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Behavioral intervention reversed obesity-related abnormalities in reward system responses to food cues

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A behavioral intervention successfully shifted the abnormal reward system activation seen in patients who are overweight or obese from unhealthy toward healthy food cues, according to research presented at Obesity Week 2014.

“This is the first demonstration that it is possible to reverse the hyperactivity of the reward center in obesity, and that people can learn to prefer healthy food and not get as triggered by cravings for junk food,” Susan B. Roberts, PhD, professor of nutrition and psychiatry at Tufts University, told Endocrine Today. “Previous studies have attempted to see whether they could do that, and they’ve all failed.”

With 20 years of obesity research, Roberts said the closest results are seen in studies with MRIs done prior to and following gastric bypass, but they show a generalized decreased responsiveness to all foods.

Roberts, founder of the online weight loss program “iDiet” implemented in the small pilot study, believes the findings hold potential for improving behavioral-based treatments of obesity.

“Basically, we have an intervention based on different scientific principles, designed to make weight loss easier,” Roberts said.

Robert and colleagues from other institutions randomized 13 patients to the myidiet.com intervention group (4 men, 4 women; mean age, 47 years; BMI, 29 kg/m²; weight, 83 kg) or the control group (1 man, 4 women; mean age, 53 years; BMI, 30 kg/m²; weight, 83 kg) to assess activation for high-calorie (HC) cues, known to encourage unhealthy food selection and overeating, vs. low-calorie (LC) cues.

Although Roberts wrote the paper, she removed herself from all data collection and analysis and messaging development, she said.

“We built a brick wall between the implementation of the intervention, which was under my control, and the collection and interpretation of the outcomes, which were done by a separate team in order to preserve the credibility of the results,” Roberts said.

Dietary composition in the novel intervention emphasized low glycemic load and high-fiber foods and offered strategies for reducing hunger and food cravings.  

The researchers used fMRI to measure blood-oxygen-level dependent (BOLD) activation of the striatum for HC and LC food images at baseline and 6 months.

Patients in the intervention group achieved greater weight loss than those in the control group (-6.3 kg vs. +2.1 kg; P<.001). Similarly, cravings decreased more with intervention than with control (-21 kg vs. +14 kg).

With intervention, patients showed increased BOLD activation for LC food images at 6 months compared with baseline in the right ventral putamen (P=.04), decreased activation for HC food images in the left dorsal putamen (P=.01) and a marked shift in activation that favored LC vs. HC foods in both regions (P<.04).

Although small, the pilot study builds on evidence documented in three related publications that showed substantially more weight loss, hunger reduction and decreased food cravings.

“This is the fourth in a series that documents changes at the neurological level,” Roberts said.

The demonstration that patients can maintain the pleasure of eating is notable, Roberts said. Other interventions including Weight Watchers are based around the notions that weight loss is difficult and that people get hungry, with goal setting and accountability to keep them on track.

“You accept being hungry, you use accountability to help you put up with that, and you get your treats,” Roberts said. “That had things completely backwards. We should be getting rid of hunger and retraining people to get their food pleasure from healthy rather than unhealthy foods. It’s completely flipping all the basic principles, and it looks like we’ve achieved doing that.” — by Allegra Tiver

For More Information: Roberts SB. Abstract T-3102-OR. Presented at: Obesity Week; Nov 2-7, 2014; Boston.

Disclosures: Roberts reports being an equity holder and scientific advisor to Instinct Health Science Inc., the parent company of www.myidiet.com and The “I” Diet (Workman Publishing 2010), and co-author of World’s Best Diet (Penguin Australia 2014).