Weight loss, behavioral change, and structural neuroplasticity in children with obesity through a multidisciplinary treatment program

The cerebellum plays more than one role in the dysregulation of appetite: Review of structural evidence from typical and eating disorder populations

OBJECTIVE

Dysregulated appetite control is characteristic of anorexia nervosa (AN), bulimia nervosa (BN), and obesity (OB). Studies using a broad range of methods suggest the cerebellum plays an important role in aspects of weight and appetite control, and is implicated in both AN and OB by reports of aberrant gray matter volume (GMV) compared to nonclinical populations. As functions of the cerebellum are anatomically segregated, specific localization of aberrant anatomy may indicate the mechanisms of its relationship with weight and appetite in different states. We sought to determine if there were consistencies in regions of cerebellar GMV changes in AN/BN and OB, as well as across normative (NOR) variation.

METHOD

Systematic review and meta-analysis using GingerALE.

RESULTS

Twenty-six publications were identified as either case-control studies (nOB  = 277; nAN/BN  = 510) or regressed weight from NOR data against brain volume (total n = 3830). AN/BN and OB analyses both showed consistently decreased GMV within Crus I and Lobule VI, but volume reduction was bilateral for AN/BN and unilateral for OB. Analysis of the NOR data set identified a cluster in right posterior lobe that overlapped with AN/BN cerebellar reduction. Sensitivity analyses indicated robust repeatability for NOR and AN/BN cohorts, but found OB-specific heterogeneity.

DISCUSSION

Findings suggest that more than one area of the cerebellum is involved in control of eating behavior and may be differentially affected in normal variation and pathological conditions. Specifically, we hypothesize an association with sensorimotor and emotional learning via Lobule VI in AN/BN, and executive function via Crus I in OB.

A school-family blended multi-component physical activity program for Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC): protocol for a cluster randomized controlled trial

BACKGROUND

Fundamental motor skills (FMSs) are crucial for children's health and comprehensive development. Obese children often encounter a considerable challenge in the development of FMSs. School-family blended PA programs are considered a potentially effective approach to improve FMSs and health-related outcomes among obese children, however, empirical evidence is still limited. Therefore, this paper aims to describe the development, implementation, and evaluation of a 24-week school-family blended multi-component PA intervention program for promoting FMSs and health among Chinese obese children, namely the Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC) employing behavioral change techniques (BCTs) and building on the Multi-Process Action Control (M-PAC) framework as well as using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework for improving and evaluating the program.

METHODS

Using a cluster randomized controlled trial (CRCT), 168 Chinese obese children (8-12 years) from 24 classes of six primary schools will be recruited and randomly assigned to one of two groups by a cluster randomization, including a 24-week FMSPPOC intervention group and a non-treatment waiting-list control group. The FMSPPOC program includes a 12-week initiation phase and a 12-week maintenance phase. School-based PA training sessions (2 sessions/week, 90 min each session) and family-based PA assignments (at least three times per week, 30 min each time) will be implemented in the initiation phase (semester time), while three 60-min offline workshops and three 60-min online webinars will be conducted in the maintenance phase (summer holiday). The implementation evaluation will be undertaken according to the RE-AIM framework. For intervention effectiveness evaluation, primary outcome (FMSs: gross motor skills, manual dexterity and balance) and secondary outcomes (health behaviors, physical fitness, perceived motor competence, perceived well-being, M-PAC components, anthropometric and body composition measures) will be collected at four time-points: at baseline, 12-week mid-intervention, 24-week post-intervention, and 6-month follow-up occasions.

DISCUSSION

The FMSPPOC program will provide new insights into the design, implementation, and evaluation of FMSs promotion among obese children. The research findings will also supplement empirical evidence, understanding of potential mechanisms, and practical experience for future research, health services, and policymaking.

TRIAL REGISTRATION

Chinese Clinical Trial Registry; ChiCTR2200066143; 25 Nov 2022.

Individualized morphometric similarity predicts body mass index and food approach behavior in school-age children

Childhood obesity is associated with alterations in brain structure. Previous studies generally used a single structural index to characterize the relationship between body mass index(BMI) and brain structure, which could not describe the alterations of structural covariance between brain regions. To cover this research gap, this study utilized two independent datasets with brain structure profiles and BMI of 155 school-aged children. Connectome-based predictive modeling(CPM) was used to explore whether children’s BMI is reliably predictable by the novel individualized morphometric similarity network(MSN). We revealed the MSN can predict the BMI in school-age children with good generalizability to unseen dataset. Moreover, these revealed significant brain structure covariant networks can further predict children’s food approach behavior. The positive predictive networks mainly incorporated connections between the frontoparietal network(FPN) and the visual network(VN), between the FPN and the limbic network(LN), between the default mode network(DMN) and the LN. The negative predictive network primarily incorporated connections between the FPN and DMN. These results suggested that the incomplete integration of the high-order brain networks and the decreased dedifferentiation of the high-order networks to the primary reward networks can be considered as a core structural basis of the imbalance between inhibitory control and reward processing in childhood obesity.

The Impact of Restrictive and Non-restrictive Dietary Weight Loss Interventions on Neurobehavioral Factors Related to Body Weight Control: the Gaps and Challenges

PURPOSE OF REVIEW

Restrictive diets, such as low-calorie diets, are difficult to maintain in the long term. For this reason, their popularity has decreased compared to non-restrictive approaches, which instead promote healthy eating strategies. Since both strategies may entail different neurobiological mechanisms, this review will examine the current evidence on the effects of restrictive and non-restrictive interventions on neurobehavioral factors.

RECENT FINDINGS

Restrictive diets appear to improve eating behaviors, and the evidence reviewed argues against the notion that they may worsen the severity of binge eating. Moreover, they may lead to short-term changes in brain structure and improvements in cerebrovascular markers which, in turn, could impact eating behaviors. Non-restrictive interventions may have a positive effect on weight management and eating behaviors. However, evidence of their neural effects is scarce. Small sample sizes, short follow-ups, and the absence of control groups are limitations of the studies targeting both interventions. Rigorous long-term randomized studies are needed to examine the neurobehavioral effects of restrictive and non-restrictive approaches.

Physiotherapy and related management for childhood obesity: A systematic scoping review

INTRODUCTION

Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity.

METHOD

A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy.

RESULTS

From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively.

CONCLUSION

When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.

Training-Induced Neural Plasticity in Youth: A Systematic Review of Structural and Functional MRI Studies

Experience-dependent neural plasticity is high in the developing brain, presenting a unique window of opportunity for training. To optimize existing training programs and develop new interventions, it is important to understand what processes take place in the developing brain during training. Here, we systematically review MRI-based evidence of training-induced neural plasticity in children and adolescents. A total of 71 articles were included in the review. Significant changes in brain activation, structure, microstructure, and structural and functional connectivity were reported with different types of trainings in the majority (87%) of the studies. Significant correlation of performance improvement with neural changes was reported in 51% of the studies. Yet, only 48% of the studies had a control condition. Overall, the review supports the hypothesized neural changes with training while at the same time charting empirical and methodological desiderata for future research.

Effects of physical activity interventions on cognitive performance of overweight or obese children and adolescents: a systematic review and meta-analysis

BACKGROUND

Physical activity (PA) and obesity were linked with poor cognition. Our study assessed PA interventions could improve domain-specific cognition among overweight/obese youth.

METHODS

Systematically searched PubMed to identify relevant studies published up to October 2019. Standardized mean differences (SMD) of pre-post intervention were calculated in meta-analysis. The level of study heterogeneity represented by I² was interpreted as small (I² ≤ 25%), moderate (25% < I² ≤ 50%), substantial (50% < I² ≤ 75%), or considerable (I² > 75%).

RESULTS

Seventeen studies met the inclusion criteria; eight were included in the meta-analysis. Meta-analysis revealed that PA interventions improved core executive functions (core-EFs) (SMD = 0.301; 95% CI = 0.002-0.600; I²% = 80.6%) and non-EFs (SMD = 0.159; 95% CI = 0.029-0.289; I²% = 0.0%), but not metacognition and academic performance. Core-EFs benefited from enriched PA (SMD = 0.535; 95% CI = 0.020-1.051; I²% = 72.0%) and enhanced and enriched PA (SMD = 1.005; 95% CI = 0.017-1.993; I²% = 90.8%) interventions, while the non-EFs benefited more from enhanced PA (SMD = 0.166; 95% CI = 0.018-0.314; I²% = 0.0%). Interventions with a favorable effect on adiposity measures resulted in a significantly greater improvement in core-EFs (SMD = 0.438; 95% CI = 0.047-0.829; I²% = 58.8%) than those with no effects.

CONCLUSIONS

PA interventions can improve several domains of cognition, especially core-EFs and non-EFs, and the effects are affected by PA characteristics among overweight and obese youth.

IMPACT

Our study is the first to quantify the effect of PA interventions on CP among overweight or obese children and adolescents. Physical activity interventions positively affect cognitive performance, especially core executive functions (core-EFs) and non-EFs. Physical activity interventions seem to not positively affect metacognition (higher-level EFs and cognitive life skills) and academic performance. Physical task characteristics could influence the effect of chronic exercise on cognitive performance. Short-term physical activity programs may be particularly beneficial to affect core-EFs.

Cognitive Impairments and Associated Structural Brain Changes in Metabolic Syndrome and Implications of Neurocognitive Intervention

Currently, metabolic syndrome has become a global health problem. Alterations in neurocognitive functions among patients with metabolic syndrome are important issues in this disorder. In this paper, studies on metabolic syndrome were reviewed and their importance emphasized for the benefit of experts and policy makers. Metabolic syndrome activates inflammatory mediators that disrupt brain metabolism. These mediators can be activated by metabolic inflammation and microvascular disorders and may further cause damage to the white matter and impair cognitive function. These alterations can result in serious changes in cognitive abilities. The association between cognitive changes and metabolic syndrome has been independently evaluated in several studies. In addition, some areas of research in the field of metabolic syndrome include the effectiveness of neurocognitive interventions to enhance normal behaviors or reduce risky behaviors in patients. Structural brain correlates of health-related behaviors provide a basis for designing more effective behavioral interventions by identifying the corresponding brain regions and using behavioral interventions.

Influence of magnitude of weight loss on Adipo/lep ratio in adolescents with obesity undergoing multicomponent therapy

BACKGROUND AND AIMS

The expansion of adipose tissue increases leptin secretion associated with a reduction of adiponectin concentration, which negatively affects health of adolescents with obesity. This study aims to investigate the effects of non-intensive interdisciplinary therapy on cardiometabolic parameters including leptin, adiponectin and adiponectin/leptin ratio as a dependent manner on its magnitude of weight loss reduction.

METHODS AND RESULTS

Thirty-eight adolescents (14-19 y.o) were enrolled in an interdisciplinary therapy for 20 weeks. Body composition, biochemical parameters, leptin and adiponectin were measured at baseline and after therapy. The adolescents were divided into two groups according to the magnitude of total weight loss, less than 5% (<5%-n = 18) or greater than or equal to 5% (≥5%-n = 20). Leptin decreased in whole group after therapy, while adiponectin, and adiponectin/leptin ratio increased. Additionally, body composition was improved. Only the group who lost ≥5% of body weight could reduce the inflammatory state.

CONCLUSION

The interdisciplinary therapy contributes to improve cardiometabolic parameters that could be involved on inflammation in adolescents with obesity, this improvement occurred mainly when the weight loss is ≥5% of body weight. It could be a target for control the inflammatory process related to obesity in adolescents.

The association between mental rotation capacity and motor impairment in children with obesity-an exploratory study

BACKGROUND

Motor impairments are relatively common in children with obesity and evidence suggests that these difficulties go beyond those expected based on the extra weight. This study aimed to investigate the mental rotation capacity in children with obesity, i.e., the ability to mentally view and rotate spatial information, which is a function of both visual-spatial and action representation processes. In particular, we examined whether children with obesity solved mental hand rotation tasks using an egocentric perspective (i.e., motor imagery) and if performance was related to their motor competence.

METHODS

Fifty children (age range: 7-11 y) of which 19 with obesity and motor impairments (OB-) as assessed by the Movement Assessment Battery for Children (2nd version), 13 with obesity without motor impairments (OB+) and 18 control children with a healthy weight (HW) and normal motor competence, were submitted to a classic hand rotation task. Sitting at a desk the children were instructed to indicate the laterality of a picture of a hand displayed on a monitor as quickly and as accurately as possible.

RESULTS

The results indicate no differences in response time between groups (2,648 ms, 2,558 ms, 2,664 ms for OB-, OB+ and HW respectively). The OB- group, however, had significantly lower accuracy rates and inverse efficiency scores than the HW group (Accuracy: 72% vs. 89%; Inverse efficiency: 4,428 vs. 3,238). No difference was observed in accuracy and inverse efficiency between the OB+ and HW group (Accuracy: 86%; Inverse efficiency: 3,432). In all groups, slower and more error-prone responses were observed when the angle of rotation was larger and when the hand on display was incongruent with the posture of the participants, which indicates that judgments were made from an egocentric perspective and involved motor imagery.

CONCLUSION

All children, including those with obesity, appear to engage in motor imagery. This notion needs to be investigated further in children with obesity and motor impairments, given their generally lower accuracy and decreased efficiency, which may indicate a reduced mental rotation capacity.

Is There a Contribution of Structural Brain Phenotypes to the Variance in Resting Energy Expenditure before and after Weight Loss in Overweight Females?

Brain gray (GM) and white matter (WM) are associated with resting energy expenditure (REE). The impact of weight loss on GM and WM masses, as well as on their associations with REE and the ratio between body and brain metabolism, i.e., encephalic measure (EM)), are unknown. Longitudinal data of 69 female Caucasian subjects (age range 19–69 years) with detailed information on fat mass (FM), fat free mas (FFM), GM, WM and REE. Mean weight loss was 14.5 ± 11.9 kg with changes in FM (−12.9 ± 9.8 kg), FFM (−1.7 ± 4.8 kg) and REE (−159 ± 191 kcal/24 h) (all p < 0.05). With weight loss, there were no changes in GM and WM. Before and after weight loss, FFM was the main determinant of REE (r² = 0.483 and 0.413; p < 0.05). After weight loss, GM added to the variances in REE (3.6%), REE_adjFFM (6.1%) and the REE on FFM residuals (6.6%). In addition, before and after weight loss GM explained 25.0% and 10.0% of the variances in EM (p < 0.05). Weight loss had no effect on volumes of GM and WM. After weight loss, both, GM added to the variances of REE, REE on FFM residuals and EM.

Weight loss, behavioral change, and structural neuroplasticity in children with obesity through a multidisciplinary treatment program

This study evaluated the effect of a multidisciplinary treatment program for children with obesity (OB) on motor competence, executive functioning (EF), and brain structure. Nineteen children with OB (7-11 years), who attended a multidisciplinary treatment program consisting of diet restriction, cognitive behavioral therapy, and physical activity, were compared with an age-matched control group of 24 children with a healthy weight (HW), who did not follow any treatment. For both groups, anthropometric measurements and tests of motor competence and EF were administered twice, with 5 months between pretest and posttest. Additionally, children's brain structure was assessed by performing a magnetic resonance imaging (MRI) scan at the pretest and posttest, which included a T1 anatomical scan, diffusion MRI scan, and magnetization transfer imaging scan. Compared to HW controls, children with OB lost a considerable amount of their body mass (p ≤ .001) and significantly improved their balance skills (p ≤ .001), while no transfer effects of the program were observed for EF. Furthermore, the program resulted in a significant increase in total (p ≤ .001) and cerebellar (p ≤ .001) gray matter volume in children with OB, while no change was observed in the HW controls. Finally, only weak to moderate (nonsignificant) correlations could be observed between structural brain alterations, weight-related changes, and behavioral improvements. Altogether, this is the first longitudinal study showing behavioral and structural brain alterations in response to a multidisciplinary weight loss program for children with OB. Our findings support the need for multidimensional intervention (and prevention) measures for children with OB to deal with this multifactorial health problem.