ESPE Yearbook of Paediatric Endocrinology

Int J Obes (Lond). 2020 Oct;44(10):2011–2022. 10.1038/s41366-020-0644-1. https://pubmed.ncbi.nlm.nih.gov/32713944/

Schur et al. addressed the question, whether responsiveness to visual food cues in functional magnetic resonance imaging (fMRI) is related to the treatment success of a 6-month Family-based Behavioral Treatment (FBT) program in (n=37) obese children.

FBT is one of the few treatment options for children and adolescents with common obesity [1,2]. However, little is known about the factors that contribute to variability in treatment responses [3]. Whereas brain activation in appetitive processing regions has been shown to be altered in obese children and adults [4,5] leading to higher food intake and weight gain [6,7] and to impair the diet and bariatric surgery treatment success in adults [8,9], its influence on treatment success in children has not been addressed so far. The authors performed fMRI scans prior to a 6-month FBT in 9-11-year-old obese children to analyze brain activation in appetite-processing regions in response to (viewing) low- and high-calorie food images before and after a standardized meal.

Pre-meal brain activation was not associated with short- and long-term changes (6 month and 1 year) in BMI z-score, whereas the pre- to post-meal reduction in brain activity by high-calorie visual food cues (but not low-calorie-food cues) was related to child BMI z-score decline and greater improvements in Healthy Eating-Index scores. Furthermore, they identified clusters of activation associated with BMI z-score change: greater pre-meal activation in the ventromedial prefrontal cortex and in the occipital pole correlated with greater BMI z-score reduction. In contrast, greater activation by high-calorie food cues in the superior portion of the precuneus, the left lateral occipital cortex and the right lingual gyrus was associated with less BMI z-score reduction.

These data focused only on pre-treatment brain activity and causality on weight change cannot be assumed. However, this extensive dataset of functional neuroimaging provides an important contribution to a better understanding of predictors and mechanisms during behavioral treatment and possible reasons for unsuccessful treatment outcomes. These results are important for our understanding of weight regulation. They relieve the patients and support pharmacological therapy approaches that influence the postprandial satiety response.

References: 1. US Preventive Services Task Force; et al. Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA 2017;317 (23): 2417–26.2. Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, Yanovski JA. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. JCEM 2017; 102(3): 709–57.3. Wilfley DE, Stein RI, Saelens BE, et al. Efficacy of maintenance treatment approaches for childhood overweight: a randomized controlled trial. – 2007; 298(14):1661–73.4. Bruce AS, Holsen LM, Chambers RJ, et al. Obese children show hyperactivation to food pictures in brain networks linked to motivation, reward and cognitive control. Int J Obes. 2010;34(10):1494–500.5. Martin LE, Holsen LM, Chambers RJ, et al. Neural mechanisms associated with food motivation in obese and healthy weight adults. Obesity. 2010;18(2):254–60.6. Melhorn SJ, Askren MK, Chung WK, et al. FTO genotype impacts food intake and corticolimbic activation. J Clin Nutr. 2018;107(2):145–54.7. Demos KE, Heatherton TF, Kelley WM. Individual differences in nucleus accumbens activity to food and sexual images predict weight gain and sexual behavior. J Neurosci 2012;32(16):5549–52.8. Holsen LM, Davidson P, Cerit H, et al. Neural predictors of 12-month weight loss outcomes following bariatric surgery. Int J Obes 2018; 42(4): 785–93.9. Murdaugh DL, Cox JE, Cook EW, Weller RE. fMRI reactivity to high-calorie food pictures predicts short- and long-term outcome in a weight-loss program. Neuroimage. 2012;59(3):2709–21.