Different brain regions support deliberation during food choice in disordered and healthy eating

The brain is wired to drive behavior towards foods that are high in sugar and fat. Yet, individuals with anorexia nervosa (AN) prefer low-sugar and low-fat foods to the point of starvation and even death. Here, we aimed to understand how alterations in decision-making processes and associated neural activity contribute to the pattern of maladaptive food-related decisions observed in AN. We combined decision-making tasks with computational modeling of behavior and fMRI to examine food-specific and general (nonfood)-related decisions in female individuals with AN and healthy controls (HC). Results from this pre-registered study suggest that patients with AN, like HC, employ a decision-making process that relies on sampling and evaluating evidence, regardless of the type of decision. However, neural activity patterns differed between groups when deliberating about what to eat: food choice-related activation among HC was localized to the hippocampus, whereas individuals with AN engaged both the hippocampus and the striatum, regions apparently serving as sources of evidence in the decision process. These findings suggest that the maladaptive reversal of food preferences in AN may be attributable to reliance on different inputs to the process that leads to restrictive food choice, rather than a maladaptive decision process per se Significance Statement Disordered eating often involves maladaptive choices about what to eat. The present research shows that the decision-making process unfolds similarly in healthy individuals and patients with anorexia nervosa but the brain regions that support deliberation about what to eat differ. Together, the findings suggest that the inputs to the decision process, rather than the decision process per se should be a point of focus in the search for novel treatments of eating disorders.