title: How Does the Brain Implement Adaptive Decision Making to Eat?
abstract: Adaptive decision making to eat is crucial for survival, but in anorexia nervosa, the brain persistently supports reduced food intake despite a growing need for energy. How the brain persists in reducing food intake, sometimes even to the point of death and despite the evolution of multiple mechanisms to ensure survival by governing adaptive eating behaviors, remains mysterious. Neural substrates belong to the reward-habit system, which could differ among the eating disorders. The present review provides an overview of neural circuitry of restrictive food choice, binge eating, and the contribution of specific serotonin receptors. One possibility is that restrictive food intake critically engages goal-directed (decision making) systems and "habit," supporting the view that persistent caloric restriction mimics some aspects of addiction to drugs of abuse.
  
  
  CONCLUSIONS
  An improved understanding of the neural basis of eating disorders is a timely challenge because these disorders can be deadly. Up to 70 million of people in the world suffer from eating disorders. Anorexia nervosa affects 1-4% of women in United States and is the first cause of death among adolescents in Europe. Studies relying on animal models suggest that decision making to eat (or not) can prevail over actual energy requirements due to emotional disturbances resulting in abnormal habitual behavior, mimicking dependence. These recent studies provide a foundation for developing more specific and effective interventions for these disorders.
authors.affiliation: Nîmes University, Place Gabriel Peri, Carmes, 30021 Nîmes, France, valerie.compan@unimes.fr.
authors.forename: Valérie
authors.initials: V
authors.lastname: Compan
authors.affiliation: New York State Psychiatric Institute/Columbia University Medical Center, New York, New York 10032.
authors.forename: B Timothy
authors.initials: BT
authors.lastname: Walsh
authors.affiliation: Eating Disorder Treatment and Research Program, Department of Psychiatry, University of California, La Jolla, California 92037.
authors.forename: Walter
authors.initials: W
authors.lastname: Kaye
authors.affiliation: Department of Psychiatry, Montana Sinai School of Medicine, New York, New York 10029, and Department of Psychology, Touro College and University System, New York, New York 10023.
authors.forename: Allan
authors.initials: A
authors.lastname: Geliebter
mesh_terms: D000818:Animals; D001921:Brain / Q000502:physiology*; D003657:Decision Making / Q000502:physiology*; D005247:Feeding Behavior / Q000502:physiology* / Q000523:psychology*; D006801:Humans; D012201:Reward
keywords: anorexia; decision making; dependence; obesity; reward; serotonin