Why Weight Restoration Comes First in ARFID Treatment
When a child is struggling with Avoidant/Restrictive Food Intake Disorder (ARFID), many parents focus first on the variety of foods. After all, ARFID often shows up as extreme pickiness, fears of choking or vomiting, or strong sensory sensitivities that make meals stressful. It makes sense to want your child to eat a broader diet.
But here’s what the research — and years of clinical experience — tells us: before working on variety, the first step is weight restoration and nutritional adequacy.
Why nutrition comes first
ARFID can cause children to fall short on calories, growth, or essential nutrients. Even modest undernutrition in a growing child can have real consequences, including:
slowed growth and delayed puberty
fatigue and low energy
increased anxiety and irritability
rigid thinking that makes it harder to try new foods
When the brain and body are under-fueled, kids are simply less able to do the hard work of therapy. Adequate nutrition helps restore flexibility, reduces anxiety, and supports the focus and resilience needed to explore new foods (Bryant-Waugh et al., 2019; Katzman et al., 2021).
Building the foundation for lasting change
Think of it like building a house. If the foundation isn’t solid, the rest won’t hold. Weight restoration is that foundation. Once the body is nourished and growth is back on track, therapy for ARFID — whether that means gradual exposure to new foods, anxiety management, or sensory work — is far more effective (Thomas et al., 2017; Eddy et al., 2019).
How treatment works in phases
Family-Based Treatment (FBT) and other evidence-based approaches often emphasize this two-step process:
Phase one: restore nutrition and weight. Parents temporarily prioritize calories and consistency over variety. That might mean relying heavily on familiar “safe” foods — but in higher volumes or fortified versions (e.g., adding cheese, nut butter, oils, or shakes). The goal is to get enough energy in to support health and growth.
Phase two: expand variety and flexibility. Once weight and nutrition are stable, therapy can focus on systematic exposures, sensory integration, and reducing fear or avoidance (Lock et al., 2019; Thomas & Eddy, 2019).
What the guidelines say
This isn’t just clinical opinion — it’s backed by guidelines across the field:
The American Psychiatric Association (2023) emphasizes nutritional rehabilitation as the first target in restrictive eating disorder treatment.
The Society for Adolescent Health and Medicine highlights restoring growth and pubertal development as urgent priorities in young patients (Golden et al., 2015).
Research on CBT-AR (Cognitive-Behavioral Therapy for ARFID) confirms that adequate nutrition is essential before food exposures can succeed (Thomas et al., 2017).
What parents can do
Partner with your treatment team to establish target weight and growth goals.
Focus first on getting enough energy in — variety can come later.
Use energy-dense foods and drinks your child already accepts.
Remember: you’re not “giving in” by relying on safe foods. You’re laying the groundwork for real recovery.
Weight matters
Weight restoration isn’t just a medical box to check. It’s what allows the brain and body to be flexible, resilient, and open to change. With nutrition in place, kids with ARFID are better able to explore new foods, manage anxiety, and move toward balanced eating for life.
References
American Psychiatric Association. (2023). Practice Guideline for the Treatment of Patients with Eating Disorders.
Bryant-Waugh, R., Micali, N., Cooke, L., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2019). Towards an evidence-based classification of ARFID. International Journal of Eating Disorders, 52(4), 439–446.
Eddy, K. T., Harshman, S. G., Becker, K. R., et al. (2019). Avoidant/Restrictive Food Intake Disorder: A three-dimensional model of neurobiology with implications for etiology and treatment. Current Psychiatry Reports, 21(8), 68.
Fisher, M. M., Rosen, D. S., Ornstein, R. M., et al. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: A “new disorder” in DSM-5. Journal of Adolescent Health, 55(1), 49–52.
Golden, N. H., Katzman, D. K., Sawyer, S. M., et al. (2015). Update on the medical management of eating disorders in adolescents. Journal of Adolescent Health, 56(4), 370–375.
Katzman, D. K., Peebles, R., Sawyer, S. M., Lock, J. (2021). The role of nutrition in the treatment of eating disorders. Journal of Adolescent Health, 68(4), 646–651.
Lock, J., Sadeh-Sharvit, S., & L’Insalata, A. (2019). Feasibility of conducting parent-only family-based treatment for ARFID. International Journal of Eating Disorders, 52(4), 428–437.
Thomas, J. J., & Eddy, K. T. (2019). Cognitive-Behavioral Treatment of Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults. Cambridge University Press.
Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/Restrictive Food Intake Disorder: A three-dimensional model of neurobiology with implications for etiology and treatment. Current Psychiatry Reports, 19(8), 54.
