How can the control of binge eating be improved?

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The fNIRS neurofeedback setup: Participants see images of food eaten during bing
The fNIRS neurofeedback setup: Participants see images of food eaten during binge eating episodes on the monitor. The aim is to reduce the size of the food images by reducing brain...

Binge eating disorder is the most common eating disorder in Germany. People who suffer from it often lose control when eating and consume large amounts of food. Anja Hilbert, Professor of Behavioral Medicine at Leipzig University, is investigating how the disorder can be cured. In a recent pilot study, she and her research team found a positive effect of food-related neurofeedback. The results have just been published in the journal Psychological Medicine.

With binge eating disorder, people lose control over what and how much they eat. Severe obesity is often the result of this mental illness. The loss of control leads to psychological suffering. Those affected find it more difficult than others to control their eating impulses. Self-regulation is impaired," explains Anja Hilbert, Professor of Behavioral Medicine at the University of Leipzig. The standard treatment for binge eating disorder is psychotherapy. Psychologist Hilbert is investigating whether this eating disorder can also be cured in other ways.

The research team at Leipzig University Medicine is pursuing neurofeedback as a therapeutic approach for binge eating disorder. Imaging techniques, such as functional near-infrared spectroscopy (fNIRS) or electroencephalography (EEG), measure brain activity and make it visible to the patient on a monitor. They then try to use this feedback to influence their brain activity in the desired way - in real time. Functional near-infrared spectroscopy (fNIRS) is a non-invasive imaging technique that detects when changes in brain activity lead to changes in the optical properties of brain tissue.

In the current randomized controlled pilot study, 72 patients received twelve one-hour sessions of fNIRS or EEG neurofeedback over a period of two months or were on a waiting list for neurofeedback. In neurofeedback, patients were instructed to regulate their brain activity in response to images of individually problematic foods, such as chocolate. The fNIRS neurofeedback aimed to increase brain activity in specific regions of the prefrontal cortex when looking at these foods in order to better resist them.

The results of the pilot study show that fNIRS neurofeedback was able to reduce binge eating just as much as EEG neurofeedback, and to a greater extent than in patients on a waiting list for neurofeedback. The effects were evident six months after the end of therapy. This indicates a delayed effect after brain training. Cravings, anxiety and the body mass index of the participants were also more improved after both neurofeedback therapies than in the patients on the waiting list.

The results show for the first time that fNIRS neurofeedback is feasible as a new therapeutic approach for binge eating disorder, similar to EEG neurofeedback, and provide initial indications of its effectiveness. In the future, it is important to investigate the short- and long-term effects and mechanisms of action in a larger-scale study. Research should also be carried out into the intensity at which neurofeedback develops its optimum effect," says Hilbert and adds: ,,From a clinical point of view, the smaller effects compared to psychotherapy speak in favor of an accompanying rather than sole use of food-specific neurofeedback in the treatment of binge eating disorder, for example during cognitive behavioral therapy. Further analyses show that patients with a lower body mass index and less severe eating disorder symptoms in particular benefit from neurofeedback."

Original publication in Psychological Medicine : Near-infrared spectroscopy and electroencephalography neurofeedback for binge-eating disorder: an exploratory randomized trial. DOI:­1723002350