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Clinical Research

Neuromodulation of the prefrontal cortex facilitates diet-induced weight loss in midlife women: a randomized, proof-of-concept clinical trial

International Journal of Obesity volume 44, pages 568–578 (2020)Cite this article

Subjects

Abstract

Background

High body mass index (BMI) is associated with neurocognitive impairments that contribute to overeating and interfere with weight loss efforts. Overweight and obesity at midlife can accelerate neurodegenerative changes and increase the risk of late-life dementia. Noninvasive neuromodulation represents a novel, affordable and scalable approach to improve neurocognitive function in this context. The purpose of this proof-of-concept study was to examine whether transcranial direct current stimulation (tDCS) aimed at enhancing prefrontal cortex activity could enhance weight loss, in combination with a hypocaloric diet, and study underlying mechanisms.

Methods

Overall, 38 women with BMI 25–35 kg/m2 underwent a 4 week randomized, double-blinded, sham-controlled, and parallel-design intervention, during which they received eight sessions of tDCS (n = 18 sham, n = 20 active) in combination with a diet (caloric goal of 20 kcal/kg/day). We evaluated longitudinal changes in body weight, appetite and food craving. In addition, we examined the contribution of cognitive-executive processes via food-modified computerized tasks.

Results

We found that the active group had more reduction in body weight than the sham group throughout the study (p = 0.020) and significant weekly weight loss. At 4 weeks, the active group lost 2.32% of initial body weight (sham: 1.29%). Components of subjective appetite and food craving showed a trend toward more reduction in the active group. These changes were paralleled by significant improvements in task performance in the active group, particularly in a dual task that required inhibitory control and working memory (p = 0.007–0.031). Improvement in inhibitory control performance predicted reduction in lack of control overeating, explaining 43.5% of its variance at the end of the study (p = 0.003). No significant adverse effects were observed.

Conclusions

Our results provide proof-of-concept validation of prefrontal-targeted tDCS, combined with a diet, in midlife women with excess body weight, paving the way for larger studies evaluating clinical efficacy and long-term effects of this intervention.

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Acknowledgements

PLV is supported by University of Alcalá (grant FPI2016). MA-A is a recipient of grants from the Boston Nutrition and Obesity Research Center, P30 DK046200, the Nutrition Obesity Research Center at Harvard, P30 DK040561, and the Center for Nutritional Research Charitable Trust. We thank Dr Daniela S. Trifu, Centro Médico Complutense, for her time, advice and supervision of the dietary component of the intervention. We are deeply grateful to all volunteers who took part in this study for their time and help.

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Authors and Affiliations

  1. Clinical Neurophysiology, Centro Médico Complutense. Alcalá de Henares, Madrid, Spain

    Carlos Amo Usanos, Ignacio Amo Usanos & Luis Cuesta Villa

  2. Department of Systems Biology. School of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain

    Pedro L. Valenzuela, Pedro de la Villa, Santiago Milla Navarro & Andresa Evelem de Melo Aroeira

  3. IRYCIS Research Institute, Madrid, Spain

    Pedro de la Villa

  4. Primary Care Unit, Centro Médico Complutense. Alcalá de Henares, Madrid, Spain

    Liliana Martínez Cancio

  5. Section on Genetics and Epidemiology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA

    Hetal Shah

  6. Laboratory of Bariatric and Nutritional Neuroscience, Center for the Study of Nutrition Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Greta Magerowski & Miguel Alonso-Alonso

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  1. Carlos Amo Usanos
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Correspondence to Miguel Alonso-Alonso.

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Amo Usanos, C., Valenzuela, P.L., de la Villa, P. et al. Neuromodulation of the prefrontal cortex facilitates diet-induced weight loss in midlife women: a randomized, proof-of-concept clinical trial. Int J Obes 44, 568–578 (2020). https://doi.org/10.1038/s41366-019-0486-x

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