Beyond Weight Gain in Family-Based Treatment for Avoidant/Restrictive Food Intake Disorder: A Response to Lock et al. (2026)
Abstract
Family-based treatment for avoidant/restrictive food intake disorder (FBT-ARFID) has recently been defended as addressing more than weight gain. This Commentary argues that therapeutic intent should be distinguished from demonstrated comparative benefit. In the primary randomized trial, FBT-ARFID showed its clearest advantage for weight restoration, while broader domains of ARFID symptomatology and psychological functioning did not consistently show between-group superiority. High treatment completion and absence of serious adverse events likewise cannot establish psychological, relational, sensory, or autonomy-related safety when these outcomes are not systematically assessed. These limitations are particularly consequential in ARFID, where sensory processing differences, fear of aversive consequences, low interest in eating, and neurodivergence may shape treatment needs and experiences. Future trials should incorporate direct child-reported outcomes, treatment burden, agency and participation, sensory distress, psychosocial functioning, adverse effects, reasons for discontinuation, and durability of change. If FBT-ARFID is to be understood as more than weight gain, its evaluation should be broader than weight gain too.
Related
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- Avoidant/Restrictive Food Intake Disorder in Children and Adolescents: Nutritional Risk, Diagnostic Boundaries, and Multidisciplinary Care—A Narrative Review
- Validation of the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) in a Flemish Sample of Community Adults
- When Food Avoidance Meets Compatible Diagnostic Criteria: Avoidant/Restrictive Food Intake Disorder Features in Irritable Bowel Syndrome
- Restrictive Eating Patterns and Eating Disorder Risk in Female Ballet Dancers: Exploratory Associations with Self-Reported Workplace Bullying and Possible Mobbing
BibTeX
@misc{cobbaert2026beyond,
title = {{Beyond Weight Gain in Family-Based Treatment for Avoidant/Restrictive Food Intake Disorder: A Response to Lock et al. (2026)}},
author = {Laurence Cobbaert},
howpublished = {PsyArXiv},
year = {2026},
month = oct,
doi = {10.31234/osf.io/ertjh_v1},
url = {https://osf.io/preprints/psyarxiv/ertjh_v1/},
note = {CC BY 4.0},
}
RIS
TY - UNPB
TI - Beyond Weight Gain in Family-Based Treatment for Avoidant/Restrictive Food Intake Disorder: A Response to Lock et al. (2026)
AU - Laurence Cobbaert
PY - 2026
DA - 2026/10/09
PB - PsyArXiv
DO - 10.31234/osf.io/ertjh_v1
UR - https://osf.io/preprints/psyarxiv/ertjh_v1/
AB - Family-based treatment for avoidant/restrictive food intake disorder (FBT-ARFID) has recently been defended as addressing more than weight gain. This Commentary argues that therapeutic intent should be distinguished from demonstrated comparative benefit. In the primary randomized trial, FBT-ARFID showed its clearest advantage for weight restoration, while broader domains of ARFID symptomatology and psychological functioning did not consistently show between-group superiority. High treatment completion and absence of serious adverse events likewise cannot establish psychological, relational, sensory, or autonomy-related safety when these outcomes are not systematically assessed. These limitations are particularly consequential in ARFID, where sensory processing differences, fear of aversive consequences, low interest in eating, and neurodivergence may shape treatment needs and experiences. Future trials should incorporate direct child-reported outcomes, treatment burden, agency and participation, sensory distress, psychosocial functioning, adverse effects, reasons for discontinuation, and durability of change. If FBT-ARFID is to be understood as more than weight gain, its evaluation should be broader than weight gain too.
ER -