The effects of neuromodulation interventions on the eating behaviors of patients with eating disorders compared to healthy controls, sham therapies, and other therapeutic approaches: A systematic review.

BACKGROUND

Standard treatments for eating disorders (EDs) typically include nutritional rehabilitation, psychotherapy, and pharmacotherapy, often resulting in modest effectiveness. Neuromodulation has been proposed as a potential add-on strategy. This review aims to critically evaluate its effects on EDs.

METHODS

The PICO framework was used to conduct a search according to the PRISMA guidelines for systematic reviews (PROSPERO Registration no. CRD42024559700). Descriptive and clinical data for each study, including comorbidity and safety, were tabulated by disorder. Quality assessment was performed using the RoB2 and ROBINS-I tools.

RESULTS

Fifty-eight studies examining rTMS, tDCS, DBS, ECT, iTBS, and dTMS in AN, BN, and BED met inclusion criteria. In AN, the effects of rTMS and tDCS on weight and BMI were modest, with notable benefits for adolescents. Conversely, in refractory AN, DBS produced significant and lasting increases in BMI and reductions in comorbid psychopathology. For BN, single-session rTMS reduced cravings acutely, while multisession results were mixed; tDCS enhanced self-control. In BED, right-DLPFC tDCS decreased cravings, food intake, and binge frequency, showing a dose-dependent effect, whereas early data on NAcc DBS were promising but limited.

CONCLUSIONS

Noninvasive stimulation methods effectively reduced cravings and impulsivity, showing more consistent improvements in BN and BED than in weight restoration for AN. Overall, this pattern replicates recent review reports. However, variations in study designs, stimulation protocols, and outcome measures may undermine the reliability of these conclusions and complicate comparisons across studies. Future studies should be adequately powered, multisession, with durability endpoints, and target and dose refinement.