Neural Activation in Response to Food Cues in Bariatric Surgery Candidates

Haley L Yarosh, PhD, Beth M Anderson, PhD, Janet Ng, PhD, Kasey O’Neil, BS, Andrea M Stone, BS, Darren Tishler, MD, Pavlos Papasavas, MD, FACS, Godfrey D Pearlson, MBBS, MD. Yale School of Medicine Department of Psychiatry, Olin Neuropsychiatric Research Center, Hartford Hospital Surgical Weight Loss Center.


Purpose: Candidates for bariatric surgery often experience a lifelong battle with weight loss that may be correlated with intensity of food cravings in these patients. The current study explores the hypothesis that failure to achieve target BMI may be related to neural signatures of “food addiction”. Through a long-term collaboration with Hartford Hospital Surgical Weight Loss Clinic and Olin Neuropsychiatric Research Center, our overall strategy is to identify endophenotypes of bariatric surgery success BMI and % excess weight loss. In addition to this task, the grant encompasses several important measures (fMRI activity, psychiatric assessment, geneticanalysis, impulsivity measures), which will help us to address this research question.

Methods: The Food Cue Reactivity Task is adapted from an fMRI (functional magnetic resonance imaging) task in which cue-induced neural activation is associated with subsequent drinking patterns in college students (Alcohol Cue Reactivity Task – Pulido et al., 2010, Dager et al., 2013). The task asks whether participants Like (left button) Dislike (middle button) or feel Neutral about (right button) particular food pictures while in an fMRI scanner. Each participant gives responses during two rounds. During the second round, participants are told that they are being observed by a weight loss professional (nutritionist). This experimental condition will also be useful to understand how weight loss coaches function to encourage or discourage choices on a neural level. 13 consenting adults from the Surgical Weight Loss Clinic at Hartford Hospital (under the care of Drs. Darren Tishler and Pavlos Papasavas) are included in this abstract.

Results : We observe the greatest neural activation in response to unhealthy food when compared to baseline of the three groups of stimuli (unhealthy food, healthy food, scrambled pictures). This includes BOLD (blood oxygen level dependent) signal activity in the right caudate – the brain’s reward center. There is also activation in the anterior cingulate, a region frequently engaged when evaluating choices and making decisions. This region shows more significant activation when subjects are told that a nutrition professional is evaluating their choices than when the observer is not present. We hope to continue recruiting patients and follow them through their first year after surgery to see if food cue reactivity may be a predictor of long-term weight loss.

Conclusions: Food images incite neural activation in regions of the brain that are traditionally associated with reward, and even more so in response to high fat foods. Preliminary data suggest that there is greater neural activation in the ACC in the presence of a weight loss professional. We will continue to explore how this activation relates to a) self report of food liking and b) observation by a nutritionist during food viewing.


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