Journal
INTERNATIONAL JOURNAL OF EATING DISORDERS
Volume 53, Issue 8, Pages 1326-1336Publisher
WILEY
DOI: 10.1002/eat.23267
Keywords
anorexia nervosa; eating behavior; eating disorders; food choice; repetitive transcranial magnetic stimulation; self-control
Funding
- National Institute of Mental Health [K24 MH113737]
- Department of Health
- King's College London
- South London and Maudsley NHS Foundation Trust
- National Institute for Health Research [PB-PG-1013-32049]
- NIHR Evaluation, Trials and Studies Coordinating Centre
- NIHR BRC for Mental Health
- United Kingdom Clinical Research Collaboration
- King's Health Partners
- National Institutes of Health Research (NIHR) [PB-PG-1013-32049] Funding Source: National Institutes of Health Research (NIHR)
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Objective Individuals with anorexia nervosa (AN) pursue low-fat, low-calorie diets even when in a state of emaciation. These maladaptive food choices may involve fronto-limbic circuitry associated with cognitive control, habit, and reward. We assessed whether high-frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) influenced food-related choice behavior in patients with severe, enduring (SE)-AN. Method Thirty-four females with SE-AN completed a Food Choice Task before and after 20 sessions of real or sham rTMS treatment and at a 4-month follow-up. During the task, participants rated high- and low-fat food items for healthiness and tastiness and then made a series of choices between a neutral-rated food and high- and low-fat foods. Outcomes included the proportion of high-fat and self-controlled choices made. A comparison group of 30 healthy women completed the task at baseline only. Results Baseline data were consistent with previous findings: relative to healthy controls, SE-AN participants showed a preference for low-fat foods and exercised self-control on a greater proportion of trials. There was no significant effect of rTMS treatment nor time on food choices related to fat content. However, among SE-AN participants who received real rTMS, there was a decrease in self-controlled food choices at post-treatment, relative to baseline. Specifically, there was an increase in the selection of tasty-unhealthy foods. Discussion In SE-AN, rTMS may promote more flexibility in relation to food choice. This may result from neuroplastic changes in the DLPFC and/or in associated brain areas.
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