Enhancing Postoperative Outcomes After Metabolic Bariatric Surgery: a Pilot Study of Inhibitory Control Training, Transcranial Direct Current Stimulation and Psychosocial Aftercare.

INTRODUCTION

Heightened food-specific impulsivity, associated with prefrontal cortex hypoactivity, may impair outcomes following metabolic bariatric surgery (MBS). This pilot study examined the feasibility of transcranial direct current stimulation (tDCS) targeting the right dorsolateral prefrontal cortex (dlPFC) combined with an individualized food-specific inhibitory control training addressing behavioral impulsivity alongside psychosocial follow-up (FU) care to support early postoperative lifestyle adaptation.

METHODS

Within 18 months post-MBS, n = 19 patients were randomized to 6 sessions of verum or sham tDCS over the right dlPFC combined with inhibition training and psychosocial group sessions. Acceptability, feasibility, food-specific impulsivity and diverse secondary outcomes (e.g., quality of life) were assessed 4 weeks (t1) and 3 months (t2) post-tDCS through (BS-specific) interviews, validated questionnaires and blood samplings.

RESULT: Retention (67 - 80%) and satisfaction (M> 4.38, 1 - 5) were high, improvements in eating behavior and impulse control moderate (M = 3.56, 1 - 5) and side effects negligible (M= 1.46, 1 - 5). Both groups showed moderate improvements in behavioral impulsivity, self-reported perceived hunger and quality of life, body-mass-index and endocrine markers.

CONCLUSION

Potential effects may have been attenuated through the small, highly motivated, treatment-seeking sample and the rapidly evolving early postoperative phase. Future fully powered trials should include neurobiological outcome measures that may capture tDCS-induced neural changes earlier and extend FU intervals to clarify efficacy and optimize postbariatric stimulation protocols. Incorporating dismantling designs would further help to disentangle the specific contributions of tDCS, the inhibitory control training and psychosocial care.