16th International Congress of Oriental Medicine, Seoul 14-16 September 2012
Obesity: A holistic, East and West approach
Karavis Miltiades, MD, FICAE
Physiatrist, Specialist in pain management and rehabilitation medicine
General Secretary of Hellenic Medical Acupuncture Association
Director of International Postgraduate Center of Acupuncture in Athens
According to WHO “obesity is defined as abnormal or excessive fat accumulation that presents a risk to health”. Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases, liver and gall bladder diseases, sleep apnea and respiratory problems, hypertension, stroke, osteoarthritis and cancer.
According to Western Medicine causes of obesity include a low resting metabolic rate, environmental factors, family behavior patterns, a poorly developed satiety response and emotional eating due to stress or anxiety. Morbid obesity is characterized by an increased number of adipocytes and a degree of irreversibility.
Many recent data mention that a reduction of calory intake and an increase of physical activity are necessary but not sufficient to achieve the best outcome for our patients. That is why medical community is working on new pharmaceutical products, new surgical techniques to treat morbid obesity and novel dietary and nutritional methods in order to minimize the consequences for obesity. Many study groups are investigating body and auricular acupuncture in order to measure the effectiveness and to evaluate their usefulness. In the past, in order to determine the effectiveness of auricular acupuncture we conducted a preliminary study (Apostolopoulos A, Karavis M., 1996, 1997): Semi-permanent needles were applied at the Stomach (solar plexus area) and Shenmen auricular points for the control of hunger, satiety, anxiety and emotional eating in 800 patients over a two year period. Press needles were inserted and left in site for 10 to 15 days at the specific auricular acupuncture points and repositioned again after 4 to 5 days. The patients were followed up for a period of one year. A reduction in overeating, satiety and hunger was reported by 81,1% of the patients and an antistress effect was seen in 46,7% of patients. We concluded that auricular acupuncture in these specific points has offered therapeutic assistance to a considerable percentage of our patients and to a satisfactory degree. I remind you that the physiological mechanism of hypothalamic regulation of appetite and metabolism through various hormones and cytokines such as leptin, orexin, ghrelin and TNFa was not adequately studied at that time. Our initial study, that goes back to 1996, was a preliminary report in order to have a general impression. Since then, significant clinical works in animals and humans allow us to extract more useful and more reliable conclusions about the therapeutic potential of acupuncture in the treatment of obesity (Cho SH 2009, Lacey JM 2003).
From the Traditional Chinese Medicine perspective, formation of adipose tissue is mostly due to phlegm and dampness. The spleen is at the root of all phlegm production and is the main organ involved in the transportation and transformation of body fluids and foods. If spleen is damaged (Spleen Qi deficiency due to trauma, emotions, cold and phlegm) it will fail to move and transform waste fluids and foods. Instead these metabolic wastes will accumulate and transform into dampness. If dampness endures over time, they will congeal into phlegm, and become fat tissue. Some of the main TCM causes of obesity are: spleen deficiency with dampness, hyperactive stomach with hypoactive spleen, phlegm/dampness obstruction in the middle burner, qi stagnation and blood stasis and spleen and kidney yang deficiency. Based on these diagnoses, a variety of acupoints are in use in the treatment of obesity (Cabyoglu MT 2006): P6, ST 44, 40, 36, 25, 21, R 4, LI 4 , 11, Sp 6, 9, Liv 3.
In this review we will present evidence of Western Medicine and Traditional Chinese Medicine on obesity in an attempt to balance evidence-based and experience-based acupuncture. We investigate the pathogenesis, the physiological mechanisms related to energy balance and metabolic parameters that are related to obesity and the feeling of hunger and satiety. We’ll describe the different therapeutic modalities of auricular acupuncture and body acupuncture which, according to the literature, help problems associated with obesity. Furthermore, we’ll try to describe the way in which hypothalamic pituitary axes control the hunger, thirst and satiety through hormones and neuro-modulators. We will describe the role of acute and chronic stress in bulimia and anorexia nervosa and the role of the stress management on energy balance and eating behavior (binge or emotional eating) (Park HJ 2005). We will refer to research data showing that acupuncture influences the production and the expression of many substances (NP-Y, orexin, ghrelin and leptin) remodulating hunger and satiety sensation and normalizing the metabolic parameters that lead to obesity (especially glucose metabolism) (Kyrou I 2006, Chrousos GP 2009). Finally, based on the above mentioned elements, we will determine the acupuncture points and the stimulation parameters of auricular and body acupuncture (TCM or medical acupuncture approach) commonly used to treat obesity.
All agree that more and better designed studies are needed to draw firm conclusions and to substantiate adequately the biological effects of acupuncture in obesity. Therefore, we’ll recommend potential targets for future research in animals and humans leading clinicians to better treatment choices for their patients.
Apostolopoulos A, Karavis M. «Bulimia Control – Treatment of obesity and weight loss by auriculotherapy in 800 cases.» The International Journal of Auricular Medicine, 1996.
Apostolopoulos A, Karavis M. «Overeating: Treatment of obesity and anxiety by auricular acupuncture. An analysis of 800 cases.» Acupuncture in Medicine, 1996, November ed.
Chrousos, GP. «Stress and disorders of the stress system.» Nat. Rev. Endocrinol., june 2009: 374-381.
HJ Park, Y Chae, J Jang, I Shim, H Lee, S Lim. «The effect of acupuncture on anxiety and neuropeptide Y expression in the basolateral amygdala of maternally separated rats.» Neuroscience letters, April 2005: 179-184.
JM Lacey, AM Tershakovec, GD Foster. «Acupuncture for the treatment of obesity: a review of the evidence.» International Journal of Obesity, 2003: 419-427.
Kyrou I, Chrousos GP, Tsigos C. «Stress, visceral obesity and metabolic complications.» Ann N Y Acad Sci, November 2006: 77-110.
Mehmet Tugrul Cabyoglu, Neyhan Ergene, Uner Tan. «The Treatment of Obesity with Acupuncture.» Intern. J. Neuroscience, 2006: 165-175.
S.H. Cho, J. S. Lee, L Thabane, J Lee. «Acupuncture for obesity: a systematic review and meta-analysis.» International Journal of Obesity, January 2009: 183-196.