Is Anorexia a Choice?

For anyone touched by an eating disorder, you know all too well how difficult these disorders are to treat. Sometimes we wonder in frustration why the person with an eating disorder doesn’t make better choices. But how much control do people with eating disorders really have over their food choices? A new study uses brain-imaging technology to investigate exactly what goes on in the head of a person with anorexia nervosa when they make food choices.

The researchers conceptualize anorexia nervosa as an eating disorder characterized by repeated maladaptive food choices that result in starvation accompanied by substantial morbidity and mortality. It has been traditionally thought that these maladaptive food choices represent goal-oriented weight loss behaviors. However, there comes a point in the course of the disease when there is a shift from wanting to engage in a behavior to needing to engage in a behavior. Despite a desire to regain health and stop restricting food intake, patients with anorexia continue to engage in restricting behaviors. In treatment, they have difficulty changing their food choices and, given the opportunity, will continue to choose low-fat and low-calorie foods.

Foerde, Steinglass, Shohamy, and Walsh (2015) conducted research published in Nature Neuroscience, using functional magnetic resonance imaging (fMRI) to compare blood oxygen level dependent (BOLD) activity among a group of 21 women newly hospitalized for the treatment of anorexia nervosa and a group of 21 healthy women without anorexia nervosa (control group). Participants engaged in a food choice task while their brain activity was observed using fMRI scanners. Results indicated that in participants with anorexia nervosa (but not in healthy controls), food choices were related to neural activity in the dorsal striatum, a part of the brain which has a critical role in the establishment and expression of action control and learned automatic behaviors. This indicates that the food “choices” that patients with anorexia nervosa make may be habitual automatic behaviors rather than true choices.

The researchers only studied women with anorexia nervosa, but I wonder if similar neural patterns are present in the brains of people struggling with other types of disordered eating, such as binge-eating disorder (BED). Many people with BED describe needing to eat, or feeling compelled to eat, certain foods despite not wanting to eat these foods. It is possible that, similar to patients with anorexia nervosa, these eating behaviors represent ingrained automatic processes in the brain rather than willful deliberate choices.

The good news is that it is possible to change the ways that our brain processes food choices. Mindfulness meditation has been shown to actually change our brains. By directing our full attention to our food choices and eating experiences (as we do in Mindful Eating), we can disrupt our brain’s automatic responses and make aware and deliberate decisions. With practice and dedication, over time we can regain the power to make true choices rather than automatic reactions.

Reference: Foerde K, Steinglass J, Shohamy D, and Walsh T (2015). Neural Mechanisms Supporting Maladaptive Food Choices in Anorexia Nervosa. Nature Neuroscience, Advance Online Publication.

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