Brain Stimulation Delivers Comparable Weight Loss in Trials
New clinical evidence suggests noninvasive brain stimulation may achieve weight loss similar to semaglutide in adults with obesity and type 2 diabetes.
A retrospective study published in Obesity reports that repetitive transcranial magnetic stimulation, a noninvasive brain-based therapy, produced 12-month weight loss comparable to semaglutide 0.5 mg weekly and greater than SGLT2 inhibitors in adults with obesity, including those with type 2 diabetes.
Study Details
Obesity treatment has largely focused on medications that alter appetite, insulin signaling, or glucose excretion. While GLP-1 receptor agonists like semaglutide have reshaped clinical practice, researchers are also exploring whether targeting brain circuits involved in craving and impulse control can offer durable benefits.
Investigators at IRCCS MultiMedica in Milan examined whether repetitive transcranial magnetic stimulation, or rTMS, could deliver weight loss outcomes comparable to commonly prescribed pharmacologic therapies in real-world clinical care.
Methodology
The researchers performed a retrospective analysis comparing three treatment strategies in adults with obesity, with or without type 2 diabetes:
rTMS delivered to brain regions involved in appetite regulation, administered three times per week for five weeks
Semaglutide 0.5 mg weekly, continued for at least one year
SGLT2 inhibitor therapy, continued for at least one year
All participants received guidance on a low-calorie Mediterranean diet and regular moderate-intensity physical activity. Body weight was assessed at six and twelve months after treatment initiation.
Key Findings
Mean weight loss at 12 months was 8.2 kg with rTMS, 5.7 kg with semaglutide, and 2.0 kg with SGLT2 inhibitors
Weight loss with rTMS and semaglutide was significantly greater than with SGLT2 inhibitors, with no meaningful difference between rTMS and semaglutide
Patients on SGLT2 inhibitors lost weight at six months but regained weight by twelve months
Both rTMS and semaglutide showed continued weight reduction through one year
rTMS effectiveness was similar in patients with obesity alone and those with obesity plus type 2 diabetes
Implications for Practice
For patients, these findings suggest that noninvasive brain stimulation may represent a future option for weight management, especially for individuals who cannot tolerate or prefer to avoid long-term injectable medications. rTMS may also appeal to those concerned about weight regain after stopping pharmacologic therapy.
For clinicians, the study highlights the brain as a therapeutic target in obesity care. rTMS could emerge as an adjunct to GLP-1 receptor agonists or as an initial intervention in selected patients, although prospective randomized trials and broader access considerations will be critical before routine adoption.
The authors note that semaglutide was used at a lower dose than currently approved for obesity, and that the retrospective design limits direct causal conclusions. Still, the magnitude and durability of weight loss observed with rTMS warrant further investigation.