Food preference and behavioural choice across the eating disorder and body weight spectrum

TL;DR

The study found that people with Anorexia Nervosa prefer low-calorie foods and make faster decisions compared to others, highlighting unique eating behaviors in eating disorders.

Contribution

The study identifies distinct food choice behaviors in Anorexia Nervosa and suggests the need for transdiagnostic approaches to eating disorders.

Findings

Anorexia Nervosa individuals chose lower-calorie foods and made faster decisions compared to healthy controls.

Bulimia Nervosa and overweight/obese groups made faster food choices but did not differ in food liking.

External eating predicted higher-calorie food choices across groups.

Abstract

Eating disorders (EDs) such as Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge-Eating Disorder (BED) share overlapping symptoms, risk factors, and maintenance mechanisms, yet differ in their behavioural manifestations. This study aimed to investigate binary food choice behaviour across EDs and weight groups, including healthy controls with normal weight, overweight and obesity in a controlled laboratory setting.

N = 189 individuals with AN (n = 40), BN (n = 29), BED (n = 24) as well as controls without eating disorders with normal weight (HC-NW, n = 57), overweight (HC-OW, n = 18) and obesity (HC-OB, n = 21) made 153 binary food choices while decision times were recorded. Participants also rated foods on liking and calorie content. The number of calories in chosen foods, the relationship between calorie content and liking ratings and decision times were analysed. We further explored the roles of eating styles, BMI and ED symptoms in food choice.

Individuals with AN chose less calories, liked lower-calorie foods more and made faster decisions, especially for lower-calorie options compared to HC-NW. The other groups did not differ from HC-NW in food choice or liking, but BN - and to a lesser degree HC-OB and HC-OW - made faster food choices. External eating positively predicted higher-calorie choices.

This study underscores the distinctiveness of AN in food choice behaviour and the need for transdiagnostic approaches to understand shared and unique mechanisms across EDs and weight groups. Future research should explore longitudinal changes in food choice processes and integrate contextual and emotional factors to better capture the complexity of eating behaviours.

The online version contains supplementary material available at 10.1186/s40337-026-01547-4.

This study looked at how people with different eating disorders (Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder) and different body weights (normal weight, overweight, and obesity) make food choices. Participants completed a computer-based task in which they chose between pairs of foods, rated how much they liked them, and estimated their calorie content. It was also measured how quickly they made the decisions. The results showed that people with Anorexia Nervosa chose lower-calorie foods more often, liked them more, and made faster decisions when they chose them compared with people of normal weight who did not have eating disorders. Other groups, including those with Bulimia Nervosa, overweight, or obesity, did not differ in the foods they liked but made faster decisions overall. People who tended to eat in response to external cues (e.g., seeing food) were more likely to choose higher-calorie options. The study highlights how food choices are different for people with Anorexia Nervosa and suggests that eating disorders share some similarities but also have unique traits. We recommend studying how food choices change over time and considering emotional and situational factors to better understand eating behaviours.

The online version contains supplementary material available at 10.1186/s40337-026-01547-4.

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