Preventing eating disorders: exploring the role of decision-making

Wide-ranging impacts, “on all areas of life”

“Eating disorders have a devastating impact on all aspects of your life,” says Amy. “They affect your physical health, such as making you very lethargic and weak. They impact your mental health, including your self-esteem and how you feel about yourself and your body. And they can make you feel very low and anxious.”

“They also impact your social life. People often find it very difficult to socialise, because they’re worried about losing control or avoiding opportunities to eat. And people’s social networks get smaller. Friends often back off. And if people go into hospital for long periods, that can be very disruptive to things like education and employment.”

A growing problem

Amy says “all eating disorders are on the rise, particularly following the COVID-19 pandemic, where more people were presenting with disorders, more people were relapsing, and getting the symptoms back and struggling.” She adds, “we’ve often thought about eating disorders in girls and women, but we know that more men are coming forward with symptoms. They’re also affecting people across the lifespan.”

Assessing how people make decisions

For the first time, Amy was able to bring together developmental psychologists, epidemiologists, and herself as a clinical psychologist, to look at decision-making and eating disorders in a large sample of children.

When they were 11 and 14, the children took on something called the ‘Cambridge Gambling Task’, which assesses how people make decisions, in a range of different scenarios.

Amy and her colleagues found that people who made less advantageous decisions on the gambling task were more likely to present with symptoms of eating disorders in adolescence, and this was the case at multiple ages. She also discovered that people with eating disorder symptoms developed their decision-making skills more slowly than their peers.

“We would expect people across adolescence to get better at making advantageous decisions because we learn and our brain develops,” says Amy, “but we didn’t see that as much in the eating disorder group. Their peers’ skills developed as expected, but the group with eating disorders didn’t improve as much on the task.”

Helping young people to ‘get better’ at decision-making

There’s an emerging train of thought that people’s cognitive skills might actually contribute to the illness, a theory supported by Amy’s findings. This means that training people to get better at decision-making, might offer protection against eating disorder symptoms.

Amy says, “We’re developing a game to help young people to make more advantageous decisions, under conditions where thoughts or behaviours associated with eating disorders might be triggered. For example, at the school canteen, a fellow student saying they’re skipping lunch because they feel overweight – how do you make an advantageous choice there? Do you join in, comfort them, or consider the consequences?”

Preventing symptoms in the first place

The ultimate aim, Amy says, is to prevent these symptoms from developing in the first place. “This could have far wider impacts, including reducing waiting times for NHS services and preventing people from getting stuck in the system for years. It could also impact policies related to children’s and young people’s mental health, offering new insights into skills that could help.”

As well as enabling her ground-breaking research discoveries, Amy says support from the Foundation has “really advanced my career as a woman in science,” including a promotion to associate professor at UCL.

Most importantly, Amy says, the research has touched people’s hearts. “When I talk about our research in carers’ groups and patient support groups in hospital settings, people find it fascinating and extremely helpful for offering insights into their difficulties. The idea that we could potentially protect against these symptoms, almost like a cognitive vaccination, is something to be proud of.”