restrictive dietary attitudes or have a history of specific diets. Therefore, it is imperative to prioritize routine screening and early identification of ARFID, especially among high-risk populations, in future research and clinical practice. Trial registration ChiCTR2100051539, on 26 September 2021. Plain English Summary Restrictive eating behaviors are common among patients with inflammatory bowel disease (IBD), which may may develop nutritional and/or quality of life impairments into avoidant/restrictive food intake disorder (ARFID). This study aimed to estimate the prevalence and characteristics of ARFID in Chinese patients with IBD, and to investigate the current attitudes and dietary behaviors of patients with and without ARFID. Participants comprised 483 patients with IBD from gastroenterology clinics of four tertiary hospitals in China. Participants completed a comprehensive questionnaire that encompassed demographic characteristics, dietary attitudes, and behaviors. Following screening with the Chinese version of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen questionnaire, it was found that 20.3% of participants met the clinical criteria for ARFID. The findings suggest that individuals with IBDmay exhibit a heightened vulnerability to ARFID. Moreover, the likelihood of ARFID was found to be significantly associated with four factors among patients with IBD, namely having Crohn’s disease, being in an active disease state, holding attitudes towards symptom management, and reporting a specific dietary history. Therefore, it is imperative to prioritize routine screening and early identification of ARFID, especially among high-risk populations, in future research and clinical practice.

Abstract Background and Aims Disordered eating is frequently reported in patients with inflammatory bowel disease (IBD). We aimed to describe the prevalence of avoidant restrictive food intake disorder (ARFID) in patients with IBD and to identify predictors of ARFID. Methods Patients with IBD at 2 academic medical centers completed questionnaires including the ARFID subscale of the Pica, ARFID, and Rumination Disorder Questionnaire (PARDI-AR-Q), disease characteristics, and psychosocial variables. IBD disease activity was determined by a review of objective data within 90 days of survey completion. Results Three hundred and twenty-five participants completed the questionnaires (56% female, average age 47.60 years, 49.5% Crohn’s disease (CD), 45.5% ulcerative colitis (UC)). Using the PARDI-AR-Q, 17.8% of the total sample screened positive for ARFID. ARFID+ respondents were younger, had shorter disease duration, and worse psychosocial functioning compared to ARFID-. A higher percentage of ARFID+ patients had objective disease activity compared to ARFID- (51% vs. 40%), but this was not statistically significant. There was no statistical difference in ARFID rates between patients with CD compared to UC. In patients with inactive disease only, 16.3% screened positive for ARFID. In hierarchical logistic regression, the only significant predictor of ARFID among patients with inactive IBD was GI-specific anxiety. Conclusions In this multi-center study, 16.3% of patients with inactive IBD met the criteria for ARFID, and 17.8% of all patients met the criteria regardless of objective disease activity. GI-specific anxiety was the only predictor of ARFID among patients with inactive IBD, highlighting the need for multidisciplinary care in IBD. Lay Summary Higher rates of ARFID are reported in IBD, but prior studies have not utilized DSM-5 criteria. In a multi-site study, 17.8% of all patients with IBD (n = 325) and 16.3% of patients with no objective disease activity met ARFID criteria using DSM-5 criteria.

A main challenge in nutritional studies is the valid and reliable assessment of food intake, as well as its effects on the body. Generally, food intake measurement is based on self-reported dietary intake questionnaires, which have inherent limitations. They can be overcome by the use of biomarkers, capable of objectively assessing food consumption without the bias of self-reported dietary assessment. Another major goal is to determine the biological effects of foods and their impact on health. Systems analysis of dynamic responses may help to identify biomarkers indicative of intake and effects on the body at the same time, possibly in relation to individuals’ health/disease states. Such biomarkers could be used to quantify intake and validate intake questionnaires, analyse physiological or pathological responses to certain food components or diets, identify persons with specific dietary deficiency, provide information on inter-individual variations or help to formulate personalized dietary recommendations to achieve optimal health for particular phenotypes, currently referred as “precision nutrition.” In this regard, holistic approaches using global analysis methods (omics approaches), capable of gathering high amounts of data, appear to be very useful to identify new biomarkers and to enhance our understanding of the role of food in health and disease.

Avoidant/restrictive food intake disorder (ARFID) is characterized in part by limited dietary variety, but dietary characteristics of this disorder have not yet been systematically studied. Our objective was to examine dietary intake defined by diet variety, macronutrient intake, and micronutrient intake in children and adolescents with full or subthreshold ARFID in comparison to healthy controls. We collected and analyzed four-day food record data for 52 participants with full or subthreshold ARFID, and 52 healthy controls, aged 9–22 years. We examined frequency of commonly reported foods by logistic regression and intake by food groups, macronutrients, and micronutrients between groups with repeated-measures ANOVA. Participants with full or subthreshold ARFID did not report any fruit or vegetable category in their top five most commonly reported food categories, whereas these food groups occupied three of the top five groups for healthy controls. Vegetable and protein intake were significantly lower in full or subthreshold ARFID compared to healthy controls. Intakes of added sugars and total carbohydrates were significantly higher in full or subthreshold ARFID compared to healthy controls. Individuals with full or subthreshold ARFID had lower intake of vitamins K and B12, consistent with limited vegetable and protein intake compared to healthy controls. Our results support the need for diet diversification as part of therapeutic interventions for ARFID to reduce risk for nutrient insufficiencies and related complications.

Avoidant/Restrictive Food Intake Disorder (ARFID) is an underdiagnosed eating disorder consisting of food avoidance that is not related to body image concerns. New evidence suggests that individuals identified as having ARFID experience elevated suicidal ideations. This association could be mediated by alexithymia, described as having difficulty in recognizing or verbalizing emotions. Therefore, this study aimed to determine whether alexithymia mediates the link between ARFID symptoms and suicidal ideation among Lebanese adults. Between September and December 2024, a cross-sectional study was conducted using snowball sampling technique. 396 Lebanese adults (mean age = 26.26) took an online Arabic survey. 40.7% of the participants had thoughts of suicide. Younger age, being unmarried, less physical activity, higher ARFID scores, and increased alexithymia were significantly associated with suicidal ideation. Alexithymia fully mediated the link between ARFID symptoms and suicidal ideation (indirect effect: Beta = 0.02; Boot SE = 0.01; Boot 95% CI 0.01, 0.04). There was a strong correlation between higher avoidant/restrictive food intake disorder and higher alexithymia. There was also a significant association between higher alexithymia and the presence of suicidal ideation. Finally, there was no association between avoidant/restrictive food intake disorder and suicidal ideation. Our findings support alexithymia as a fundamental psychological process linking ARFID symptoms and suicidal ideation. Given the sociocultural stigma and limited mental health resources in Lebanon, clinicians should consider screening for alexithymia among individuals with eating disorders and suicidal thinking. Interventions that focus on emotions could therefore be used to reduce suicide risk in this vulnerable population.

Avoidant/restrictive food intake disorder (ARFID) leads to faltering growth and psychosocial impairment. Three phenotypes can co-occur: fear of aversive consequences of eating ( phenotype), sensory sensitivity, and lack of interest in eating/food. We hypothesized that youth with ARFID, especially phenotype, would show hyperactivation of fear-related regions in response to ARFID-specific fear images, compared to healthy controls (HC), and activation of these regions would positively correlate with ARFID fear severity. Youth (N=103: 76 ARFID, including 20 phenotype; 27 HC) underwent functional MRI scanning while viewing ARFID-specific fear (e.g. vomiting, choking) versus neutral images. We compared blood-oxygen-level-dependent (BOLD) response in fear-related region of interests (ROI; e.g. amygdala, hippocampus, insula) between ARFID and phenotype versus HC. We evaluated the association between brain response and ARFID fear severity in phenotype. Across individuals, there was a robust bilateral amygdala response to ARFID-specific fear versus neutral images. Compared to HC, phenotype showed a greater insula response to ARFID-specific fear versus neutral images (p=0.049). There were no other group differences and no significant relationships between BOLD response and ARFID fear severity in phenotype. ARFID-specific fear images elicit amygdala responses across individuals, with greater activation in the insula only in phenotype versus HC. These findings validate the ARFID-specific fear paradigm and highlight the intriguing possibility that, in the phenotype, universally feared experiences such as choking and vomiting serve as the unconditioned stimulus in developing ARFID and may partially be mediated by the insular cortex.