ESPE Abstracts

Background: Obesity interventions often result in increased motivation to eat after weight loss.

Objective: We investigated relationships between obesity outcomes and changes in brain activation by visual food cues and hormone levels in response to obesity intervention by family-based behavioral treatment (FBT).

Design, Methods, and Participants: Functional neuroimaging and plasma hormone assessments before and after 24-week FBT intervention in children with obesity (OB, n=28), or children of healthy weight without intervention (HW, n=17), all 9-11-year-old males and females.

Main Outcome Measure(s): Evaluation of meal-induced changes in neural activation in response to viewing high- vs. low-calorie food cues across appetite-processing brain regions and gut hormones.

Results: Among children with OB who underwent FBT, greater declines of BMI z-score were associated with less reductions after the FBT intervention in meal-induced changes in neural activation to high- vs. low-calorie food cues across appetite-processing brain regions (P<0.05), and the slope of relationship was significantly different compared to children of HW. In children with OB, less reduction in brain responses to a meal from before to after FBT was associated with greater meal-induced reduction in ghrelin and increased meal-induced stimulation in peptide YY and glucagon-like peptide-1 (all P<0.05). Furthermore, a greater reduction of BMI z-score was associated with a greater reduction of free leptin index and increase of the adiponectin to leptin ratio (all P<0.01), indicating an increase in leptin sensitivity. After FBT, an increased buffet meal intake was associated with higher leptin levels (P<0.05).

Conclusions: In response to FBT, adaptations of central satiety responses and peripheral satiety-regulating hormones were noted. After weight loss, changes of peripheral hormone secretion support weight loss, but there was a weaker central satiety response. The findings suggest that even when peripheral satiety responses by gut hormones are intact, the central regulation of satiety is disturbed in children with OB who significantly improve their weight status during FBT, which could favor future weight regain.