Executive control circuitry differentiates degree of success in weight loss following gastric-bypass surgery


  • Disclosures: Dr. Goldman has no conflicts of interest. Dr. Borckardt receives research support from NIAMS and NIDA at NIH, The North American Spine Society, and The American Society for Gastrointestinal Endoscopy. Drs. Canterberry, Madan, and Hanlon receive research support from NIH. Dr. Byrne has no conflicts. Dr. George has no conflicts. Dr. O'Neil receives research support from NovoNordisk, Orexigen Therapeutics, and Weight Watchers. Dr. O'Neil also receives honoraria and/or travel support from Pharmatecture, Vindico CME, Vivus, CMEducation Resources, and CMEIncite.

  • Funding agencies: This study was supported by Covidien through a grant from the Obesity Society. The following grants enabled Drs. Canterberry and Hanlon to contribute to this study: K01DA027756 (to C.H.) and T32DA02788 (to M.C.).

  • The first two authors equally contributed to this study. Current address for Rachel L. Goldman,Department of Psychiatry, NYU School of Medicine, Department of Surgery, Bellevue Hospital Center, 462 First Avenue, Amb Care Building 1st Floor New York, New York, USA.



While overall success rates of bariatric surgery are high, approximately 20% of patients either regain or never lose the expected amount of weight. The purpose of this study was to determine whether, after gastric-bypass surgery, the degree of weight loss can be differentiated based on the neural response to food cues.

Design and Methods

In this functional MRI study, 31 post-surgical patients viewed food and neutral images in two counterbalanced runs during which they were either instructed to “crave” or to “resist” craving. The neural response to food cues was assessed within and between runs for all participants, and further analyzed between more successful (n = 24) and less successful (n = 7) groups. More successful was defined by meeting 50% excess weight loss.


Overall, instructions to “crave” elicited significant activity in the dorsomedial prefrontal cortex (PFC) whereas “resist” elicited significant activity in the dorsolateral PFC (DLPFC). Between groups there was no brain difference when instructed to “crave.” The more successful participants however had significantly more activity in the DLPFC when instructed to “resist.”


These findings suggest that the ability to mobilize neural circuits involved in executive control post-gastric-bypass surgery may be a unique component of successful outcome post-surgery.