Neural correlates to food-related behavior in normal-weight and overweight/obese participants

Neuroimaging Investigations of Obesity: a Review of the Treatment of Sex from 2010

PURPOSE OF REVIEW

To summarize the results of adult obesity neuroimaging studies (structural, resting-state, task-based, diffusion tensor imaging) published from 2010, with a focus on the treatment of sex as an important biological variable in the analysis, and identify gaps in sex difference research.

RECENT FINDINGS

Neuroimaging studies have shown obesity-related changes in brain structure, function, and connectivity. However, relevant factors such as sex are often not considered. We conducted a systematic review and keyword co-occurrence analysis. Literature searches identified 6281 articles, of which 199 met inclusion criteria. Among these, only 26 (13%) considered sex as an important variable in the analysis, directly comparing the sexes (n = 10; 5%) or providing single-sex/disaggregated data (n = 16, 8%); the remaining studies controlled for sex (n = 120, 60%) or did not consider sex in the analysis (n = 53, 27%). Synthesizing sex-based results, obesity-related parameters (e.g., body mass index, waist circumference, obese status) may be generally associated with more robust morphological alterations in men and more robust structural connectivity alterations in women. Additionally, women with obesity generally expressed increased reactivity in affect-related regions, while men with obesity generally expressed increased reactivity in motor-related regions; this was especially true under a fed state. The keyword co-occurrence analysis indicated that sex difference research was especially lacking in intervention studies. Thus, although sex differences in the brain associated with obesity are known to exist, a large proportion of the literature informing the research and treatment strategies of today has not specifically examined sex effects, which is needed to optimize treatment.

More complex than you might think: Neural representations of food reward value in obesity

Obesity reached pandemic proportions and weight-loss treatments are mostly ineffective. The level of brain activity in the reward circuitry is proposed to be proportionate to the reward value of food stimuli, and stronger in people with obesity. However, empirical evidence is inconsistent. This may be due to the double-sided nature of high caloric palatable foods: at once highly palatable and high in calories (unhealthy). This study hypothesizes that, viewing high caloric palatable foods, a hedonic attentional focus compared to a health and a neutral attentional focus elicits more activity in reward-related brain regions, mostly in people with obesity. Moreover, caloric content and food palatability can be decoded from multivoxel patterns of activity most accurately in people with obesity and in the corresponding attentional focus. During one fMRI-session, attentional focus (hedonic, health, neutral) was manipulated using a one-back task with individually tailored food stimuli in 32 healthy-weight people and 29 people with obesity. Univariate analyses (p < 0.05, FWE-corrected) showed that brain activity was not different for palatable vs. unpalatable foods, nor for high vs. low caloric foods. Instead, this was higher in the hedonic compared to the health and neutral attentional focus. Multivariate analyses (MVPA) (p < 0.05, FDR-corrected) showed that palatability and caloric content could be decoded above chance level, independently of either BMI or attentional focus. Thus, brain activity to visual food stimuli is neither proportionate to the reward value (palatability and/or caloric content), nor significantly moderated by BMI. Instead, it depends on people's attentional focus, and may reflect motivational salience. Furthermore, food palatability and caloric content are represented as patterns of brain activity, independently of BMI and attentional focus. So, food reward value is reflected in patterns, not levels, of brain activity.

Reassessing relationships between appetite and adiposity in people at risk of obesity: A twin study using fMRI

BACKGROUND

Neuroimaging studies suggest that appetitive drive is enhanced in obesity.

OBJECTIVE

To test if appetitive drive varies in direct proportion to the level of body adiposity after accounting for genetic factors that contribute to both brain response and obesity risk.

SUBJECTS/METHODS

Participants were adult monozygotic (n = 54) and dizygotic (n = 30) twins with at least one member of the pair with obesity. Body composition was assessed by dual-energy X-ray absorptiometry. Hormonal and appetite measures were obtained in response to a standardized meal that provided 20% of estimated daily caloric needs and to an ad libitum buffet meal. Pre- and post-meal functional magnetic resonance imaging (fMRI) assessed brain response to visual food cues in a set of a priori appetite-regulating regions. Exploratory voxelwise analyses outside a priori regions were performed with correction for multiple comparisons.

RESULTS

In a group of 84 adults, the majority with obesity (75%), body fat mass was not associated with hormonal responses to a meal (glucose, insulin, glucagon-like peptide-1 and ghrelin, all P>0.40), subjective feelings of hunger (β=-0.01 mm [95% CI -0.35, 0.34] P = 0.97) and fullness (β=0.15 mm [-0.15, 0.44] P = 0.33), or buffet meal intake in relation to estimated daily caloric needs (β=0.28% [-0.05, 0.60] P = 0.10). Body fat mass was also not associated with brain response to high-calorie food cues in appetite-regulating regions (Pre-meal β=-0.12 [-0.32, 0.09] P = 0.26; Post-meal β=0.18 [-0.02, 0.37] P = 0.09; Change by a meal β=0.29 [-0.02, 0.61] P = 0.07). Conversely, lower fat mass was associated with being weight reduced (β=-0.05% [-0.07, -0.03] P<0.001) and greater pre-meal activation to high-calorie food cues in the dorsolateral prefrontal cortex (Z = 3.63 P = 0.017).

CONCLUSIONS

In a large study of adult twins, the majority with overweight or obesity, the level of adiposity was not associated with excess appetitive drive as assessed by behavioral, hormonal, or fMRI measures.

Sensory cue reactivity: Sensitization in alcohol use disorder and obesity

Neuroimaging techniques to measure the function of the human brain such as electroencephalography (EEG), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI), are powerful tools for understanding the underlying neural circuitry associated with alcohol use disorder (AUD) and obesity. The sensory (visual, taste and smell) paradigms used in neuroimaging studies represent an ideal platform to investigate the connection between the different neural circuits subserving the reward/executive control systems in these disorders, which may offer a translational mechanism for novel intervention predictions. Thus, the current review provides an integrated summary of the recent neuroimaging studies that have applied cue-reactivity paradigms and neuromodulation strategies to explore underlying alterations in neural circuitry as well in treatment strategies in AUD and obesity. Finally, we discuss literature on mechanisms associated with increased alcohol sensitivity post-bariatric surgery (BS) which offers guidance for future research to use sensory percepts in elucidating the relation of reward signaling in AUD development post-BS.

Impact of High Fat Diet and Ethanol Consumption on Neurocircuitry Regulating Emotional Processing and Metabolic Function

The prevalence of psychiatry disorders such as anxiety and depression has steadily increased in recent years in the United States. This increased risk for anxiety and depression is associated with excess weight gain, which is often due to over-consumption of western diets that are typically high in fat, as well as with binge eating disorders, which often overlap with overweight and obesity outcomes. This finding suggests that diet, particularly diets high in fat, may have important consequences on the neurocircuitry regulating emotional processing as well as metabolic functions. Depression and anxiety disorders are also often comorbid with alcohol and substance use disorders. It is well-characterized that many of the neurocircuits that become dysregulated by overconsumption of high fat foods are also involved in drug and alcohol use disorders, suggesting overlapping central dysfunction may be involved. Emerging preclinical data suggest that high fat diets may be an important contributor to increased susceptibility of binge drug and ethanol intake in animal models, suggesting diet could be an important aspect in the etiology of substance use disorders. Neuroinflammation in pivotal brain regions modulating metabolic function, food intake, and binge-like behaviors, such as the hypothalamus, mesolimbic dopamine circuits, and amygdala, may be a critical link between diet, ethanol, metabolic dysfunction, and neuropsychiatric conditions. This brief review will provide an overview of behavioral and physiological changes elicited by both diets high in fat and ethanol consumption, as well as some of their potential effects on neurocircuitry regulating emotional processing and metabolic function.

Effects of hunger on mood and affect reactivity to monetary reward in women with obesity - A pilot study

Worldwide, nearly 3 million people die every year because of being overweight or obese. Although obesity is a metabolic disease, behavioral aspects are important in its etiology. Hunger changes the rewarding potential of food in normal-weight controls. In obesity, impairments related to reward processing are present, but it is not clear whether these are due to mental disorders more common among this population. Therefore, in this pilot study, we aimed at investigating whether fasting influence mood reactivity to reward in people with obesity. Women with obesity (n = 11, all mentally healthy) and normal weight controls (n = 17) were compared on a computerized monetary reward task (the wheel of fortune), using self-reports of mood and affect (e.g., PANAS and mood evaluation during the task) as dependent variables. This task was done in 2 satiety conditions, during fasting and after eating. Partially, in line with our expectation of a reduced affect and mood reactivity to monetary reward in participants with obesity accentuated by fasting, our results indicated a significant within-group difference across time (before and after the task), with monetary gains significantly improving positive affect in healthy controls (p>0.001), but not in individuals with obesity (p = 0.32). There were no significant between-group differences in positive affect before (p = 0.328) and after (p = 0.70) the task. In addition, women with obesity, compared to controls, reported more negative affect in general (p < 0.05) and less mood reactivity during the task in response to risky gains (p < 0.001) than healthy controls. The latter was independent of the level of satiety. These preliminary results suggest an impairment in mood reactivity to monetary reward in women with obesity which is not connected to the fasting state. Increasing the reinforcing potential of rewards other than food in obesity may be one target of intervention in order to verify if that could reduce overeating.

Oxytocin reduces the functional connectivity between brain regions involved in eating behavior in men with overweight and obesity

Background:

Oxytocin (OXT), shown to decrease food intake in animal models and men, is a promising novel treatment for obesity. We have shown that in men with overweight and obesity, intranasal (IN) OXT reduced the functional magnetic resonance imaging (fMRI) blood oxygenation level-dependent signal in the ventral tegmental area (VTA), the origin of the mesolimbic dopaminergic reward system, in response to high-calorie food vs. non-food images. Here, we employed functional connectivity fMRI analysis, which measures the synchrony in activation between neural systems in a context-dependent manner. We hypothesized that OXT would attenuate the functional connectivity of the VTA with key food motivation brain areas only when participants viewed high-calorie food stimuli.

Methods:

This randomized, double-blind, placebo-controlled crossover study of 24 IU IN OXT included 10 men with overweight or obesity (mean±SEM BMI: 28.9±0.8 kg/m²). Following drug administration, subjects completed an fMRI food motivation paradigm including images of high and low-calorie foods, non-food objects, and fixation stimuli. A psychophysiological interaction analysis was performed with the VTA as seed region.

Results:

Following OXT administration, compared with placebo, participants exhibited significantly attenuated functional connectivity between the VTA and the insula, oral somatosensory cortex, amygdala, hippocampus, operculum, and middle temporal gyrus in response to viewing high-calorie foods (Z≥3.1, cluster-corrected, p<0.05). There was no difference in functional connectivity between VTA and these brain areas when comparing OXT and placebo for low-calorie food, non-food, and fixation images.

Conclusion:

In men with overweight and obesity, OXT attenuates the functional connectivity between the VTA and food motivation brain regions in response to high-calorie visual food images. These findings could partially explain the observed anorexigenic effect of OXT, providing insight into the mechanism through which OXT ameliorates food cue-induced reward anticipation in patients with obesity. Additional studies are ongoing to further delineate the anorexigenic effect of OXT in obesity.

Hungry brains: A meta-analytical review of brain activation imaging studies on food perception and appetite in obese individuals

The dysregulation of food intake in chronic obesity has been explained by different theories. To assess their explanatory power, we meta-analyzed 22 brain-activation imaging studies. We found that obese individuals exhibit hyper-responsivity of the brain regions involved in taste and reward for food-related stimuli. Consistent with a Reward Surfeit Hypothesis, obese individuals exhibit a ventral striatum hyper-responsivity in response to pure tastes, particularly when fasting. Furthermore, we found that obese subjects display more frequent ventral striatal activation for visual food cues when satiated: this continued processing within the reward system, together with the aforementioned evidence, is compatible with the Incentive Sensitization Theory. On the other hand, we did not find univocal evidence in favor of a Reward Deficit Hypothesis nor for a systematic deficit of inhibitory cognitive control. We conclude that the available brain activation data on the dysregulated food intake and food-related behavior in chronic obesity can be best framed within an Incentive Sensitization Theory. Implications of these findings for a brain-based therapy of obesity are briefly discussed.

Functional and structural plasticity contributing to obesity: roles for sex, diet, and individual susceptibility

The role of cortico-striatal pathways in cue-triggered motivational processes have been extensively studied. However, recent work has begun to examine the potential contribution of plasticity in these circuits to obesity. Despite the inclusion of women in human obesity studies examining neurobehavioral alterations in cue-triggered motivation, preclinical studies have focused mainly on male subjects. This lack of female subjects in preclinical research had led to a gap in the basic understanding of the neural mechanisms underlying over-eating in females. In this review, we highlight recent work from our lab and others that has begun to elucidate how diet, obesity, and individual susceptibility to weight gain influence functional and structural plasticity within the nucleus accumbens and prefrontal cortex in adult rats. As is the case throughout neuroscience, studies of females or sex differences are largely lacking in this area. Thus, below we describe preliminary neurobehavioral results from female studies in our labs and point out areas for future investigation.

Taste at first (person) sight: Visual perspective modulates brain activity implicitly associated with viewing unhealthy but not healthy foods

Every day, people are exposed to images of appetizing foods that can lead to high-calorie intake and contribute to overweight and obesity. Research has documented that manipulating the visual perspective from which eating is viewed helps resist temptation by altering the appraisal of unhealthy foods. However, the neural basis of this effect has not yet been examined using neuroimaging methods. Moreover, it is not known whether the benefits of this strategy can be observed when people, especially overweight, are not explicitly asked to imagine themselves eating. Last, it remains to be investigated if visual perspective could be used to promote healthy foods. The present work manipulated camera angles and tested whether visual perspective modulates activity in brain regions associated with taste and reward processing while participants watch videos featuring a hand grasping (unhealthy or healthy) foods from a plate during functional magnetic resonance imagining (fMRI). The plate was filmed from the perspective of the participant (first-person perspective; 1PP), or from a frontal view as if watching someone else eating (third-person perspective; 3PP). Our findings reveal that merely viewing unhealthy food cues from a 1PP (vs. 3PP) increases activity in brain regions that underlie representations of rewarding (appetitive) experiences (amygdala) and food intake (superior parietal gyrus). Additionally, our results show that ventral striatal activity is positively correlated with body mass index (BMI) during exposure to unhealthy foods from a 1PP (vs. 3PP). These findings suggest that unhealthy foods should be promoted through third-person (video) images to weaken the reward associated with their simulated consumption, especially amongst overweight people. It appears however that, as such, manipulating visual perspective fails to enhance the perception of healthy foods. Their promotion thus requires complementary solutions.

Parental control and overconsumption of snack foods in overweight and obese children

The associations between snack food consumption, parent feeding practices and general parenting in overweight in obese children are largely unknown. Therefore, we examined these relationships in 117 treatment-seeking overweight and obese children (10.40 ± 1.35 years; 53% female; 52% Caucasian; BMI-z: 2.06 ± .39). Children consumed a dinner meal, completed an Eating in the Absence of Hunger (EAH) free access paradigm (total EAH intake = EAH%-total; sweet food intake = EAH%-sweet), and completed the Child Report of Parent Behavior Inventory. Parents completed the Child Feeding Questionnaire. Child EAH%-total and EAH%-sweet were positively associated with dinner consumption (p's < .01). Girls had significantly higher EAH%-total compared to boys (p < .05). In separate models, higher EAH%-total was associated with greater use of maternal psychological control (p < .05) and EAH%-sweet was positively associated with parent monitoring (p < .05). In analyses examining factors associated with the consumption of specific foods, EAH snack food, parent restriction, pressure to eat, monitoring, and maternal psychological control were positively correlated with intake of Hershey's(®) chocolate bars (p's < .05). In summary, parental monitoring is associated with child sweet snack food intake and maternal psychological control is associated with child total snack food consumption. Future research should evaluate the complex relationship between child eating and parenting, especially with regard to subgroups of foods.

Brain regulation of food craving: relationships with weight status and eating behavior

OBJECTIVES

Food craving is a driving force for overeating and obesity. However, the relationship between brain mechanisms involved in its regulation and weight status is still an open issue. Gaps in the studied body mass index (BMI) distributions and focusing on linear analyses might have contributed to this lack of knowledge. Here, we investigated brain mechanisms of craving regulation using functional magnetic resonance imaging in a balanced sample including normal-weight, overweight and obese participants. We investigated associations between characteristics of obesity, eating behavior and regulatory brain function focusing on nonlinear relationships.

SUBJECTS/METHODS

Forty-three hungry female volunteers (BMI: 19.4-38.8 kg m(-2), mean: 27.5±5.3 s.d.) were presented with visual food stimuli individually pre-rated according to tastiness and healthiness. The participants were instructed to either admit to the upcoming craving or regulate it. We analyzed the relationships between regulatory brain activity as well as functional connectivity and BMI or eating behavior (Three-Factor Eating Questionnaire, scales: Cognitive Restraint, Disinhibition).

RESULTS

During regulation, BMI correlated with brain activity in the left putamen, amygdala and insula in an inverted U-shaped manner. Functional connectivity between the putamen and the dorsolateral prefrontal cortex (dlPFC) correlated positively with BMI, whereas that of amygdala with pallidum and lingual gyrus was nonlinearly (U-shaped) associated with BMI. Disinhibition correlated negatively with the strength of functional connectivity between amygdala and dorsomedial prefrontal (dmPFC) cortex as well as caudate.

CONCLUSIONS

This study is the first to reveal quadratic relationships of food-related brain processes and BMI. Reported nonlinear associations indicate inverse relationships between regulation-related motivational processing in the range of normal weight/overweight compared with the obese range. Connectivity analyses suggest that the need for top-down (dlPFC) adjustment of striatal value representations increases with BMI, whereas the interplay of self-monitoring (dmPFC) or eating-related strategic action planning (caudate) and salience processing (amygdala) might be hampered with high Disinhibition.

The central nervous norepinephrine network links a diminished sense of emotional well-being to an increased body weight

OBJECTIVES

The neurobiological mechanisms linking obesity to emotional distress remain largely undiscovered.

METHODS

In this pilot study, we combined positron emission tomography, using the norepinephrine transporter (NET) tracer [(11)C]-O-methylreboxetine, with functional connectivity magnetic resonance imaging, the Beck depression inventory (BDI), and the impact of weight on quality of life-Lite questionnaire (IWQOL-Lite), to investigate the role of norepinephrine in the severity of depression (BDI), as well as in the loss of emotional well-being with body weight (IWQOL-Lite).

RESULTS

In a small group of lean-to-morbidly obese individuals (n=20), we show that an increased body mass index (BMI) is related to a lowered NET availability within the hypothalamus, known as the brain's homeostatic control site. The hypothalamus displayed a strengthened connectivity in relation to the individual hypothalamic NET availability to the anterior insula/frontal operculum, as well as the medial orbitofrontal cortex, assumed to host the primary and secondary gustatory cortex, respectively (n=19). The resting-state activity in these two regions was correlated positively to the BMI and IWQOL-Lite scores, but not to the BDI, suggesting that the higher the resting-state activity in these regions, and hence the higher the BMI, the stronger the negative impact of the body weight on the individual's emotional well-being was.

CONCLUSIONS

This pilot study suggests that the loss in emotional well-being with weight is embedded within the central norepinephrine network.

Eating behavior associated with gray matter volume alternations: A voxel based morphometry study

Little is known about whether eating behavior is associated with alterations of brain structure or whether the possible alterations are related to body weight status. The current study employed structural imaging from an open MRI data set (http://fcon_1000.

PROJECTS

nitrc.org/indi/pro/nki.html) to examine the relationship between eating behavior traits and brain structural changes. The eating behavior traits were measured by the Three Factor Eating Questionnaire Scale. The brain structural alterations were analyzed using the Voxel Based Morphometry (VBM) method, and a multiple linear regression model was constructed to identify significant brain structural changes that related to eating behavior factors. We found that cognitive restraint of eating was positively correlated with the gray matter volume (GMV) in the dorsolateral prefrontal cortex (DLPFC) and negatively correlated with the GMV in the putamen; disinhibition scores were negatively associated with the GMV in the left middle frontal gyrus; hunger scores showed a positive correlation with the GMV in the hypothalamus and the visual memory areas and a negative association with the GMV in the inferior temporal gyrus and the bilateral middle frontal gyrus. These results indicated a close connection between the eating behavior traits and structural changes in particular brain regions. Conjunction analysis was also performed to further explore the brain structural alterations that were commonly associated with eating behavior and weight status. The findings add to our understanding of the neural basis underlying eating behaviors, and the connection between these behaviors and body weight status.

Neural responses to visual food cues according to weight status: a systematic review of functional magnetic resonance imaging studies

Emerging evidence from recent neuroimaging studies suggests that specific food-related behaviors contribute to the development of obesity. The aim of this review was to report the neural responses to visual food cues, as assessed by functional magnetic resonance imaging (fMRI), in humans of differing weight status. Published studies to 2014 were retrieved and included if they used visual food cues, studied humans >18 years old, reported weight status, and included fMRI outcomes. Sixty studies were identified that investigated the neural responses of healthy weight participants (n = 26), healthy weight compared to obese participants (n = 17), and weight-loss interventions (n = 12). High-calorie food images were used in the majority of studies (n = 36), however, image selection justification was only provided in 19 studies. Obese individuals had increased activation of reward-related brain areas including the insula and orbitofrontal cortex in response to visual food cues compared to healthy weight individuals, and this was particularly evident in response to energy dense cues. Additionally, obese individuals were more responsive to food images when satiated. Meta-analysis of changes in neural activation post-weight loss revealed small areas of convergence across studies in brain areas related to emotion, memory, and learning, including the cingulate gyrus, lentiform nucleus, and precuneus. Differential activation patterns to visual food cues were observed between obese, healthy weight, and weight-loss populations. Future studies require standardization of nutrition variables and fMRI outcomes to enable more direct comparisons between studies.

Milk protein fractions moderately extend the duration of satiety compared with carbohydrates independently of their digestive kinetics in overweight subjects

Digestive kinetics are believed to modulate satiety through the modulation of nutrient delivery. We hypothesised that the duration of satiety could be extended by modulating the kinetics of dietary amino acid delivery in overweight subjects, using snacks containing casein and whey protein. In the present study, eighty-two subjects underwent a first satiety test where they received a control snack containing 60 g maltodextrin. For the next 5 d, the subjects consumed a liquid protein snack containing 30 g carbohydrates and 30 g proteins (casein, whey protein or an equal mix of the two; n 26–28 per group). The subjects then underwent a second satiety test after ingesting the protein snack. The time period elapsing between the snack and request for lunch, food intake at lunch and satiety scores were recorded. A subgroup of twenty-four subjects underwent a digestive and metabolic investigation after ingesting their protein snack. Gastric emptying times were 2·5, 4 and 6 h for whey protein, mix and casein, respectively, displaying different kinetics of appearance of dietary N in plasma but without affecting pancreatic and gastrointestinal hormones. Compared with the control snack, proteins extended the duration of satiety (+17 min, P= 0·02), with no difference between the protein groups. The satiating effect of proteins was greater in subjects who ate their lunch early after the snack (below the median value, i.e. 2 h) at the control test (+32 min, P= 0·001). Energy intake at lunch was not modulated by proteins. The satiating effect of proteins is efficient in overweight subjects, especially when the duration of satiety is short, but independently of their digestive and plasma amino acid kinetics.

Reward for food odors: an fMRI study of liking and wanting as a function of metabolic state and BMI

Brain reward systems mediate liking and wanting for food reward. Here, we explore the differential involvement of the following structures for these two components: the ventral and dorsal striatopallidal area, orbitofrontal cortex (OFC), anterior insula and anterior cingulate. Twelve healthy female participants were asked to rate pleasantness (liking of food and non-food odors) and the desire to eat (wanting of odor-evoked food) during event-related functional magnetic resonance imaging (fMRI). The subjective ratings and fMRI were performed in hunger and satiety states. Activations of regions of interest were compared as a function of task (liking vs wanting), odor category (food vs non-food) and metabolic state (hunger vs satiety). We found that the nucleus accumbens and ventral pallidum were differentially involved in liking or wanting during the hunger state, which suggests a reciprocal inhibitory influence between these structures. Neural activation of OFC subregions was correlated with either liking or wanting ratings, suggesting an OFC role in reward processing magnitude. Finally, during the hunger state, participants with a high body mass index exhibited less activation in neural structures underlying food reward processing. Our results suggest that food liking and wanting are two separable psychological constructs and may be functionally segregated within the cortico-striatopallidal circuit.

Gastrointestinal morbidity in obesity

Obesity is a complex disease that results from increased energy intake and decreased energy expenditure. The gastrointestinal system plays a key role in the pathogenesis of obesity and facilitates caloric imbalance. Changes in gastrointestinal hormones and the inhibition of mechanisms that curtail caloric intake result in weight gain. It is not clear if the gastrointestinal role in obesity is a cause or an effect of this disease. Obesity is often associated with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Obesity is also associated with gastrointestinal disorders, which are more frequent and present earlier than T2DM and CVD. Diseases such as gastroesophageal reflux disease (GERD), cholelithiasis, or nonalcoholic steatohepatitis are directly related to body weight and abdominal adiposity. Our objective is to assess the role of each gastrointestinal organ in obesity and the gastrointestinal morbidity resulting in those organs from the effects of obesity.

Comparing the effects of food restriction and overeating on brain reward systems

Both caloric restriction and overeating have been shown to affect neural processes associated with reinforcement. Both preclinical and some clinical studies have provided evidence that food restriction may increase reward sensitivity, and while there are mixed findings regarding the effects of overeating on reward sensitivity, there is strong evidence linking this behavior with changes in reward-related brain regions. Evidence of these changes comes in part from findings that show that such eating patterns are associated with increased drug use. The data discussed here regarding the differential effects of various eating patterns on reward systems may be particularly relevant to the aging population, as this population has been shown to exhibit altered reward sensitivity and decreased caloric consumption. Moreover, members of this population appear to be increasingly affected by the current obesity epidemic. Food, like alcohol or drugs, can stimulate its own consumption and produce similar neurochemical changes in the brain. Age-related loss of appetite, decreased eating, and caloric restriction are hypothesized to be associated with changes in the prevalence of substance misuse, abuse, and dependence seen in this cohort.

Chronic stress exposure may affect the brain's response to high calorie food cues and predispose to obesogenic eating habits

Exaggerated reactivity to food cues involving calorically-dense foods may significantly contribute to food consumption beyond caloric need. Chronic stress, which can induce palatable "comfort" food consumption, may trigger or reinforce neural pathways leading to stronger reactions to highly rewarding foods. We implemented functional magnetic resonance imaging (fMRI) to assess whether chronic stress influences activation in reward, motivation and executive brain regions in response to pictures of high calorie and low calorie foods in thirty women. On separate lab visits, we also assessed food intake from a snack food buffet and circulating cortisol. In women reporting higher chronic stress (HCS), pictures of high calorie foods elicited exaggerated activity in regions of the brain involving reward, motivation, and habitual decision-making. In response to pictures of high calorie food, higher chronic stress was also associated with significant deactivation in frontal regions (BA10; BA46) linked to strategic planning and emotional control. In functional connectivity analysis, HCS strengthened connectivity between amygdala and the putamen, while LCS enhanced connectivity between amygdala and the anterior cingulate and anterior prefrontal cortex (BA10). A hypocortisolemic signature and more consumption of high calorie foods from the snack buffet were observed in the HCS group. These results suggest that persistent stress exposure may alter the brain's response to food in ways that predispose individuals to poor eating habits which, if sustained, may increase risk for obesity.