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Open Access Highly Accessed Research article

Reduction in neural activation to high-calorie food cues in obese endometrial cancer survivors after a behavioral lifestyle intervention: a pilot study

Nora L Nock12*, Anastasia Dimitropoulos3, Jean Tkach4, Heidi Frasure5 and Vivan vonGruenigen6

Author Affiliations

1 Department of Epidemiology and Biostatistics, Case Western Reserve University, Wolstein Research Building, 2103 Cornell Road, Cleveland, OH, 44106-7281, USA

2 Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, 44106, USA

3 Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA

4 Case Center for Imaging Research, Department of Radiology, Case Western Reserve University, Cleveland, OH, 44106, USA

5 University Hospitals Case Medical Center, Cleveland, OH, 44106, USA

6 Department of Reproductive Biology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, 44106, USA

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BMC Neuroscience 2012, 13:74  doi:10.1186/1471-2202-13-74

Published: 25 June 2012



Obesity increases the risk of endometrial cancer (EC) and obese EC patients have the highest risk of death among all obesity-associated cancers. However, only two lifestyle interventions targeting this high-risk population have been conducted. In one trial, food disinhibition, as determined by the Three-Factor Eating Questionnaire, decreased post-intervention compared to baseline, suggesting an increase in emotional eating and, potentially, an increase in food related reward. Therefore, we evaluated appetitive behavior using functional magnetic resonance imaging (fMRI) and a visual food task in 8 obese, Stage I/II EC patients before and after a lifestyle intervention (Survivors in Uterine Cancer Empowered by Exercise and a Healthy Diet, SUCCEED), which aimed to improve nutritional and exercise behaviors over 16 group sessions in 6 months using social cognitive theory.


Congruent to findings in the general obese population, we found that obese EC patients, at baseline, had increased activation in response to high- vs. low-calorie food cues after eating a meal in brain regions associated with food reward (insula, cingulate gyrus; precentral gyrus; whole brain cluster corrected, p < 0.05). At 6 months post-intervention compared to baseline, we observed decreased activation for the high-calorie vs. non-food contrast, post-meal, in regions involved in food reward and motivation (posterior cingulate, cingulate gyrus, lateral globus pallidus, thalamus; claustrum; whole brain cluster corrected, p < 0.05).


Our preliminary results suggest behavioral lifestyle interventions may help to reduce high-calorie food reward in obese EC survivors who are at a high-risk of death. To our knowledge, this is the first study to demonstrate such changes.

Obesity; Endometrial cancer; fMRI; Reward; High-calorie foods; Lifestyle intervention