BACKGROUND: Although some studies have reported significant reductions in food cravings following repetitive transcranial magnetic stimulation (rTMS), none have examined changes in body weight. OBJECTIVE: We conducted 2-week randomized, sham-controlled, single-blind, parallel-group trial to examine the effect of rTMS on body weight in obese patients. METHODS: Sixty obese patients (body mass index [BMI] ≥25 kg/m) aged between 18 and 65 years were recruited. A total of 4 sessions of rTMS targeting the left dorsolateral prefrontal cortex (DLPFC) was provided over a period of 2 weeks, with a follow-up assessment conducted two weeks after treatment had finished. The primary outcome measure was weight change in kilograms from baseline to 4 weeks. Secondary endpoints included changes in anthropometric measures, cardiovascular risk factors, food intake, and appetite. RESULTS: Of the 60 volunteers, 57 completed the 4-week follow-up (29 in the TMS group and 28 in the sham treatment group). Participants in the rTMS group showed significantly greater weight loss from baseline following the 4 session of rTMS (p = 0.002). Consistent with weight loss, there was a significant reduction in BMI, fat mass and VAT at week 4 in the rTMS group compared with the control group (p < 0.05). After the 4 sessions of rTMS, the TMS group consumed fewer total kilocalories per day than the control group (p < 0.01). CONCLUSIONS: rTMS delivered to the left DLPFC was effective in decreasing food intake and facilitating weight loss in obese patients. The results of this study suggest that rTMS could be an effective treatment option for obesity. TRIAL REGISTRATION: Clinical trial registered with the Clinical Trials Tegistry at https://cris.nih.go.kr (KCT0001455).