A comparison of food‐based decision‐making between restricting and binge‐eating/purging subtypes of anorexia nervosa

Abstract

Objective: By definition, restricting (ANR) and binge-eating/purging (ANBP) subtypes of anorexia nervosa (AN) differ in some manifestations of maladaptive eating behavior. This study aimed to determine whether the groups differ in the choices they make about what to eat, and whether there are differences in valuation related to food choice, using an experimental paradigm. Method: Inpatients with ANR (n = 40) and ANBP (n = 46) participated in a Food Choice Task. During the task, participants rated 76 food images for healthiness and tastiness, and choice preferences. Groups were compared in percent selection of high-fat and low-fat foods, value ratings of foods, and engagement of self-control in food choice. Results: There were no differences between AN subtypes in healthiness or tastiness ratings, or in tendency to limit choice of high-fat foods. There was no difference between the groups in measures of self-control in food choice. Discussion: Individuals with ANR and ANBP similarly manifest reduced choices of high-fat foods, with similar tendencies to undervalue the tastiness of high-fat foods. These results suggest that while individuals with ANR and ANBP differ across a range of clinical characteristics, the decision-making process associated with the maladaptive restriction of high-fat foods characteristic of AN is shared by both subtypes.

Neural Representations of Food-Related Attributes in the Human Orbitofrontal Cortex During Choice Deliberation in Anorexia Nervosa

“…This complements behavioral findings that patients with AN-more so than healthy individualsconsider health more strongly in their food-related choices (Foerde et al, 2015(Foerde et al, , 2020Steinglass et al, 2015Steinglass et al, , 2016Uniacke et al, 2020). These findings point to an important role for the OFC in the over-consideration of health information during maladaptive decision-making in AN and complement previous work showing that the vmPFC is related to the ability to exert executive control and bias the influence of food-related attributes on choice in healthy individuals (Hare et al, 2009;Maier et al, 2015).…”

“…Neural evidence of health attribute information in patterns of activity in the OFC was predictive of the magnitude of choice preferences made by individuals with AN, suggesting that the OFC has a fundamental role in using health information to guide food choices among these patients. This complements behavioral findings that patients with AN—more so than healthy individuals— consider health more strongly in their food-related choices (Foerde et al, 2015, 2020; Steinglass et al, 2015, 2016; Uniacke et al, 2020). These findings point to an important role for the OFC in the over-consideration of health information during maladaptive decision-making in AN and complement previous work showing that the vmPFC is related to the ability to exert executive control and bias the influence of food-related attributes on choice in healthy individuals (Hare et al, 2009; Maier et al, 2015).…”

“…Evaluations of taste and health attributes play different roles during food choices among individuals with AN as compared to healthy individuals (Foerde et al, 2015(Foerde et al, , 2018(Foerde et al, , 2020Steinglass et al, 2015Steinglass et al, , 2016Uniacke et al, 2020). In an fMRI study, overall levels of activity assessed in univariate analyses of taste and health attribute ratings were differentially associated with choices across individuals, with choice-related ventromedial prefrontal cortex (vmPFC) activity correlated with tastiness-related activity among healthy controls (HC) and healthiness-related activity among patients with AN (Foerde et al, 2015).…”

Bad mood food? Increased versus decreased food cue reactivity in anorexia nervosa and bulimia nervosa during negative emotions

“…AN and BN found low calorie foods equally pleasant, which again could indicate that restriction is limited to high-calorie foods only in both clinical groups (Gianini et al, 2019;Uniacke et al, 2020). However, DTE ratings revealed clear evidence for enhanced cue reactivity in BN, which was specific for negative emotions and hcal foods.…”

Healthier decisions in the cued-attribute food choice paradigm have high test-retest reliability across five task repetitions over 14 days

“…Food choice paradigms are a critical tool for investigating the nature of the decision process itself at the behavioral, computational, and neural levels [6][7][8][9][10][11][12][13][14][15][16][17][18] . In addition, they can be used to compare groups [19][20][21][22][23] , evaluate the effectiveness of a separate intervention (e.g. behavioral, pharmacological, surgical) 2-4, 16, 24-26 , or even be incorporated into the intervention itself [27][28][29][30] .…”