The Effectiveness of rTMS on Improving Food Craving and Weight Control in Adults Without Serious Mental Illness
Phase: NA
Conditions: Food Cravings, rTMS
Sponsor: The University of Hong Kong

 
 
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The effectiveness of rTMS on improving food craving and weight control in adults without serious 
mental illness 
 
Background 
Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation technique that 
uses magnetic fields to modulate neural activity in targeted brain regions. Over the years, rTMS has 
shown promise in treating various mental health conditions, including depression1,2, obsessive-
compulsive disorder (OCD)3,4 and eating-related disturbance5,6. 
Food cravings are a common experience that can significantly impact an individual's mental and physical 
health. These intense desires for specific foods often lead to overconsumption of unhealthy foods, 
contributing to obesity, poor nutritional intake, and associated health conditions. Understanding the neural 
mechanisms behind food cravings is crucial for developing effective interventions to manage them. 
Prior research on rTMS and food craving has primarily focused on clinical populations, particularly 
individuals with obesity or eating disorders. While these studies have provided valuable insights, there is 
a burgeoning interest in exploring the effects of rTMS on food craving and weight control in the general 
population, specifically targeting those who report eating or weight problems but do not meet the criteria 
for clinical disorders. 
This research proposal aims to investigate the effects of rTMS on food craving and weight control among 
healthy adults experiencing subclinical eating and weight issues. By focusing on this population, we hope 
to uncover the potential of rTMS as a preventive intervention, offering individuals a non-pharmacological 
option to enhance diet and weight control without the side effects often associated with medications. 
 
Methodology 
Study Design 
This open-label pilot study aims to evaluate the effectiveness of repetitive transcranial magnetic 
stimulation (rTMS) in improving food craving and weight control among healthy adults with eating or 
weight issues. The study will enrol 30 participants who meet the inclusion criteria.  
 
Hypothesis 
rTMS significantly improves food cravings and weight control among healthy adults with food craving or 
weight control issues. 
 
Participants 
Participants will be recruited based on the following criteria: 
• 
Healthy adults aged 18-65 
• 
Self-reported food craving or weight control issues 
 
Exclusion criteria 
• 
People with serious mental illness, severe neurological conditions, and contraindications for 
rTMS. 
• 
People on weight-reduction medications 
 

 
 
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Intervention setting 
Participants will undergo a treatment protocol involving six sessions of rTMS using the EXOMIND™ 
device, administered once or twice a week. Each session will deliver 6,300 pulses at alternating 
frequencies of 12, 15, and 18 Hz, with a total duration of 24 minutes and 30 seconds. The target site 
would be left dorsolateral prefrontal cortex (DLPFC), determined by the most common used 5-cm rule. 
The procedure would be conducted in our research centre with medical staff supported. 
 
Baseline Assessments   
The subjects’ basic demographic data, including age, gender, years of education, place of birth, marital 
status, number of children, financial condition, household income, family history of eating difficulties 
will be collected upon study entry. Medical history in relation to mental illnesses and medications will 
also be assessed. 
 
Outcome Measures 
Assessments will be conducted at three time points: baseline (pre-intervention), post-intervention, and 
four weeks post-intervention. 
 
Primary Outcome 
• 
Food Cravings Questionnaire—Trait (FCQ-T): Measures food cravings. 
Secondary Outcomes 
• 
Perceived Stress Scale (PSS): Evaluates perceived stress levels. 
• 
Patient Health Questionnaire-9 (PHQ-9): Assesses depressive symptoms. 
• 
Body weight & BMI: Monitoring changes in body weight and BMI because of reduced cravings 
Adverse effects 
A checklist of potential adverse effects from TMS administration will be referenced from existing 
literature to monitor tolerability and adverse events during each session. Blood pressure and heart rate 
will be recorded at the beginning and end of each session. 
Sample size: 
• 
We aim to recruit 30 participants in this study.  
• 
An existing literature studying the effects of rTMS on food cravings in overweight or obese 
patients with similar outcome measures, has sample size of 37. 
 
Statistical Analysis 
Data will be analyzed using SPSS version 26.0 or a similar statistical software package. 
All the descriptive data including the age and educations will calculate means and standard deviations for 
continuous variables and frequencies and percentages for categorical variables. Repeated measures 
ANOVA will be used to assess changes in FCQ-T, PSS and PHQ-9 scores, as well as BMI across the 
three time points (baseline, post-intervention, and 4 weeks post-intervention). A p-value of <0.05 will be 
considered statistically significant. 
 
Impact of the study 

 
 
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This study contributes to the growing body of literature on non-pharmacological interventions for 
improvement in food craving and weight control. By focusing on a non-clinical population, it expands the 
understanding of how rTMS enhance individuals’ diet and weight control. Results could pave the way for 
integrating rTMS as a preventive intervention in clinical practice, offering an alternative to traditional 
medications. This could be particularly beneficial for individuals who are sensitive to medication side 
effects or those who prefer non-drug therapies. As a pilot study, this research sets the groundwork for 
larger, more comprehensive trials. Positive findings could lead to further exploration of rTMS 
applications across different populations and settings, encouraging innovation in eating disorder 
treatments. 
 
Handling and storage of personal data and study data  
Personal data will be anonymized and kept in password protected computers during and after the study; 
raw data will be anonymized and kept in locked rooms. Only principal investigator and authorized 
research assistants will have access to and are responsible for safekeeping of the stored data.  
Personal data will be kept for 5 years after completion of study and publications to keep track on potential 
side effects related to the intervention, and will be destroyed after completion of publications.  
 
Compliance with the ICH-GCP  
This study complies with ICH-GCP.  
 
Compliance with Declaration of Helsinki 
It declares that the research was conducted according to ethical standards, including the Declaration of 
Helsinki and its amendments.  
 
Conflicts of Interests 
There are no conflicts of interest regarding the use of the rTMS machine in this study that influenced the 
design, implementation, or interpretation of the research. 
 
Funding 
This research received no specific grant from any funding agency in the public, commercial, or not-for-
profit sectors. 
  
  
  
 
  
 
 

 
 
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References: 
1. Sabé, Michel, et al. "Transcranial magnetic stimulation and transcranial direct current stimulation 
across mental disorders: a systematic review and dose-response meta-analysis." JAMA network 
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2. Voineskos, Daphne, et al. "Neurophysiological effects of repetitive transcranial magnetic 
stimulation (rTMS) in treatment resistant depression." Clinical Neurophysiology 132.9 (2021): 
2306-2316. 
3. Fitzsimmons, Sophie MDD, et al. "Repetitive transcranial magnetic stimulation for obsessive-
compulsive disorder: A systematic review and pairwise/network meta-analysis." Journal of 
affective disorders 302 (2022): 302-312. 
4. Liang, Kaili, et al. "Efficacy and tolerability of repetitive transcranial magnetic stimulation for the 
treatment of obsessive-compulsive disorder in adults: a systematic review and network meta-
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transcranial magnetic stimulation (rtms) treatment on cerebral blood flow and its relation to 
clinical outcomes in severe enduring anorexia nervosa. Journal of Eating Disorders, 9(1). 
https://doi.org/10.1186/s40337-021-00420-w 
6. Hall, P. A., Vincent, C. M., & Burhan, A. M. (2018). Non-invasive brain stimulation for food 
cravings, consumption, and disorders of eating: A review of methods, findings and controversies. 
Appetite, 124, 78–88. https://doi.org/10.1016/j.appet.2017.03.006