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

Abstract

The prevalence of obesity in pediatric populations has reached epidemic levels, largely due to consumption of ultra-processed foods (UPFs), whose formulations are optimized for hyperpalatability and promote overconsumption in children and adolescents due to neurodevelopmental vulnerabilities. The prefrontal cortex, which governs planning, decision-making, and impulse control, reaches full maturity around 25 years of age. Children and adolescents have limited self-regulatory capacity, as their reward circuitry responds excessively to palatable stimuli. The high palatability and marketing of UPFs may interact with this neurobiological imbalance, triggering dopamine release and promoting addictive-like eating behaviors. Despite public health interventions such as front-of-package labeling, nutrient-based taxes, and restrictions on child-targeted marketing, evidence suggests these measures have had modest impact on consumption patterns. We hypothesize that the limited success of these approaches may be explained by their failure to address the underlying neurobiological mechanisms driving excessive consumption. Therefore, a paradigm shift toward parental education programs that foster healthy home food environments and promote early self-regulation skills is warranted, combined with family-based behavioral treatment. Finally, the potential role of pharmacological agents (e.g., glucagon-like peptide-1 agonists) that target the reward system in cases of severe pediatric compulsive overconsumption warrants future research, given the limited safety data in children.

Keywords: Childhood obesity; Ultra-processed foods; Food addiction; Prefrontal cortex; Reward system; Public health policy; Parental education; Family-based therapy

Core Tip: The obesity epidemic in the pediatric population has been linked to the overconsumption of ultra-processed foods, whose hyper-palatability stimulates reward and disrupts the balance between the immature prefrontal cortex and the overactive reward circuitry during neurodevelopment. Current regulatory measures such as front-of-pack labeling, nutrition-based taxation and advertising restrictions have shown disappointing results in decreasing pediatric obesity. We propose a paradigm shift by giving parents education programs, developing early self-regulation skills in children, implementing cognitive behavioral and family-based therapies, and carefully evaluating dopamine-targeted pharmacological agents as a potential future option for severe, treatment-refractory cases, given limited long-term safety data in children.