Seeing Is Craving: Neural Dynamics of Appetitive Processing During Food-Cue Video Watching and Its Impact on Obesity

Background/Objectives: Digital food-related videos significantly influence cravings, appetite, and weight outcomes; however, the dynamic neural mechanisms underlying appetite fluctuations during naturalistic viewing remain unclear. This study aimed to identify neural activity patterns associated with moment-to-moment appetite changes during naturalistic food-cue video viewing and to examine their relationships with cravings and weight-related outcomes. Methods: Functional magnetic resonance imaging (fMRI) data were collected from 58 healthy female participants as they viewed naturalistic food-cue videos. Participants concurrently provided continuous ratings of their appetite levels throughout video viewing. Hidden Markov Modeling (HMM), combined with machine learning regression techniques, was employed to identify distinct neural states reflecting dynamic appetite fluctuations. Findings were independently validated using a shorter-duration food-cue video viewing task. Results: Distinct neural states characterized by heightened activation in default mode and frontoparietal networks consistently corresponded with increases in appetite ratings. Importantly, the higher expression of these appetite-related neural states correlated positively with participants' Body Mass Index (BMI) and post-viewing food cravings. Furthermore, these neural states mediated the relationship between BMI and food craving levels. Longitudinal analyses revealed that the expression levels of appetite-related neural states predicted participants' BMI trajectories over a subsequent six-month period. Participants experiencing BMI increases exhibited a significantly greater expression of these neural states compared to those whose BMI remained stable. Conclusions: Our findings elucidate how digital food cues dynamically modulate neural processes associated with appetite. These neural markers may serve as early indicators of obesity risk, offering valuable insights into the psychological and neurobiological mechanisms linking everyday media exposure to food cravings and weight management.