#BED #ED #rTMS #Neuromodulation #Craving
#InhibitoryControl
Binge Eating Disorder (BED) is an eating disorder characterized by
repeated episodes of excessive food intake in a short period of time. These
episodes are associated with a loss of control and occur without compensatory
behaviors (such as vomiting, restriction, etc.). BED is the most common eating
disorder in the general population, particularly affecting individuals with
obesity. It is often accompanied by significant psychological distress and
psychiatric comorbidities, including anxiety, depression, and metabolic
disorders.
Current treatment strategies—primarily
psychotherapy and some
pharmacological approaches—show only partial
effectiveness. In practice, fewer than half of patients achieve complete
abstinence from binge episodes in the medium term. These treatments are also
limited by
side effects, individual variability in response, and the absence of
predictive biomarkers of therapeutic success.
One of the main challenges in managing BED is
the regulation of inhibitory control, which is often impaired in these
patients, and the management of food cravings, which are closely linked
to neural reward mechanisms similar to those observed in addictive disorders.
This neurobiological similarity with addictions has led to the exploration of neuromodulation
techniques, such as repetitive transcranial magnetic stimulation (rTMS).
In this context, the study was designed to
evaluate the effects of rTMS applied to the left dorsolateral prefrontal
cortex (dlPFC)—a key brain region involved in impulse control and craving
regulation. The goal was to determine whether non-invasive stimulation could
reduce the frequency of binge eating episodes in obese women with BED. A
secondary objective was to evaluate side effects, treatment tolerability, and
the impact on craving, mood, and associated psychological disorders.
Stimulating the brain, calming the appetite?
This double-blind randomized controlled trial
aimed to assess the effects of 20 sessions of neuronavigated 10 Hz rTMS
applied to the left dorsolateral prefrontal cortex. The primary endpoint was
the reduction in the number of binge eating episodes. Researchers also
evaluated craving intensity, along with several secondary indicators,
including Body Mass Index (BMI), levels of anxiety and depression,
and specific eating disorder symptoms. Participants were followed up to 16
weeks after being assigned to intervention groups.
The study included 59 obese women
diagnosed with BED. Results showed that active rTMS significantly reduced
the frequency of binge episodes compared to the sham group, both at the end of
treatment and at the 8-week follow-up. However, no significant
difference was observed between the groups regarding craving, BMI changes,
or psychopathological scores.
The treatment was generally well tolerated,
with only a few reports of moderate headaches. Blinding was adequately
maintained, with only 16% of participants correctly guessing their group
allocation.
A boost to break the binge cycle
Binge Eating Disorder is a common and
debilitating condition marked by recurrent, uncontrolled food intake, often
linked to psychological distress and obesity. Despite available treatments,
clinical outcomes remain modest, with a high rate of partial remission,
especially in patients with inhibitory control issues.
One of the main therapeutic challenges lies in
the inability of conventional approaches to sustainably correct food
compulsivity and prevent relapse. With this in mind, repetitive transcranial
magnetic stimulation targeting the left dorsolateral prefrontal cortex
has been proposed as a promising intervention due to its role in impulse
regulation and decision-making.
Results from this trial indicate that active
rTMS significantly decreases the frequency of binge episodes, without
significantly affecting craving intensity or BMI. This suggests
that dlPFC stimulation may primarily enhance behavioral control,
rather than directly targeting food motivation. The observed effect appears to
be specific to impulsive behavior reduction, supporting the dlPFC as a
relevant target for neuromodulation in self-control disorders.
However, some methodological limitations
remain and warrant further research to confirm and expand these findings. Larger-scale
studies with longer follow-ups, additional neurocognitive and biological
measurements, and more diverse populations are needed. Integrating rTMS
into cognitive-behavioral interventions may offer more effective,
personalized, and combined strategies to break the binge eating cycle in a
lasting way.
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