04 Mar Anorexia Nervosa: So Brain Changes Persist After Weight Restoration
MedicalResearch.com Interview with:
Guido K.W. Frank, M.D., FAED
Associate Professor of Psychiatry and Neuroscience
Associate Director, Eating Disorder Program
Director, Developmental Brain Research Program
Pediatric Mental Health Institute | Children’s Hospital | University of Colorado Anschutz Medical Campus Colorado
MedicalResearch.com: What is the background for this study?
Response: Anorexia nervosa is an eating disorder that primarily affects young females and is associated with high mortality. The diagnostic criteria include restriction of energy intake that leads to significantly low body weight and an intense fear of gaining weight or becoming fat. The etiology of anorexia nervosa is complex, and only recently have we begun to better understand its underlying neurobiology. Brain scans of anorexia nervosa patients have implicated brain reward circuits in the disease, brain regions that govern food intake. On the other hand, how much we eat also affects over time reward system response and eating too much or too little has important implications on brain reward function.
Previous studies from our lab as well as basic science research suggest that underweight is associated with heightened reward system response. In this study wanted to test whether we would find heightened brain activity in adolescents with anorexia nervosa and whether this would normalize once the patient regained weight.
MedicalResearch.com: What are the main findings?
Response: Study participants were adolescent girls who were between 15 and 16 years old. They underwent a reward-learning taste task, which has been associated with dopamine function, while their brains were being scanned using functional magnetic resonance imging (fMRI) of the brain.
The results show that reward responses were higher in adolescents with anorexia nervosa than in those without it. This normalized somewhat after weight gain but still remained elevated. Those changes occurred in parts of the brain like the insula, which processes taste along with a number of other functions including body self-awareness, as well as the caudate, a region that processes rewarding stimuli and contributes to motivation to act and approach rewards including food.
Another important finding was that the more severely altered the brain was before treatment, the harder it was to treat the illness, that is the harder it was to gain weight during eating disorder treatment.
MedicalResearch.com: What should readers take away from your report?
Response: In summary, the study suggests that sensitization of brain reward
responsiveness may last long into recovery and brain response may be a marker for illness severity. Whether individuals with anorexia nervosa have a genetic predisposition for such sensitization requires further study. It is important to know that after weight restoration the brain of an adolescent with anorexia nervosa is not well or recovered by any means and still needs much support and specialized treatment.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future research will need to address the underlying neurotransmitter alterations that contribute to these findings and whether we can use brain imging to direct clinical care.
MedicalResearch.com: Is there anything else you would like to add?
Response: I do not have any disclosures but I’d like to recommend a book that I recently wrote, “WHAT CAUSES EATING DISORDERS – AND WHAT DO THEY CAUSE?”
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Marisa DeGuzman, B.A., B.S., Megan E. Shott, B.S., Tony T. Yang, M.D., Ph.D., Justin Riederer, B.S., Guido K.W. Frank, M.D. Association of Elevated Reward Prediction Error Response With Weight Gain in Adolescent Anorexia Nervosa. American Journal of Psychiatry, February 2017
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