So what does this all mean? We think metabolic ill-health is accompanied by a cognitive shift towards energy conservation, a recalibration of the brain's willingness to expend effort for reward. This may be one pathway through which poor metabolic health contributes to psychiatric comorbidity.
This wasn't just a categorical difference between groups - metabolic health appears to scale *dimensionally* with effort-based decision-making. Across the full sample, metabolic risk continuously predicted motivational bias. Worse metabolic health = lower willingness to exert effort for reward.
We found clear group differences: participants with diabetes currently on semaglutide showed the lowest motivational acceptance bias, followed by those with diabetes off semaglutide, and controls with elevated metabolic risk; those with a low metabolic risk had the highest motivational bias.