Intensive lifestyle intervention might provide better long-term weight-loss effects than a diabetes support and education program, offering superior cognitive control and attention and visual processing in response to high-calorie food cues, according to study results published in Obesity.

To compare the long-term effects of intensive lifestyle intervention and diabetes support and education on weight loss, researchers analyzed the neural food cue activity of participants from the Look AHEAD study 10 years after randomization ( identifier: NCT00017953). In the trial, overweight or obese patients with type 2 diabetes were randomly assigned to a diabetes support and education program or an intensive lifestyle intervention.

The researchers in this substudy used functional magnetic resonance imaging (fMRI) to assess 232 participants from the previous trial for neural response to high-calorie foods and nonfoods. The intensive lifestyle intervention group had a mean weight loss of 7.1 kg from baseline vs 6.2 kg in diabetes support and education.

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Results of fMRI scans revealed that participants in the control group had greater reward-processing activity in the left caudate than those in the intervention group. Conversely, intervention participants had greater activity in the attention- and visual-processing regions (P <.05).

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Using post hoc correlation analyses, the researchers determined that the greater weight loss experienced by the intervention participants was associated with brain activation that indicated increased cognitive control and attention and visual processing in response to high-calorie food cues (P <.001). As such, the greater the weight loss, the greater the activity in related regions of the brain.

Limitations to this study include an absence of fMRI data at baseline and an exclusion of less healthy trial participants unable to complete the fMRI.

“Findings from this study suggest there was a legacy effect of participation in the [behavioral weight loss] intervention that led to reduced reward-related activity and enhanced attention and visual processing in response to high-calorie food cues,” said the researchers. “Correlations between weight loss and brain activity in executive function as well as attention-processing areas highlight key regions of the brain and neural processes that may be implicated in long-term weight loss.”

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McDermott KD, Williams SE, Espeland MA, et al; Action for Health in Diabetes Brain Magnetic Resonance Imaging (Look AHEAD Brain) Ancillary Study Research Group. Impact of intensive lifestyle intervention on neural food cue reactivity: action for health in diabetes brain ancillary study [published online May 21, 2019]. Obesity. doi:10.1002/oby.22496