Prefrontal cortex immaturity and reward circuit hijacking: Why anti-obesity policies fail to protect children from ultra-processed food overconsumption

Figure 4 Proposed multitargeted intervention to prevent ultra-processed foods overconsumption in children and adolescents. The upper panel illustrates the current limitations of public health policies [taxes on ultra-processed foods (UPFs), front-of-package labeling, and restrictions on child-targeted marketing]. These policies primarily target the obesogenic environment but fail to address the core neurodevelopmental vulnerabilities: A hyper-reactive reward circuit combined with an immature prefrontal cortex (PFC) that provides limited impulse control. This imbalance leads to excessive dopamine release triggered by UPFs consumption, promoting compulsive and addictive-like eating behaviors, which in turn contribute to obesity and metabolic diseases. Traditional dietary interventions are shown as having limited impact because they do not target the underlying neurobiological mechanisms. The lower panel proposes a comprehensive multi-targeted intervention model. On the left side, it emphasizes the recognition of UPFs addiction as a clinical condition (aligned with Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria for binge-eating disorder and related disorders) as a necessary prerequisite to enable rigorous research on pharmacological therapies already used in adults for weight management. These include selective serotonin reuptake inhibitors, buspirone, bupropion combined with naltrexone (opioid pathway modulation), and GLP-1 agonists such as liraglutide. On the right side, the model highlights family-centered strategies as the central and immediately actionable pillar: (1) Parental nutrition education; (2) Family-based treatment; and (3) Modification of the home food environment to increase the availability and accessibility of healthy foods. These interventions aim to strengthen children’s self-regulation skills, reduce exposure to UPFs cues, and support the maturing PFC in exerting greater inhibitory control over reward-driven eating. Arrows indicate the proposed transition from current policy limitations toward an integrated approach that combines neurobehavioral, family-based, and potential future pharmacological strategies. UPF: Ultra-processed foods; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, fifth edition.