Food avoidance, especially avoiding high-calorie foods, was associated with severity of AN, shown by EAT-26 scores, and with mood and anxiety scores. Those who developed AN at a younger age were more likely to have continuing food avoidance
One helpful observation among the researchers and the treatment team was that by restricting food, patients might include some higher-fat foods in their diets, but they also can restrict the amounts of these foods without reducing the appearance of dietary diversity. This was a true challenge for nutritionists and dietitians on the treatment team; in addition, little has been published about this behavior. Among the patients who reintroduced at least one high-fat food into their diets, EAT-26 scores were lower at baseline and improved during treatment. This confirmed that food avoidance is related to the severity of AN. A younger age at onset of AN was associated with stronger maintenance of food avoidance.
Avoiding calorie-rich foods is a well-known strategy used by AN patients to alleviate their anxiety; however, this can also have an important negative effect. Avoiding calorie-rich foods contributes to anxiety because of reduced dietary intake of micronutrients such as folate and selenium. Both affect neuronal function and have been linked to depression and anxiety (Nutrients. 2019.11:E792). According to the authors, the correlation between AN severity, nutritional status, and anxiety and depression underlies the concept that AN is a metabolic-psychiatric disorder (Nat Genet. 2019. 51:1207).
Dr. Lodovico and coauthors concluded that food avoidance could be an informative indicator of the severity of AN. There is a clear need for further study.