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The present article reviewed magnetic resonance imaging studies between January 2011 and March 2024 examining the brain's role in pediatric obesity, including parental influences and diverse interventions. A literature search identified 97 eligible MRI studies in the pediatric population. Findings suggest that altered brain structures and functions in pediatric obesity are strongly dependent on the developmental stage of children and adolescents. The function and structure of limbic regions, such as the hippocampus, amygdala, and striatum, as well as the prefrontal cortex, seem to be particularly affected by higher body mass index during development. In response to palatable foods, children and adolescents with excess weight have increased activation in reward\u2010related regions and decreased activation in regions involved in interoceptive signal processing, especially during decision processes. In addition, children of mothers with obesity and gestational diabetes mellitus show alterations in brain structure and function independent of their current obesity. Behavioral, exercise, and weight\u2010loss intervention studies showed promising effects on the brain, with increased structural integrity, decreased brain responses to reward, and strengthened inhibitory brain responses in children and adolescents with excess weight after the intervention.<\/jats:p>","DOI":"10.1111\/obr.70001","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T01:34:43Z","timestamp":1754357683000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Structural and Functional Brain Changes in Children and Adolescents With Obesity"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5140-0261","authenticated-orcid":false,"given":"Sixiu","family":"Zhao","sequence":"first","affiliation":[{"name":"Institute for Diabetes Research and Metabolic Diseases Helmholtz Center Munich at the University of T\u00fcbingen  T\u00fcbingen 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