Objective
Individuals with anorexia nervosa (AN) pursue low‐fat, low‐calorie diets even when in a state of emaciation. These maladaptive food choices may involve fronto‐limbic circuitry associated with cognitive control, habit, and reward. We assessed whether high‐frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) influenced food‐related choice behavior in patients with severe, enduring (SE)‐AN.
Method
Thirty‐four females with SE‐AN completed a Food Choice Task before and after 20 sessions of real or sham rTMS treatment and at a 4‐month follow‐up. During the task, participants rated high‐ and low‐fat food items for healthiness and tastiness and then made a series of choices between a neutral‐rated food and high‐ and low‐fat foods. Outcomes included the proportion of high‐fat and self‐controlled choices made. A comparison group of 30 healthy women completed the task at baseline only.
Results
Baseline data were consistent with previous findings: relative to healthy controls, SE‐AN participants showed a preference for low‐fat foods and exercised self‐control on a greater proportion of trials. There was no significant effect of rTMS treatment nor time on food choices related to fat content. However, among SE‐AN participants who received real rTMS, there was a decrease in self‐controlled food choices at post‐treatment, relative to baseline. Specifically, there was an increase in the selection of tasty‐unhealthy foods.
Discussion
In SE‐AN, rTMS may promote more flexibility in relation to food choice. This may result from neuroplastic changes in the DLPFC and/or in associated brain areas.