A pilot randomized trial of a cognitive reappraisal obesity prevention program

• High reward response and low inhibitory response to food may drive overeating.
• We tested a cognitive reappraisal based obesity prevention program.
• Reappraisals aimed to reduce reward activation & increase inhibitory activation.
• We assessed neural response to food, BMI & body fat in an RCT over 6-months.
• The reappraisal program resulted in short-term decreases in fat & neural changes.

Background/ObjectivesEvaluate a selective obesity prevention program promoting use of cognitive reappraisals to reduce reward region response and increase inhibitory region response to high-fat/high-sugar foods and reduce intake of fat and sugar to prevent blunted reward region response to intake of such foods.Subjects/MethodsYoung adults at risk for future weight gain by virtue of weight concerns (N = 148) were randomized to this new prevention program (Minding Health), an alternative prevention program promoting participant-driven gradual reductions in caloric intake and increases in physical activity (Healthy Weight), or an obesity education video control condition, completing assessments at pre-, post-, and 6-month follow-up. A subset of Minding Health and control participants completed an fMRI scan at pre- and post-assessing neural response to images of high-fat/sugar foods and to receipt and anticipated receipt of a high-fat/sugar food.ResultsMinding Health participants showed significantly greater reductions in body fat than controls and caloric intake from fat and sugar than Healthy Weight participants. Minding Health participants also showed greater activation of an inhibitory control region and reduced activation of an attention/expectation region in response to palatable food images relative to pretest and controls. However, Healthy Weight participants showed greater reductions in BMI and eating disorder symptoms than Minding Health participants.ConclusionsAlthough the Minding Health intervention produced some of the hypothesized effects, it did not produce lasting reductions in body fat or BMI and showed limited effects on neural responsivity, implying it will be vital to increase the efficacy of this new prevention program.