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Title: Pilot randomized trial demonstrating reversal of obesity-related abnormalities in reward system responsivity to food cues with a behavioral intervention

Author
item DECKERSBACH, THILO - Harvard University
item DAS, SAI KRUPA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item URGAN, LORIEN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item SALINDARDI, TAYLOR - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item BATRA, PAYAL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item RODMAN, ALEXANDRA - Harvard University
item ARULPRAGASAM, AMANDA - Harvard University
item DOUGHERTY, DARIN - Harvard University
item ROBERTS, SUSAN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Nutrition and Diabetes
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/27/2014
Publication Date: 9/1/2014
Citation: Deckersbach, T., Das, S., Urgan, L.E., Salindardi, T., Batra, P., Rodman, A.M., Arulpragasam, A.R., Dougherty, D., Roberts, S. 2014. Pilot randomized trial demonstrating reversal of obesity-related abnormalities in reward system responsivity to food cues with a behavioral intervention. Nutrition and Diabetes. 4:e129. https://doi.org/10.1038/nutd.2014.26.
DOI: https://doi.org/10.1038/nutd.2014.26

Interpretive Summary: Activation of the brain's reward system for unhealthy food over healthy food is proposed as an important underlying cause of unhealthy eating habits and obesity. A pilot study tested the effects of a novel behavioral intervention on reward system responsiveness to healthy and unhealthy food items, using functional magnetic resonance imaging. The behavioral intervention focused on effective hunger management and cognitive restructuring exercises to reduce food cravings, and participants were measured at baseline and 6 months with randomization to the intervention or a wait-listed control after baseline measurements. There was a significant change in reward system responsiveness over time in the intervention group versus the control group, with increased responsiveness to healthy food and decreased responsiveness to unhealthy food in different areas of the striatum. These results provide the first demonstration that behavioral interventions can beneficially change reward system responsiveness to healthy versus unhealthy foods.

Technical Abstract: OBJECTIVES: Obesity is associated with hyperactivation of the reward system for high-calorie (HC) versus low-calorie (LC) food cues, which encourages unhealthy food selection and overeating. However, the extent to which this hyperactivation can be reversed is uncertain, and to date there has been no demonstration of changes by behavioral intervention. SUBJECTS AND METHODS: We used functional magnetic resonance imaging to measure changes in activation of the striatum for food images at baseline and 6 months in a pilot study of 13 overweight or obese adults randomized to a control group or a novel weight-loss intervention. RESULTS: Compared to controls, intervention participants achieved significant weight loss (-6.3 +/- 1.0 kg versus +2.1 +/- 1.1 kg, P<0.001) and had increased activation for LC food images with a composition consistent with that recommended in the behavioral intervention at 6 months versus baseline in the right ventral putamen (P=0.04), decreased activation for HC images of typically consumed foods in the left dorsal putamen (P=0.01). There was also a large significant shift in relative activation favoring LC versus HC foods in both regions (P<0.04). CONCLUSIONS: This study provides the first demonstration of a positive shift in activation of the reward system toward healthy versus unhealthy food cues in a behavioral intervention, suggesting new avenues to enhance behavioral treatments of obesity.