Multi-session tDCS protocol combined with nutritional intervention in women with obesity: A pilot randomized trial

Obesity is associated with reduced dorsolateral prefrontal cortex (DLPFC) activity, a brain region involved in eating behavior regulation. Transcranial direct current stimulation (tDCS) targeting this area may enhance the regulation of appetite and food craving. This study evaluated the effects of a multi-session tDCS protocol combined with nutritional intervention on appetite, food craving, and eating behavior in women with class I and II obesity. In this pilot randomized, triple-blind clinical trial, 22 women were allocated to active or sham stimulation. Participants received 15 tDCS sessions (2 mA, 20 min) over five consecutive days. tDCS was delivered with the anode positioned over the left DLPFC (F3) and the cathode over the right supraorbital region, combined with nutritional education activities. Outcomes included anthropometric measures, body composition, appetite (VAS), food craving (FCQ-S/T), and eating behavior (TFEQ), assessed at baseline, during the intervention, and at 1-, 3-, and 6-month follow-ups. No between-group differences were observed in body weight, BMI, or body composition. The active tDCS group showed a reduction in momentary food craving immediately after the intervention (FCQ-S, p = 0.02) and a sustained decrease in habitual food craving up to six months (FCQ-T, p = 0.01). Changes in TFEQ domains were observed in both groups, suggesting an additional effect of the nutritional intervention. Although the combined protocol did not produce anthropometric changes, it reduced food craving in women with obesity. These findings provide preliminary evidence supporting multi-session tDCS as a promising adjunctive strategy for behavioral modulation in obesity management.