Dietetic-led cognitive behavioral therapy for ARFID: a novel approach to avoidant/restrictive food intake disorder with case studies

Background: Cognitive-behavioral therapy for avoidant/restrictive food intake disorder (CBT-AR) is an emerging treatment for adults with avoidant/restrictive food intake disorder (ARFID). This article explores how CBT-AR can be integrated with and enhanced by the dietetics skillset and presents two case studies in which a dietitian primarily provided treatment within a multidisciplinary team. Methods: The dietetic-led CBT-AR treatment journeys are described for two patients. We utilised dietetic and psychological assessments to measure change, including: nutrient pathology; weight; Pica, ARFID and Rumination Disorder Interview scores; Australian Core Food Score; and Structured Assessment of Gastrointestinal Symptoms. We describe the stages of CBT-AR with examples of how a dietitian's skillset might be utilised within this treatment approach. Results: Both patients demonstrated significant improvements in ARFID psychopathology and dietetic measures after completing dietitian-led CBT-AR. These findings provide preliminary evidence that dietitians with specialised expertise in eating disorders could effectively deliver CBT-AR as part of a multidisciplinary team. Conclusions: These case studies highlight the potential for dietitians to act as primary clinicians in delivering CBT-AR and provide preliminary evidence on how their skillset could lead to clinically meaningful improvements for adults living with ARFID. Future research trials are required to confirm that dietitian-led CBT-AR could be a viable treatment option for ARFID.