Assessing food appeal and desire to eat: the effects of portion size & energy density

Does 'portion size' matter? Brain responses to food and non-food cues presented in varying amounts

Larger portions of food elicit greater intake than smaller portions of food, particularly when foods are high in energy density (kcal/g; ED). The neural mechanisms underlying this effect remain unclear. The present study used fMRI to assess brain activation to food (higher-ED, lower-ED) and non-food (office supplies) images presented in larger and smaller (i.e., age-appropriate) amounts in 61, 7-8-year-olds (29 male, 32 female) without obesity. Larger amounts of food increased activation in bilateral visual and right parahippocampal areas compared to smaller amounts; greater activation to food amount (larger > smaller) in this cluster was associated with smaller increases in food intake as portions increased. Activation to amount (larger > smaller) was stronger for food than office supplies in primary and secondary visual areas, but, for office supplies only, extended into bilateral parahippocampus, inferior parietal cortex, and additional visual areas (e.g., V7). Activation was greater for higher-vs. lower-ED food images in ventromedial prefrontal cortex for both larger and smaller amounts of food; however, this activation extended into left lateral orbital frontal cortex for smaller amounts only. Activation to food cues did not differ by familial risk for obesity. These results highlight potentially distinct neural pathways for encoding food energy content and quantity.

Cerebellar Prediction and Feeding Behaviour

Given the importance of the cerebellum in controlling movements, it might be expected that its main role in eating would be the control of motor elements such as chewing and swallowing. Whilst such functions are clearly important, there is more to eating than these actions, and more to the cerebellum than motor control. This review will present evidence that the cerebellum contributes to homeostatic, motor, rewarding and affective aspects of food consumption.Prediction and feedback underlie many elements of eating, as food consumption is influenced by expectation. For example, circadian clocks cause hunger in anticipation of a meal, and food consumption causes feedback signals which induce satiety. Similarly, the sight and smell of food generate an expectation of what that food will taste like, and its actual taste will generate an internal reward value which will be compared to that expectation. Cerebellar learning is widely thought to involve feed-forward predictions to compare expected outcomes to sensory feedback. We therefore propose that the overarching role of the cerebellum in eating is to respond to prediction errors arising across the homeostatic, motor, cognitive, and affective domains.

The effects of resistance exercise on appetite sensations, appetite related hormones and energy intake in hormone receptor-positive breast cancer survivors

Appetite is a determinant of dietary intake and is impacted by sex hormones, exercise, and body composition among individuals without chronic conditions. Whether appetite is altered by exercise in the context of estrogen suppression and cancer survivorship is unknown. This randomized cross-over study compared appetite and ad libitum energy intake (EI) after acute resistance exercise (REx) versus sedentary (SED) conditions and in relation to body composition and resting metabolic rate (RMR) in breast cancer survivors (BCS). Physically inactive premenopausal females with previous stage I-III estrogen receptor-positive breast cancer completed a single bout of REx or SED 35 minutes after a standardized breakfast meal. Appetite visual analog scales and hormones (total ghrelin and peptide-YY [PYY]) were measured before and 30, 90, 120, 150, and 180 minutes post-meal and expressed as area under the curve (AUC). Participants were offered a buffet-type meal 180 minutes after breakfast to assess ad libitum EI. Body composition (dual X-ray absorptiometry) and RMR (indirect calorimetry) were measured during a separate visit. Sixteen BCS were included (age: 46 ± 2 y, BMI: 24.9 ± 1.0 kg/m²). There were no differences in appetite ratings or EI between conditions. There were no differences in appetite hormone AUC, but REx resulted in lower ghrelin 120 (-85 ± 39 pg/mL, p = 0.031) and 180 (-114 ± 43 pg/mL, p = 0.018) minutes post-breakfast and higher PYY 90 (21 ± 10 pg/mL, p = 0.028) and 120 (14 ± 7 pg/mL, p = 0.041) minutes post-breakfast. Fat-free mass and RMR negatively correlated with hunger and prospective food consumption AUC after SED, but not REx. In sum, a single REx bout temporarily reduces orexigenic and increases anorexic appetite hormones, but not acute subjective appetite sensations or EI.

Sex Differences in Effects of Mood, Eating-Related Behaviors, and BMI on Food Appeal and Desire to Eat: A Cross-Sectional Survey Study

Although sex differences in food intake have been observed consistently, contributing factors are not well understood. Using a cross-sectional online survey (n = 306; 151 men, 155 women), this study aimed to assess how sex impacts relationships between food ratings (appeal/desire to eat for high-calorie (HC) and low-calorie (LC) food images) and eating-related attitudes/behaviors, body mass index (BMI), and mood. Across participants, increased state- and trait-based hunger, disinhibition, and cravings were associated with both increased HC appeal and desire (p < 0.001). Increased state-based hunger and cravings were associated with greater LC desire (p < 0.001). Greater satiety was associated with decreased desire for both HC and LC (p < 0.001), while greater anxiety was associated with increased desire for both HC and LC (p < 0.001). Significant associations between BMI and food ratings were not observed. Women reported greater dietary restraint, trait-based hunger, disinhibition, eating disorder-related behaviors, depression, and stress compared to men, in addition to greater appeal and familiarity with LC foods (all p < 0.05). Significant effects of sex on the associations between food ratings and eating-related attitudes/behaviors, BMI, and mood were not observed, however. Findings support the importance of considering mood and eating-related attitudes/behaviors in investigations of food cue responsivity.

An implicit priming intervention alters brain and behavioral responses to high-calorie foods: a randomized controlled study

BACKGROUND

Conditioned food cues (e.g., smell, sight) can affect intake of foods associated with those cues, regardless of homeostatic need. As such, altering automatic associations with food cues could support weight loss or maintenance efforts by affecting the salience of those cues and the effort required to resist consumption.

OBJECTIVES

This study investigated neuronal and behavioral effects of an implicit priming (IP) intervention, in which negatively valenced images were paired with high-calorie foods and positively valenced images with low-calorie foods. Priming images were presented immediately before food images, but below conscious perception (20 ms). We hypothesized that this evaluative conditioning approach could alter food cue responses by modifying affective associations.

METHODS

The final sample included 41 adults with BMI ≥25 kg/m2 (n = 22, active IP; n = 19, control IP). In control IP, food images were primed with neutral, scrambled images. Participants completed a visual food cue task during fMRI, both before and after IP. To determine the replicability of prior behavioral findings, food image ratings were completed before and after IP as a secondary outcome.

RESULTS

In a whole-brain analysis, reduced dorsolateral prefrontal cortex (dlPFC) response to high-calorie foods was observed after active compared with control IP (t = 4.93, P = 0.033). With a region of interest analysis, reduced response to high-calorie foods in active compared with control IP was also observed in the striatum (t = 2.40, P = 0.009) and insula (t = 2.38, P = 0.010). Active compared with control IP was associated with reduced high-calorie food ratings (F = 4.70, P = 0.038).

CONCLUSIONS

Reduced insula and striatum response to high-calorie foods after active compared with control IP suggests effectiveness of IP in altering food cue salience. Reduced dlPFC response to high-calorie foods after active compared with control IP may reflect fewer attentional resources being directed to those images and reduced engagement of inhibitory processes.This trial was registered at clinicaltrials.gov as NCT02347527.

Measuring short-term eating behaviour and desire to eat: Validation of the child eating behaviour questionnaire and a computerized 'desire to eat' computerized questionnaire

The Child Eating Behaviour Questionnaire (CEBQ) is designed to measure 'usual' eating behaviour, with no time period attached, thus may not be suitable for assessing the effectiveness of short-term experimental studies. The aim of this study was to validate i) the CEBQ adapted to measure 'past week' rather than 'usual' eating behaviour, and ii) a computerized questionnaire assessing desire to eat core and non-core foods, against an objective measure of eating behaviour and food intake (eating in the absence of hunger (EAH) experiment). Children (n = 103) aged 8-12 years completed the desire to eat questionnaire followed by the EAH experiment while primary caregivers completed the adapted CEBQ. Results from the CEBQ showed that children with greater 'satiety responsiveness' (1-point higher) consumed less energy (-342 kJ; 95% CI -574, -110) whereas those with greater 'enjoyment of food' scale consumed more energy (380 kJ; 95% CI 124, 636) during the ad-libitum phase of the EAH experiment. Higher scores for slowness in eating (-705 kJ; 95% CI -1157, -254), emotional undereating (-590 kJ; 95% CI -1074, -106) and food fussiness (-629 kJ; 95% CI -1103, -155) were associated with lower total energy intake. Children who expressed greater desire to eat non-core foods consumed more energy in total (275 kJ; 95% CI 87, 463). Overall, this adapted CEBQ appears valid for measuring several short-term eating behaviours in children. The desire to eat questionnaire may be useful for identifying short-term susceptibility to overeating, however further investigation into how ratings of desire relate to the intake of highly palatable, energy dense foods is warranted.

Development and Validation of the Military Eating Behavior Survey

OBJECTIVE

To describe the Military Eating Behavior Survey (MEBS), developed, and validated for use in military populations.

DESIGN

Questionnaire development using a 6-phase approach that included item generation, subject matter expert review, cognitive interviewing, factor analysis, test-retest reliability testing, and parallel forms testing.

SETTING

US Army soldiers were surveyed at 8 military bases from 2016 to 2019 (n = 1,561).

MAIN OUTCOME MEASURE

Content, face, and construct validity and reliability of the MEBS.

ANALYSIS

Item variability, internal consistency, and exploratory factor analysis using principal coordinates analysis, orthogonal varimax rotation, and scree test (correlation coefficient and Cronbach alpha), as well as consistency and agreement (intraclass correlation coefficient) of test-retest reliability and parallel forms reliability.

RESULTS

Over 6 phases of testing, a comprehensive tool to examine military eating habits and mediators of eating behavior was developed. Questionnaire length was reduced from 277 items to 133 items (43 eating habits; 90 mediating behaviors). Factor analysis identified 14 eating habit scales (hunger, satiety, food craving, meal pattern, restraint, diet rigidity, emotional eating, fast/slow eating rate, environmental triggers, situational eating, supplement use, and food choice) and 8 mediating factor scales (body composition strategy, perceived stress, food access, sleep habits, military fitness, physical activity, military body image, and nutrition knowledge).

CONCLUSIONS AND IMPLICATIONS

The MEBS provides a new approach for assessing eating behavior in military personnel and may be used to inform and evaluate health promotion interventions related to weight management, performance optimization, and military readiness and resiliency.

Is There a "Gestalt Bias" in Indulgence? Subjectively Constructing Food Units Into Wholes (vs. Parts) Increases Desire to Eat and Actual Consumption

In the present work we extend research into the unit bias effect and its extension—the portion size effect—by demonstrating the existence of a “Gestalt bias.” Drawing on the tenets of Gestalt psychology, we show that a unit bias effect can be observed for food portions that are composed of identical basic units, but which are subjectively grouped into, or perceived as a Gestalt—a larger whole. In three studies, we find that such subjectively constructed food wholes constitute a new (perceptual) unit that is perceived bigger than the units it is constructed from, thereby prompting increased eating and desire to eat.

The effect of online restaurant menus on consumers' purchase intentions during the COVID-19 pandemic

As COVID-19 escalated globally in 2020, mandated suspension of dine-in services was instilled to control virus transmission. Restaurants lost billions of dollars, millions experienced severe employment changes, and numerous small restaurants closed. For those remaining in business, converting to online food ordering was essential. Unique to the food ordering setting, this study extended the Stimulus-Organism-Response model to predict the purchase intentions of participants in an online food ordering context. Using structural equation modeling, this study discovered the indirect effects of the menu's visual appeal and informativeness, and the perception of COVID-19 risks on consumer purchase intentions. This causal relationship was significantly mediated by consumers' desire for food and their perceived convenience of online food ordering. Through providing theoretical and managerial implications for how to identify appropriate products, utilize content marketing effectively, and attract new customers, this study could assist restaurants in adapting to remaining competitive, even post COVID-19.

Development of MacroPics: A novel food picture set to dissociate the effects of carbohydrate and fat on eating behaviors

Emerging evidence suggests that fat and carbohydrate interact to potentiate the reward value of food (DiFeliceantonio et al., 2018). The primary goal of the current study was to develop a novel picture set to facilitate research into the effects of macronutrient composition on food choice and eating behavior. Toward this aim, we developed "MacroPics." In Experiment 1, we photographed 120-kcal portions of 60 snack foods falling into one of the three macronutrient categories: (1) mostly carbohydrate, (2) mostly fat, or (3) a combination of fat and carbohydrate. Sixty-one participants rated the images for liking, familiarity, frequency of consumption, healthiness, estimated energy content (in kcal), and expected satiation. A subset of these images consisting of 36 items was then selected in an iterative process to minimize differences in ratings between the macronutrient categories while simultaneously ensuring similar within-category variability on a number of food characteristics (e.g., energy density, portion size, retail price) and visual properties (e.g., color, complexity, visual area). In Experiment 2, an independent sample of 67 participants rated the pictures of the final 36-item MacroPics. Both experiments reveal similar participant ratings across categories for item liking, familiarity, frequency, healthiness, and estimated energy content. Protein content was higher in the fat compared to the carbohydrate and combination categories, leading to higher ratings of estimated satiety and energy density for fatty foods. Item and macronutrient category characteristics of the final MacroPics set are reported.

The Dessert Flip: Consumer preference for desserts with a high proportion of fruit and nuts

American adults consume excess added sugar and saturated fat, and not enough fruit. A possible solution is the "Dessert Flip," a shift in which the proportions of more sustainable plant-based garnishes, such as fruit and nuts, are increased, while the proportion of conventional dessert is reduced. We hypothesized that the pleasing properties of fruits and nuts-color, variety, flavor, and texture-would allow the Dessert Flip to be liked as well or better than a conventional dessert by college-aged students in a dining hall. In a sensory test, participants (n = 118) significantly preferred plated flipped desserts-those containing 80% by weight fruit (strawberries, raspberries, blueberries, and mangoes) and nuts with 20% cake-over the conventional versions of those desserts with 80% cake and 20% fruit and nuts. No significant differences were found in overall liking. In a second experiment, after eating an entrée, participants (n = 150) chose pictures of multiple varieties of flipped cakes with 60% fruit and 40% cake significantly more than pictures of conventional 80% cake for dessert. Based on the U.S. average fruit prices, the Dessert Flip can be equal or lower in price per serving compared to an ungarnished typically sized cake. We conclude that the Dessert Flip offers a feasible option for increasing servings of fruits and nuts in desserts as well as reducing added sugar and saturated fat while maintaining sensory appeal. Future dietary guidelines could include this general strategy as a recommendation for helping adults include more fruits in their diets. PRACTICAL APPLICATION: The Dessert Flip offers an appetizing way for foodservice to promote healthier eating by increasing servings of fruits and nuts in their desserts while reducing added sugar and saturated fat. Consumers can try this strategy at home by cutting a smaller piece of cake and adding fruit on the side.

Effects of Intrinsic and Extrinsic Visual Cues on Consumer Emotion and Purchase Intent: A Case of Ready-to-Eat Salad

With increasing demand for ready-to-eat (RTE) fresh vegetables, it is important to understand how visual information cues, both intrinsic and extrinsic, affect consumer perception of these products. This study developed an emotional and wellness lexicon related to RTE salads. Subsequent questionnaires with images of salads were used to quantify consumer (N = 150) emotional and hedonic perceptions related to green color shade, shape/size of pieces, multicolor scheme, product name, and packaging. The different visual cues significantly impacted emotions and their intensities. Qualitatively, feelings of health and wellness predominated across salad samples. Negative emotions were more influenced by size of piece and green-color (intrinsic), while positive emotions were influenced by viewing salads of multiple colors (intrinsic) and packaging (extrinsic). Pale green salads were generally less liked than darker green ones. Values, in one case, ranged from 4.39 to 7.28 (on a 9-point hedonic scale), but naming the product (“iceberg lettuce”) did raise the lowest score to 5.75. The addition of vegetables with orange and purple colors to the salad mix had a positive impact on the perception of pale green salads. This study demonstrated that intrinsic and extrinsic visual cues significantly influenced consumer emotions, hedonic perception and purchase intent of RTE salads, but the effects of extrinsic cues were generally less prominent.

Rethinking Food Reward

The conscious perception of the hedonic sensory properties of caloric foods is commonly believed to guide our dietary choices. Current and traditional models implicate the consciously perceived hedonic qualities of food as driving overeating, whereas subliminal signals arising from the gut would curb our uncontrolled desire for calories. Here we review recent animal and human studies that support a markedly different model for food reward. These findings reveal in particular the existence of subcortical body-to-brain neural pathways linking gastrointestinal nutrient sensors to the brain's reward regions. Unexpectedly, consciously perceptible hedonic qualities appear to play a less relevant, and mostly transient, role in food reinforcement. In this model, gut-brain reward pathways bypass cranial taste and aroma sensory receptors and the cortical networks that give rise to flavor perception. They instead reinforce behaviors independently of the cognitive processes that support overt insights into the nature of our dietary decisions.

Effects of Exercise during Weight Loss Maintenance on Appetite Regulation in Women

Exercise is accepted as a method to improve weight loss maintenance; however, the mechanisms by which this occurs have yet to be elucidated. In this pilot study, 13 women with obesity underwent a structured weight loss program (goal 8%-10% weight loss) and were then randomized to either a 12-wk diet (n = 7) or an aerobic exercise training (n = 6) intervention aimed at maintaining weight loss. At baseline, post-weight loss, and following the weight loss maintenance interventions, measurements of appetite (hunger and satiety) and appetite-regulating hormones (leptin, ghrelin, peptide tyrosine tyrosine, and glucagon-like peptide 1) were obtained after an overnight fast and for 3 h after a standardized test meal. Ad libitum energy intake was measured at a lunch meal. During the weight loss phase, participants lost 9.1% ± 1.1% of baseline body weight. Participants in both groups maintained weight loss during the 12-wk weight loss maintenance intervention. No differences in fasting leptin (P = 0.68) or in ghrelin (P = 0.30), peptide tyrosine tyrosine (P = 0.93), and glucagon-like peptide 1 (P = 0.98) area under the curve were detected between groups. Similarly, ratings of hunger (P = 0.99) and satiety (P = 0.65) area under the curve after the standardized test meal also did not differ between the groups nor did ad libitum energy intake at lunch. In summary, the 12-wk diet and exercise interventions were equally effective at maintaining weight loss in women, and no differences in measures of appetite regulation and food intake were found.

Dietary energy density and appetite: A systematic review and meta-analysis of clinical trials

Studies have suggested that dietary energy density (DED) may affect weight gain by altering appetite. Although many studies have investigated the effect of DED on appetite, findings are inconsistent and, to our knowledge, there are no systematic reviews and meta-analyses on this topic. Therefore, the aim of this systematic review and meta-analysis was to summarize the effect of DED on appetite. The current meta-analysis revealed changing the DED had no significant effect on hunger but increased fullness. More high-quality randomized controlled trials are needed to investigate the effects of DED on appetite components. We searched titles, abstracts, and keywords of articles indexed in ScienceDirect, MEDLINE, and Google Scholar databases up to July 2018 to identify eligible RCT studies. Random effects model was used to estimate the pooled effect of DED on appetite. Among the 21 studies identified in the systematic literature search, 11 reports were included in the meta-analysis. Based on the Cochrane Collaboration Risk of Bias tool, 6 studies were considered as good quality, two were fair, and three studies were poor. The mean ± standard deviation for energy density, in studies which assessed fullness, was 1.65 ± 1 in high energy dense (HED) diet and 0.93 ± 0.93 in low energy dense (LED) diet. The corresponding values for hunger were 1.67 ± 0.69 and 0.70 ± 0.32, respectively. Compared with a LED diet, consumption of HED increased fullness (weighed mean difference [WMD] 2.95 mm; 95% CI 0.07-5.82, P = 0.044, I² 98.1%) but had no significant effect on hunger (WMD 1.31 mm; 95% CI -7.20 to 9.82, P = 0.763, I² 99.1%). The current meta-analysis revealed changing the DED had no significant effect on hunger but increased fullness. More high-quality RCTs are needed to investigate the effects of DED on appetite components.

Moderate eating with pleasure and without effort: Toward understanding the underlying psychological mechanisms

Integrating research on elementary eating behaviors, savoring, mental imagery, mindfulness, cooking, and dinner rituals, a psychological theory of moderate eating is formulated that does not require effortful self-control and giving up on the pleasures of eating. The theory proposes that taste and pleasure can be combined with a relatively objective attitude toward food, resulting in a relatively slow, gentle, and thoughtful manner of eating that enhances satiation. The objective food attitude is thought to result from (a) the accumulation of multiple sensorimotor expectancies and perspectives and (b) a motivational mechanism underlying prosocial behavior, food sharing, and aggression-inhibiting dinner rituals.

Do food cinemagraphs evoke stronger appetitive responses than stills?

Viewing images of food triggers the desire to eat and this effect increases when images represent food in a more vivid way. Cinemagraphs are a new medium that is intermediate between photographs and videos: most of the frame is static, while some details are animated in a seamless loop, resulting in a vivid viewing experience. On social media cinemagraphs are increasingly used for food-related communication. Given their vivid appearance we hypothesized that food cinemagraphs may evoke stronger appetitive responses than their static counterparts (stills). This would make them a promising medium for food advertisements on the Internet or on digital menu boards. In this study we measured the ‘wanting’ (appetitive) and ‘liking’ (affective) responses to both cinemagraph and stills representing a wide range of different food products. Our results show that food cinemagraphs slightly increase ‘wanting’ scores while not affecting ‘liking’ scores, compared to similar stills. Although we found no overall main effect of image dynamics on ‘liking’, we did observe a significant effect for some individual food items. The effects of image dynamics on ‘wanting’ and ‘liking’ appear to be product specific: while dynamic images were scored higher on ‘wanting’ or ‘liking’ for some products, static images were scored higher on these factors for other products. Observer responses to a free association task indicate that image dynamics can affect the appeal of a food product in two ways: by emphasizing its hedonic qualities (lusciousness, freshness) and by enhancing the observers’ awareness of their own core affect (‘liking’) for the product. We conclude that the effective use of cinemagraphs in food advertisements therefore requires a careful consideration of the characteristics (hedonic aspects) of the food product that are to be highlighted through image motion and the inherent preferences (core liking) of the target group.

Comparison of surgical versus diet-induced weight loss on appetite regulation and metabolic health outcomes

Bariatric surgery is associated with significant and sustained weight loss and improved metabolic outcomes. It is unclear if weight loss alone is the main mechanism of improved metabolic health. The purpose of this trial was to compare indices of appetite regulation, insulin sensitivity and energy intake (EI) between participants achieving 10 kg of weight loss via Roux-en-Y Gastric Bypass (RYGB) or dietary restriction (DIET); intake of a very low calorie liquid diet (800 kcal/d; 40% protein, 40% fat, 20% carbohydrate that matched the post-RYGB dietary protocol). Adults qualifying for bariatric surgery were studied before and after 10 kg of weight loss (RYGB [n = 6]) or DIET [n = 17]). Appetite (hunger, satiety, and prospective food consumption [PFC]), appetite-related hormones, and metabolites (ghrelin, PYY, GLP-1, insulin, glucose, free fatty acids [FFA], and triglycerides [TG]) were measured in the fasting state and every 30 min for 180 min following breakfast. Participants were provided lunch to evaluate acute ad libitum EI, which was similarly reduced in both groups from pre to post weight loss. Fasting ghrelin was reduced to a greater extent following RYGB compared to DIET (P = 0.04). Area under the curve (AUC) for ghrelin (P = 0.01), hunger (P < 0.01) and PFC (P < 0.01) increased after DIET compared to RYGB, following 10 kg weight loss. Satiety AUC increased after RYGB and decreased after DIET (P < 0.01). Glucose and insulin (fasting and AUC) decreased in both groups. FFA increased in both groups, with a greater increase in AUC seen after RYGB versus DIET (P = 0.02). In summary, appetite-related indices were altered in a manner that, if maintained, may promote a sustained reduction in energy intake with RYGB compared to DIET. Future work with a larger sample size and longer follow-up will be important to confirm and extend these findings.

Increased brain and behavioural susceptibility to portion size in children with loss of control eating

BACKGROUND

Portion size influences intake (i.e. the portion size effect [PSE]), yet determinants of susceptibility to the PSE are unclear.

OBJECTIVE

We tested whether children who reported an episode of loss of control (LOC) eating over the last 3 months would be more susceptible to the PSE and would show differential brain responses to food cues compared with children with no-LOC.

METHODS

Across five sessions, children (n = 47; 7-10 years) consumed four test meals at 100%, 133%, 167% and 200% conditions for portion size and completed a functional magnetic resonance imaging scan while viewing pictures of foods varied by portion size and energy density (ED). Incidence of LOC over the past 3 months was self-reported. Random coefficient models were tested for differences in the shape of the PSE curve by LOC status. A whole-brain analysis was conducted to determine response to food cues during the functional magnetic resonance imaging.

RESULTS

Reported LOC (n = 13) compared with no-LOC (n = 34) was associated with increased susceptibility to the PSE, as evidenced by a positive association with the linear slope (P < 0.005), and negative association with the quadratic slope (P < 0.05) of the intake curve. Children who reported LOC compared with no-LOC showed increased activation in the left cerebellum to small relative to large portions (P < 0.01) and right cerebellum to High-ED relative to Low-ED food cues (P < 0.01).

CONCLUSION

Children who reported LOC were more susceptible to the PSE and showed alterations in food-cue processing in the cerebellum, a hindbrain region implicated in satiety signalling.

EmojiGrid: A 2D pictorial scale for cross-cultural emotion assessment of negatively and positively valenced food

Because of the globalization of world food markets there is a growing need for valid and language independent self-assessment tools to measure food-related emotions. We recently introduced the EmojiGrid as a language-independent, graphical affective self-report tool. The EmojiGrid is a Cartesian grid that is labeled with facial icons (emoji) expressing different degrees of valence and arousal. Users can report their subjective ratings of valence and arousal by marking the location on the area of the grid that corresponds to the emoji that best represent their affective state when perceiving a given food or beverage. In a previous study we found that the EmojiGrid is robust, self-explaining and intuitive: valence and arousal ratings were independent of framing and verbal instructions. This suggests that the EmojiGrid may be a valuable tool for cross-cultural studies. To test this hypothesis, we performed an online experiment in which respondents from Germany (GE), Japan (JP), the Netherlands (NL) and the United Kingdom (UK) rated valence and arousal for 60 different food images (covering a large part of the affective space) using the EmojiGrid. The results show that the nomothetic relation between valence and arousal has the well-known U-shape for all groups. The European groups (GE, NL and UK) closely agree in their overall rating behavior. Compared to the European groups, the Japanese group systematically gave lower mean arousal ratings to low valenced images and lower mean valence ratings to high valenced images. These results agree with known cultural response characteristics. We conclude that the EmojiGrid is potentially a valid and language-independent affective self-report tool for cross-cultural research on food-related emotions. It reliably reproduces the familiar nomothetic U-shaped relation between valence and arousal across cultures, with shape variations reflecting established cultural characteristics.

Appearance alteration of fruits and vegetables to increase their appeal to and consumption by school-age children: A pilot study

Picky eating with regard to fruit and vegetables is common among children. This study investigated the effectiveness of enhancing the visual appeal of fruit and vegetables to increase children’s liking and consumption of fruit and vegetables. A pre–post experimental design was used, and the control and experimental groups were repeatedly exposed to the original food and transformed food, respectively, over 6 weeks. Significant differences in the consumption of pumpkin, sweet potato, spinach, carrot and aubergine were observed between the groups, demonstrating that the appearance appeal of fruit and vegetables improves the willingness of children to try disliked fruit and vegetables and increases their vegetable consumption.

Greater Reward-Related Neuronal Response to Hedonic Foods in Women Compared with Men

OBJECTIVE

The current study aimed to identify how sex influences neurobiological responses to food cues, particularly those related to hedonic eating, and how this relates to obesity propensity, using functional magnetic resonance imaging (fMRI).

METHODS

Adult men and women who were either obesity resistant (OR) or obesity prone (OP) underwent fMRI while viewing visual food cues (hedonic foods, neutral foods, and nonfood objects) in both fasted and fed states.

RESULTS

When fasted, a significant sex effect on the response to hedonic vs. neutral foods was observed, with greater responses in women than men in the nucleus accumbens (P = 0.0002) and insula (P = 0.010). Sex-based differences were not observed in the fed state. No significant group effects (OP vs. OR) or group-by-sex interactions were observed in fasted or fed states.

CONCLUSIONS

Greater fasted responses to hedonic food cues in reward-related brain regions were observed in women compared with men, suggesting that women may be more sensitive to the reward value of hedonic foods than men when fasted. This may indicate sex-dependent neurophysiology underlying eating behaviors.

The impact of visual impairment on nutritional status: A systematic review

The aim of this review was to evaluate the literature that has investigated the impact of visual impairment on nutritional status. We identified relevant articles through a multi-staged systematic approach. Fourteen articles were identified as meeting the inclusion criteria. The sample size of the studies ranged from 9 to 761 participants. It was found that visual impairment significantly affects nutritional status. The studies reported that visually impaired people have an abnormal body mass index (BMI); a higher prevalence of obesity and malnutrition was reported. Visually impaired people find it difficult to shop for, eat, and prepare meals. Most studies had a small sample size, and some studies did not include a study control group for comparison. The limitations of these studies suggest that the findings are not conclusive enough to hold true for only those who are visually impaired. Further studies with a larger sample size are required with the aim of developing interventions.

Explicit wanting and liking for palatable snacks are differentially affected by change in physiological state, and differentially related to salivation and hunger

Incentive salience theory (IST) suggests that 'wanting' and liking are dissociable processes. We argue that explicit measures of wanting in humans can reflect the impact of implicit 'wanting' as envisaged by IST, suggesting that dissociations should also be evident for explicit judgments of wanting and liking. To test this, participants were asked to make ratings of these variables for 8 palatable snack foods - and in a related test salivation rate was also assessed. Participants viewed and sniffed each snack food and rated wanting, and then sampled it and rated liking and whether they wanted more of it. Following a lunch eaten to satiety, and composed in part of half of the palatable snack foods, participants repeated their evaluations of the snack foods (and salivation rate). Liking changed less across lunch than wanting and want more ratings, the last-mentioned changing the most. Change in liking was associated with change in salivation rate, independent of wanting, and change in wanting was associated with change in hunger independent of liking. We argue these dissociations are consistent with 'wanting' influencing explicit wanting, and that want more ratings may represent a 'purer' measure of IST 'wanting'.

Consuming Almonds vs. Isoenergetic Baked Food Does Not Differentially Influence Postprandial Appetite or Neural Reward Responses to Visual Food Stimuli

Nuts have high energy and fat contents, but nut intake does not promote weight gain or obesity, which may be partially explained by their proposed high satiety value. The primary aim of this study was to assess the effects of consuming almonds versus a baked food on postprandial appetite and neural responses to visual food stimuli. Twenty-two adults (19 women and 3 men) with a BMI between 25 and 40 kg/m² completed the current study during a 12-week behavioral weight loss intervention. Participants consumed either 28 g of whole, lightly salted roasted almonds or a serving of a baked food with equivalent energy and macronutrient contents in random order on two testing days prior to and at the end of the intervention. Pre- and postprandial appetite ratings and functional magnetic resonance imaging scans were completed on all four testing days. Postprandial hunger, desire to eat, fullness, and neural responses to visual food stimuli were not different following consumption of almonds and the baked food, nor were they influenced by weight loss. These results support energy and macronutrient contents as principal determinants of postprandial appetite and do not support a unique satiety effect of almonds independent of these variables.

Reproducibility assessment of brain responses to visual food stimuli in adults with overweight and obesity

OBJECTIVE

The brain's reward system influences ingestive behavior and subsequently obesity risk. Functional magnetic resonance imaging (fMRI) is a common method for investigating brain reward function. This study sought to assess the reproducibility of fasting-state brain responses to visual food stimuli using BOLD fMRI.

METHODS

A priori brain regions of interest included bilateral insula, amygdala, orbitofrontal cortex, caudate, and putamen. Fasting-state fMRI and appetite assessments were completed by 28 women (n = 16) and men (n = 12) with overweight or obesity on 2 days. Reproducibility was assessed by comparing mean fasting-state brain responses and measuring test-retest reliability of these responses on the two testing days.

RESULTS

Mean fasting-state brain responses on day 2 were reduced compared with day 1 in the left insula and right amygdala, but mean day 1 and day 2 responses were not different in the other regions of interest. With the exception of the left orbitofrontal cortex response (fair reliability), test-retest reliabilities of brain responses were poor or unreliable.

CONCLUSIONS

fMRI-measured responses to visual food cues in adults with overweight or obesity show relatively good mean-level reproducibility but considerable within-subject variability. Poor test-retest reliability reduces the likelihood of observing true correlations and increases the necessary sample sizes for studies.

Hedonic Hunger Is Related to Increased Neural and Perceptual Responses to Cues of Palatable Food and Motivation to Consume: Evidence from 3 Independent Investigations

BACKGROUND

The Power of Food Scale (PFS) seeks to identify individuals who experience high appetitive drive in response to food cues, which is a construct termed "hedonic hunger."

OBJECTIVE

The purpose of this study was to assess cross-sectional correlates and predictive power of PFS scores to probe the construct of hedonic hunger.

METHODS

Separate data from 3 studies (study 1, n = 44; study 2, n = 398; study 3, n = 100) were used to evaluate the construct of hedonic hunger. We examined the correlations between the PFS and neural responsivity during intake and anticipated intake of palatable foods, behavioral food reinforcement, perceptual hedonic ratings of food images, and change in body mass index (BMI) and binge eating over time.

RESULTS

Hedonic hunger was strongly related to bilateral brain response in regions implicated in oral somatosensory processing during cue-elicited anticipation of food intake (study 1; right postcentral gyrus: r = 0.67, P < 0.001; left postcentral gyrus: r = 0.64, P < 0.001), and was correlated with behavioral food reinforcement (study 2; r = 0.31, P = 0.03) and perceptual hedonic ratings (study 3; r = 0.24, P = 0.02). Hedonic hunger was not associated with baseline BMI (studies 1-3: P = 0.14, 0.21, and 0.37, respectively) or change in BMI over the 2-y follow-up (studies 1 and 2: P = 0.14 and 0.37, respectively) but was significantly correlated with baseline binge eating in 2 samples (study 1: r = 0.58, P = 0.001; study 2: r = 0.31, P = 0.02; and study 3: P = 0.02).

CONCLUSIONS

Hedonic hunger was not predictive of weight regulation. However, individuals who report high hedonic hunger are likely to show increased neural and perceptual responses to cues of palatable foods, increased motivation to consume such foods, and a greater likelihood of current binge eating.

Effects of Dietary Protein and Fiber at Breakfast on Appetite, ad Libitum Energy Intake at Lunch, and Neural Responses to Visual Food Stimuli in Overweight Adults

Increasing either protein or fiber at mealtimes has relatively modest effects on ingestive behavior. Whether protein and fiber have additive or interactive effects on ingestive behavior is not known. Fifteen overweight adults (5 female, 10 male; BMI: 27.1 ± 0.2 kg/m²; aged 26 ± 1 year) consumed four breakfast meals in a randomized crossover manner (normal protein (12 g) + normal fiber (2 g), normal protein (12 g) + high fiber (8 g), high protein (25 g) + normal fiber (2 g), high protein (25 g) + high fiber (8 g)). The amount of protein and fiber consumed at breakfast did not influence postprandial appetite or ad libitum energy intake at lunch. In the fasting-state, visual food stimuli elicited significant responses in the bilateral insula and amygdala and left orbitofrontal cortex. Contrary to our hypotheses, postprandial right insula responses were lower after consuming normal protein vs. high protein breakfasts. Postprandial responses in other a priori brain regions were not significantly influenced by protein or fiber intake at breakfast. In conclusion, these data do not support increasing dietary protein and fiber at breakfast as effective strategies for modulating neural reward processing and acute ingestive behavior in overweight adults.

Harnessing the power of disgust: a randomized trial to reduce high-calorie food appeal through implicit priming

BACKGROUND

In our increasingly obesogenic environment, in which high-calorie convenience foods are readily available, food choices can drastically affect weight and overall health. Learned food preferences, which are developed through repeated pairings with positively and negatively valenced stimuli, can contribute to obesity susceptibility if positive attitudes toward high-calorie foods are developed. Thus, the modification of automatic associations with food may be a viable strategy to promote healthier eating behaviors.

OBJECTIVE

In this study, we investigated the ability of an implicit priming (IP) intervention to alter responses to visual food cues by using an evaluative conditioning approach. The main objective was to implicitly (i.e., below conscious perception) associate disgust with high-calorie foods with the aim of reducing liking of these foods.

DESIGN

Participants were randomly assigned to active or control IP. In active IP (n = 22), high-calorie food images were implicitly primed with negatively valenced images, and low-calorie food images were implicitly primed with positively valenced images. In control IP (n = 20), all food images were primed with neutral images of fixation crosses. Food images were rated on the desire to eat immediately before and after IP.

RESULTS

A significant main effect of calorie (high compared with low; P < 0.001) and a significant calorie-by-group (active compared with control) interaction (P = 0.025) were observed. Post hoc tests identified a significantly greater high-calorie rating decline after active IP than after control IP (P = 0.036). Furthermore, there was significantly greater change in high-calorie ratings than in low-calorie ratings in the active group (P = 0.001). Active IP effects extended to high-calorie foods not specifically included in the intervention, which suggested an effect generalization. Moreover, a greater change in high-calorie ratings than in low-calorie ratings persisted 3-5 d after active IP (P < 0.007), which suggested lasting effects.

CONCLUSION

This study provides initial evidence that IP can be used to alter high-calorie food preferences, which could promote healthier eating habits.

Propensity to obesity impacts the neuronal response to energy imbalance

The mechanisms responsible for the propensity to gain weight or remain normal weight are poorly understood. The objective of this study was to study the neuronal response to visual food cues during short-term energy imbalance in healthy adults recruited as obesity-resistant (OR) or obesity-prone (OP) based on self-identification, body mass index, and personal/family weight history. Twenty-five OR and 28 OP subjects were studied in underfed (UF) and overfed (OF) as compared to eucaloric (EU) conditions in a randomized crossover design. Each study phase included a 3-day run-in diet, 1 day of controlled feeding (basal energy needs for EU, 40% above/below basal energy needs for OF/UF), and a test day. On the test day, fMRI was performed in the acute fed stated (30 min after a test meal) while subjects viewed images of foods of high hedonic value and neutral non-food objects. Measures of appetite and hormones were also performed before and every 30 min after the test meal. UF was associated with significantly increased activation of insula, somatosensory cortex, inferior and medial prefrontal cortex (PFC), parahippocampus, precuneus, cingulate, and visual cortex in OR. However, UF had no impact in OP. As a result, UF was associated with significantly greater activation, specifically in the insula, inferior PFC, and somatosensory cortex in OR as compared to OP. While OF was overall associated with reduced activation of inferior visual cortex, no group interaction was observed with OF. In summary, these findings suggest that individuals resistant to weight gain and obesity are more sensitive to short-term energy imbalance, particularly with UF, than those prone to weight gain. The inability to sense or adapt to changes in energy balance may represent an important mechanism contributing to excess energy intake and risk for obesity.

Mechanisms of the portion size effect. What is known and where do we go from here?

Childhood obesity is a persistent problem worldwide, and of particular concern in the United States. Clarifying the role of the food environment in promoting overeating is an important step toward reducing the prevalence of obesity. One potential contributor to the obesity epidemic is the increased portion sizes of foods commonly served. Portion sizes of foods served both at home and away from home have dramatically increased over the past 40 years. Consistently, short-term studies have demonstrated that increasing portion size leads to increased food intake in adults and children, a phenomenon known as the portion size effect. However, the mechanisms underlying this effect are poorly understood. Understanding these mechanisms could assist in clarifying the relationship between portion size and weight status and help inform the development of effective obesity interventions. First, we review the role of visual cues, such as plate size, unit, and utensil size as a potential moderator of the portion size effect. In addition, we discuss meal microstructure components including bite size, rate, and frequency, as these may be altered in response to different portion sizes. We also review theories that implicate post-ingestive, flavor-nutrient learning as a key moderator of the portion size effect. Furthermore, we present preliminary data from an ongoing study that is applying neuroimaging to better understand these mechanisms and identify modifiable child characteristics that could be targeted in obesity interventions. Our tentative findings suggest that individual differences in cognitive (e.g. loss of control eating) and neural responses to food cues may be critical in understanding the mechanisms of the portion size effect. To advance this research area, studies that integrate measures of individual subject-level differences with assessment of food-related characteristics are needed.

Using participant hedonic ratings of food images to construct data driven food groupings

Little is known regarding how individuals' hedonic ratings of a variety of foods interrelate and how hedonic ratings correspond to habitual dietary intake. Participant ratings of food appeal of 104 food images were collected while participants were in a fed state (n = 129). Self-reported frequency of intake of the food items, perceived hunger, body mass index (BMI), and dietary restraint were also assessed. Principal components analysis (PCA) was employed to analyze hedonic ratings of the foods, to identify component structures and to reduce the number of variables. The resulting component structures comprised 63 images loading on seven components including Energy-Dense Main Courses, Light Main Courses and Seafood as well as components more analogous to traditional food groups (e.g., Fruits, Grains, Desserts, Meats). However, vegetables were not represented in a unique, independent component. All components were positively correlated with reported intake of the food items (r's = .26-.52, p <.05), except for the Light Main Course component (r = .10). BMI showed a small positive relation with aggregated food appeal ratings (r = .19; p <.05), which was largely driven by the relations between BMI and appeal ratings for Energy-Dense Main Courses (r = .24; p <.01) and Desserts (r = .27; p <.01). Dietary restraint showed a small significant negative relation to Energy-Dense Main Courses (r = -.21; p <.05), and Meats (r = -.18; p <.05). The present investigation provides novel evidence regarding how individuals' hedonic ratings of foods aggregate into food components and how these component ratings relate to dietary intake. The notable absence of a vegetable component suggests that individuals' liking for vegetables is highly variable and, from an empirical standpoint, not related to how they respond hedonically to other food categories.

A review of visual cues associated with food on food acceptance and consumption

Several sensory cues affect food intake including appearance, taste, odor, texture, temperature, and flavor. Although taste is an important factor regulating food intake, in most cases, the first sensory contact with food is through the eyes. Few studies have examined the effects of the appearance of a food portion on food acceptance and consumption. The purpose of this review is to identify the various visual factors associated with food such as proximity, visibility, color, variety, portion size, height, shape, number, volume, and the surface area and their effects on food acceptance and consumption. We suggest some ways that visual cues can be used to increase fruit and vegetable intake in children and decrease excessive food intake in adults. In addition, we discuss the need for future studies that can further establish the relationship between several unexplored visual dimensions of food (specifically shape, number, size, and surface area) and food intake.

Cognitive regulation of food craving: effects of three cognitive reappraisal strategies on neural response to palatable foods

Objective

Obese versus lean individuals show greater reward region and reduced inhibitory region responsivity to food images, which predict future weight gain. Thinking of the costs of eating palatable foods and craving suppression have been found to modulate this neural responsivity, but these cognitive reappraisal studies have primarily involved lean participants. Herein we evaluated the efficacy of a broader range of reappraisal strategies in modulating neural responsivity to palatable food images among individuals who ranged from lean to obese and tested whether Body Mass Index (BMI) moderates the effects of these strategies.

Materials and method

functional Magnetic Resonance Imaging (fMRI) assessed the effects of three cognitive reappraisal strategies in response to palatable food images versus an imagined intake comparison condition in a sample of adolescents (N = 21; M age = 15.2).

Results

Thinking of the long-term costs of eating the food, thinking of the long-term benefits of not eating the food, and attempting to suppress cravings for the food increased activation in inhibitory regions (e.g., superior frontal gyrus, ventrolateral prefrontal cortex) and reduced activation in attention-related regions (e.g., precuneus, and posterior cingulate cortex). The reappraisal strategy focusing on the long-term benefits of not eating the food more effectively increased inhibitory region activity and reduced attention region activity compared to the other two cognitive reappraisal strategies. BMI did not moderate the effects.

Discussion

These novel results imply that cognitive reappraisal strategies, in particular those focusing on the benefits of not eating the food, could potentially increase the ability to inhibit appetitive motivation and reduce unhealthy food intake in overweight individuals.

Eating-related behaviors and appetite during energy imbalance in obese-prone and obese-resistant individuals

While the majority of Americans are now overweight, some individuals maintain their weight with minimal effort. This study investigated behavioral differences between 58 individuals recruited as either obese-resistant (OR) or obese-prone (OP) based on self-identification, BMI, and personal/family weight history. Subjects were studied during Eucaloric (EU), Overfed (OF), and Underfed (UF) phases which included a run-in diet, 1 day intervention diet, and a study day. At baseline, subjects completed the Three Factor Eating Questionnaire (TFEQ) and Power of Food Scale (PFS). On the study day, ratings of appetite, food appeal and desire, and food cravings were performed in response to a breakfast shake. OF resulted in reduced hunger and food desire while UF resulted in increased hunger and food appeal and desire. While hunger did not differ between groups, OP had higher scores for TFEQ measures (hunger, restraint and disinhibition), higher "hedonic hunger" as measured by the PFS, and greater food cravings and ratings of food appeal and desire. These results suggest that subjective hunger and desire for food change significantly after only one day of over- or underfeeding. Additionally, we found several behavioral differences between groups that are likely to promote weight gain over time in the OP.

Differences in the neuronal response to food in obesity-resistant as compared to obesity-prone individuals

Despite living in an obesogenic environment, some individuals maintain a thin phenotype compared to the majority who are at risk for weight gain and obesity. Understanding how these different phenotypes regulate energy intake is critical. The objective of this study was to examine the differences in neuronal response to visual food cues in adults recruited as either obesity-resistant (OR) or obesity-prone (OP) based on self-identification, BMI, and personal/family weight history. 25 OR and 28 OP individuals were studied after 4 days of eucaloric energy intake. Functional magnetic resonance imaging (fMRI) was performed in the fasted and acute fed states (30 min after a test meal) while subjects viewed images of foods of high hedonic value and neutral non-food objects. Measures of appetite using visual analog scales were performed before and every 30 min after the test meal for 3 h. In the fasted state, food as compared to nonfood images elicited significant response in the insula, somatosensory cortex, parietal cortex, and visual cortex in both OR and OP. The acute fed state resulted in significant attenuation of these and other brain areas in the OR but not OP individuals. Furthermore, OP as compared to OR individuals showed greater activation of medial and anterior prefrontal cortex (PFC) in response to the test meal. Adjusting for fat mass did not impact these results. Attenuation of insula/PFC response to food images in the fed state was associated with greater reductions in hunger. These findings suggest that individuals prone to weight gain and obesity have altered neuronal responses to food cues in brain regions known to be important in energy intake regulation. These altered responses may represent an important mechanism contributing to excess energy intake and risk for obesity.

Piece of cake. Cognitive reappraisal of food craving

A common emotion regulation strategy, cognitive reappraisal, involves altering the meaning of a situation so that the emotional response to the situation is changed. Most research on reappraisal has focused on down-regulation of negative emotion; few studies exist on reappraisal of positive affect, and even fewer have examined the cognitive reappraisal of craving for energy-dense (e.g., "junk") foods. In the present study we examined this form of cognitive reappraisal using a new adaptation of a classic emotion regulation task. Subjects chose idiosyncratic categories of craved (and not craved) energy-dense foods as stimuli, and were instructed either to look at the stimulus or to reappraise it in a way that reduced desire to eat the depicted food using a strategy that could be used in the real world. A repeated-measures ANOVA and follow-up tests revealed that reappraisal significantly reduced self-reported desirability of both Craved and Not Craved foods, but for a greater degree in Craved foods. In addition, the degree to which subjects decreased their desire to consume Craved foods positively correlated with the cognitive restraint subscale of the Three-Factor Eating Questionnaire, a measure of self-control of eating in everyday life.

The effects of exercise on the neuronal response to food cues

Increased physical activity is associated with successful long-term weight loss maintenance due to mechanisms likely more complex than simply increased energy expenditure. The impact of physical activity on the central regulation of food intake may be an important mechanism of this effect. The objective of this study was to examine the effects of exercise training and acute exercise on the neuronal response to food cues as well as eating behaviors. fMRI was performed in the fasted state at baseline and again after a 6 month progressive exercise intervention (supervised, 5 days/wk) both with and without an acute exercise bout in 12 overweight/obese (5 women, 7 men; BMI 33 ± 4 kg/m(2)) healthy adults. fMRI data were acquired while subjects were presented with visual stimuli of foods of high hedonic value as compared to neutral control objects. Questionnaires on eating behaviors, ratings of appeal and desire for foods, and ratings of appetite (hunger, satiety, prospective intake) using visual analog scales were also performed at baseline and again after the 6-month exercise intervention. While only a trend was observed for a reduction in body weight (102 ± 5 to 99 ± 6 kg, p=0.09), a significant reduction in fat mass was observed (36.4 ± 2.8 to 33.7 ± 3.2 kg, p=0.04), although as expected changes in fat mass were variable (-10.0 to +3.7 kg). Chronic exercise was associated with a reduction in the neuronal response to food, primarily in the posterior attention network and insula. A significant positive correlation between the change in fat/body mass and the change in insula response to food cues with chronic exercise was observed. An acute exercise bout attenuated the effects of chronic exercise. The exercise intervention, however, did not impact any of the measures of appetitive behavior. In summary, despite no effects on behavioral measures of appetite, chronic exercise training was associated with attenuation in the response to visual food cues in brain regions known to be important in food intake regulation. The insula, in particular, appears to play an important role in the potential exercise-induced weight loss and weight loss maintenance.