Sonja Yokum

Background: Test whether a dissonance-based transdiagnostic eating disorder treatment, body project treatment (BPT), produces greater reduction in brain reward region response to the thin ideal and behaviors used to pursue this ideal and eating disorder symptoms, and higher abstinence from eating disorder behaviors and remittance from eating disorder diagnoses than a matched transdiagnostic interpersonal psychotherapy (IPT). Methods: Women with various eating disorders ( N = 83) were randomized to 8-week group-implemented BPT or IPT and completed functional magnetic resonance imaging (fMRI) at pretest and posttest, and surveys and masked diagnostic interviews at pretest, posttest, and 6-month follow-up. Results: BPT versus IPT participants showed significantly greater reductions in mid cingulate cortex response to thin models, anterior cingulate cortex response to eating disorder behavior words, eating disorder symptoms ( d = 0.54), and body dissatisfaction ( d = 0.57), and marginally greater reductions in psychosocial impairment ( d = 0.39) at posttest, as well as significantly greater reductions in body dissatisfaction ( d = 0.68) and psychosocial impairment ( d = 0.63), and marginally greater reductions in eating disorder symptoms ( d = 0.53) at 6-month follow-up. At posttest, BPT versus IPT participants showed significantly greater abstinence from binge eating and purging (48% versus 23%, respectively) but did not differ on remittance from eating disorder diagnoses (52% versus 44%, respectively). Conclusions: Results provide further evidence of target engagement for BPT and suggest that it is more effective than IPT in treating a range of eating disorders.

Food advertisements target adolescents, contributing to weight gain and obesity. However, whether brain connectivity during those food advertisements can predict weight gain is unknown. Here, 121 adolescents [14.1 ± 1.0 years; 50.4% female; body mass index (BMI): 23.4 ± 4.8; 71.9% White] completed both a baseline fMRI paradigm viewing advertisements (unhealthy fast food, healthier fast food, and nonfood) and an anthropometric assessment 2 years later. We used connectome-based predictive modeling to derive brain networks that were associated with BMI both at baseline and the 2-year follow-up. During exposure to unhealthy fast-food commercials, we identified a brain network comprising high-degree nodes in the hippocampus, parahippocampal gyrus, and fusiform gyrus rich with connections to prefrontal and occipital nodes that predicted lower BMI at the 2-year follow-up (r = 0.17; P = .031). A similar network was derived from baseline BMI (n = 168; r = 0.34; P < .001). Functional connectivity networks during exposure to the healthier fast food (P = .152) and nonfood commercials (P = .117) were not significant predictors of 2-year BMI. Key brain regions in our derived networks have been previously shown to encode aspects of memory formation, visual processing, and self-control. As such, the integration of these regions may reflect a mechanism of adolescents’ ability to exert self-control toward obesogenic food stimuli.

Background: We conducted a prospective study to advance knowledge of biological factors that predict the future onset of binge eating and compensatory weight control behaviors because few biological risk factors for eating pathology have been identified. Methods: Adolescent girls free of binge eating or compensatory behaviors (N = 88; M_age = 14.5; [SD = 0.9]) completed functional magnetic resonance imaging tasks assessing individual differences in neural responsivity hypothesized to increase risk for onset of binge eating and compensatory behaviors, along with additional self-report measures, and were assessed over a 4-year follow-up. Results: Elevated responsivity of regions implicated in attention and valuation (dorsal anterior cingulate cortex; ventromedial prefrontal cortex) to thin models and lower responsivity of a reward valuation region (caudate) to anticipated milkshake tastes (which correlated with feeling fat) predicted the future onset of binge eating or compensatory behaviors over 4-year follow-up. Parental history of binge eating and compensatory behaviors, emotionality, weight/shape overvaluation, feeling fat, and elevated BMI also predicted the future onset of binge eating or compensatory behaviors. Conclusions: The evidence that elevated attentional bias for, and valuation of the thin ideal, in combination with lower valuation of high-calorie foods, predicted the future onset of eating-disordered behaviors are novel findings. The evidence that weight/shape overvaluation, feeling fat, elevated body mass, emotionality, and parental history of eating pathology predicted the future onset of eating-disordered behaviors extend past findings.

Objective: To test whether overweight/obesity is associated with an elevated reward region response to milkshake cues and a low reward region response to milkshake receipt. To test whether the risk for eating pathology moderates the effects of weight status on the neural response to milkshake cues and milkshake receipt. Method: The current study used functional magnetic resonance imaging (fMRI) to examine the neuronal responses of female adolescents (n = 80; M age = 14.6 ± 0.9; M BMI = 21.9 ± 3.6; 41% with a biological parental history of eating pathology) during a food receipt paradigm. Results: Females with overweight/obesity showed a greater ventromedial prefrontal cortex (vmPFC), and ventral anterior cingulate (ACC) response to milkshake cues and a greater ventral striatum, subgenual ACC, and dorsomedial prefrontal cortex response to milkshake receipt than those with a healthy weight. Females with overweight/obesity plus a parental history of eating pathology showed a greater vmPFC/medial orbitofrontal cortex response to milkshake cues than those without a parental history of eating pathology and those with a healthy weight. Females with overweight/obesity and without a parental history of eating pathology showed a greater thalamus and striatum response to milkshake receipt. Conclusions: Overweight/obesity is associated with an elevated reward region response to palatable food cues and food receipt. A risk for eating pathology enhances the reward region response to food cues in those with excess weight.

Functional MRI (fMRI) tasks are increasingly being used to advance knowledge of the etiology and maintenance of obesity and eating disorders. Thus, understanding the test-retest reliability of BOLD signal contrasts from these tasks is important. To evaluate test-retest reliability of responses in reward-related brain regions to food receipt paradigms (palatable tastes, anticipated palatable tastes), food picture paradigms (high-calorie food pictures), a monetary reward paradigm (winning money and anticipating winning money), and a thin female model picture paradigm (thin female model pictures). We conducted secondary univariate contrast-based analyses in data drawn from 4 repeated-measures fMRI studies. Participants (Study 1: N = 60, mean [M] age = 15.2 ± 1.1 y; Study 2: N = 109, M age = 15.1 ± 0.9 y; Study 3: N = 39, M age = 21.2 ± 3.7 y; Study 4: N = 62, M age = 29.7 ± 6.2 y) completed the same tasks over 3-wk to 3-y test-retest intervals. Studies 3 and 4 included participants with eating disorders and obesity, respectively Test-retest reliability of the food receipt and food picture paradigms was poor, with average ICC values ranging from 0.07 to 0.20. The monetary reward paradigm and the thin female model picture paradigm also showed poor test-retest reliability: average ICC values 0.21 and 0.12, respectively. Although several regions demonstrated moderate to good test-retest reliability, these results did not replicate across studies using similar paradigms. In Studies 3 and 4, but not Study 1, test-retest reliability in visual processing regions was moderate to good when contrasting single conditions with a low-level baseline. Results underscore the importance of examining the temporal reliability of fMRI tasks and call for the development and use of well-validated standardized fMRI tasks in eating- and obesity-related studies that can provide more reliable measures of neural activation. The trials were registered at clinicaltrials.gov as NCT02084836, NCT01949636, NCT03261050, and NCT03375853.

Identifying correlates of brain response to food cues and taste provides critical information on individual differences that may influence variability in eating behavior. However, a few studies examine how brain response changes over repeated exposures and the individual factors that are associated with these changes. Using functional magnetic resonance imaging, we examined how brain response to a palatable taste and proceeding cues changed over repeated exposures and how individual differences in weight, familial obesity risk, dietary restraint and reward responsiveness correlate with these changes. In healthy-weight adolescents (n = 154), caudate and posterior cingulate cortex (PCC) response increased with repeated cue presentations, and oral somatosensory cortex and insula response increased with repeated milkshake tastes. The magnitude of increase over exposures in the left PCC to cues was positively associated with body mass index percentile (r = 0.18, P = 0.026) and negatively associated with dietary restraint scores (r = −0.24, P = 0.003). Adolescents with familial obesity risk showed higher cue-evoked caudate response across time, compared to the low-risk group (r = 0.12, P = 0.035). Reward responsiveness positively correlated with right oral somatosensory cortex/insula response to milkshake over time (r = 0.19, P = 0.018). The results show that neural responses to food cues and taste change over time and that individual differences related to weight gain are correlated with these changes.

We tested if we could replicate the main effect relations of elevated striatum and lateral orbitofrontal cortex (OFC) response to high-calorie food stimuli to weight gain reported in past papers in six prospective datasets that used similar functional MRI (fMRI) paradigms. Participants in Study 1 (N = 37; M (mean) age = 15.5), Study 2 (N = 160; M age = 15.3), Study 3 (N = 130; M age = 15.0), Study 4 (N = 175; M age = 14.3), Study 5 (N = 45; M age = 20.8) and Study 6 (N = 49; M age = 31.1) completed fMRI scans at the baseline and had their body mass index (BMI) and body fat (Studies 4 and 6 only) measured at the baseline and over follow-ups. Elevated striatal response to palatable food images predicted BMI gain in Studies 1 and 6 and body fat gain in Study 6. Lateral OFC activation did not predict weight gain in any of the six studies. The result provide limited support for the hypothesis that elevated reward region responsivity to palatable food images predicts weight gain. Factors that make replication difficult are discussed and potential solutions considered.