Effects of Repetitive Transcranial Magnetic Stimulation on Appetite-Related Outcomes in Adults with Obesity: A Randomized, Double-Blind, Sham-Controlled Trial.

BACKGROUND & AIMS: To evaluate the effects of high-frequency repetitive Transcranial Magnetic Stimulation (rTMS) applied over the left dorsolateral prefrontal cortex (DLPFC) on appetite-related measures and other obesity-related outcomes in adults with obesity.

METHODS

Fifty-one adults with obesity of both sexes were enrolled in a randomized, double-blind, sham-controlled trial. Participants received either active rTMS or sham-rTMS stimulation over the left DLPFC across 24 sessions (10 Hz, 10 minutes/day, three times per week for 8 weeks). Appetite-related measures were assessed using a Visual Analogue Scale (VAS) as the primary outcome. Secondary outcomes were: Binge eating symptom severity was assessed using the Binge Eating Scale (BES); Quality of life was assessed using the Short Form-36 questionnaire; and Anthropometric measures and biochemical parameters. Physical activity level was evaluated using the International Physical Activity Questionnaire (IPAQ). Participants were instructed to maintain their lifestyle habits, and no diet or physical exercise intervention was implemented. Participants and outcome interviewers were blinded to the treatment.

RESULTS

Appetite-related measures showed no significant treatment-specific effects (p>0.05). A significant time-by-treatment interaction was observed only for fullness, with greater increases in the sham-rTMS group (p<0.05). rTMS was associated with a reduction in binge eating symptom severity compared to sham-rTMS (between-group difference: -5.60 points; 95% CI [-11.09 to -0.12], p=0.045). No significant effects of rTMS treatment were observed on body weight, anthropometric measurements, biochemical parameters or quality of life.

CONCLUSION

High-frequency rTMS applied to the left DLPFC showed no changes in appetite-related outcomes, body weight, anthropometric measures, or biochemical parameters. Our secondary analysis suggests a possible effect of rTMS on binge eating symptoms severity in adults with obesity. Additional clinical trials using rTMS focused on binge symptoms should be developed to confirm our data.

CLINICAL TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos (ReBEC), RBR-9x9kctn.