Insurance claim lines tied to avoidant/restrictive food intake disorder, or ARFID, rose 305% as a share of all US medical claim lines between 2018 and 2022, according to a FAIR Health analysis reported by Yahoo News on 18 October 2026. The figure signals a sharp rise in clinical attention to an eating disorder that has nothing to do with body image and everything to do with fear, sensory sensitivity, or simple disinterest in food.
For Singapore and the wider ASEAN region, where healthcare systems are upgrading mental health capacity and insurers are pricing in behavioural health risk, the data point deserves a closer look. Eating disorder infrastructure in the region remains thin relative to demand, and ARFID is the kind of condition that slips through paediatric screens when clinicians are trained only to look for anorexia.
What is ARFID and why does the 305% figure need context?
ARFID was added to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) in 2013, the standard classification reference of the American Psychiatric Association. Its diagnosis code only entered billing systems in 2017, which means the recent statistical surge started from a smaller base than that of better-known eating disorders.
The FAIR Health metric also measures claim lines, meaning individual services or procedures billed to insurers, not the number of patients. Growing awareness among both patients and providers likely explains much of the increase.
“It makes sense that a recent increase in awareness, both in patients and providers, likely has an influence on increased diagnoses,” said Jen Carter, PhD, an associate professor in the Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center.
How ARFID differs from anorexia and ordinary picky eating
“ARFID is a diagnosis that involves restricted eating without concerns for shape or weight,” explained Chrissy Cammarata, PhD, a psychologist at Brandywine Psychology who treats ARFID patients. That distinction separates it from anorexia nervosa, where restriction is tied to fear of weight gain.
“In ARFID, people often want to eat more,” said P. Evelyna Kambanis, PhD, a clinical psychologist at the Eating Disorders Clinical and Research Program at Massachusetts General Hospital. The condition affects both children and adults but tends to present in younger patients.
Any parent in the region knows the makan standoff: the child who refuses anything beyond white rice and fish crackers. Picky eating, what Singaporeans might call a “choosy eater” or what Filipino families label as pihikan, is developmentally normal. The clinical threshold is impact.
“If there is a nutritional deficiency, weight restriction or failure to grow, or conversely high weight due to limited diet, this may indicate ARFID,” Cammarata said. Social impairment counts too. “They're unable to eat with friends or go out to eat at a restaurant,” Kambanis said. “They may have to eat differently from the rest of their family.”
Why do people with ARFID avoid food?
Three drivers dominate: fear, sensory sensitivity, and low interest. “One of the main reasons someone with ARFID lands in my clinic is because these kids fear the negative consequences of eating, gagging or choking,” said Jessica Bodie, PhD, director of child services at the Center for the Treatment and Study of Anxiety in the Perelman School of Medicine at the University of Pennsylvania. “Some may also have a fear that they won't like a food.”
Some patients have never found food appealing and treat it as a chore. “They think of food as something they have to ingest multiple times a day,” Bodie explained. Digestive symptoms or health complications can also strip the pleasure out of eating early in life, she added.
Warning signs that warrant a clinical conversation
According to the Yahoo News report, patterns that merit discussion with a clinician include:
- Avoiding entire food groups, or foods with certain textures, tastes, or smells
- Gagging or retching in response to specific foods
- An extremely limited diet, or missing meals completely
- Avoiding social food settings such as hawker centres or family gatherings
- Weight loss, stalled growth, or nutritional deficiency
- Reliance on supplements, or anxieties that restrict intake
None of these signs establishes a diagnosis on its own. A clinician needs to assess the pattern, its effects, and other explanations, including gastrointestinal conditions where the restriction may be medically warranted.
“If parents are finding it difficult to feed their child, that alone is enough,” Bodie said. She recommends seeking help when someone avoids an entire food category without an allergy or other medical reason. Kambanis calls the primary care doctor or paediatrician a “good first step,” and advises requesting a referral to an eating disorder specialist if concerns are dismissed.
What treatment involves, and how long it takes
The frontline treatment is cognitive behavioural therapy (CBT), which helps patients identify the thoughts and behaviours damaging their health while lowering anxiety around food. Patients work through graded sensory and food challenges to widen their diet.
For children, parents are part of the protocol. Bodie uses structured, clinician-guided rewards, and she is candid about the mechanics: “Picky eaters can be very stubborn. But if you get a kid 'hungry' enough for screen time, five days in, they'll say, 'Fine, just give me the mac and cheese.'”
Medication may be prescribed for co-occurring conditions, though the Cleveland Clinic notes evidence for drug use specifically in ARFID remains limited. Severe cases can require medical stabilization, feeding tubes, or higher levels of care such as residential or intensive outpatient programs.
Duration varies. “It can range anywhere from 15 sessions for someone who is not underweight to 30 sessions for someone who is underweight,” Kambanis said. The goal is functional, not gastronomic. “We don't expect anyone to go on to become a foodie, but we want them to experience less anxiety and stress around meals,” she said.
“The bravery will increase, but it takes weeks and months, not days,” Bodie added.
Why this matters for ASEAN health systems
The US data offers a preview of a demand curve that regional health systems have not yet mapped. Singapore's push toward integrated mental health services, and similar capacity building under ASEAN health cooperation frameworks, will eventually have to account for diagnoses like ARFID, which standard anorexia-focused screening misses entirely.
Early detection is also cheaper. Fifteen sessions of CBT cost a fraction of the hospitalization that severe cases can require, a trade-off insurers and policymakers in the region, much as with other conditions where delayed diagnosis drives cost, will recognize from data patterns like those behind