Brain stimulation can limit the urge to overeat, study says

Brain stimulation can limit the urge to overeat, study says

What if the uncontrollable urge to eat large amounts of food quickly is rooted in a damaged brain circuit? If that were the case, people living with binge eating disorder — psychiatric diagnosis — may be no more to blame for overeating than a Parkinson’s patient is for his tremors.

That question has led doctors to try a new treatment unlike anything that’s ever been tried to help people with this common but underreported eating disorder. At least 3 percent population has it, said Dr. Casey Halpern, a neurosurgeon at the University of Pennsylvania.

He and his colleagues decided to try deep brain stimulation, a method routinely used to suppress tremors in Parkinson’s patients. It involves placing electrodes in the brain to regulate abnormal signals. The wires connected to the electrodes are placed under the scalp, where they are invisible and inconspicuous. To treat overeating, the device only stimulates neurons when the device detects a signal to start overeating.

The pilot study, funded by the National Institutes of Health and published earlier this year in the journal Nature Medicine, includes two women and will be expanded in a few months to include four more people living with binge eating disorder who have regained the weight they lost after bariatric surgery. operations. Before the Food and Drug Administration approves the treatment, researchers will have to rigorously test the method in at least 100 people at multiple medical centers. Such a study would take several years to complete.

Two women who had the devices implanted a year ago will be monitored for up to three years. They had the option of having their devices removed after 12 months, but both wanted to keep them because they no longer felt an overwhelming urge to drink.

One of them, Robyn Baldwin, 58, of Citrus Heights, Calif., described herself as a “chubby kid” who “was always big.” She tried a wide variety of diets. She once consumed only protein shakes for a month.

In 2003, she had gastric surgery, which usually involves a change in the digestive system so that the stomach is smaller and food is more difficult to digest. It has enabled many people to lose weight when other methods have failed. But for Ms. Baldwin, the lost weight has returned.

Lena Tolly, 48, another patient in the study, lives in Sacramento. She also tried a large number of diets and drugs for obesity. Her parents gave her a month at a vegan camp as a college graduation present. While there, she walked 10 miles a day.

In August 2005, Mrs. Tolly had bariatric surgery. She lost 100 pounds, but the weight came back.

“It has to be more than willpower,” she said.

In her case—and in Mrs. Baldwin’s—it was. Their binge eating isn’t what most people call binge eating, like when they occasionally start with a bag of chips or a gallon of ice cream and just keep going. Instead, their condition is found in the Diagnostic and Statistical Manual of Mental Disorders. This includes binging multiple times a week. Binge eating is accompanied by the feeling that they are almost in another state in which they lose all control, quickly consuming large amounts of food. Many, ashamed of their behavior, drink in secret. It’s normal to feel disgusted and ashamed when the binge is over.

The study involving Ms. Baldwin and Ms. Tolly is part of a movement to use deep brain stimulation to treat a variety of disorders that can be caused by problems with electrical signals in the brain. They include movement disorders and psychiatric conditions such as depression and obsessive-compulsive disorder, said Dr. Edward Chang, a professor of neurosurgery at the University of California, San Francisco, who was not involved in the binge-eating study.

Researchers have found precise brain circuits, often in areas just millimeters in diameter, that regulate the symptoms of some of these disorders. The discoveries pave the way for deep brain stimulation studies.

dr. Halpern conducted a pilot experiment with Ms. Baldwin and Ms. Tolly. But first he and his colleagues started with mice that were prone to obesity. The animals were fed, but when the researchers put butter in their cage, they gobbled it up, eating more than 25 percent of their daily calories in one hour.

The area of ​​their brains that was activated was the nucleus accumbens, the key hub of the brain’s reward center, located deep in the center of the brain. In mice, neurons in the nucleus accumbens became active immediately before drunkenness. When the researchers used deep brain stimulation to quiet these neurons, they were able to prevent the mice from overeating.

But can it work in humans?

A group of scientists began advertising for people who regained all the weight after bariatric surgery, believing it could be due to binge eating disorder.

Mrs. Baldwin and Mrs. Tolly answered. Neither of them realized they had a binge eating disorder. But binge eating is “really, really common in people who come in for weight loss surgery,” said Lauren Breithaupt, a psychologist at Massachusetts General Hospital who studies eating disorders.

When Ms. Baldwin and Ms. Tolly met with Dr. Halpern, both weighed more than they had before the weight loss surgery.

As part of the study, researchers gave each woman a 5,000-calorie feast of their favorite foods when they weren’t hungry. The women described specific emotional triggers that could trigger binge eating: for Ms. Tolly, thoughts of her mother, who had recently died; and for Ms. Baldwin, thoughts on her work schedule and responsibilities at home. They agreed to allow researchers to induce them to binge drink with these triggers as part of the study.

The researchers recorded electrical impulses in the women’s nucleus accumbens as they ate, finding that neurons fired just before overeating and that these electrical impulses correlated with the women’s sense of loss of control. A direct brain stimulator may have been able to intercept the signals and stop the women from wanting to drink.

After attaching the devices to the women’s brains, investigators told Ms. Baldwin and Ms. Tolly that they would activate the devices at some point over the next few months, but would not say when. Both women said they knew immediately when the devices were activated. Suddenly they no longer felt the insatiable need to eat.

Now their weight is slowly decreasing. Both say that, without actively thinking about it, they eat differently.

“That’s not self-control,” said Mrs. Tolly. “I make better decisions.” But she didn’t start eating food that she never liked. “I’m not applying for kale.”

Ms Baldwin said she noticed a change in her food preferences. She loved peanut butter and would find herself eating it out of the jar with a spoon. Now he no longer longs for it.

“I would get into habits like going to the pharmacy to get a prescription, but I might detour to Ben and Jerry’s,” she said.

After the device was activated, she said, “I could go to the drug store and not think about ice cream.”

She also reveals that her tastes have changed. Now her favorite food is salty instead of sweet.

“It’s not like I don’t think about food at all,” Ms. Baldwin said. “But I’m not a yearning person anymore.”

But does this show that direct brain stimulation may be the answer for people with extreme binge eating?

Dr. Breithaupt is cautious.

“It’s just two people,” she said.

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