Neurosurgery in the treatment of obesity

Current pharmacological and behavioral approaches to obesity face high dietary relapse rates. Suboptimal outcomes have also been reported following bariatric surgery. Neuropsychiatric components of obesity may be responsible for such relapse, and neuro-modulation of brain regions associated with appetite, satiety, and reward may be useful for patients who have failed bariatric surgery. Deep brain stimulation (DBS) surgery has been shown to be safe and effective in the treatment of movement disorders, and it is increasingly used for the treatment of neuropsychiatric disorders. In DBS, an electrode is lowered to a specific neural target and adjustable electrical stimulation is administered. We propose DBS as a potential approach in the treatment of refractory obesity. In this chapter, we discuss potential indications, the DBS procedure, candidate neural targets, and challenges inherent in surgically targeting specific brain regions.