Scientific advances in understanding the "addiction circuitry" of the brain may lead to effective treatment for obesity using deep brain stimulation (DBS), according to a review article in the August issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
Electrical brain stimulation targeting the "dysregulated reward circuitry" could make DBS—already an accepted treatment for Parkinson's disease—a new option for the difficult-to-treat problem of obesity. Dr. Alexander Taghva of Ohio State University and University of Southern California was lead author of the new review.
New Insights into 'Reward Circuitry'
Obesity is a major public health problem that is notoriously difficult to treat. Although various approaches can promote weight loss, patients typically gain weight soon after the end of treatment. Drug options have shown limited success, with several products removed from the market because of serious adverse effects. Bariatric surgery is effective in many cases of obesity but has a significant failure rate and is associated with side effects.
Drug treatments for obesity have targeted the homeostatic (self-regulating) mechanism regulating appetite and body weight. The homeostatic mechanism is thought to involve the "feeding center" in the hypothalamus, which produces hormones (such as leptin and insulin) that affect feeding behavior.
Initial experiments exploring DBS as a treatment for obesity have targeted the hypothalamus. However—as with drug options focusing on the homeostatic mechanisms—success has been limited.
Possible Role of DBS for Obesity
More recent studies have explored a different mechanism: specifically, the "reward circuitry," of the brain. Research has suggested that obesity is associated with a "relative imbalance" of the reward circuitry. Studies show that obese subjects—like those with addictive behaviors—are more impulsive and less able to delay gratification. The reward circuitry is intimately interconnected with the homeostatic mechanisms.