Potential of transcranial magnetic stimulation in correction of compulsive overeating in patients with metabolic syndrome
Morzhanaeva М.А., Svechnikova E.V., Artemyeva N.O., Schepkina E.V., Badaeva A.V.
Introduction: Metabolic syndrome (MS) is a cluster of metabolic abnormalities, including abdominal obesity, insulin resistance, hypertension, and dyslipidemia, that substantially increase the risk of cardiovascular disease and type 2 diabetes mellitus. Disordered eating represents one of the most important comorbid conditions associated with MS and is largely regulated by the prefrontal cortex. Targeting this brain region using non-invasive brain stimulation may therefore represent a promising strategy for modulating eating behavior. The two principal non-invasive brain stimulation techniques are transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (TES).
Materials and methods: The study included 33 overweight or obese adults (27 women and 6 men) undergoing a course of Exomind transcranial magnetic stimulation combined with lifestyle modification. Eating behavior was assessed using the Binge Eating Scale (BES; 16 items, score range 0–46) and the Food Cravings Questionnaire–State (FCQ-S; 15 items, score range 15–75). Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS), consisting of two 7-item subscales (HADS-Anxiety and HADS-Depression; score range 0–21 for each). DNA was isolated from buccal swab samples. Genotyping was performed using real-time polymerase chain reaction. Sixteen single nucleotide polymorphisms (SNPs) involved in energy metabolism, lipid metabolism, incretin signaling, taste perception, and dopaminergic neurotransmission were analyzed: FTO (rs9939609), GLUT2 (rs5400), CD36 (rs1761667), TAS1R2 (rs35874116), MC4R (rs17782313), DRD2 (rs1800497), TCF7L2 rs7903146, TCF7L2 rs12255372, SLC30A8 (rs13266634), GCKR (rs780094), KCNJ11 (rs5219), PPARG2 (rs1801282), LPL (rs328), ADRB3 (rs4994), APOA5 rs662799, and APOA5 rs3135506. All participants received six weekly TMS sessions.
Results: At baseline, clinically significant binge eating (BES ≥18) was observed in 48% (n = 16) of participants, all of whom belonged to the metabolic syndrome group. Weight loss of at least 2.3 kg (the median threshold) was achieved by 52% (n = 17) of participants, whereas 33% (n = 11) lost at least 3 kg. Clinically elevated anxiety (HADS ≥8) and depression were present before treatment in 79% (n = 26) and 48% (n = 16) of participants, respectively. Following treatment, the prevalence of elevated anxiety decreased to 39% (n = 13), whereas elevated depression decreased to 27% (n = 9). In the dominant genetic model, the only significant difference between participants with and without metabolic syndrome was observed for DRD2: the variant allele was detected in 68% of patients with MS compared with 29% of those without MS (p = 0.037; OR = 5.42, 95% CI: 1.20–24.54).
Discussion: MS was strongly associated with clinically significant binge eating, as all participants with BES scores ≥18 belonged to the MS group. Patients with MS were also more likely to achieve weight loss of at least 2.3 kg, although this difference disappeared when a 3-kg threshold was applied, likely reflecting differences in baseline body weight. In addition, participants with MS had substantially higher baseline anxiety and depression scores; however, these between-group differences were no longer evident after treatment, suggesting greater psychological improvement among patients with more severe baseline impairment. The correlation structure of weight-loss predictors also differed according to MS status: among participants without MS, weight loss was associated with baseline binge eating severity, whereas no linear associations with psychological or behavioral variables were observed in the MS group. Furthermore, the association between food cravings and affective symptoms in the overall cohort appeared to be largely explained by stratification according to metabolic syndrome. Collectively, these findings suggest that Exomind-assisted TMS may represent a promising therapeutic approach for patients with metabolic syndrome, binge eating, and anxiety-depressive symptoms.
Conclusion: The findings indicate that the response to TMS is multifactorial and reflects the interaction of psychological and genetic determinants. Greater weight loss was observed in participants with higher baseline depressive symptoms and stronger food cravings, suggesting that these individuals may derive greater benefit from neuromodulation of the dorsolateral prefrontal cortex using Exomind technology, potentially through improvements in psychological well-being and reductions in food craving. From a clinical perspective, elevated baseline FCQ-S and HADS-Depression scores should not necessarily be regarded as unfavorable prognostic factors, as these patients may demonstrate greater weight-loss responses. Genotyping of TCF7L2 rs7903146, PPARG2, APOA5 rs662799, and CD36 may contribute to personalized prediction of treatment outcomes, although these findings require validation in larger cohorts. Future studies should determine whether improvements in psychological status are mediated by weight loss or occur through independent mechanisms and identify genetic variants associated with greater reductions in anxiety and depressive symptoms among patients with metabolic syndrome.
For citations: Morzhanaeva М.А., Svechnikova E.V., Artemyeva N.O., Schepkina E.V., Badaeva A.V. Potential of transcranial magnetic stimulation in correction of compulsive overeating in patients with metabolic syndrome. Pharmateca. 2026;33(5):82-96. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2026.5.82-96
Authors’ contribution: Svechnikova E. V., Morzhanaeva M. A. – research idea generation, formulation of objectives, editing and approval of the final version of the manuscript. Morzhanaeva M. A., Artemyeva N. O., Badaeva A. V. – collection and systematization of clinical materials, genetic analysis, preparation of the article. Shchepkina E. V. – development of the statistical analysis design, performance of statistical calculations, interpretation of the obtained data. All authors reviewed and approved the final version of the manuscript.
Conflicts of interest: Morzhanaeva M.A. is an employee of the company BTL Russia, other authors declare no conflict of interest.
Funding: This article was prepared with the support of BTL Russia.
Ethical Approval: The study protocol was approved by the local ethics committee.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors’ Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
Keywords
binge eating
metabolic syndrome
transcranial magnetic stimulation
Exomind
anxiety
depression
personalized medicine
About the Authors
Maria A. Morzhanaeva, Cand. Sci. (Med.), Cosmetologist, Medical Director of the Aesthetic Department, BTL Russia, Moscow, Russia;maria_morzhanaeva@mail.ru, ORCID: https://orcid.org/0000-0001-8657-9559 (corresponding author)
Elena V. Svechnikova, Dr. Sci. (Med.), Professor, Head of the Department of Dermatovenereology and Cosmetology, Polyclinic No. 1 of the Administrative Directorate of the President of the Russian Federation; Head of the Department of Dermatooncology, Medical Institute of Continuous Education, Russian Biotechnological University (ROSBIOTECH), Moscow, Russia; ORCID: https://orcid.org/0000-0002-5885-4872
Natalya O. Artemyeva, Cand. Sci. (Med.), Nutritionist and Geneticist, OMNIUS Expert Multidisciplinary Clinic, Moscow, Russia;
natalya.artemeva.89@mail.ru, ORCID: https://orcid.org/0000-0002-5619-6757
Elena V. Shchepkina, Cand. Sci. (Sociol.), Chief Specialist, Russian Presidential Academy of National Economy and Public Administration; Analyst, Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Moscow Healthcare Department, Moscow, Russia; elenaschepkina@yandex.ru, ORCID: https://orcid.org/0000-0002-2079-1482, AuthorID: 959277, Scopus Author ID: 57211515165, ResearcherID: IAR-4060-2023
Anastasia V. Badaeva, Neurologist, Teaching Assistant at the Department of Pathological Physiology, Institute of Digital Biodesign and Artificial Intelligence in Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; badaeva_a_v@staff.sechenov.ru,
ORCID: https://orcid.org/0000-0002-9870-4414, Scopus Author ID: 58306496300
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