ESPE Yearbook of Paediatric Endocrinology

Christian.roth@deattlechildrens.org J Clin Endocrinol Metab. 2022; doi: 10.1210/clinem/dgac299. https://pubmed.ncbi.nlm.nih.gov/35544121/

Brief Summary: In this intervention study, the effect of a 24-week family-based behavioral obesity intervention on brain activation, measured by visual food cues via functional magnetic resonance imaging (fMRI), and on gut hormone levels was investigated in 9 to 11 year old children with obesity (n=28) and children with normal weight without intervention (n=17). Greater reductions in BMI z-score were associated with a weaker central satiety response, as demonstrated by lesser reductions in meal-induced brain activation to high- vs low-calorie food cues across appetite-processing brain regions from before to after obesity intervention. In contrast, peripheral gut hormones (leptin, ghrelin, peptide YY and glucagon-like peptide 1) improved in individuals with greater reductions in BMI z-score, suggesting an intact peripheral satiety response.

fMRI studies in adults have shown that an increased brain activation to food cues after significant weight loss is associated with weight regain [1, 2]. This study provides important information to understand the underlying mechanisms of dysregulated central and peripheral energy homeostasis. Knowledge about these mechanisms will allow us to develop specific drugs to improve weight loss and prevent future weight regain in children with obesity. However, the results should be interpreted with caution due to the small sample size and the clinically small change in BMI SDS (−0.20±0.22), raising the question if this change is sufficient to cause definite changes in the central satiety response. In addition, the comparison with normal-weight children is difficult to interpret because it is currently unknown whether the different brain responses in children with normal weight and obesity are acquired or inherited, and whether the disturbed brain responses in children with obesity are reversible. Future studies with larger cohorts are therefore needed to investigate the changes in brain activity in children with obesity and find out who responds and who does not respond to obesity interventions.

References: 1. Murdaugh, DL., et al. fMRI reactivity to high-calorie food pictures predicts short- and long-term outcome in a weight-loss program. Neuroimage, 2012. 59(3): p. 2709–21. 2. Neseliler S, et al. Neurocognitive and Hormonal Correlates of Voluntary Weight Loss in Humans. Cell Metab, 2019. 29(1): p. 39–49.e4.