Abnormal eating behavior in video-recorded meals in anorexia nervosa

•Meal-time behaviors in anorexia nervosa differed from those of healthy controls.•Several meal-time behaviors were related to energy intake in anorexia nervosa.•Several meal-time behaviors were related to anxiety in anorexia nervosa.

ObjectiveEating behavior during meals in anorexia nervosa (AN) has long been noted to be abnormal, but little research has been done carefully characterizing these behaviors. These eating behaviors have been considered pathological, but are not well understood. The current study sought to quantify ingestive and non-ingestive behaviors during a laboratory lunch meal, compare them to the behaviors of healthy controls (HC), and examine their relationships with caloric intake and anxiety during the meal.MethodA standardized lunch meal was video-recorded for 26 individuals with AN and 10 HC. Duration, frequency, and latency of 16 mealtime behaviors were coded using computer software. Caloric intake, dietary energy density (DEDS), and anxiety were also measured.ResultsNine mealtime behaviors were identified that distinguished AN from HC: staring at food, tearing food, nibbling/picking, dissecting food, napkin use, inappropriate utensil use, hand fidgeting, eating latency, and nibbling/picking latency. Among AN, a subset of these behaviors was related to caloric intake and anxiety.DiscussionThese data demonstrate that the mealtime behaviors of patients with AN and HC differ significantly, and some of these behaviors may be associated with food intake and anxiety. These mealtime behaviors may be important treatment targets to improve eating behavior in individuals with AN.