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Behavior, Psychology and Sociology

Efficacy and acceptability of noninvasive brain stimulation interventions for weight reduction in obesity: a pilot network meta-analysis

International Journal of Obesity volume 45, pages 1705–1716 (2021) Cite this article

Subjects

Abstract

Background/Objectives:

Obesity has recently been recognized as a neurocognitive disorder involving circuits associated with the reward system and the dorsolateral prefrontal cortex (DLPFC). Noninvasive brain stimulation (NIBS) has been proposed as a strategy for the management of obesity. However, the results have been inconclusive. The aim of the current network meta-analysis (NMA) was to evaluate the efficacy and acceptability of different NIBS modalities for weight reduction in participants with obesity.

Methods:

Randomized controlled trials (RCTs) examining NIBS interventions in patients with obesity were analyzed using the frequentist model of NMA. The coprimary outcome was change in body mass index (BMI) and acceptability, which was calculated using the dropout rate.

Results:

Overall, the current NMA, consisting of eight RCTs, revealed that the high-frequency repetitive transcranial magnetic stimulation (TMS) over the left DLPFC was ranked to be associated with the second-largest decrease in BMI and the largest decrease in total energy intake and craving severity, whereas the high-frequency deep TMS over bilateral DLPFC and the insula was ranked to be associated with the largest decrease in BMI.

Conclusion:

This pilot study provided a “signal” for the design of more methodologically robust and larger RCTs based on the findings of the potentially beneficial effect on weight reduction in participants with obesity by different NIBS interventions.

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Fig. 1: Flowchart of the current network meta-analysis.
The alternative text for this image may have been generated using AI.
Fig. 2: The network structure of coprimary outcome: (2A) changes in BMI after individual NIBS intervention and (2B) acceptability, reflected by the dropout rate.
The alternative text for this image may have been generated using AI.
Fig. 3: Forest plot of the coprimary outcome: (3A) changes in BMI after individual NIBS intervention and (3B) acceptability with respect to dropout rate.
The alternative text for this image may have been generated using AI.

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Acknowledgements

The authors of this work were supported by the following grants: Brendon Stubbs is supported by a Clinical Lectureship (ICA-CL-2017-03-001) jointly funded by Health Education England (HEE) and the National Institute for Health Research (NIHR). Brendon Stubbs is part-funded by the NIHR Biomedical Research Center at South London and Maudsley NHS Foundation Trust. Brendon Stubbs is also supported by the Maudsley Charity, King’s College London, and the NIHR South London Collaboration for Leadership in Applied Health Research and Care (CLAHRC) funding. This paper presents independent research. The views expressed in this publication are those of the authors and not necessarily those of the acknowledged institutions. The work of Kuan-Pin Su is supported by the following grants: MOST 106-2314-B-039-027-MY3, 107-2314-B-039-005, 108-2320-B-039-048, and 108-2314-B-039-016 from the Ministry of Science and Technology, Taiwan; and DMR-107-091, DRM-108-091, CRS-108-048, CMU108-SR-106, DMR-108-216, CMRC-CMA-3, DMR-109-102 and the Chinese Medicine Research Center from the China Medical University, Taiwan. The work by Pao-Yen Lin is supported by the following grants: MOST 106-2314-B-182A-085 -MY2 and MOST 105-2314-B-182A-057 from the Ministry of Science and Technology, Taiwan; and CMRPG8F1371, CMRPG8E1061F from Kaohsiung Chang Gung Memorial Hospital, Taiwan. The work of Yu-Kang Tu was supported by a grant from the Ministry of Science and Technology, Taiwan (grant no: 106‐2314‐B‐002 ‐098 ‐MY3). Dr Brunoni reports grants from São Paulo Research State Foundation (2012/20911-5, 2017/50223-6, 2018/10861-7), Brazilian National Council of Scientific Development productivity support (PQ-1B), and University of São Paulo Medical School productivity support (PIPA-A), during the conduct of the study; personal fees from Neurocare GMBH outside the submitted work; and Dr. Brunoni is Chief Medical Advisor of Flow Neuroscience (Malmö, Sweden) and has small equity in this company. This role started in June 2019. This manuscript was edited by Elsevier Language Editing Services.

Author information

Author notes

  1. These authors contributed equally: Bing-Yan Zeng, Bing-Syuan Zeng, Yen-Wen Chen

Authors and Affiliations

  1. Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan

    Bing-Yan Zeng & Bing-Syuan Zeng

  2. Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan

    Yen-Wen Chen & Ping-Tao Tseng

  3. Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan

    Chao-Ming Hung

  4. School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan

    Chao-Ming Hung

  5. Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan

    Cheuk-Kwan Sun

  6. I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan

    Cheuk-Kwan Sun

  7. Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai’s Home, Kaohsiung, Taiwan

    Yu-Shian Cheng

  8. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Brendon Stubbs & Kuan-Pin Su

  9. Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK

    Brendon Stubbs

  10. Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK

    Brendon Stubbs

  11. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Andre F. Carvalho

  12. Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada

    Andre F. Carvalho

  13. Service of Interdisciplinary, Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27), University of Sao Paulo, Sao Paulo, Brazil

    Andre R. Brunoni

  14. Interdisciplinary Center for Applied Neuromodulation University Hospital, University of Sao Paulo, Sao Paulo, Brazil

    Andre R. Brunoni

  15. Mind-Body Interface Laboratory (MBI-Lab), China Medical University and Hospital, Taichung, Taiwan

    Kuan-Pin Su

  16. An-Nan Hospital, China Medical University, Tainan, Taiwan

    Kuan-Pin Su

  17. Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

    Yu-Kang Tu

  18. Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan

    Yu-Kang Tu

  19. Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan

    Yi-Cheng Wu

  20. Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan

    Tien-Yu Chen

  21. Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Tien-Yu Chen

  22. Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Pao-Yen Lin & Chih-Wei Hsu

  23. Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Pao-Yen Lin

  24. Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan

    Chih-Sung Liang

  25. Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan

    Chih-Sung Liang

  26. Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan

    Ping-Tao Tseng

  27. Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan

    Ping-Tao Tseng

  28. Division of Community & Rehabilitation Psychiatry, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan

    Cheng-Ta Li

  29. Department of psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Cheng-Ta Li

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  1. Bing-Yan Zeng
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  10. Kuan-Pin Su
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Zeng, BY., Zeng, BS., Chen, YW. et al. Efficacy and acceptability of noninvasive brain stimulation interventions for weight reduction in obesity: a pilot network meta-analysis. Int J Obes 45, 1705–1716 (2021). https://doi.org/10.1038/s41366-021-00833-2

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