Clinical Studies and Practice

Brain substrates of unhealthy versus healthy food choices: influence of homeostatic status and body mass index

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Unhealthy dietary choices are a major contributor to harmful weight gain and obesity. This study interrogated the brain substrates of unhealthy versus healthy food choices in vivo, and evaluated the influence of hunger state and body mass index (BMI) on brain activation and connectivity.


Thirty adults (BMI: 18–38 kg m−2) performed a food-choice task involving preference-based selection between beverage pairs consisting of high-calorie (unhealthy) or low-calorie (healthy) options, concurrent with functional magnetic resonance imaging (fMRI). Selected food stimuli were delivered to participants using an MRI-compatible gustometer. fMRI scans were performed both after 10-h fasting and when sated. Brain activation and hypothalamic functional connectivity were assessed when selecting between unhealthy–healthy beverage pairings, relative to unhealthy–unhealthy and healthy–healthy options. Results were considered significant at cluster-based family-wise error corrected P<0.05.


Selecting between unhealthy and healthy foods elicited significant activation in the hypothalamus, the medial and dorsolateral prefrontal cortices, the anterior insula and the posterior cingulate. Hunger was associated with higher activation within the ventromedial and dorsolateral prefrontal cortices, as well as lower connectivity between the hypothalamus and both the ventromedial prefrontal cortex and dorsal striatum. Critically, people with higher BMI showed lower activation of the hypothalamus—regardless of hunger state—and higher activation of the ventromedial prefrontal cortex when hungry.


People who are overweight and obese have weaker activation of brain regions involved in energy regulation and greater activation of reward valuation regions while making choices between unhealthy and healthy foods. These results provide evidence for a shift towards hedonic-based, and away from energy-based, food selection in obesity.

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This study was funded by a Medical Research Grant from the Ian Potter Foundation (2015) and a Strategic Grant from the Faculty of Medicine, Monash University (Strategic Grant Scheme, 2015) (to AVG). IHH supported by Australian National Health and Medical Research Council Fellowship (1106533). ZBA supported by Australian National Health and Medical Research Council Fellowship (1084344). CSM supported by a Miguel Servet contract from the Carlos III Health Institute (CPII16/00048). We would like to acknowledge Helen Truby and Alastair Kwok for developing the beverages used in the task, the Monash Instrumentation Office for developing the gustometer, and Erynn Christensen and Sarah Giles for invaluable help with data collection.

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Correspondence to A Verdejo-Garcia.

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Supplementary Information accompanies this paper on International Journal of Obesity website

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