Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Neural predictors of 12-month weight loss outcomes following bariatric surgery

International Journal of Obesity volume 42, pages 785–793 (2018)Cite this article

Subjects

Abstract

Background/Objectives:

Despite the effectiveness of bariatric surgery, there is still substantial variability in long-term weight outcomes and few factors with predictive power to explain this variability. Neuroimaging may provide a novel biomarker with utility beyond other commonly used variables in bariatric surgery trials to improve prediction of long-term weight-loss outcomes. The purpose of this study was to evaluate the effects of sleeve gastrectomy (SG) on reward and cognitive control circuitry postsurgery and determine the extent to which baseline brain activity predicts weight loss at 12-month postsurgery.

Subjects/Methods:

Using a longitudinal design, behavioral, hormone and neuroimaging data (during a desire for palatable food regulation paradigm) were collected from 18 patients undergoing SG at baseline (<1 month prior) and 12-month post-SG.

Results:

SG patients lost an average of 29.0% of their weight (percentage of total weight loss (%TWL)) at 12-month post-SG, with significant variability (range: 16.0–43.5%). Maladaptive eating behaviors (uncontrolled, emotional and externally cued eating) improved (P<0.01), in parallel with reductions in fasting hormones (acyl ghrelin, leptin, glucose, insulin; P<0.05). Brain activity in the nucleus accumbens (NAcc), caudate, pallidum and amygdala during desire for palatable food enhancement vs regulation decreased from baseline to 12 months (P (family-wise error (FWE))<0.05). Dorsolateral and dorsomedial prefrontal cortex activity during desire for palatable food regulation (vs enhancement) increased from baseline to 12 months (P(FWE)<0.05). Baseline activity in the NAcc and hypothalamus during desire for palatable food enhancement was significantly predictive of %TWL at 12 months (P (FWE)<0.05), superior to behavioral and hormone predictors, which did not significantly predict %TWL (P>0.10). Using stepwise linear regression, left NAcc activity accounted for 54% of the explained variance in %TWL at 12 months.

Conclusions:

Consistent with previous obesity studies, reward-related neural circuit activity may serve as an objective, relatively robust predictor of postsurgery weight loss. Replication in larger studies is necessary to determine true effect sizes for outcome prediction.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Adams TD, Davidson LE, Litwin SE, Kolotkin RL, LaMonte MJ, Pendleton RC et al. Health benefits of gastric bypass surgery after 6 years. JAMA 2012; 308: 1122–1131.

    Article  CAS  Google Scholar 

  2. Carlin AM, Zeni TM, English WJ, Hawasli AA, Genaw JA, Krause KR et al. The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Ann Surg 2013; 257: 791–797.

    Article  Google Scholar 

  3. Courcoulas AP, Christian NJ, Belle SH, Berk PD, Flum DR, Garcia L et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 2013; 310: 2416–2425.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Ikramuddin S, Korner J, Lee WJ, Connett JE, Inabnet WB, Billington CJ et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA 2013; 309: 2240–2249.

    Article  CAS  Google Scholar 

  5. Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012; 366: 1567–1576.

    Article  CAS  Google Scholar 

  6. Sjostrom L, Peltonen M, Jacobson P, Sjostrom CD, Karason K, Wedel H et al. Bariatric surgery and long-term cardiovascular events. JAMA 2012; 307: 56–65.

    Article  Google Scholar 

  7. Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 2009; 361: 445–454.

    Article  Google Scholar 

  8. Courcoulas AP, Christian NJ, O'Rourke RW, Dakin G, Patchen Dellinger E, Flum DR et al. Preoperative factors and 3-year weight change in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium. Surg Obes Relat Dis 2015; 11: 1109–1118.

    Article  Google Scholar 

  9. Courcoulas AP, Yanovski SZ, Bonds D, Eggerman TL, Horlick M, Staten MA et al. Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. JAMA Surg 2014; 149: 1323–1329.

    Article  Google Scholar 

  10. Gabrieli JD, Ghosh SS, Whitfield-Gabrieli S . Prediction as a humanitarian and pragmatic contribution from human cognitive neuroscience. Neuron 2015; 85: 11–26.

    Article  CAS  Google Scholar 

  11. Hall PA . Prevention neuroscience: a new frontier for preventive medicine. Prev Med 2016; 86: 114–116.

    Article  Google Scholar 

  12. Nichols TE, Das S, Eickhoff SB, Evans AC, Glatard T, Hanke M et al. Best practices in data analysis and sharing in neuroimaging using MRI. Nat Neurosci 2017; 20: 299–303.

    Article  CAS  Google Scholar 

  13. Furey ML, Drevets WC, Hoffman EM, Frankel E, Speer AM, Zarate CA Jr . Potential of pretreatment neural activity in the visual cortex during emotional processing to predict treatment response to scopolamine in major depressive disorder. JAMA Psychiatry 2013; 70: 280–290.

    Article  Google Scholar 

  14. Whitfield-Gabrieli S, Ghosh SS, Nieto-Castanon A, Saygin Z, Doehrmann O, Chai XJ et al. Brain connectomics predict response to treatment in social anxiety disorder. Mol Psychiatry 2016; 21: 680–685.

    Article  CAS  Google Scholar 

  15. van Veenendaal TM, IJff DM, Aldenkamp AP, Hofman PA, Vlooswijk MC, Rouhl RP et al. Metabolic and functional MR biomarkers of antiepileptic drug effectiveness: a review. Neurosci Biobehav Rev 2015; 59: 92–99.

    Article  CAS  Google Scholar 

  16. Marhe R, Luijten M, van de Wetering BJ, Smits M, Franken IH . Individual differences in anterior cingulate activation associated with attentional bias predict cocaine use after treatment. Neuropsychopharmacology 2013; 38: 1085–1093.

    Article  Google Scholar 

  17. Murdaugh DL, Cox JE, Cook EW 3rd, Weller RE . fMRI reactivity to high-calorie food pictures predicts short- and long-term outcome in a weight-loss program. Neuroimage 2012; 59: 2709–2721.

    Article  Google Scholar 

  18. Heller AS, Johnstone T, Light SN, Peterson MJ, Kolden GG, Kalin NH et al. Relationships between changes in sustained fronto-striatal connectivity and positive affect in major depression resulting from antidepressant treatment. Am J Psychiatry 2013; 170: 197–206.

    Article  Google Scholar 

  19. Ten Kulve JS, Veltman DJ, van Bloemendaal L, Barkhof F, Drent ML, Diamant M et al. Liraglutide reduces CNS activation in response to visual food cues only after short-term treatment in patients with type 2 diabetes. Diabetes Care 2016; 39: 214–221.

    Article  CAS  Google Scholar 

  20. Bruce AS, Bruce JM, Ness AR, Lepping RJ, Malley S, Hancock L et al. A comparison of functional brain changes associated with surgical versus behavioral weight loss. Obesity (Silver Spring) 2014; 22: 337–343.

    Article  Google Scholar 

  21. Bruce JM, Hancock L, Bruce A, Lepping RJ, Martin L, Lundgren JD et al. Changes in brain activation to food pictures after adjustable gastric banding. Surg Obes Relat Dis 2012; 8: 602–608.

    Article  Google Scholar 

  22. Faulconbridge LF, Ruparel K, Loughead J, Allison KC, Hesson LA, Fabricatore AN et al. Changes in neural responsivity to highly palatable foods following roux-en-Y gastric bypass, sleeve gastrectomy, or weight stability: an fMRI study. Obesity (Silver Spring) 2016; 24: 1054–1060.

    Article  Google Scholar 

  23. Ochner CN, Kwok Y, Conceicao E, Pantazatos SP, Puma LM, Carnell S et al. Selective reduction in neural responses to high calorie foods following gastric bypass surgery. Ann Surg 2011; 253: 502–507.

    Article  Google Scholar 

  24. Ochner CN, Laferrere B, Afifi L, Atalayer D, Geliebter A, Teixeira J . Neural responsivity to food cues in fasted and fed states pre and post gastric bypass surgery. Neurosci Res 2012; 74: 138–143.

    Article  Google Scholar 

  25. Ochner CN, Stice E, Hutchins E, Afifi L, Geliebter A, Hirsch J et al. Relation between changes in neural responsivity and reductions in desire to eat high-calorie foods following gastric bypass surgery. Neuroscience 2012; 209: 128–135.

    Article  CAS  Google Scholar 

  26. Scholtz S, Miras AD, Chhina N, Prechtl CG, Sleeth ML, Daud NM et al. Obese patients after gastric bypass surgery have lower brain-hedonic responses to food than after gastric banding. Gut 2014; 63: 891–902.

    Article  Google Scholar 

  27. Frank S, Heinze JM, Fritsche A, Linder K, von Feilitzsch M, Konigsrainer A et al. Neuronal food reward activity in patients with type 2 diabetes with improved glycemic control after bariatric surgery. Diabetes Care 2016; 39: 1311–1317.

    Article  CAS  Google Scholar 

  28. Goldman RL, Canterberry M, Borckardt JJ, Madan A, Byrne TK, George MS et al. Executive control circuitry differentiates degree of success in weight loss following gastric-bypass surgery. Obesity (Silver Spring) 2013; 21: 2189–2196.

    Article  Google Scholar 

  29. Buchwald H, Oien DM . Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013; 23: 427–436.

    Article  Google Scholar 

  30. Nguyen NT, Nguyen B, Gebhart A, Hohmann S . Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy. J Am Coll Surg 2013; 216: 252–257.

    Article  Google Scholar 

  31. Hollmann M, Hellrung L, Pleger B, Schlogl H, Kabisch S, Stumvoll M et al. Neural correlates of the volitional regulation of the desire for food. Int J Obes (Lond) 2012; 36: 648–655.

    Article  CAS  Google Scholar 

  32. Kober H, Mende-Siedlecki P, Kross EF, Weber J, Mischel W, Hart CL et al. Prefrontal-striatal pathway underlies cognitive regulation of craving. Proc Natl Acad Sci USA 2010; 107: 14811–14816.

    Article  CAS  Google Scholar 

  33. Siep N, Roefs A, Roebroeck A, Havermans R, Bonte M, Jansen A . Fighting food temptations: the modulating effects of short-term cognitive reappraisal, suppression and up-regulation on mesocorticolimbic activity related to appetitive motivation. Neuroimage 2012; 60: 213–220.

    Article  Google Scholar 

  34. Yokum S, Stice E . Cognitive regulation of food craving: effects of three cognitive reappraisal strategies on neural response to palatable foods. Int J Obes (Lond) 2013; 37: 1565–1570.

    Article  CAS  Google Scholar 

  35. Val-Laillet D, Aarts E, Weber B, Ferrari M, Quaresima V, Stoeckel LE et al. Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity. Neuroimage Clin 2015; 8: 1–31.

    Article  CAS  Google Scholar 

  36. Zijlstra H, van Middendorp H, Devaere L, Larsen JK, van Ramshorst B, Geenen R . Emotion processing and regulation in women with morbid obesity who apply for bariatric surgery. Psychol Health 2012; 27: 1375–1387.

    Article  Google Scholar 

  37. Handley JD, Williams DM, Caplin S, Stephens JW, Barry J . Changes in cognitive function following bariatric surgery: a systematic review. Obes Surg 2016; 26: 2530–2537.

    Article  Google Scholar 

  38. Gross JJ, John OP . Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol 2003; 85: 348–362.

    Article  Google Scholar 

  39. van Strien T, Frijters JER, Bergers GPA, Defares PB . The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. Int J Eat Disord 1986; 5: 295–315.

    Article  Google Scholar 

  40. Stunkard AJ, Messick S . The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res 1985; 29: 71–83.

    Article  CAS  Google Scholar 

  41. Lowe MR, Butryn ML, Didie ER, Annunziato RA, Thomas JG, Crerand CE et al. The Power of Food Scale. A new measure of the psychological influence of the food environment. Appetite 2009; 53: 114–118.

    Article  Google Scholar 

  42. Beck AT, Steer RA, Brown GK . Manual for the Beck Depression Inventory-II. Psychological Corporation: San Antonio, TX, USA, 1996.

    Google Scholar 

  43. Spielberger CD, Gorsuch RL, Lushene RE . Manual for the State-Trait Anxiety Inventory. Consultin Psychologists Press: Palo Alto, CA, USA, 1970.

    Google Scholar 

  44. Maldjian JA, Laurienti PJ, Kraft RA, Burdette JH . An automated method for neuroanatomic and cytoarchitectonic atlas-based interrogation of fMRI data sets. Neuroimage 2003; 19: 1233–1239.

    Article  Google Scholar 

  45. Whitfield-Gabrieli S . Region of Interest Extraction (REX) Toolbox. Gabrieli Lab, MIT Department of Brain and Cognitive Sciences: Cambridge, MA, USA, 2009.

    Google Scholar 

  46. Faul F, Erdfelder E, Lang AG, Buchner A . G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39: 175–191.

    Article  Google Scholar 

  47. Sczepaniak JP, Owens ML, Shukla H, Perlegos J, Garner W . Comparability of weight loss reporting after gastric bypass and sleeve gastrectomy using BOLD data 2008-2011. Obes Surg 2015; 25: 788–795.

    Article  Google Scholar 

  48. Rieber N, Giel KE, Meile T, Enck P, Zipfel S, Teufel M . Psychological dimensions after laparoscopic sleeve gastrectomy: reduced mental burden, improved eating behavior, and ongoing need for cognitive eating control. Surg Obes Relat Dis 2013; 9: 569–573.

    Article  Google Scholar 

  49. Chao A, Grilo CM, White MA, Sinha R . Food cravings, food intake, and weight status in a community-based sample. Eat Behav 2014; 15: 478–482.

    Article  Google Scholar 

  50. Buscemi J, Rybak TM, Berlin KS, Murphy JG, Raynor HA . Impact of food craving and calorie intake on body mass index (BMI) changes during an 18-month behavioral weight loss trial. J Behav Med 2017; 40: 565–573.

    Article  Google Scholar 

  51. Meule A, Richard A, Platte P . Food cravings prospectively predict decreases in perceived self-regulatory success in dieting. Eat Behav 2017; 24: 34–38.

    Article  Google Scholar 

  52. Mans E, Serra-Prat M, Palomera E, Sunol X, Clave P . Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test. Am J Clin Nutr 2015; 102: 540–547.

    Article  CAS  Google Scholar 

  53. van der Plasse G, van Zessen R, Luijendijk MC, Erkan H, Stuber GD, Ramakers GM et al. Modulation of cue-induced firing of ventral tegmental area dopamine neurons by leptin and ghrelin. Int J Obes (Lond) 2015; 39: 1742–1749.

    Article  CAS  Google Scholar 

  54. Buhle JT, Silvers JA, Wager TD, Lopez R, Onyemekwu C, Kober H et al. Cognitive reappraisal of emotion: a meta-analysis of human neuroimaging studies. Cereb Cortex 2014; 24: 2981–2990.

    Article  Google Scholar 

  55. Staudinger MR, Erk S, Walter H . Dorsolateral prefrontal cortex modulates striatal reward encoding during reappraisal of reward anticipation. Cereb Cortex 2011; 21: 2578–2588.

    Article  Google Scholar 

  56. Kolata G . After weight-loss surgery, a year of joys and disappointments. New York Times, 27 December 2016.

  57. Goldstein-Piekarski AN, Korgaonkar MS, Green E, Suppes T, Schatzberg AF, Hastie T et al. Human amygdala engagement moderated by early life stress exposure is a biobehavioral target for predicting recovery on antidepressants. Proc Natl Acad Sci USA 2016; 113: 11955–11960.

    Article  CAS  Google Scholar 

  58. Stice E, Yokum S, Burger K, Rohde P, Shaw H, Gau JM . A pilot randomized trial of a cognitive reappraisal obesity prevention program. Physiol Behav 2015; 138: 124–132.

    Article  CAS  Google Scholar 

  59. Gluck ME, Alonso-Alonso M, Piaggi P, Weise CM, Jumpertz-von Schwartzenberg R, Reinhardt M et al. Neuromodulation targeted to the prefrontal cortex induces changes in energy intake and weight loss in obesity. Obesity (Silver Spring) 2015; 23: 2149–2156.

    Article  Google Scholar 

  60. Hall PA, Vincent CM, Burhan AM . Non-invasive brain stimulation for food cravings, consumption, and disorders of eating: a review of methods, findingss and controversies. Appetite 2017. epub ahead of print 11 March 2017 doi:10.1016/j.appet.2017.03.006.

    Article  Google Scholar 

  61. Hanlon CA, Dowdle LT, Austelle CW, DeVries W, Mithoefer O, Badran BW et al. What goes up, can come down: novel brain stimulation paradigms may attenuate craving and craving-related neural circuitry in substance dependent individuals. Brain Res 2015; 1628 (Pt A): 199–209.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the study participants for volunteering their time; Vanessa Calderon, Mark Gorman and Noreen Harrington for coordinating subject recruitment and Max Curran for programming the fMRI paradigm. This work was funded by the Harvard Nutrition Obesity Research Center (P30 DK040561), Global Foundation for Eating Disorders and the Harvard Catalyst/The Harvard Clinical and Translational Science Center (NIH Award #UL1 RR 025758 and financial contributions from Harvard University and affiliated academic health-care centers). Support for a portion of LMH’s time was provided by NIMH K01 HD019222 and BWH BRI Fund for Research Excellence.

Author information

Authors and Affiliations

  1. Division of Women’s Health, Department of Medicine, Brigham & Women’s Hospital, Boston, MA, USA

    L M Holsen, H Cerit, T Hye, P Moondra & J M Goldstein

  2. Department of Psychiatry, Brigham & Women’s Hospital, Boston, MA, USA

    L M Holsen, P Davidson, F Haimovici & J M Goldstein

  3. Harvard Medical School, Boston, MA, USA

    L M Holsen, P Davidson, H Cerit, F Haimovici, S Sogg, S Shikora, J M Goldstein, A E Evins & L E Stoeckel

  4. Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham & Women’s Hospital, Boston, MA, USA

    P Davidson & S Shikora

  5. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    S Sogg, J M Goldstein, A E Evins & L E Stoeckel

  6. MGH Weight Center, Massachusetts General Hospital, Boston, MA, USA

    S Sogg

  7. Division of Psychiatric Neuroscience, Athinoula A. Martinos Center, Massachusetts General Hospital, Boston, MA, USA

    J M Goldstein & A E Evins

  8. Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA

    L E Stoeckel

Authors
  1. L M Holsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P Davidson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H Cerit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T Hye
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P Moondra
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F Haimovici
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S Sogg
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S Shikora
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J M Goldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A E Evins
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. L E Stoeckel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L M Holsen.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on International Journal of Obesity website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Holsen, L., Davidson, P., Cerit, H. et al. Neural predictors of 12-month weight loss outcomes following bariatric surgery. Int J Obes 42, 785–793 (2018). https://doi.org/10.1038/ijo.2017.190

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2017.190

This article is cited by

Search

Advanced search

Quick links