Brain Activation and Satiety in Children: Functional Magnetic Resonance Imaging
Condition: Childhood Obesity
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      BASIC fMRI is a prospective single center intervention trial using fMRI imaging in 9-11 year
      old obese male and females pre and post family-based behavioral treatment of 24 weeks
      duration to determine the relationship between impulsivity and central satiety responses.
    

Detailed description: 
      The high prevalence of childhood obesity in the U.S. demands a better understanding of
      factors that drive weight gain and influence the outcome of pediatric obesity interventions.
      This project investigates the hypothesis that, as in adults, a subset of obese children
      experience a diminished satiety response to food consumption, and that these children are
      more resistant to gold standard family-based behavioral treatment (FBT) for obesity. FBT is
      targeted almost exclusively toward parents; however, there is evidence that obesity
      development and response to intervention may depend on additional factors such as individual
      internal satiety perception and variability in the function of brain centers associated with
      impulsivity and reward. The proposed research uses functional magnetic resonance imaging
      (fMRI) to characterize brain function related to satiety and examines fMRI along with
      behavioral, cognitive, and hormonal testing to fully examine potential mediators of
      children's experience of satiety and response to FBT. The approach is based on evidence that
      failure to attenuate the reward value of palatable foods after eating can be a manifestation
      of a blunted central satiety response that is reliably detected using fMRI. Key objectives
      will be to determine if differences in the central satiety response exist between obese and
      non-obese children, and, among obese children, if the strength of the central satiety
      response is associated with impulsivity and/or the success of obesity treatment. The central
      hypothesis is that, in obese children, a blunted central nervous system satiety response
      impairs the success of obesity interventions. To achieve study objectives, brain activation
      by high-calorie visual food cues before and after food consumption will be measured by fMRI.
      Participants will be obese and non-obese children aged 9-11 years. The 49 obese children will
      be evaluated before and after they participate in a 6-month evidence-based FBT intervention.
      Their pre-intervention fMRI will be compared to those of 20 non-obese controls to test for a
      blunted central satiety response (Aim 1). The relationship of impulsivity to satiety
      responses and food intake will be determined in obese children (Aim 2). The longitudinal
      component tests whether central satiety responses prior to treatment predict treatment
      outcomes (Aim 3A) and whether changes in central satiety responses during treatment predict
      maintenance of reduced weight 6 and 12 months after treatment cessation (Aim 3B). Behavioral,
      cognitive, and hormonal measures will be examined as potential mediating or confounding
      factors contributing to fMRI responses. The proposed research is guided by an integrated,
      transdisciplinary team with expertise in pediatric and adult neuroimaging, appetite
      regulation, and family-based childhood obesity treatment. This research will provide new
      insights into the neurobiological basis of child obesity and the relevance of neurobiological
      factors to treatment success. The long-term objective is to translate these findings to
      improve obesity interventions cost-effectively and sustain better long-term results.

      During years 1-3, obese children will be enrolled into intervention groups of 9-11 families
      with staggered start dates by 3-6 months. Years 1-4 includes enrollment, intervention,
      longitudinal follow-up, and data collection for obese children. Control children will
      primarily be recruited during years 2-3 to facilitate matching. FMRI scans are processed on a
      rolling basis as studies are completed. In years 3 and 4 hormonal assays will be performed.
      Final data analyses will be completed in year 4.
    

Intervention name(s): Family Based Behavioral Treatment
Intervention type(s): Behavioral
Intervention description(s): Obese children accompanied by at least one parent or caregiver will attend 24 weekly in-person sessions. Sessions will include 25-30 min. meetings between an interventionist and each child/parent pair to individualize treatment, followed by separate child and parent group meetings lasting 40 - 45 min. Parents will serve as primary agents of change for their child and for themselves. Training will focus on food and physical activity education, parenting around food and physical activity, and use of behavioral skills (e.g., self-monitoring, environmental control, contingency management). Intervention groups of 9-11 children/families will be initiated every 3-6 mos. in study yrs. 1-3.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: Family Based Behavioral Treatment; functional magnetic resonance imaging (fMRI); Childhood Obesity; Satiety; BMI z-score; Impulsive; Non-obese controls; Visual food cues; Leptin; Hormones