A systematic review on neuromodulation therapies for reducing body weight in patients with obesity

Abstract

Summary The global prevalence of obesity increases yearly along with a rising demand for efficacious, safe, and accessible treatments. Neuromodulation interventions (i.e., deep brain stimulation [DBS], transcranial magnetic stimulation [TMS], transcranial direct current stimulation [tDCS], percutaneous neurostimulation [PENS], vagus nerve stimulation [VNS], and gastric electrical stimulation [GES]) have been proposed as novel therapies. This systematic review sought to examine the safety and efficacy of neuromodulation therapies in reducing body weight in patients with obesity. Using PRISMA guidelines, we performed a systematic review for studies on neuromodulation for the treatment of obesity, resulting in 60 trials included (7 DBS, 5 TMS, 7 tDCS, 17 PENS and VNS, and 24 GES; a total of 3,042 participants). While promising results have been reported in open label studies, double‐blinded randomized clinical trials often did not reach their primary endpoints, with no technique inducing a striking reduction in body weight. Bearing in mind the complexity and multifactorial nature of obesity, it is possible that a single treatment may not be enough for patients to lose or maintain the weight lost at long term.

Case report: 5 Years follow-up on posterior hypothalamus deep brain stimulation for intractable aggressive behaviour associated with drug-resistant epilepsy

“…and SHBG levels could contribute to the reduction of body fat; II. DBS of distinct hypothalamic areas have been reported to reduce body weight in patients with obesity [8]; III. The changes in medication after surgery, especially the removal of Olanzapine from the patient's drug regime, could play an important role in the reduction of body weight.…”

Novel approaches to tackling emotional loss of control of eating across the weight spectrum

“…Several systematic review studies have examined the effect of neuromodulation on the underlying processes related to overeating and emotional eating such as craving (72,73) , and inhibitory control and impulsivity (74,75) with some positive effects. However, a systematic review that examined the effectiveness of these techniques for people falling within the overweight category did not find positive effects on weight reduction (76) . Similarly, repetitive transcranial magnetic stimulation has so far shown limited efficacy in reducing binge eating (77)(78)(79) .…”

Hepatic Vagal Afferents Convey Clock-Dependent Signals to Regulate Circadian Food Intake

“…Neuromodulation of the vagus nerve has been found to moderately improve body weight gain and metabolic outcomes in human patients (39)(40)(41). However, the results are variable, and the long-term efficacy is questionable due to the general modulation of function-and tissue-specific vagal fibers by current vagal neuromodulation techniques.…”