An Influential Choice

We live in a world of convenience and temptation, and it’s difficult to know how to influence food choice in a healthy way. I was particularly reminded of this since having a toddler, who knows what he wants and has very little impulse control.

We were recently on a walk round the park, him on his little balance bike and me walking the dog. He’s zooming around, so I’m happy to follow his lead, but it doesn’t take long to realise that his zoomies have a definite target, which is the café at the park. The café that just happens to sell ice cream. Soon enough we get there and, surprise surprise, he wants a tasty treat.

But then, we are biologically designed in a way to seek out the high reward palatable foods, and not at all for a modern world with multi-billion pound corporations whose business models depend on us gorging ourselves to morbid obesity. As another example, it only took one or two visits to a certain fast-food chain (parenting is hard, don’t judge me) before the little man recognised the signs for said shop and would request the rewarding food they sell.

It might be obvious, from an evolutionary perspective, why we seek high reward foods, but it’s not so obvious how this is coordinated by the brain. In this post I’ll explore some of what we know about the selection of highly palatable food, why this is important for the control of body weight, and some thoughts on how to influence food choice pharmacologically to improve health.

Starting from the beginning, we’ve known for a long time that giving animals access to palatable foods (high fat and/or sugar) causes an increase in body weight1. The story becomes more interesting when we look at intake related to food choice.

In an early study, human subjects were locked in a lab for a couple of weeks and either given unlimited access to monotonous food, or given normal food restricted to the same number of calories as the “monotonous” group. The first group voluntarily decreased their caloric intake (so the second group had theirs decreased), and both cohorts lost weight.

The interesting point of this study is that the monotonous group that voluntarily decreased their food intake didn’t notice their hunger to the same extent as the calorie restricted group. This clearly emphasises the importance of the food environment we live in when it comes to food choice.

My thoughts following on from such food-choice studies were about the possibility of how to influence food choice pharmacologically. As far as I can tell, all the pharmaceutical attempts at combating obesity aim to administer long-lasting modulators of hunger/satiety (increasing energy expenditure has proven problematic for reasons I may go into another time).

Unfortunately, the neuronal pathways that control food intake are so intertwined with other functions (such as mood and nausea), that you get off-target effects. Furthermore, the receptors and signalling pathways you target will naturally compensate to counter the effects, so any effects of food intake and body weight are short-lived.

What if we could administer short-acting compounds that, rather than hammering down our desire to eat with diminishing returns, merely changes the preference away from the unhealthy foods that cause the pathogenic weight gain? It doesn’t matter how hungry you are, if your appetite is limited to carrots and broccoli, it is impossible for you to become obese.

But, how would we go about doing this? I believe that some of our more recent knowledge about AgRP neurones hints at a solution. Back in 2015, Chen et al. showed that AgRP neurones become rapidly inhibited in response to sensory detection of food3, but more importantly that the degree of response was related to the palatability of the food (Figure 1).

We have since seen that this AgRP response is a teaching signal for caloric entrainment – the AgRP response to a particular food detection will change over time depending on the caloric value (Figure 2)4.

We have also seen that driving AgRP neurones activity (with opto stimulation), drives a marked decrease in preference (Figure 3)5.

So, it appears that AgRP neurones are a fundamental link between sensory detection of food, hunger, and the learned seeking of high caloric foods. More specifically, the drop in AgRP neurones activity upon sensory detection of a food seems to be the determinant of how much of that food the animal wants to eat.

Now, what if we could (briefly) activate AgRP neurones during consumption of an unhealthy meal? I say activate, but it could equally mean limit the inhibition upon detection and consumption of the meal. Classic wisdom would suggest that when you activate AgRP neurones you increase hunger and food intake. And that may happen initially.

However, given the results from Betley et al.5, I would argue that over time, with repeated exposures to the same high calorie meal and activation of the AgRP neurones, you would drive a preference away from that unhealthy meal in the future.

How I envisage this working in practice: we would have short-acting (half-life of 20 minutes or so) modulators of AgRP neurone activity, ideally in an easily administered form, such as in an asthma-type inhaler. An overweight individual who wants to eat better to lose weight and become healthier would then take a hit from an AgRP activator at the start of an unhealthy meal, which will decrease their preference for that food. Conversely, they could take a hit from an AgRP inhibitor at the start of a healthy meal, which will increase their preference for that food.

The goal of this pharmacology is not to alter a person’s hunger in any way, but rather to break the evolutionary drive to overconsume high caloric foods, and in that way to give their willpower a boost to selecting healthy food choices. The idea is that you turn any unhealthy foods into the “monotonous” type that we saw earlier, so the person will voluntarily decrease intake of that food. And the best thing about this is that it hijacks the obscenely effective marketing that companies use to push unhealthy food, and instead links that advertising with unrewarding food.

Great, so I like this idea, but how would we go about showing this experimentally? Well, I would start by continuing on from Betley’s work5, but see if I could use optogenetic stimulation of AgRP neurones to shift preference between foods of unequal palatability.

Ideally, we would provide opto-connected AgRP-ChR2 mice long-term access to chow and high energy diet (HED), and set up the optogenetic system to stimulate the AgRP neurones whenever the mice go to eat the HED, but not the chow. Hopefully, the mice would shift their natural preference for HED away to chow.

If this is successful, the next step would be to mimic the same response using pharmacology – my thought would be to test out a number of known compounds that affect AgRP neurone activity (eg. PYY and CCK, or their antagonists), possibly using combinations to yield a bigger effect.

Well, that’s about as far as I’ve come with this idea of how to influence food choice. I did pitch the concept at lab meeting a few months ago, and it went down about as well as season 8 of Game of Thrones. Oh well, hopefully my loyal readers will find it more interesting than my colleagues.

1. Sclafani and Springer, Physiol Behav 17(3), 461-471 (1976) Dietary obesity in adult rats: similarities to hypothalamic and human obesity syndromes.

2. Cabanac and Rabe, Physiol Behav 17(4), 675-8 (1976) Influence of a monotonous food on body weight regulation in humans.

3. Chen et al., Cell 160, 829-841 (2015) Sensory detection of food rapidly modulates arcuate feeding circuits.

4. Su et al., Cell Reports 21, 2724-2736 (2017) Nutritive, post-ingestive signals are the primary regulators of AgRP neuron activity.

5. Betley et al., Nature 521, 180-185 (2015) Neurons for hunger and thirst transmit a negative-valence teaching signal.

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