Sagittal MRI Highlighting the Nucleus Accumbens

Can Deep Brain Stimulation Stop Binge Eating?

Two patients. This fits our definition of a small pilot study and Nature Medicine published it recently. In this study, Rajat Shivacharan and colleagues treated binge eating disorder and severe obesity in two patients, using responsive deep brain stimulation. It involves the placement of tiny electrodes in the brain, connected to a pulse generator implanted elsewhere in the body.

In this proof of concept study, the device sent electrical pulses to a part of the brain called the nucleus accumbens when it detected brain activity linked to bingeing episodes. The results were striking. After six months, episodes of eating with a loss of control dropped by 80 percent for one of the subjects. It dropped by 87 percent in the other. Both patients are losing weight. One of the patients, Robyn Baldwin, told Gina Kolata of the New York Times:

“It’s not like I don’t think about food at all. But I’m no longer a craving person.”

Proof of Concept

It’s worth remembering what a pilot or proof of concept study is. It’s a way to see if a new concept is even worth studying. It proves that this a feasible method for treating binge eating disorder in patients with severe obesity. But it’s not proof that it works. Just that it might work.

The researchers on this study are quite clear that much more work is necessary. But the technology they used is not totally experimental. This kind of device is approved by FDA for treating Parkinson’s disease, tremors, obsessive-compulsive disorder, and epilepsy.

It’s the Brain, Stupid

This study does not exist in isolation. A recent systematic review and meta-analysis tells us that neuromodulation can “lead to a sustained reduction of craving and consumption in individuals with addiction or overeating behaviour.”

The present research and broader work on deep brain stimulation is valuable because of what it tells us about obesity. This is a disorder that often starts in the brain. Choices might play a role, but the brain regulates how a person takes in energy and stores it as fat. In these particular patients, the research reminds us the guilt and stigma they might feel about their disordered eating is unjustified. Signals in the brain that trigger it are part of a neurological disorder. Not the result of voluntary choices.

So this is a promising area for further research. Deep brain stimulation might be useful for a few patients or many patients. But in any event, it will likely have very targeted indications. Perhaps the most important thing it can do, though, is point to new pathways for even more broadly useful obesity treatment.

Click here for the study in Nature Medicine and here for further reporting on it in the Times. For the meta analysis, click here. Finally, you can find an analysis here  of the potential for deep brain stimulation to be a cost-effective obesity treatment.

Sagittal MRI Highlighting the Nucleus Accumbens, image by Geoff B. Hall / Wikimedia Commons

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November 14, 2022