Printer Friendly

Efficacy of transcutaneous electrical acupoint stimulation compared to electroacupuncture at the main acupoints for weight reduction in obese Thai women.

Introduction and Background

Obesity is a grave and recalcitrant problem, the cause of substantial morbidity and mortality throughout the globe, and reduction of quality of life [1]. It is well established that obesity can be an underlying cause of many disorders such as arthritis, lung disease, diabetes, hypertension, coronary artery disease, heart failure, cataracts, cancer, and even early death [2, 3, 4]. The psychological effects are serious and may include depreciation of body self-image, poor quality of life and depression [3, 5].

Despite traditional treatment options, a noteworthy percentage of the elderly population remains obese. Because of the prevalent and stubborn nature of obesity, many investigators have started to focus on the various treatment options to solve this problem. Some recommend completely abandoning the dieting paradigm, which is has been found to be ineffective and even harmful [2, 6, 7]. This approach can only produce psychological changes without resulting in an actual weight loss [2, 7]. Some authors suggest the intake of the foods that cause obesity should be reduced, and support the use of herbs or nontraditional methods such as acupuncture for obese patients [2]. Comprehensive published data relating to acupuncture in the treatment of obesity is not to be found in the international literature.

A few reports showed acupuncture therapy was effective for reduction of weight in obesity [2, 8, 9, 10], but some negative reports also existed [11, 12]. Electroacupuncture (EA) was found to reduce body weight by decrease in food intake, by increase in energy expenditur or by both routes. However, common complications with EA are needle shock, organ puncture, sometimes resulting in internal injuries, especially when performed by inexperienced or unlicensed individuals. A new method of acupuncture, transcutaneous electrical acupoint stimulation (TEAS), is considered to be safe, and a useful treatment without adverse reactions. This study is aimed at determining the effect of TEAS as an option for anti-obesity treatment.

Materials and Methods

A prospective randomized open-label study was conducted in overweight or obese women by the Acupuncture Clinic, Srinakharinwirot University Hospital, during the period March to July 2010. Forty-five overweight or obese women aged over 15 years with body mass index (BMI) > 23 kg/[m.sup.2][13] and waist circumference > 80 cm were recruited for the study. Women with any history of bleeding disorders, pacemaker, epilepsy, uncontrolled hypertension, active dermatological problems at the area of acupuncture points, or currently committed to other methods for weight reduction, were excluded from the study. Pregnancy and lactatation were also exclusion factors.

The study protocol was approved by the ethics committee of the Faculty of Medicine, Srinakharinwirot University. Written informed consent was obtained from all participants before enrolment in the study.

Groups and intervention

Study participants were randomized to TEAS (n=23) or EA (n=22) groups using computer-generated random numbers and women in both groups received each treatment protocol over a period of 8 weeks. Ten acupoints were used for treatment: one point each at Guanyuan (RN 4), Qihai (RN 6), Xiawan (RN 10), Zhongwan (RN 12), and 2 points each at Tianshu (ST 25), Shuidao (ST 28), and Daheng (SP 15) (Figure 1). At each acupoint, subjects assigned to EA group were needled with disposable needles (0.25 x 25mm) while electrodes (1 x 1 cm) were attached for the subjects in the TEAS group. An electrical stimulator model HM Sti[m.sup.2] fit[R] (Wuxi Jiajian Medical Instrument Co Ltd, Wuxi, China) was applied with 0.2 ms pulses, at 40 Hz in the constant mode within the subject's tolerance level via the needles or electrodes, in accordance with their group. The needles or electrodes were left for 30 minutes and then removed. The treatment was rendered twice weekly for 8 weeks by a licensed acupuncturist (LR) with a minimum of 3 years experience. To adjust for the response to treatment by distinction of types of obesity recognized by traditional Chinese medicine (TCM), all participants were sorted into one of two groups: the excessive type (excessive of the spleen and stomach) and the deficiency type (spleen deficiency or primary Qi deficiency)[14]. The main manifestations of the excessive type are excessive fat deposition, especially over the lumbar area with strong muscles, whereas the characterizing features of the deficiency type are obvious obesity in face, neck, abdomen or gluteal regions, and with lax muscles. During the study period, no specific instruction was given to the participants in regard to diet or exercise and medication for weight reduction.

Measurements

Demographic data and anthropometric parameters including age, weight, height, waist and hip circumference were recorded at the beginning and the end of the study [15]. Weight was additionaly measured at the 2nd and 4th week. Weight was measured to the nearest 0.1 kg using an electronic scale (Tanita[R], BF-680W, Tokyo, Japan). Height, waist and hip circumferences were measured by tape to the nearest 0.1 cm.

Waist circumference was measured at the midpoint between the lower costal margin and the top of the iliac crest while the subject was in a standing position. Hip circumference was measured in the standing position at the maximum circumference over the buttocks [15]. The body mass index was calculated as the ratio of weight/ [(height).sup.2] [kg/[m.sup.2]][13]. All measurements were carried out by trained staff. Any adverse events during the treatment were recorded.

Statistical analysis

After being tested for normal distribution by Kolmogorov-Sminov test, all anthropometric data were found normally distributed and were descriptively presented as mean, standard deviation and 95% confidence interval. Differences of anthropometric characteristics and their change from baseline at each measure week between two groups were examined using student's t-test. The outcome measures at the end of the study were compared with the measures obtained at baseline using the paired t-test. A univariate analysis of variance was used to test the main and interaction effects of categorical variables of treatment methods and TCM classification on weight change during treatment. Statistical analysis was performed with SPSS (version 11.0, SPSS, Chicago, IL, USA). A p-value <0.05 was considered as statistically significant.

Results

After randomization of 45 women subjects, 23 women received transcutaneous electrical acupoint stimulation (TEAS) and 22 women received electroacupuncture (EA) therapy. All participants completed the study without withdrawal. Mean age of the study population was 33.6 [+ or -] 7.0 (range 21-59 years). Baseline characteristics of the study population are detailed in Table 1. At the beginning of the study, subjects in TEAS and EA group were not significantly different in age, weight, BMI and hip circumference. Only the waist circumference was found significantly different (99.4 [+ or -] 9.7 (EA) vs 92.8 [+ or -] 5.5 (TEAS); p<0.01) between the two groups.

Of 23 participants in TEAS, 9 and 14 participants were classified as excess type and deficiency type, respectively. Of the 22 participants in EA, 9 and 13 participants were classified as excess type and deficiency type, respectively. In each treatment group, there were no significant differences in any anthropometric data at the beginning of the study between TCM types. Mean body weight, BMI, waist and hip circumferences of excess type and deficiency types of obesity were 71.4 kg vs. 73.7 kg, 28.39 kg/m2 vs. 29.57 kg/m2, 96.5 cm vs. 95.8 cm, and 101.9 cm vs. 105.2 cm, respectively (P > 0.05).

At the end of the study, all anthropometric parameters of the participants in both groups significantly decreased from the baseline measures of study (P < 0.01). Furthermore, none of the parameters were significantly different between the groups. Waist circumference which was larger in subjects EA group than subjects in TEAS group at the beginning of the study (99.4 and 92.8 cm, respectively; P<0.01) was found to be non-significant at the end of the study (90.7 and 89.3 cm, respectively; P = 0.60). During the study, weight and BMI gradually decreased. Table 1 represents the changes in parameters at the end of study.

A univariate analysis of variance revealed no significant major effect of treatment methods (F=0.052; P=0.82), TCM classification (F=3.487; P=0.07) and interaction effects (f=0.01; P=0.98) on weight reduction at the end of treatment from the beginning of study. Table 2 represents the changes observed during the study. No adverse events were reported by the participants.

Discussion

The present study showed that at the 8th weeks of TEAS treatment, various indicators of obesity were significantly reduced as they were seen after the EA treatment. The study established that TEAS is as effective as the conventional treatment of acupuncture in reducing body weight, although it was seen that the EA group had a greater reduction in waist circumference compared to TEAS. The possible explanation could be the direct effects of needle puncture in the deep tissue rather that transit electrical energy penetration through skin as in TEAS. However, it is worth mentioning that the TEAS treatment produced less pain and is also free from the complications of needle acupuncture. Interestingly, the changes in anthropometric parameters were more consistent after each treatment of TEAS. The treatment had started to show its effectiveness after 2 weeks and from then on produced more success in the results. BMI was also found to be improved after treatment.

Previous research of acupuncture as a treatment option for obesity have focused on weight reduction and most of the trials indicated modest effect on weight reduction [16]. A meta-analysis review showed that acupuncture therapies, with various durations and protocols of treatment, had resulted in weight reduction ranging from 1.5 to 1.9 kg compared with various control settings [16]. Compared to previous studies, the results of the present study did not show the same degree of weight reduction, which might be explained by the single intervention used and a lower initial body weight and BMI of the participants.

The present study using either TEAS or EA has shown the significant weight reduction of 1.2-1.3 kg in 8 weeks of treatment, equal to 1.7% reduction in body weight. This figure may not be comparable with previous studies which employed multiple forms of treatment, including diet and exercise therapy in conjunction with acupuncture [9, 17]. Previous studies using combined therapies produced weight reduction of 4.8-5.6 %, however, diet restriction alone had resulted in a 2.5% weight reduction in the same study [9]. Neither diet modification nor exercise programs were included in the present study; therefore, we can emphasize the weight reduction was the real effect of either TEAS or EA. However, further study of combined therapy of TEAS and diet modification or exercise is advocated to clarify the optimal efficacy of this method.

Subjects in the present study might have lower initial body fat tissue than other studies as we used the diagnostic criteria of obesity for Asian (> 23 kg/[m.sup.2]) rather than those for European populations (> 30 kg/[m.sup.2]). Previous study showed the reduction of body fat percentage in the same degree of weight reduction in patients who received acupuncture therapy [18]. Moreover, there was some evidence that weight reduction by acupuncture therapy might relate to its lipolitic activity [19]. Further study comparing the efficacy of TEAS treatment for various degrees of obesity may elucidate those different responses.

Even the overall weight reduction from the present might not be comparable with other studies; some interesting points might be drawn from the present study. From our previous work in the same clinical setting as the present study, without any interventions, Thai obese women (BMI > 23 kg/[m.sup.2]) who were on the list waiting for acupuncture treatment had an average weight gain of 1.2 kg/month [10]. As the weight trended to increase in the obese women, acupuncture could control and stop the rising weight without any adverse reaction observed. Weight reduction in the present study might be lower than our previous study which reduced weight for 2.6 kg in 8 weeks [10]. This might be explained by the differences in location and numbers of acupoints. However, the present study still supports our concept to simplify acupuncture therapy to use a common set of acupoints for all types of obesity classified by TCM rather than the specific set of acupoints for each type of obesity [20, 21] Our recommended acupoints, which achieved weight reduction in both types of obesity, may help the acupuncturists who have no experience to classify the correct obesity type. Moreover, all of the applied acupoints were not on the back. Our recommended acupoints only on the abdominal wall may help patients to restrict movement so they can lie steadily on their back during acupuncture which may last for over 30 minutes. Use of a portable gadget of TEAS, as in the present study, might give an option for persons wishing to control weight for a longer period.

In the present study, either TEAS or EA was used as a sole intervention for weight reduction differs from other studies reporting the combined effects of acupuncture, diet and exercise [22, 23, 24]. The present study reports acupuncture as the sole treatment without the confounding factors of other interventions.

The exact mechanism of acupuncture for weight reduction is not well elucidated. In TCM theory, the imbalance of life force (Qi) is believed to be the cause of obesity. Stimulation of the specific acupoints helps to correct this imbalance and leads to weight loss [2]. In the scientific concepts, they observed that acupuncture increased the neural activity of the ventromedial and lateral hypothalamus leading to decrease of appetite in the animal models [25, 26]. Increase of serotonin level in both central nervous system (CNS) and plasma was also observed in acupuncture model which induced weight loss by suppressing appetite and rearranging the psychomotor balance [19, 27]. Various studies of acupuncture therapy also showed the increase of beta endorphin both in CNS and serum which induced the lipolitic activity and caused weight loss [28, 29, 30]. However, the exact mechanism of weight loss resulting from acupuncture is outside the scope our study. Further study to elucidate this mechanism is advocated.

In conclusion, transcutaneous electrical acupoint stimulation is as effective as conventional electroacupuncture for weight reduction in obese Thai women. Additionally, TEAS is a practical and safe method for weight reduction in obese women.

Funding/Support:

The present study was supported by grants from Faculty of Medicine, Srinakharinwirot University, Thailand.

Role of the Sponsor:

Sponsor is not involved in any process of the study.

Acknowledgements:

The present study was supported by grants from Faculty of Medicine, Srinakharinwirot University, Thailand. We thank Kulvadee Robloo for her assistance in recruiting participants for the study.

Conflict of interest: The authors have no conflict of interest to report.

References

[1] Cherniack EP. Potential applications for alternative medicine to treat obesity in an aging population. Altern Med Rev 2008;13: 34-42.

[2] Lacey JM, Tershakovec AM, Foster GD. Acupuncture for the treatment of obesity: a review of the evidence. Int J Obes Relat Metab Disord 2003;27: 419-27.

[3] Carpenter KM, Hasin DS, Allison DB, et al. Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study. Am J Public Health 2000;90: 251-7.

[4] Zamboni M, Mazzali G, Zoico E, et al. Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes (Lond) 2005;29: 1011-29.

[5] Kushner RF, Foster GD. Obesity and quality of life. Nutrition 2000;16: 947-52.

[6] Allison DB, Fontaine KR, Heshka S, et al. Alternative treatments for weight loss: a critical review. Crit Rev Food Sci Nutr 2001;41:1-28; discussion 39-40.

[7] Klein S. Alternative therapies for obesity: benefit or rip-off. Crit Rev Food Sci Nutr 2001;41: 33-4.

[8] Richards D, Marley J. Stimulation of auricular acupuncture points in weight loss. Aust Fam Physician 1998;27 Suppl 2: S73-7.

[9] Cabioglu MT, Ergene N. Electroacupuncture therapy for weight loss reduces serum total cholesterol, triglycerides, and LDL cholesterol levels in obese women. The American journal of Chinese medicine 2005;33: 525-33.

[10] Rerksuppaphol L, Rerksuppaphol S. Efficacy of electro-acupuncture at the main acupoints for weight reduction in Thai obese women. . Asian Biomedicine 2010;4: 943-7.

(11) Allison DB, Kreibich K, Heshka S, et al. A randomised placebo-controlled clinical trial of an acupressure device for weight loss. Int J Obes Relat Metab Disord 1995;19: 653-8.

(12) Mazzoni R, Mannucci E, Rizzello SM, et al. Failure of acupuncture in the treatment of obesity: a pilot study. Eat Weight Disord 1999;4: 198-202.

(13) Weisell RC. Body mass index as an indicator of obesity. Asia Pac J Clin Nutr 2002;11 Suppl 8: S681-4.

(14) Wei BH. [Diagnostic criteria and therapeutic efficacy of traditional Chinese medicine and Western medicine in simple obesity]. Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine / Zhongguo Zhong xi yi jie he xue hui, Zhongguo Zhong yi yan jiu yuan zhu ban 1992;12: 690-1.

[15] Zhao HY. [Clinical observation on acupuncture for treatment of central obesity]. Zhongguo Zhen Jiu 2006;26: 629-31.

[16] Cho SH, Lee JS, Thabane L, et al. Acupuncture for obesity: a systematic review and meta-analysis. International journal of obesity (2005) 2009;33: 183-96.

[17] Huang MH, Yang RC, Hu SH. Preliminary results of triple therapy for obesity. Int J Obes Relat Metab Disord 1996;20: 830-6.

[18] Sun Q, Xu Y. Simple obesity and obesity hyperlipemia treated with otoacupoint pellet pressure and body acupuncture. Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan / sponsored by All-China Association of Traditional Chinese Medicine, Academy of Traditional Chinese Medicine 1993;13: 22-6.

[19] Cabyoglu MT, Ergene N, Tan U. The treatment of obesity by acupuncture. The International journal of neuroscience 2006;116: 165-75.

[20] Hu J. Acupuncture treatment of obesity. Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan / sponsored by All-China Association of Traditional Chinese Medicine, Academy of Traditional Chinese Medicine 2005;25: 310-4.

[21] Qunli W, Zhicheng L. Acupuncture treatment of simple obesity. Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan / sponsored by All-China Association of Traditional Chinese Medicine, Academy of Traditional Chinese Medicine 2005;25: 90-4.

[22] Yang JJ, Xing HJ, Xiao HL, et al. [Effects of acupuncture combined with diet adjustment and aerobic exercise on weight and waist-hip ratio in simple obesity patients]. Zhongguo zhen jiu = Chinese acupuncture & moxibustion 2010;30: 555-8.

[23] Nourshahi M, Ahmadizad S, Nikbakht H, et al. The effects of triple therapy (acupuncture, diet and exercise) on body weight: a randomized, clinical trial. International journal of obesity (2005) 2009;33: 583-7.

[24] Chen ZX. [Clinical observation on acupuncture combined with diet control for treatment of simple obesity]. Zhongguo zhen jiu = Chinese acupuncture & moxibustion 2008;28: 888-90.

[25] Shiraishi T, Onoe M, Kojima T, et al. Effects of auricular stimulation on feeding-related hypothalamic neuronal activity in normal and obese rats. Brain research bulletin 1995;36: 141-8.

[26] Zhao M, Liu Z, Su J. The time-effect relationship of central action in acupuncture treatment for weight reduction. Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan / sponsored by All-China Association of Traditional Chinese Medicine, Academy of Traditional Chinese Medicine 2000;20: 26-9.

[27] Wenhe Z, Yucun S. Change in levels of monoamine neurotransmitters and their main metabolites of rat brain after electric acupuncture treatment. The International journal of neuroscience 1981;15: 147-9.

[28] Jin HO, Zhou L, Lee KY, et al. Inhibition of acid secretion by electrical acupuncture is mediated via beta-endorphin and somatostatin. The American journal of physiology 1996;271: G524-30.

[29] Takeshige C, Nakamura A, Asamoto S, et al. Positive feedback action of pituitary beta-endorphin on acupuncture analgesia afferent pathway. Brain research bulletin 1992; 29: 37-44.

[30] Fu H. What is the material base of acupuncture? The nerves! Medical hypotheses 2000;54: 358-9.

Lakkana Rerksuppaphol (1), Sanguansak Rerksuppaphol (2) *

(1) Department of Preventive Medicine, Faculty of Medicine, Srinakharinwirot University, Thailand

(2) Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Thailand

* Corresponding Author
Table 1: Anthropometry at baseline and at the
end of study (week 8) in study population

                                       TEAS (n = 23)

                                                 Paired
                                                 t-test
                           Mean [+ or -] SD     (p value)

Age (yr)                   34.4 [+ or -] 7.7
Weight (kg)
  * Baseline (wk 0)        71.2 [+ or -] 8.5
  * End of study (wk 8)    70.1 [+ or -] 8.4      <0.01
BMI (kg/[m.sup.2])
  * Baseline (wk 0)       28.26 [+ or -] 3.13
  * End of study (wk 8)   27.79 [+ or -] 3.13     <0.01
Waist (cm)
  * Baseline (wk 0)        92.8 [+ or -] 5.5
  * End of study (wk 8)    89.3 [+ or -] 4.5      0.01
Hip (cm)
  * Baseline (wk 0)       102.3 [+ or -] 5.8
  * End of study (wk 8)   100.3 [+ or -] 4.8      <0.01
Waist/Hip ratio
  * Baseline (wk 0)        0.91 [+ or -] 0.04
  * End of study (wk 8)    0.89 [+ or -] 0.04     <0.01

                                        EA (n = 22)         P value

                                                 Paired
                                                 t-test     Between
                           Mean [+ or -] SD     (p value)   groups

Age (yr)                   32.7 [+ or -] 6.3                 0.45
Weight (kg)
  * Baseline (wk 0)        74.6 [+ or -] 10.3                0.24
  * End of study (wk 8)    73.3 [+ or -] 10.6     <0.01      0.26
BMI (kg/[m.sup.2])
  * Baseline (wk 0)       29.97 [+ or -] 3.68                0.10
  * End of study (wk 8)   29.45 [+ or -] 3.76     <0.01      0.11
Waist (cm)
  * Baseline (wk 0)        99.4 [+ or -]  9.7               <0.01
  * End of study (wk 8)    90.7 [+ or -] 11.2     <0.01      0.60
Hip (cm)
  * Baseline (wk 0)       105.5 [+ or -] 6.7                 0.09
  * End of study (wk 8)   101.1 [+ or -] 7.1      <0.01      0.67
Waist/Hip ratio
  * Baseline (wk 0)        0.94 [+ or -] 0.07                0.05
  * End of study (wk 8)    0.90 [+ or -] 0.08     <0.01      0.80

Table 2: Change in anthropometric characteristics
from the beginning of the study

                                    TEAS (n = 23)

Weight change (kg) (1)
  * At 2 weeks              0.6 [+ or -] 0.8 (0.3-1.0) *
  * At 4 weeks              0.6 [+ or -] 1.1 (0.1-1.0) *
  * At 6 weeks              0.8 [+ or -] 1.7 (0.1-1.5) *
  * At 8 weeks              1.2 [+ or -] 1.7 (0.5-1.9) *
BMI change (1)
  * At 2 weeks             0.25 [+ or -] 0.32 (0.11-0.39) *
  * At 4 weeks             0.23 [+ or -] 0.44 (0.04-0.42) *
  * At 6 weeks             0.30 [+ or -] 0.66 (0.02-0.59) *
  * At 8 weeks             0.47 [+ or -] 0.66 (0.18-0.75) *
Waist change at 8 wk (1)    3.5 [+ or -] 4.2 (1.6-5.3) *
Hip change at 8 wk1         2.0 [+ or -] 2.6 (0.9-3.1) *
Waist/hip ratio change     0.02 [+ or -] 0.05 (-0.003-0.04)

                                     EA (n = 22)              P-value

Weight change (kg) (1)
  * At 2 weeks              0.6 [+ or -] 1.3 (-0.01-1.1)       0.87
  * At 4 weeks              0.7 [+ or -] 1.3 (0.1-1.3) *       0.78
  * At 6 weeks              1.0 [+ or -] 1.6 (0.3-1.7) *       0.58
  * At 8 weeks              1.3 [+ or -] 1.6 (0.6-2.0) *       0.84
BMI change (1)
  * At 2 weeks             0.22 [+ or -] 0.51 (-0.01-0.46)     0.86
  * At 4 weeks             0.27 [+ or -] 0.53 (0.03-0.51) *    0.79
  * At 6 weeks             0.42 [+ or -] 0.64 (0.13-0.70) *    0.56
  * At 8 weeks             0.51 [+ or -] 0.65 (0.22-0.80) *    0.80
Waist change at 8 wk (1)    8.8 [+ or -] 7.0 (5.6-11.9) *      <0.01
Hip change at 8 wk1         4.4 [+ or -] 4.8 (2.3-6.5) *       0.04
Waist/hip ratio change     0.05 [+ or -] 0.07 (0.01-0.08) *    0.11
  at 8 wk (1)

(* Significant differences from the beginning of the
study (P<0.05); (1) presented as Mean [+ or -] SD (95%CI))
COPYRIGHT 2011 DRUNPP
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2011 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Rerksuppaphol, Lakkana; Rerksuppaphol, Sanguansak
Publication:International Journal of Collaborative Research on Internal Medicine & Public Health (IJCRIMPH)
Article Type:Report
Geographic Code:9THAI
Date:Nov 1, 2011
Words:3999
Previous Article:Omental transplantation for peripheral vascular disease-our experience.
Next Article:Early predictors of neurodevelopmental adverse outcome in term infants with postasphyxial hypoxic ischemic encephalopathy.
Topics:

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters