Food choices are not controlled by willpower alone. Reward, learned cues and cognitive control all contribute to eating behavior and researchers are investigating whether TMS can influence some of these circuits.
Anyone who has experienced a strong food craving knows that wanting to eat is not always the same as being hungry. Eating behavior emerges from an interaction between homeostatic signals, reward, learned cues and cognitive control. This has made the brain and particularly the dorsolateral prefrontal cortex (DLPFC) an interesting target in research on craving and eating-related behavior. [1]
The DLPFC contributes to cognitive control and has therefore been investigated using non-invasive brain stimulation. A review by Ester and Kullmann describes the neurobiology of eating behavior and supports the DLPFC as a biologically relevant target, although much of the intervention evidence in that review concerns tDCS rather than rTMS. [1]
Can stimulation change a craving in the moment?
Van den Eynde et al. randomized 38 people with bulimic-type eating disorders to one session of active or sham high-frequency rTMS over the left DLPFC. Active rTMS reduced cue-induced food craving relative to sham immediately after stimulation. This provides evidence for an acute effect on craving in a specific clinical population, but it does not establish long-term changes in eating behavior or body weight. [2]
From craving to body weight
Ferrulli et al. later conducted a randomized double-blind sham-controlled pilot study in 33 adults with obesity. Participants received five weeks of high-frequency deep TMS, low-frequency deep TMS or sham in addition to physical exercise and a hypocaloric diet. High-frequency deep TMS was associated with greater weight loss than sham. Food craving showed a decreasing trend, but the between-group result did not reach conventional statistical significance. [3]
A newer retrospective study explored rTMS in people with type 2 diabetes and obesity and compared one-year outcomes with groups receiving an SGLT2 inhibitor or semaglutide, alongside moderate dietary counseling. Participants receiving rTMS showed reductions in body weight and improvements in several metabolic measures over the follow-up period. The authors proposed that modulation of brain regions involved in appetite and eating behavior may have contributed to these changes. However, because the study was retrospective and participants were not randomly assigned to treatment, the results should be considered exploratory rather than evidence that rTMS is comparable to established weight-management therapies. [4]
The most compelling wellness story here is therefore not “effortless weight loss.” It is the growing understanding that eating behavior has a neural component and that circuits involved in craving and cognitive control can be modulated. TMS research in this area is still early, and obesity is not an established wellness indication for TMS, but the findings offer an intriguing window into the biology behind craving, self-regulation and eating behavior. [1-4]
References
[1] Ester T, Kullmann S. Neurobiological regulation of eating behavior: Evidence based on non-invasive brain stimulation. Rev Endocr Metab Disord. 2022; 23:753-772. doi:10.1007/s11154-021-09697-3.
[2] Van den Eynde F, Claudino AM, Mogg A, et al. Repetitive transcranial magnetic stimulation reduces cue-induced food craving in bulimic disorders. Biol Psychiatry. 2010; 67(8):793-795. doi:10.1016/j.biopsych.2009.11.023.
[3] Ferrulli A, Macri C, Terruzzi I, et al. Weight loss induced by deep transcranial magnetic stimulation in obesity: A randomized, double-blind, sham-controlled study. Diabetes Obes Metab. 2019; 21(8):1849-1860. doi:10.1111/dom.13741.
[4] Ferrulli A, Senesi P, Sonaglioni A, et al. Weight Loss With SGLT2 Inhibitors, Semaglutide, and Transcranial Magnetic Stimulation in Type 2 Diabetes and Obesity. Obesity (Silver Spring). 2026; 34(2):317-322. doi:10.1002/oby.70105.
