Real-time fMRI neurofeedback training to improve eating behavior by self-regulation of the dorsolateral prefrontal cortex: A randomized controlled trial in overweight and obese subjects

Simon H Kohl, Ralf Veit, Maartje S Spetter, Astrid Günther, Andriani Rina, Michael Lührs, Niels Birbaumer, Hubert Preissl, Manfred Hallschmid

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Obesity is associated with altered responses to food stimuli in prefrontal brain networks that mediate inhibitory control of ingestive behavior. In particular, activity of the dorsolateral prefrontal cortex (dlPFC) is reduced in obese compared to normal-weight subjects and has been linked to the success of weight-loss dietary interventions. In a randomized controlled trial in overweight/obese subjects, we investigated the effect on eating behavior of volitional up-regulation of dlPFC activity via real-time functional magnetic resonance imaging (fMRI) neurofeedback training. Thirty-eight overweight or obese subjects (BMI 25-40 kg/m2) took part in fMRI neurofeedback training with the aim of increasing activity of the left dlPFC (dlPFC group; n = 17) or of the visual cortex (VC/control group; n = 21). Participants were blinded to group assignment. The training session took place on a single day and included three training runs of six trials of up-regulation and passive viewing. Food appraisal and snack intake were assessed at screening, after training, and in a follow-up session four weeks later. Participants of both groups succeeded in up-regulating activity of the targeted brain area. However, participants of the control group also showed increased left dlPFC activity during up-regulation. Functional connectivity between dlPFC and ventromedial PFC, an area that processes food value, was generally increased during up-regulation compared to passive viewing. At follow-up compared to baseline, both groups rated pictures of high-, but not low-calorie foods as less palatable and chose them less frequently. Actual snack intake remained unchanged but palatability and choice ratings for chocolate cookies decreased after training. We demonstrate that one session of fMRI neurofeedback training enables individuals with increased body weight to up-regulate activity of the left dlPFC. Behavioral effects were observed in both groups, which might have been due to dlPFC co-activation in the control group and, in addition, unspecific training effects. Improved dlPFC-vmPFC functional connectivity furthermore suggested enhanced food intake-related control mechanisms. Neurofeedback training might support therapeutic strategies aiming at improved self-control in obesity, although the respective contribution of area-specific mechanisms and general regulation effects is in need of further investigation.

Original languageEnglish
Pages (from-to)596-609
Number of pages14
JournalNeuroimage
Volume191
Early online date21 Feb 2019
DOIs
Publication statusPublished - 1 May 2019

Keywords

  • AMYGDALA NEUROFEEDBACK
  • ASSOCIATION
  • DECISION-MAKING
  • Dorsolateral prefrontal cortex
  • Eating behavior
  • FOOD IMAGES
  • FUNCTIONAL CONNECTIVITY
  • IMPULSE CONTROL
  • INHIBITORY CONTROL
  • LESS ACTIVATION
  • METAANALYSIS
  • Neurofeedback
  • Obesity
  • Overweight
  • Real-time functional magnetic resonance imaging
  • WEIGHT

Cite this

Kohl, Simon H ; Veit, Ralf ; Spetter, Maartje S ; Günther, Astrid ; Rina, Andriani ; Lührs, Michael ; Birbaumer, Niels ; Preissl, Hubert ; Hallschmid, Manfred. / Real-time fMRI neurofeedback training to improve eating behavior by self-regulation of the dorsolateral prefrontal cortex : A randomized controlled trial in overweight and obese subjects. In: Neuroimage. 2019 ; Vol. 191. pp. 596-609.
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Real-time fMRI neurofeedback training to improve eating behavior by self-regulation of the dorsolateral prefrontal cortex : A randomized controlled trial in overweight and obese subjects. / Kohl, Simon H; Veit, Ralf; Spetter, Maartje S; Günther, Astrid; Rina, Andriani; Lührs, Michael; Birbaumer, Niels; Preissl, Hubert; Hallschmid, Manfred.

In: Neuroimage, Vol. 191, 01.05.2019, p. 596-609.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Real-time fMRI neurofeedback training to improve eating behavior by self-regulation of the dorsolateral prefrontal cortex

T2 - A randomized controlled trial in overweight and obese subjects

AU - Kohl, Simon H

AU - Veit, Ralf

AU - Spetter, Maartje S

AU - Günther, Astrid

AU - Rina, Andriani

AU - Lührs, Michael

AU - Birbaumer, Niels

AU - Preissl, Hubert

AU - Hallschmid, Manfred

N1 - Copyright © 2019. Published by Elsevier Inc.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Obesity is associated with altered responses to food stimuli in prefrontal brain networks that mediate inhibitory control of ingestive behavior. In particular, activity of the dorsolateral prefrontal cortex (dlPFC) is reduced in obese compared to normal-weight subjects and has been linked to the success of weight-loss dietary interventions. In a randomized controlled trial in overweight/obese subjects, we investigated the effect on eating behavior of volitional up-regulation of dlPFC activity via real-time functional magnetic resonance imaging (fMRI) neurofeedback training. Thirty-eight overweight or obese subjects (BMI 25-40 kg/m2) took part in fMRI neurofeedback training with the aim of increasing activity of the left dlPFC (dlPFC group; n = 17) or of the visual cortex (VC/control group; n = 21). Participants were blinded to group assignment. The training session took place on a single day and included three training runs of six trials of up-regulation and passive viewing. Food appraisal and snack intake were assessed at screening, after training, and in a follow-up session four weeks later. Participants of both groups succeeded in up-regulating activity of the targeted brain area. However, participants of the control group also showed increased left dlPFC activity during up-regulation. Functional connectivity between dlPFC and ventromedial PFC, an area that processes food value, was generally increased during up-regulation compared to passive viewing. At follow-up compared to baseline, both groups rated pictures of high-, but not low-calorie foods as less palatable and chose them less frequently. Actual snack intake remained unchanged but palatability and choice ratings for chocolate cookies decreased after training. We demonstrate that one session of fMRI neurofeedback training enables individuals with increased body weight to up-regulate activity of the left dlPFC. Behavioral effects were observed in both groups, which might have been due to dlPFC co-activation in the control group and, in addition, unspecific training effects. Improved dlPFC-vmPFC functional connectivity furthermore suggested enhanced food intake-related control mechanisms. Neurofeedback training might support therapeutic strategies aiming at improved self-control in obesity, although the respective contribution of area-specific mechanisms and general regulation effects is in need of further investigation.

AB - Obesity is associated with altered responses to food stimuli in prefrontal brain networks that mediate inhibitory control of ingestive behavior. In particular, activity of the dorsolateral prefrontal cortex (dlPFC) is reduced in obese compared to normal-weight subjects and has been linked to the success of weight-loss dietary interventions. In a randomized controlled trial in overweight/obese subjects, we investigated the effect on eating behavior of volitional up-regulation of dlPFC activity via real-time functional magnetic resonance imaging (fMRI) neurofeedback training. Thirty-eight overweight or obese subjects (BMI 25-40 kg/m2) took part in fMRI neurofeedback training with the aim of increasing activity of the left dlPFC (dlPFC group; n = 17) or of the visual cortex (VC/control group; n = 21). Participants were blinded to group assignment. The training session took place on a single day and included three training runs of six trials of up-regulation and passive viewing. Food appraisal and snack intake were assessed at screening, after training, and in a follow-up session four weeks later. Participants of both groups succeeded in up-regulating activity of the targeted brain area. However, participants of the control group also showed increased left dlPFC activity during up-regulation. Functional connectivity between dlPFC and ventromedial PFC, an area that processes food value, was generally increased during up-regulation compared to passive viewing. At follow-up compared to baseline, both groups rated pictures of high-, but not low-calorie foods as less palatable and chose them less frequently. Actual snack intake remained unchanged but palatability and choice ratings for chocolate cookies decreased after training. We demonstrate that one session of fMRI neurofeedback training enables individuals with increased body weight to up-regulate activity of the left dlPFC. Behavioral effects were observed in both groups, which might have been due to dlPFC co-activation in the control group and, in addition, unspecific training effects. Improved dlPFC-vmPFC functional connectivity furthermore suggested enhanced food intake-related control mechanisms. Neurofeedback training might support therapeutic strategies aiming at improved self-control in obesity, although the respective contribution of area-specific mechanisms and general regulation effects is in need of further investigation.

KW - AMYGDALA NEUROFEEDBACK

KW - ASSOCIATION

KW - DECISION-MAKING

KW - Dorsolateral prefrontal cortex

KW - Eating behavior

KW - FOOD IMAGES

KW - FUNCTIONAL CONNECTIVITY

KW - IMPULSE CONTROL

KW - INHIBITORY CONTROL

KW - LESS ACTIVATION

KW - METAANALYSIS

KW - Neurofeedback

KW - Obesity

KW - Overweight

KW - Real-time functional magnetic resonance imaging

KW - WEIGHT

U2 - 10.1016/j.neuroimage.2019.02.033

DO - 10.1016/j.neuroimage.2019.02.033

M3 - Article

C2 - 30798010

VL - 191

SP - 596

EP - 609

JO - Neuroimage

JF - Neuroimage

SN - 1053-8119

ER -