Abstract
ObjectivesWe examined whether decision-making at age 11 and 14 is associated with prodromal eating pathology at age 14 and whether it would persist across adolescence and also be present at age 17.DesignThis prospective, observational, population-based cohort study used a longitudinal design.SettingData from the Millennium Cohort Study (MCS), a UK longitudinal cohort study involving 19 244 families from England, Scotland, Wales and Northern Ireland, were analysed.ParticipantsWe modelled data from 8922 boys and girls aged 11, 14 and 17 (MCS sweeps 5, 6 and 7).Primary and secondary outcomesWe investigated decision-making using the risk-taking, quality of decision-making, deliberation time, delay aversion and risk adjustment subscales of the Cambridge Gambling Task and prodromal eating pathology through binary response items measuring: body dissatisfaction (whether the participant perceived their body as being too overweight); intention to lose weight (whether participants reported a strong desire to lose weight); dietary restriction (whether participants reported actively eating less to influence their shape/weight) and excessive exercise (whether participants reported exercising in a driven way in order to influence weight/shape). Data were analysed using latent class analysis and logistic regression.ResultsLower scores on quality of decision-making (OR=0.46) and deliberation time (OR=0.99) at age 14 were associated with prodromal eating pathology at both ages 14 and 17 (all p<0.05), indicating an association between less frequently opting to bet on the most likely outcome and taking less time to decide on which bet to choose and the persistence of prodromal eating pathology over adolescence. Lower deliberation time (OR=0.99) and delay aversion (OR=0.62) at 11 and lower risk-taking scores at 14 (OR=0.43) were associated with the absence of prodromal eating pathology at 14 and 17 (all p<0.05), indicating that a moderate approach under conditions of risk in childhood and mid-adolescence is associated with reduced eating pathology across adolescence.ConclusionsTraining advantageous decision-making might protect from later prodromal eating pathology.