A combination of brain stimulation and attitude training reduced binge eating.
Researchers from the Institute of Psychiatry, Psychology and Neuroscience at King’s College, London, recently investigated the feasibility of a new home-administered treatment for binge eating disorder (BED). The new treatment combines a brain stimulation technique, transcranial direct current stimulation (tDCS), with a training program that targets unhelpful patterns of attention around food (BJPsych Open. 2024. Jun 6;10(4):e118).
A team led by Dr. Michaela Flynn, Research Associate at King’s College, recruited 82 participants who were overweight or living with obesity and who met criteria for a diagnosis of BED. Participants were then allocated to one of four groups that received one of the following treatments over two to three weeks: (1) 10 sessions of at-home self-administered tDCS during ABMT; (2) 10 sessions of sham tDCS with a headset that did not deliver electrical stimulation during ABMT; (3) 10 sessions of ABMT only, or (4) no treatment. The last group remained on a wait list for 8 weeks.
Brain stimulation
The noninvasive brain stimulation technique uses two electrodes to send a gentle current through electrodes. In tDCS, this constant, weak direct current is applied via electrodes placed on the scalp to increase or decrease neuronal excitability in regions beneath the electrodes and in functionally connected networks. These changes in excitability outlast the stimulation period (up to 60 minutes after a single session) and, with repeated administration, may lead to lasting changes in brain function, according to the authors.
Attention bias modification training
In those with BED and obesity, ABMT aims to alter automatic attention biases toward food cues by training attention away from high-calorie food cues and directing them to healthy food cues. This attentional shift is thought to implicitly modify food cues. For example, high-calorie foods will become less rewarding and/or healthy foods will become more appealing. The shift in attitude then alters eating behavior. Findings have been mixed, but meta-analyses have shown that ABMT reduces high-calorie food consumption and craving in adults with ‘healthy’ weight, and adults who are overweight or obese. In this study, participants completed all components of treatment and assessment from home with researcher support via video calls.
Results: less binge eating, weight loss, and improved mood
Dr. Flynn and her colleagues reported that changes to binge-eating behaviors were most pronounced in those who received real tDCS with ABMT. In this group, binge episodes were reduced from around 20 times a month on average at baseline to six times a month at follow-up six weeks later.
Participants in the real tDCS with ABMT group also reported that they lost approximately 3.5 to 4.0 kg between baseline and six-week follow-up (reduction in mean body mass index [BMI] of 1.28 points). In comparison, over the same period, those who received ABMT with sham tDCS reported that they lost about 1.5 to 2 kg on average (a reduction in mean BMI of 0.52 points) and those who received ABMT only reported negligible change in their weight (reduction in mean BMI of 0.07 points). There was no change in eating behavior or weight loss in the no-treatment control group.
The group who received real tDCS with ABMT also reported substantial improvement in their mood between baseline and follow-up. No similar change in mood was reported in those who received sham tDCS with ABMT or in those who received ABMT only, and there was no change in mood in the no-treatment control group. Also, no change in eating behavior or weight loss was reported in the control group.
Overcoming barriers to care
At-home self-administered tDCS overcomes a number of barriers, such as the time and expense of traveling to treatment centers, and to obtaining BED treatment in general. However, the authors point out that even when equipment is designed for self-administration at home, it cannot be guaranteed that stimulation has been delivered precisely to the correct cortical target, or that it has been delivered exactly the same way each time.
Dr. Flynn notes that “Our study is the first to look at a new option for home-based treatment that offers a different approach to treating binge eating disorder. TDCS targets the brain-driven patterns of behavior that might be contributing to the loss of control around food, enabling people to shift entrenched thinking and behavior around food.”
Janice Goldschmidt
Has worked with individuals with IDD for the last decade, and written and presented her work in a range of professional formats. She received her Master’s degree in Nutrition from the University of Maryland-College Park, where she initially developed her program for development of food preparation skills, Active Engagement. As Director of Nutrition Services at Community Support Services, Inc. (Gaithersburg, MD), she has continued to build on Active Engagement, which now includes many differing contexts for guiding individuals with IDD and autism to independent cooking skills. She has also worked on the identification, classification, and treatment of eating disorders for this population.