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Neuroimage. 2019 May 1;191:596-609. doi: 10.1016/j.neuroimage.2019.02.033. Epub 2019 Feb 21.

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.

Author information

1
Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Jülich, Germany.
2
Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen; German Center for Diabetes Research (DZD), Tübingen, Germany; High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.
3
Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany; School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK.
4
Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany.
5
Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany; High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
6
Brain Innovation B.V, Research Department, Maastricht, Netherlands; Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, Netherlands.
7
Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany; Wyss Center for Bio and Neuroengineering, Geneva, 1202, Switzerland.
8
Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen; German Center for Diabetes Research (DZD), Tübingen, Germany; Institute of Pharmaceutical Sciences, Interfaculty Centre for Pharmacogenomics and Pharma Research, Department of Pharmacy and Biochemistry, University of Tübingen, Tübingen, Germany. Electronic address: hubert.preissl@uni-tuebingen.de.
9
Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen; German Center for Diabetes Research (DZD), Tübingen, Germany.

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 contributions of area-specific mechanisms and general regulation effects are in need of further investigation.

KEYWORDS:

Dorsolateral prefrontal cortex; Eating behavior; Neurofeedback; Obesity; Overweight; Real-time functional magnetic resonance imaging

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