Strengthening children’s decision-making skills to help prevent eating disorders in adolescence

Grand challenge: Mental Health and Wellbeing 

Eating disorders are increasing alarmingly among children and young people, with diagnosis rates among 13–16-year-olds rising by 42% between 2020 and 2022 (Trafford et al., 2023). While most research tends to focus on diagnosis and treatment of these disorders, IOE research has shifted attention to their prevention, earlier in childhood. It has found that strengthening children’s early decision-making can help prevent the later onset of eating problems. The research is playing a vital role in helping address the ever-greater demands being placed on already stretched mental health provision for children and young people. 

Prevention and early intervention

The research, led by Dr Amy Harrison and Dr Marta Francesconi (Department of Psychology and Human Development, UCL Institute of Education) and supported by the Medical Research Council (MRC) and the Medical Research Foundation, contributes to the advancement of UCL’s Grand Challenge of Mental Health & Wellbeing, which focuses on advancing prevention and implementing early intervention strategies through interdisciplinary collaboration. 

Eating disorders are complex and often misunderstood, with stigma and misinformation creating barriers to early intervention, while diagnosis rates continue to rise. Traditional research has largely focused on individuals already diagnosed with conditions like anorexia nervosa. Harrison and Francesconi’s groundbreaking study challenged this approach by examining over 11,000 young people to identify early indicators of disordered eating before symptoms escalate. 

The researchers used the Cambridge Gambling task, a widely adopted approach to assess decision-making and risk-taking behaviour, to explore how children made decisions about their bodies and diet (for instance, feelings of dissatisfaction with their bodies, and attitudes to restricting their diet and to exercise). The quality of the reasoning applied to these decisions was shown to significantly reduce the risk of later eating disorders. 

Building on these insights, the researchers developed prevention tools designed to equip young people and their families with strategies to foster healthier relationships with food and exercise and support positive decision-making. These tools, which include interactive resources and workshops, have reached over 5,000 people, including 3000 children and young people, 1200 carers and 800 educators, offering practical guidance on recognising and addressing early risk factors. Participants reported a 64% improvement in their understanding of eating disorders, with carers noting that learning about brain-based factors reduced self-blame and improved their ability to support loved ones. 

Harrison and Francesconi actively collaborated with educators, health professionals and individuals with lived experience of eating disorders to refine their approach. Their engagement extended beyond academia through both a widely accessed podcast reaching 40,000 subscribers in the education sector, and their contributions to public awareness campaigns aimed at dispelling myths surrounding common eating disorders. 

Their research also shaped national policy, with their evidence informing the UK Health and Social Care Select Committee’s inquiry into Children and Young People’s Mental Health, which considered, among other issues, whether the health system should be reformed toward a more holistic approach that prioritises early intervention and prevention. 

Looking ahead, the team is leading an interdisciplinary collaboration and working with early career researchers and industry partners to develop an interactive digital tool. The tool will be designed to help children and young people make decisions that lead to better longer-term health outcomes in relation to eating and exercise. A group of 17 young people aged 11–14 has been involved in the initial development of this new tool, which uses gamification to teach advantageous decision-making. By continuing to translate their research into practical interventions, they aim to scale their impact further and collaborate with new partners interested in supporting early intervention efforts.

Related links

• Grand Challenge: Mental Health and Wellbeing
• Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based study, (Trafford et al., 2023)
• Amy Harrison
• Marta Francesconi
• Department of Psychology and Human Development
• Does decision-making at age 11 predict prodromal eating pathology at ages 14 and 17? A prospective, observational, UK population-based cohort study, (Harrison, Francesconi, Flouri)
• Written evidence submitted by UCL Institute of Education (CYP0038)
• UK Health and Social Care Select Committee’s inquiry into Children and Young People’s Mental Health