Experimental brain surgery assuaged food cravings in 2 people with binge eating disorder

The first two patients to undergo experimental brain surgery for binge eating disorder say that a year later they feel more in control of what they eat and have fewer cravings.

“I’m fully aware of my cravings,” Robyn Baldwin, 58, of Citrus Heights, Calif., told NBC News. “Sometimes I can just stop, catch my breath and say, ‘No.'”

Baldwin, along with Lena Tolly, 48, of Elk Grove, Calif., had the surgery after failing to respond to other treatments for binge eating.

Preliminary results on the effects of the surgery – part of a pilot study that will include a total of six people – were reported Monday in the journal natural medicine.

It’s the first time deep brain stimulation has been used to treat binge eating disorder. In the study, surgeons implanted a device that learned to detect when patients had an urge to overeat, then deliver a small zap to the brain to reduce the urge.

“The fact that it can be done is pretty amazing,” said Dr. Kai Miller, associate professor of neurosurgery at Mayo Clinic in Rochester, Minnesota.

“It’s brain surgery, and it comes with its own set of risks,” said Miller, who was not involved in the new research. “But these patients improved over time and had fewer episodes of binge eating.”

Robyn Baldwin felt her food cravings felt more under control after deep brain stimulation.
Robyn Baldwin said her food cravings were better controlled after deep brain stimulation.Courtesy of Robyn Baldwin

For Baldwin, the change was almost immediate. “Within days, I could tell the cravings were getting under control,” she said. “I wasn’t constantly thinking about food.”

It took Tolly longer to feel an effect, but after several months she echoed the feeling of control. “I will never give up carbs,” she said, “but I have a better relationship with them and I make better choices.”

Binge eating disorder is the most common eating disorder in the United States, exceeding anorexia and bulimia. People with binge eating lose control of how much food they eat, even after feeling full.

This loss of control, said the study’s lead author, Dr. Casey Halpern, is the result of misfired signals in the brain.

“It’s not that they can’t control themselves,” said Halpern, a neurosurgeon and chief of stereotactic and functional neurosurgery at Penn Medicine in Philadelphia. “It’s a signal in the brain that has gone wrong.”

How it works?

During the operation, a pacemaker-like device is implanted under the scalp. This device is then connected to the nucleus accumbens, an area of ​​the brain that plays a vital role in how people experience reward and satisfaction.

Halpern and his colleagues directed these wires specifically to two smaller parts of this brain region: one that regulates how people deal with their impulses and one that controls appetite.

The device has two jobs. It records brain activity and can also deliver small electric shocks to the brain, intended to help quell food cravings. There is no physical sensation when these zaps occur, but patients may notice mood swings.

Initially, the device must be trained to detect which types of brain activity are linked to binge eating cravings. To do this, Baldwin and Tolly wave a magnetically charged wand over their head when they feel the urge to binge, signaling to the device that the brain activity he sees is related to cravings. Eventually, he is able to decode such brain activity himself and deliver a zap to the brain when it appears the person is likely to binge.

Six months after turning on the device, both women felt more in control of their binge eating, Halpern said. One, he added, no longer met the criteria for binge eating.

“Both patients are definitely reporting and feeling like they have more self-control than before,” he said.

Longer term data on Baldwin and Tolly should be analyzed and published later. Two other patients are scheduled to undergo surgery within the next six months. The study will ultimately include six patients.

A limitation to the current findings is that the two women are demographically similar: middle-aged and overweight.

While this appears to be an innovative approach to treating binge eating disorder, it’s unclear whether the technique would be helpful in the majority of patients, said Stephen Wonderlich, co-chair of the National Eating Disorders Association Research Advisory Board.

“How far does this apply?” Wonderlich said. “Would the results generalize to people of different heights? We don’t know.”

The research isn’t the first to use deep brain stimulation to treat food cravings.

Dr. Ali Rezai, a neurosurgeon and executive chairman of West Virginia University’s Rockefeller Neuroscience Institute, is studying the technique as a way to treat opioid use disorder.

The binge eating results, he said, are consistent with other studies that show changes in brain activity in people with other neuropsychiatric disorders.

Rezai added that it will be important to confirm the results in other patients with binge eating and to follow up on longer-term data.

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