Obesity represents a major public health challenge, stemming from a complex interplay of various factors. Food-related hedonic stimuli and poor inhibitory control often act as specific maintenance factors, rendering conventional treatments ineffective. Transcranial magnetic stimulation (TMS) is emerging as a promising treatment option. This article will explore the potential of TMS as a weight loss solution, discussing its mechanisms, effectiveness, and safety.
Obesity: A Growing Public Health Challenge
The increasing prevalence of obesity is a major global public health challenge. Excess body weight significantly increases the risk of a number of chronic diseases, such as type 2 diabetes mellitus, non-alcoholic fatty liver disease, hypertension, and cardiovascular disease, including myocardial infarction and stroke. Obesity is also strongly associated with a wide range of health problems, including osteoporosis, joint disease, renal dysfunction, dyslipidaemia, obstructive sleep apnoea, and certain cancers. It can also lead to musculoskeletal problems and rapid cognitive decline.
Obesity results from the complex interaction of many etiopathogenetic factors. The hedonic aspect of eating, characterised by strong cravings and challenges in resisting certain foods, adds another layer of complexity to the problem. The increasing importance of neural function and control mechanisms in weight management, beyond metabolic or lifestyle factors, is now recognised. Investigations suggest that obesity may result from imbalances in brain networks, with some pathways associated with gratification mechanisms and others involved in cognitive control and impulse inhibition.
What is TMS Therapy?
Transcranial magnetic stimulation (TMS) is a non-invasive method of modulating brain activity. TMS employs electromagnetic induction to elicit localized electrical currents within the brain, thereby modulating neuronal activity. TMS is a potential intervention for modifying neural circuits that are essential for controlling appetite, reducing food cravings, and regulating impulses. These components are closely linked to the development and treatment of obesity.
Initially developed to treat stubborn psychiatric conditions such as mood disorders, substance abuse, and post-traumatic stress disease, the application of TMS has subsequently expanded to encompass a range of neurocognitive disorders such as schizophrenia, dementia, and eating disorders. TMS is FDA-approved for adults with major depressive disorder (MDD) who haven’t found relief with medication or therapy.
Read also: Weight Loss Guide Andalusia, AL
Repetitive Transcranial Magnetic Stimulation (rTMS) and deep Transcranial Magnetic Stimulation (dTMS) constitute the core methodologies within the TMS framework. The rTMS protocol employs a figure-of-eight electromagnetic coil to generate focal magnetic pulses or sequences of pulses that target discrete cortical regions to a depth of approximately 1.5 cm below the scalp. These magnetic pulses can modulate cortical excitability, either augmenting or diminishing the electrical activity within the targeted neuronal circuits. Conversely, dTMS is characterised by the use of an H-coil, which is designed to extend stimulation to both cortical and subcortical structures, achieving penetration depths of 4.5 to 5.5 cm from the cranial surface.
In both rTMS and dTMS modalities, the use of high-frequency stimulation (≥5 Hz) is associated with an excitatory effect on neuronal excitability, whereas low-frequency stimulation (≤1 Hz) is associated with inhibitory effects. Further diversification within TMS techniques includes intermittent theta burst stimulation (iTBS) and continuous theta burst stimulation (cTBS). iTBS, characterised by its high-frequency burst pattern, is postulated to induce an increase in cortical excitability, whereas cTBS is associated with a decrease in cortical excitability. As it has been reported, these stimulation protocols have been found to provide a range of modulatory effects on neural circuits, which highlights the potential usefulness of TMS in the therapeutic modulation of neurocognitive and neuropsychiatric conditions.
TMS is highly valued within the clinical paradigm for its ability to induce lasting therapeutic changes beyond the temporal limits of the stimulation sessions themselves. The significance of the neurophysiological changes induced by TMS is highlighted by its capacity to induce long-term synaptic plasticity. Further, rTMS can be classified into single-session and multi-session approaches. The former, a single-session application, is extensively employed in experimental research to evaluate the immediate neurophysiological effects of rTMS. The efficacy and specificity of TMS interventions depend on the precise localization of the targeted brain region. encephalography (EEG) or structural magnetic resonance imaging (MRI), are necessary for this purpose. These techniques should be complemented by neuronavigation technologies, a methodology that has been extensively documented in the literature. Precision in targeting is essential to optimize the therapeutic outcome of TMS.
How Does TMS Therapy Work for Weight Loss?
By using electromagnetic pulses to stimulate targeted areas of the brain, the treatment helps regulate mood and behavior. The process involves placing a specialized coil over the scalp that sends out electric pulses. The energy from the pulses can reach deep into the brain, activating specific regions that help modulate emotions and behaviors.
It's believed that TMS Therapy works by altering the way specific brain circuits function, which can lead to an improved mood and decreased cravings for food. manage stress more effectively, which can contribute to healthier eating habits. Studies have also shown that TMS can help to motivate and increase physical activity levels, leading to further weight loss. By stimulating the parts of the brain responsible for regulating appetite, TMS can help people who struggle with emotional eating or unhealthy snacking habits.
Read also: Beef jerky: A high-protein option for shedding pounds?
Targeting specific brain regions, such as the dorsolateral prefrontal cortex (dlPFC), was found to be effective in modulating acute food craving and improving cognitive control. In particular, the dlPFC is a key neural site for modulating hunger and satiety signals and plays an essential role in regulating impulses and food choices. This region has become a specific target of neurostimulation techniques for addictive behaviours and eating disorders because of its role in the executive functions that manage the cognitive regulation of food consumption.
What Makes TMS Different from Other Weight Loss Methods?
TMS Therapy is a relatively new weight loss treatment that has shown promising results in recent years. While it may sound complex, the process is quite simple. TMS Therapy utilizes a strong magnetic field to stimulate specific brain areas responsible for regulating hunger and cravings. This stimulation can help to reduce the urge to overeat, allowing users to lose weight more naturally.
Unlike medications, TMS doesn’t cause systemic side effects like weight gain or fatigue. Unlike other weight loss treatments, such as diet and exercise, TMS does not require significant lifestyle changes. Patients can usually carry on with their regular daily routine while undergoing treatment. TMS is entirely non-invasive and no recovery time is required. The procedure is relatively quick and painless, and patients can return to their daily activities immediately.
The most significant advantage of TMS Therapy is that it offers a safe, effective solution for those struggling to lose weight despite trying other methods. By targeting the source of the problem - your brain - TMS Therapy can give you the push you need to reach your weight loss goals without relying on dangerous or drastic measures. The bottom line is that TMS Therapy offers a safe, non-invasive way to help manage eating behaviors and cravings. For many, it can produce lasting lifestyle changes and support weight loss efforts long-term.
Studies on TMS and Weight Loss
Several studies have investigated the effects of TMS in obese individuals, focusing on rTMS and dTMS techniques. These studies often involve comparing TMS modulation techniques with sham interventions to determine the impact of such stimulations on key indicators of interest in the field of obesity research.
Read also: Inspiring Health Transformation
Studies on rTMS
According to a study conducted by Kim and colleagues in 2018, 57 individuals between the ages of 18 and 65 were randomly assigned to two groups in a two-week, single-blind trial. Of the participants, 29 received rTMS, while 28 received sham treatment. The rTMS sessions, each lasting 20 minutes at a frequency of 10 Hz, targeted the left dlPFC. The primary outcome measure was weight change in kilograms from baseline to 4 weeks. Participants in the rTMS group showed significantly greater weight loss from baseline following the 4 session of rTMS. Consistent with weight loss, there was a significant reduction in BMI, fat mass and VAT at week 4 in the rTMS group compared with the control group. rTMS delivered to the left DLPFC was effective in decreasing food intake and facilitating weight loss in obese patients.
Continuing from the previous study, the research group conducted a four-week study on 43 patients who were classified as obese and aged between 18 and 70. The participants were divided into two groups: 21 individuals received eight 20-minute sessions of rTMS at 10 Hz, while the remaining 22 individuals received sham treatments. The study results indicate that individuals who received rTMS treatment experienced a significantly greater weight loss (2.75 kg, SD 2.37) compared to those who received the sham treatment (0.38 kg, SD 1.0). Furthermore, the rTMS group also showed significant reductions in fat mass and visceral adipose tissue by the fourth week.
In a study conducted in 2019, the effects of combining rTMS with a low-carbohydrate diet were tested on 37 overweight or obese patients. The participants were randomly assigned to two groups: 18 followed the diet with rTMS, and 19 followed the diet with sham rTMS.
In 2020, a study was conducted on 29 obese Filipino patients aged between 15 and 65. The patients were randomly assigned to either a treatment group (15 subjects) or a sham group (14 subjects). They received four 20-minute rTMS sessions at 10 Hz to the left dlPFC over two weeks in a single-blind, monocentric setting. Upon completion of the study, the treatment group exhibited a significant decrease in BMI (-0.6, SD 0.6) and body weight (-1.3 kg, SD 1.3).
Studies on dTMS
A pilot study was conducted on 33 obese individuals (9 men, 24 women, mean age 48.1 years, SD 10.6). The participants were divided into three groups: 13 underwent a 5-week high-frequency dTMS treatment (18 Hz; HF group), 10 received low-frequency dTMS (1 Hz; LF group), and 10 received placebo treatments (sham group). The stimulation targeted the bilateral Prefrontal Cortex (PFC) and Insula, consisting of 15 sessions, each lasting 30 minutes. The mixed-model analysis for repeated measures showed a significant interaction of time and groups for body weight (P = 0.001) and BMI (P = 0.001), with a significant body weight (-7.83 ± 2.28 kg; P = 0.0009) and BMI (-2.83 ± 0.83, P = 0.0009) decrease in the HF versus the sham group. A decreasing trend in food craving in the HF versus the LF and sham groups (P = 0.073) was observed. The findings showed a significant decrease in both body weight and BMI in the HF group compared to the sham group. Additionally, there was a significant trend towards reduced food cravings in the HF group compared to the LF and sham groups. We demonstrated the safety and efficacy of dTMS, in addition to physical exercise and a hypocaloric diet, in reducing body weight for up to 1 year in obese people.
In another study involving 22 obese individuals (17 female; mean age 44.9 ± 2.2 years; BMI 37.5 ± 1.0 kg/m2), the same researchers suggested that dTMS may have the potential to influence both the pathways of the brain-gut communication and the composition of the gut microbiome. The study involved randomising participants into three groups, each attending 30-minute sessions three times a week for five weeks. They received either high-frequency (18 Hz - HF), low-frequency (1 Hz - LF), or sham dTMS treatments, respectively, with the stimulation site being the bilateral PFC and Insula. After 5 weeks, the HF group showed significant weight loss compared to the LF and sham groups (HF: -4.1 kg, SD 0.8 vs. LF: -1.9 kg, SD 0.8 vs. sham: -1.3 kg, SD 0.6).
A preliminary randomized, double-blind, placebo-controlled study was conducted to investigate the resting-state functional connectivity (rsFC) in obese patients after 15 sessions of 30-minute treatments. Nine participants underwent high-frequency (18 Hz - HF) dTMS treatment, focusing on the bilateral PFC and Insula, three times a week for five weeks, while 8 were given placebo treatments (sham TMS group). Out of the 17 participants, 6 were diagnosed with Type 2 Diabetes (T2D). The results indicate that the experimental group experienced a significant decrease in body weight and BMI, which persisted through a one-month follow-up. Additionally, there was an observed enhancement in the functional brain connectivity within the medial Orbitofrontal Cortex (mOFC), coupled with a reduction in connectivity with the occipital pole.
A study was conducted to examine the correlation between psychological symptoms and neuroendocrine parameters in individuals with obesity. The study also investigated the effects of a 5-week treatment regimen involving 30-minute high-frequency (18 Hz) stimulations targeting the bilateral PFC and Insula using dTMS.
A study was conducted on 45 patients who were obese, out of which 33 were female. The patients had an average age of 48.8 years (SD 9.9), body weight of 97.6 kg (SD 14.2), and BMI of 36.2 (SD 4.2). The patients were randomly assigned to two groups, out of which 26 patients received high-frequency (HF) dTMS, while 19 underwent sham stimulation. The study found that the HF group showed a significant reduction in body weight and BMI, along with a decrease in impulsivity levels. Additionally, a positive correlation was observed between decreased impulsivity and leptin levels.
Impact on Food Cravings and Psychological Well-being
These studies suggest that both TMS methods are effective in reducing body weight and BMI, with high-frequency stimulation of the dlPFC showing particular promise, which is in line with previous research. However, further research is required to investigate the effects on food cravings. The current evidence suggests that by reducing the frequency and intensity of food cravings, it may be possible to decrease calorie intake and facilitate fat loss. In other words, by strengthening cognitive regulatory competencies, individuals may be better equipped to exercise discipline in their dietary practices. This enhancement provides the opportunity to choose healthier food options instead of those prompted by impulsive or emotional consumption patterns, which can aid in the weight loss process.
The phenomenon of craving, characterized as an intense and uncontrollable urge to consume, is believed to be influenced by dysfunction in frontostriatal brain circuits that are involved in both substance abuse and overeating. High-frequency rTMS can selectively activate dlPFC while reducing activity in deeper regions such as the orbitofrontal cortex (OFC) and anterior cingulate cortex (ACC).
Weight loss over 5weeks of Deep TMS treatment was associated with psychological benefit; the improvement of psychological conditions in obese subjects has been hypothesized to be due to a direct effect of HF Deep TMS, as well as a weight loss secondary result.
Safety and Side Effects
TMS is considered a safe and non-invasive method that is generally well-tolerated. Yes. The expert panel reviewed nearly 2,400 studies and confirmed that TMS is safe and effective, even for people whose depression hasn’t responded to medications. TMS is generally very well tolerated. The most common side effects are mild, like scalp discomfort or headaches. Serious side effects, such as seizures, are extremely rare.
However, it has been reported that the incidence of side effects was approximately 5%. The most common were headache (46%), lightheadedness (22%), muscle twitching (10%), and a general feeling of lightheadedness (10%). The most common side effects reported from TMS Therapy are mild, such as headaches and tingling sensations. Other side effects may include jaw pain, scalp discomfort, and nausea. Most of these go away as a person adjusts to the treatment. Overall, the potential side effects of TMS Therapy are generally mild and do not pose a significant risk for most people considering this form of treatment. Before beginning treatment, it is essential to talk to your doctor about any potential side effects that could occur with this type of therapy.