When most people think of eating disorders, they imagine conditions tied to extreme thinness or weight loss, such as anorexia nervosa.
But a growing body of research shows that eating disorders can take many different forms—and they don’t always fit the stereotype.
One disorder in particular, avoidant/restrictive food intake disorder (ARFID), challenges long-held assumptions about who is affected.
ARFID is a condition in which people severely limit the types or amounts of food they eat. Unlike other eating disorders, it is not motivated by a desire to lose weight or change body shape.
Instead, the condition often stems from strong negative reactions to food, such as anxiety about choking, disgust over taste or texture, or a general lack of interest in eating.
These behaviors can lead to serious health problems, including malnutrition, low energy, and psychological distress.
Traditionally, ARFID has been studied in children and in individuals who are underweight.
However, new findings from the University of Leipzig Medical Center in Germany show that adults with higher body weight can also suffer from the disorder—though their symptoms may look different.
The study, published in the journal Psychotherapy and Psychosomatics, is helping broaden understanding of the condition.
The research team, led by Dr. Ricarda Schmidt and Professor Anja Hilbert, surveyed 369 adults, with some participants also completing clinical interviews.
They found that about one-third of adults with ARFID—34%—had higher body weight. This finding challenges the common assumption that ARFID is mainly a disorder of underweight individuals.
Interestingly, the study revealed key differences between participants with higher body weight and those with lower body weight.
Those with higher weight were more likely to show selective eating patterns, meaning they avoided a wide variety of foods. They also reported more difficulties in daily life and a greater risk of developing metabolic conditions such as diabetes or high blood pressure.
Perhaps most striking, every single participant with higher body weight said they experienced psychosocial impairments, such as difficulties in relationships or social situations, compared with 65% of those with lower body weight.
Another important insight was that many higher-weight participants also expressed concerns about their body shape and weight. These concerns are often misinterpreted in clinical settings as signs of other eating disorders or simply dismissed as dieting behavior.
As Dr. Schmidt explains, this misunderstanding means ARFID frequently goes undiagnosed in people who don’t match the traditional profile. Without proper recognition, individuals may not receive the treatment they urgently need.
To close this gap, the researchers argue that diagnostic tools for ARFID must be revised to work across all body types, not just those who are underweight. Health professionals also need better training to recognize the disorder in its different forms.
Treatment plans—whether based on therapy, medication, or both—should be adapted to address the unique challenges faced by higher-weight individuals with ARFID.
“By showing that ARFID affects people across the weight spectrum, we are broadening the understanding of this disorder and highlighting a group that has been largely overlooked,” said Dr. Schmidt. The University of Leipzig Medical Center team is now conducting follow-up studies to explore the causes of ARFID in greater depth and to test new approaches for treatment.
This research marks an important step forward. It reminds us that eating disorders do not always fit neat categories—and that recognizing their many faces is key to helping those affected find relief and recovery.
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