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Pediatrics

Child neurobiology impacts success in family-based behavioral treatment for children with obesity

International Journal of Obesity volume 44, pages 2011–2022 (2020)Cite this article

Subjects

Abstract

Background and objectives

Family-based behavioral treatment (FBT) is the recommended treatment for children with common obesity. However, there is a large variability in short- and long-term treatment response, and mechanisms for unsuccessful treatment outcomes are not fully understood. In this study, we tested if brain response to visual food cues among children with obesity before treatment predicted weight or behavioral outcomes during a 6-month behavioral weight management program and/or long-term relative weight maintenance over a 1-year follow-up period.

Subjects and methods

Thirty-seven children with obesity (age 9–11 years, 62% male) who entered active FBT (attended two or more sessions) and had outcome data. Brain activation was assessed at pretreatment by functional magnetic resonance imaging across an a priori set of appetite-processing brain regions that included the ventral and dorsal striatum, mOFC, amygdala, substantia nigra/ventral tegmental area, and insula in response to viewing food images before and after a standardized meal.

Results

Children with more robust reductions in brain activation to high-calorie food cue images following a meal had greater declines in BMI z-score during FBT (r = 0.42; 95% CI: 0.09, 0.66; P = 0.02) and greater improvements in Healthy Eating Index scores (r = −0.41; 95% CI: −0.67, −0.06; P = 0.02). In whole-brain analyses, greater activation in the ventromedial prefrontal cortex, specifically by high-calorie food cues, was predictive of better treatment outcomes (whole-brain cluster corrected P = 0.02). There were no significant predictors of relative weight maintenance, and initial behavioral or hormonal measures did not predict FBT outcomes.

Conclusions

Children’s brain responses to a meal prior to obesity treatment were related to treatment-based weight outcomes, suggesting that neurophysiologic factors and appetitive drive, more so than initial hormone status or behavioral characteristics, limit intervention success.

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Fig. 1: Study paradigm detailing the longitudinal design and pretreatment study visit day and individual trajectores of children’s BIM z-scores throughout study.
Fig. 2: Association of pretreatment brain response to a meal with change in BMI z-score, behavioral, and hormonal outcomes by FBT.
Fig. 3: Whole-brain cluster analyses of premeal brain activation in association with change in BMI z-score by FBT.

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Acknowledgements

This work was supported by the National Institutes of Health award R01DK098466 (CLR), P30DK035816 (University of Washington Nutrition and Obesity Research Center); and the University of Washington Institute of Translational Health Sciences (UL1TR002319). We would like to thank Sue Kearns and Holly Callahan for their contributions to study planning and execution, Mark Abbey-Lambertz for support during treatment visits and execution of study assessments, and Gabrielle D’Ambrosio, Habiba Mohamed and Cordelia Franklin for their excellent support for performing the study visits.

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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, University of Washington, 750 Republican St, Box 358062, Seattle, WA, 98109, USA

    Ellen A. Schur, Susan J. Melhorn & Mary Rosalynn B. De Leon

  2. Seattle Children’s Research Institute, 1900 Ninth Ave, Seattle, WA, 98101, USA

    Kelley Scholz, Clinton T. Elfers, Maya G. Rowland, Brian E. Saelens & Christian L. Roth

  3. Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA

    Brian E. Saelens & Christian L. Roth

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  1. Ellen A. Schur
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Contributions

EAS, BES, and CLR designed the study; SJM, KS, CTE, MGR, and MRBDL acquired data; CTE performed assays; SJM and EAS designed and/or performed fMRI analyses; SJM, CTE, CLR, and EAS performed statistical analyses; EAS, SJM, CTE, BES, and CLR wrote the manuscript.

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Correspondence to Ellen A. Schur.

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Schur, E.A., Melhorn, S.J., Scholz, K. et al. Child neurobiology impacts success in family-based behavioral treatment for children with obesity. Int J Obes 44, 2011–2022 (2020). https://doi.org/10.1038/s41366-020-0644-1

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