Lower Numeracy and Risky Decision-making in Individuals at Risk for Eating Disorders: A Comparative and Cross-sectional Study

Background: Low numeracy—the ability to understand and use numeric information—may be linked to eating disorders (ED). Decision-making styles could contribute to this association. Aims: To examine whether lower numeracy is associated with higher ED risk and whether numeracy mediates the relationship between decision-making and ED risk. Methods: We conducted a cross-sectional online survey (Google Forms) including a sociodemographic questionnaire, the Subjective Numeracy Scale (SNS), the Melbourne Decision-Making Questionnaire (MDMQ) and the SCOFF. Of 310 participants, 196 had a negative SCOFF (controls) and 114 a positive SCOFF (at risk). We ran bivariate tests and multivariable models adjusting for age, BMI, gender, education, and medical/psychiatric history. Mediation analysis tested whether numeracy mediated the association between decision-making and ED risk. Results: Numeracy scores were higher in the SCOFF-negative group ( P < 0.001), whereas MDMQ scores were higher in the SCOFF-positive group ( P < 0.001). In multivariable analysis, numeracy independently predicted SCOFF status ( P = 0.04) after adjustment for covariates. Mediation analysis indicated that decision-making influenced ED risk via numeracy (indirect effect P < 0.001). Conclusions: Individuals at risk for ED may exhibit lower numeracy, which may partially mediate the link between maladaptive decision-making and ED risk. Longitudinal and interventional studies should assess whether strengthening numeracy and decision skills reduces ED risk.