UCL Great Ormond Street Institute of Child Health


Great Ormond Street Institute of Child Health


Physical complications in children and young people with Avoidant Restrictive Food Intake Disorder

Supervisors: Dr Nadia Micali, Dr Lee Hudson

Physical complications in children and young people with Avoidant Restrictive Food Intake Disorder (ARFID)

ARFID is a type of eating disorder resulting in an child or young person’s energy and nutritional needs failing to be met.1 As a mental health condition, ARFID is a key example of where physical health and mental health must be integrated. Effects on growth, pubertal development and bone density are seen in children with ARFID, with potential long-term effects.2 In contrast to Anorexia Nervosa, there is a paucity of research on the topic.3 Understanding these and relevant risk factors will help clinicians and parents (and CYP) understand complications better, which can be used to improve clinical pathways. This will have international relevance and impact.

1) To study medical correlates including growth patterns, pubertal development and bone mineral density (BMD) in children and young people with ARFID referred to a feeding and eating disorder service.
2) To identify potential risk factors for the deleterious effects of ARFID on growth patterns, pubertal development and BMDin children and young people with ARFID.

Children and young people will be recruited at Great Ormond Street Hospital’s feeding and eating disorder service which receives referrals from across the UK. At baseline, CYP will be assessed for evidence of medical instability (using established risk assessment for AN) and growth, puberty and BMD compared to population normative data. Associations will be sought between duration of symptoms and psychological measures of severity. Patients will then be followed up to two years at repeated time points to assess: i) growth trajectories ii) pubertal development change iii) bone mineral density. The effects of psychological change and weight restoration upon the above parameters will be studied. The majority of clinical parameters used will be those used for clinical care, which will improve ethical conduct of the study. Normative (z-scorable) data for growth, puberty and BMD will be used as comparators for change. The effect of biological sex will also be investigated. There will be consideration of a sub-study of patient and carer perceptions on the effects of growth and BMD using qualitative methodology. Opportunities for learning in the PhD include: 1) directing a clinical research study (including recruitment), 2) data collection and a range of statistical analyses (including cross-sectional and longitudinal techniques with support from the biostatistics colleagues within the department) 3) working alongside a range of expert clinicians, researchers within the clinical and research departments. It is expected that there will be a range of potential publications from a PhD in this project, and as an emerging field would put a PhD graduate in a good position to develop a further research career in this area. This PhD project would be suitable for a range of students from different health backgrounds including psychology, nutrition, paediatrics or psychiatry. The project would be valuable for a student who wished to ultimately follow both clinical or research careers pathways. Referrals to the department have increased since COVID started, and there is not expected to be an issue with data collection, however retrospective data is available. Sample size would be >50 patients per year.

1.  Mammel KA, Ornstein RM. (2017). Avoidant/restrictive food intake disorder: a new eating disorder diagnosis in the diagnostic and statistical manual 5. Curr Opin Pediatr. 29(4): p. 407-413.
2.  Hudson, L. D., & Chapman, S. (2020). Paediatric medical care for children and young people with eating disorders: Achievements and where to next. Clin Child Psychol Psychiatry, 1359104520931573. doi:10.1177/1359104520931573.
3.  Alberts, Z., Fewtrell, M., Nicholls, D. E., Biassoni, L., Easty, M., & Hudson, L. D. (2020). Bone mineral density in Anorexia Nervosa versus Avoidant Restrictive Food Intake Disorder. Bone, 115307. doi:10.1016/j.bone.2020.115307.