Harnessing food cue evoked neuroimaging towards treatment optimisation for obesity and binge eating disorder

Obesity and binge eating disorder (BED) are global health concerns that share overlapping neural mechanisms. These include alterations in the brain's reward and control systems leading to heightened sensitivity to food cues and impaired self-regulation, which underpin overeating. Identifying neuroimaging-based biomarkers that index these mechanisms could advance individualised treatments. This scoping review examined evidence on fMRI food cue reactivity as a potential approach for developing predictive and response biomarkers relevant to the treatment of obesity and BED. A systematic search of MEDLINE, Scopus, PsycINFO, and Embase (to July 2025) identified 57 eligible studies incorporating fMRI cue reactivity measures in the context of pharmacological, surgical, psychological, and lifestyle interventions. Of these, 7 reported predictive outcomes only (6 for adults with obesity and 1 for children and adolescents with obesity), 41 reported response outcomes only (36 for adults with obesity, 3 for children and adolescents with obesity and 2 for adults with binge eating), and 9 reported both predictive and response outcomes (8 for adults with obesity and 1 for adults with binge eating). Across paradigms and intervention modalities, there was consistent involvement of reward (striatum, insula, orbitofrontal and ventromedial prefrontal cortex) and cognitive control regions (dorsolateral and dorsomedial prefrontal cortex) as response outcomes from successful treatment. Reductions in reward-system reactivity following interventions were consistently associated with improved clinical outcomes, supporting the potential of fMRI food cue reactivity as a candidate biomarker of treatment response. However, this finding is highly skewed towards obesity, given the limited number of studies that report results for BED (3 studies). Furthermore, consistent evidence for reliable predictive biomarkers was also limited, likely due to methodological variability and small sample sizes. Overall, this review supports the potential of response outcomes from fMRI food cue reactivity as an indicator of treatment efficacy in obesity and highlights the limited evidence in BED. We also emphasise the need for further standardisation of paradigms and biomarker validation efforts.