Change in food choice during acute treatment and the effect on longer-term outcome in patients with anorexia nervosa

• Published in: Psychological medicine Vol. 54; no. 6; pp. 1133 - 1141
• Main Authors: Steinglass, Joanna E, Fei, Wenbo, Foerde, Karin, Touzeau, Caroline, Ruggiero, Julia, Lloyd, Caitlin, Attia, Evelyn, Wang, Yuanjia, Walsh, B Timothy
• Format: Journal Article
• Language: English
• Published: England Cambridge University Press 01.04.2024
• Subjects: Anorexia; Anorexia Nervosa - diagnosis; Anorexia Nervosa - therapy; Behavior change; Body fat; Body Mass Index; Computerization; Eating behavior; Eating disorders; Feeding and Eating Disorders; Food; Food intake; Food Preferences; Food selection; Hospitalization; Humans; Inpatient care; Magnetic resonance imaging; Meals; Objectives; Patients; Psychopathology; Self control; Short term; Treatment Outcome; Weight loss; treatment; inpatient; eating disorders; anorexia nervosa; cognitive neuroscience; treatment outcome; food choice
• DOI: 10.1017/S0033291723002933
• ISSN: 0033-2917

Restriction of food intake is a central pathological feature of anorexia nervosa (AN). Maladaptive eating behavior and, specifically, limited intake of calorie-dense foods are resistant to change and contribute to poor long-term outcomes. This study is a preliminary examination of whether change in food choices during inpatient treatment is related to longer-term clinical course. Individuals with AN completed a computerized Food Choice Task at the beginning and end of inpatient treatment to determine changes in high-fat and self-controlled food choices. Linear regression and longitudinal analyses tested whether change in task behavior predicted short-term outcome (body mass index [BMI] at discharge) and longer-term outcome (BMI and eating disorder psychopathology). Among 88 patients with AN, BMI improved significantly with hospital treatment ( < 0.001), but Food Choice Task outcomes did not change significantly. Change in high-fat and self-controlled choices was not associated with BMI at discharge ( = 0.13, = 0.22 and = 0.10, = 0.39, respectively). An increase in the proportion of high-fat foods selected ( = 0.91, = 0.02) and a decrease in the use of self-control ( = -1.50, = 0.001) predicted less decline in BMI over 3 years after discharge. Short-term treatment is associated with improvement in BMI but with no significant change, on average, in choices made in a task known to predict actual eating. However, the degree to which individuals increased high-fat choices during treatment and decreased the use of self-control over food choice were associated with reduced weight loss over the following 3 years, underscoring the need to focus on changing eating behavior in treatment of AN.