Objective Neurocognitive deficits in pediatric obesity relate to poor developmental outcomes. We sought preliminary evidence for changes in brain and cognitive functioning relevant to obesogenic behavior following vertical sleeve gastrectomy (VSG) in adolescents relative to wait-listed (WL) and healthy (HC) controls. Methods Thirty-six adolescents underwent fMRI twice 4 months apart, during executive, reward, and episodic memory encoding, in addition to behavioral testing for reward-related decision making. Results VSG adolescents lost weight, while WL gained weight and HC did not change between timepoints. Gains in executive and reward-related performance were larger in VSG than control groups. Group x Time interaction (p <0.05 corrected) in left prefrontal cortex during N-back showed greater pre-surgical activation and post-surgical reduction comparable to HC levels, but increased in WL between timepoints. Similarly, left striatal parametric response to reward value reduced after surgery to HC levels; WL did not change. Memory-related medial temporal activation did not change in any group. Conclusion Results provide pilot evidence for functional brain changes induced by VSG in adolescents with severe obesity. Weight loss and gain was paralleled by reduced and increased prefrontal activation, respectively, suggesting neural plasticity related to metabolic change.

According to the terror management health model (TMHM), life‐threatening health conditions have the potential to make people think about death, which triggers anxiety and motivates people to engage in defensive behaviors that may or may not facilitate health. This model has been used to explain health‐defeating reactions to the COVID‐19 pandemic (e.g., intentional nonadherence to mitigation guidelines) and to inform recommendations for current and future public health campaigns. Unfortunately, these recommendations do not account for psychological reactance, an aversive motivational state known to undermine persuasive messages. For this reason, we argue that the TMHM for pandemics is incomplete in its current form and should be expanded to account for reactance processes. We also highlight two reactance‐reducing strategies (inoculation messages and restoration postscripts) that could potentially increase the efficacy of the public health messages proposed by the TMHM for pandemics. We conclude with a discussion of how psychological reactance theory can augment the TMHM more broadly. Overall, we hope to illustrate both the utility and feasibility of considering more than one theoretical approach when designing empirically supported public health messages.

Pre-operative binge eating should be a target for identification and treatment prior to sleeve gastrectomy in adolescents. Although not directly or indirectly associated with EBMI loss, perceived social support around exercise was associated with increased exercise, which may make it a consideration for a target for intervention as well.

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