A behavioural therapist could be as important as a calorie-cutting diet for folks who want to lose weight, researchers say.
Brain scans reveal that people who are better at losing weight have more activity in regions of the brain associated with self-control, a small new study reports.
Teaching people to trigger their brain's self-control centres could be a key factor in losing weight and keeping it off, said senior researcher Dr Alain Dagher. He's a neurologist with McGill University's Montreal Neurological Institute in Canada.
"The analogy that's good here is smoking," he said. "Cigarette smoking has been largely beaten in the Western world through a combination of strategies, and some of these target self-control."
Dieting is a brawl between two different regions of the brain, Dagher said.
Weight loss causes the body to signal that there's an energy deficit, activating a region of the brain associated with motivation and desire, he said. That region - the ventromedial prefrontal cortex - promotes hunger pangs in response.
But there's a counterbalancing force, another section of the brain that promotes self-control, called the lateral prefrontal cortex.
"It's a struggle, and we're doing brain imaging of that struggle, the struggle between the desire to lose weight and the desire to eat tasty food," Dagher said.
For the study, Dagher and his colleagues took brain scans of 24 people enrolled in a 1 200 calorie-per-day diet at a weight-loss clinic. One brain scan took place before starting the diet, another one month into the diet, and a third at three months.
"We showed them appetising pictures of food and measured the brain response to these pictures," which naturally triggered the motivation region of the brain, Dagher said.
People who lost the most weight also displayed increased activity in the brain regions that promote self-control, overriding the hunger signals from the motivation centers, the researchers said.
According to Dr Jeffrey Zigman, an endocrinologist with UT Southwestern Medical Center in Dallas, "Those people who achieved greater weight loss had a greater activation of brain regions that are involved in self-regulation, which might suggest they are better able to self-control their food intake."
In addition, Zigman said, "It seemed to indicate that in people who regained weight further down the line, those areas of the brain were not as active. It does suggest that a person's ability to activate those areas of the brain involved in cognitive control or self-regulation did better with achieving greater weight loss."
Dagher noted that it isn't as simple as saying that some people are better wired to maintain a healthy weight, since many factors can influence how well the self-control center functions.
For example, stress tends to cause a person's self-control systems to fail, Dagher said.
"It's possible people who had less success were more stressed. Events in their lives conspired to make it difficult for them to activate those brain regions," he said.
Effective weight-loss plans might need to include treatments that promote self-control, such as cognitive behavioral therapy, Dagher suggested.
Smokers use cognitive behavioral therapy to come up with strategies that head off urges to reach for a cigarette. The same could be done for dieters, he explained.
"People will say, 'I tend to overeat in this situation.' You train people to understand that and to engage an automatic system of response," Dagher said. "I know when I'm stressed I eat junk food, so I'm going to have another plan. Whenever I'm stressed and I have a craving for junk food, I'm going to have a healthy snack instead. You can actually train people to automatically enact those sort of plans."
Even better might be a combination of such therapy with medications that control hunger hormones, Dagher added.
However, Zigman said, it could be difficult for dieters to find a qualified cognitive behavioural therapist to help them lose weight.
"It's often the case, unfortunately, that those types of therapies are not easily available to people," Zigman said. "It's very difficult to make those types of changes, but this suggests it might be worth people's while to try to seek out those sort of behavioral treatments."
The study was published online October 18 in the journal Cell Metabolism.
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