Lesions involving the insula are associated with reduced appetite and weight loss

Eating-related disorders such as anorexia nervosa, bulimia nervosa and obesity are associated with high rates of morbidity and mortality in the United States. To investigate the neuroanatomical structures involved in appetite and weight change, we employed lesion symptom mapping. 358 patients with focal brain lesions and appetite ratings were recruited, as well as 48 patients with pre- and post-lesion weight records. Partial least squares regression identified a significant association between patterns of brain damage and appetite change (model R2 = 0.13, P = 0.006), and the relationship between lesion location and weight change was explored using the proportional subtraction method. The right posterior insula was the peak region associated with both decreased appetite and weight loss, providing new insight into the neural correlates of higher-order appetite regulation and weight management.