BULIMIA CONTROL TREATMENT OF OBESITY AND WEIGHT LOSS BY AURICULAR ACUPUNCTURE IN 800 CASES.


Apostolopoulos Apostolos M.D.,Dip.Ac.
Karavis Miltiades M.D.,Dip.Ac.

Abstract

Auricular acupuncture (placement of press needles) was applied at the stomach point (according to Nogier) and some times at the point of psychic balance (Shenmen) for the control of anxiety and for help in weight loss in 800 patients during a 1993 - 1994 two - years period. Press needles left for 10 - 15 days at the auricular acupuncture point and placed again after 4 - 5 days were used. At the same time, instructions were given for the proper treatment of obesity (information leaflet, low - calorie diet, aerobic exercise, behavior modification, psychological support etc.). The results were followed up for a period of one year.

The participants were 683 women and 117 men aged between 15 and 76 years. The Body Mass Index (weight/V height) was < 25 in 151 patients (normal weight), 25 - 30 in 226 patients (moderate obesity), 30 - 40 in 367 (severe obesity) and > 40 in 56 (malignant obesity). The cases were divided into three groups according to the number of acupuncture sessions as follows: 468 patients (58.5%, group A) had one acupuncture session, 278 patients (34.8%, group B) 2 - 4 patients (6.8%, group C) over 4 sessions every 15 - 20 day intervals. 649 (81,1%) patients acknowledged that treatment helped in the reduction of bulimia and 326 (46.7%) of the 697 patients who reported existing "anxiety" symptoms acknowledged that treatment helped in the reduction of anxiety. Regular exercise was started for 305 patients (43.4%) of the 703 who had no such habit.

There was no significant weight loss in 282 patients (35.2%). There was an initial (1 - 3 months) significant percentage of body weight loss (%B.W.L.) in 518 patients (64.8%) and a percentage of body weight loss at 6 - 12 months in 284 patients (35.5%). The percentage B.W.L. was higher in groups B and C and remained higher at six months and one year after acupuncture treatment started. Group B presented a good six - months result in 61.2% and a good annual result in 39.1% of the participants. In group C there was a good six - month result in 88.9% and a good annual result in 77.8% of the participants. In 28 patients there was a significant recovery within one year.

The therapeutic help offered in the control of bulimia and anxiety by auricular acupuncture at the stomach point and at the Shenmen point is valuable. Its correct use in a "integrated" obesity control program may help significantly and in a long term period possibly more than other comparable medical programs (e.g, drugs, diets, psychological support).

Material and method

Auricular acupuncture on the «stomach area» and sometimes on the «psychical balance point» (Shenmen) was employed for the control of bulimia and anxiety and as an aid to weight loss in 800 individuals in the 1993 - 1994 period.The location of this two auricular areas is of primary importance.

We localize «stomach area» at the anatomic auricular region caled «root of the helix», where solar plexus reflex area is found. In this area exist three points of particular interest. The zero point (O-point) , the plexus point , and the stomach point. According to Nogier, stomach point is located «in the center of the concha, on the frontier separating the lower hemi-concha from the upper hemi-concha. It is exactly on the helix root, at equal distance from point Zero and the antihelix edge. This point is placed on a cartilaginous incisure which can be felt with the nail. According to Bourdiol the «stomach point» is projected «onto the middle of the concha, on the middle part of the root of the helix. Its lesser curvature forms an anteriorly concave curve that embrances Zero point». Generaly speaking, this area has a parasympathiticolitic effect to the stomach function and influences all abdominal organs. All these points receive sensory innervation from auricular branch of Pneumogastric nerve. We use these points to treat stress, visceral metabolism troubles, visceralgia, aerophagia etc.

We locate «Shenmen» (chinese point) at the region just above the border between the lower and median thirds of the upper crus of the antihelix. According to Kropej, this is the location of a special «general tonification point». These two points have important neurovegetative, antiinflammatory, antidepressive and ancholytic action and receive innervation from a branch of Auriculo-temporal nerve of Trigeminal.

Press needles were used. We didn't try to locate the specific areas (or points) with manual detector or using electrical (diascope, punctoscope, etc) devises because we didn't find any «active» area in the ear of our obese patiens. We believe that these points are «silente» because obesity is an multifactorial disturbance (due to social, economic and psychical factors) and not an organic or functional active disease, only rarely caused by disturbances of endocrine system). That's why we used «blind» method to put our press needles to the sedation area and stomach area. The needles remain in place for 10 - 15 days and were repositioned after 4 - 5 days. At the same time, instructions were given for the proper treatment of obesity (information leaflets, low calorie diet, aerobic exercise, modification of behaviour, psychological support etc.). The results were followed up on an annual basis.

The participants included 683 women and 117 men aged from 15 to 76 years.

The distribution by decade of age is given in table 1.

The distribution by decade of age with relation to the sex is given in table 2.

The overwhelming majority was women (85.4%) and in particular women between 31 - 40 years (36%) and 21 - 30 years (29%).

Table 3 gives the individual case histories. 445 persons had an obesity - free history, 209 persons had a clinically recognisable obesity - scales (weight) anxiety and 163 persons had a history of many diets and yo-yo effect. 197 persons (table 3, points 3 and 6) had intense psychosomatic problems.

Table 4 gives the absolute distribution of body weight. The degree of obesity was classified in accordance with the Body Mass Index (B.M.I) into four categories: normal weight (0), moderate (1), severe (2) and malignant (3) obesity (table 5). The Body Mass Index (weight /V height) was < 25 in 151 subjects (normal weight), 25 - 30 in 226 subjects (moderate obesity), 30 - 40 in 367 subjects (severe obesity) and more than 40 in 56 subjects (malignant obesity) (table 6). The distribution of the B.M.I. with relation to sex is given in table 6 and with relation to age in table 7.

Results

468 subjects were submitted to one session (58.5%, group A), 278 subjects to 2 - 4 sessions (34.8%, group B) and 54 subjects (6.8%, Group C) to more than 4 sessions, every 15 - 20 days (table 8).

649 subjects (81.1%) recognised some help in the reduction of bulimia and 326 (46.7%) of the 697 subjects that stated that they had "anxiety" symptoms recognised a reduction of anxiety with auriculo-acupuncture. The reduction of bulimia was marked in 57.5% of the cases and moderate in 23.6% of the cases, as checked by a question asked during the second treatment session after 20 days (table 9).

305 subjects (43.4%) of the 703 who had no regular exercise habit began having regular exercise (table 10).

Particulary important is the very higt percentage (88%) of subjects with no regular exercise habit in persons of an urban type of living (sedentary life) as a causative factor of obesity and successful long - term treatment. There was no important weigt loss in 282 subjects (35.2%). There was an initial (1 - 3 months) percentage of Body Weight Loss (% B.W.L.) in 518 subjects (64.8%) and % B.W.L. at 6 - 12 months in 284 subjects (35.5%), (table 11).

Table 12 gives the % B.W.L. in 518 subjects at the 1st, 3rd, 6th and 12th month from the beginning of the sessions and the dietary efforts. A % B.W.L. at six months is noted in 284 subjects (54.8%) and at one year in 196 subjects (37.8%). These persentages concern the successful continuation of the dietary effort and the conservation of the result.

Tables 13 , 14 and 15 show this result in groups A, B and C based on the number of treatment sessions and the % B.W.L. In group A (1 session) there was % B.W.L. at 6 months in 36% and at one year in 24.7%. In group B (2 - 4 sessions), there was a corresponding % B.W.L. in 61.2% and 39.1%. In group C (over 4 sessions) the relevant result was 88.9% and 77.8%. The % B.W.L. was higher in groups B and C and remained higher at 6 months and at one year.

As it can be seen from tables 16 and 17 % B.W.L. is related to the size of obesity (B.M.I.) in both 6 month follow-up periods. At 6 - 12 months (table 17) the percentage of sudjects with % B.W.L. was 40.9% and 50.9% in the groups with a B.M.I. of 2 and 3 as compared with 26.1% and 29.5% of individuals with a B.M.I. of 0 and 1. In 28 subjects there was a considerable regaining of weight within the year.

Discussion

Many approaches to weight loss have been tried in obese people with limited succes. Diet pills, comlex diets, liquid protein diets, surgical prosedure (intestinal bypass and gastric bypass), behaviour modification treatments used to aid weight loss without significant results and some of them produces severe side effects. Because the medical and social promblem of obesity still remains waiting a solution, we used auriculo-puncture to support (physically and/or psychologically) our patiens to follow a diet program knowing that not side effects are discribed in bibliography.

The possible mechanism of action of auricular "stomach" point or area (according to Nogier) may be analysed by means of the neuronal theory of action of acupuncture. According to Nogier, the stomach projects to the region adjoining the oesophagus behind the origin of the root of the helix around which it winds. It covers most of the dorsal part of the superior hemiconcha. According to Bossy, the projection of the viscera was found to be within the vagal zone (parasympathetic innervation). The regional action of this point is related to the vagal nerve and concerns on one hand the reduction of the motility of the stomach (in particular) and of the digestive tract (in general) and on the other hand, the reduction of the secretion of gastric acid (sympathomimetic action). The clinical effect of this action is the reduced sense of hunger. It can be considered that the central action of this point is related to the presence of appetite reducing peptides (saturation peptides) from C.N.S. nuclei. It is well known that the dietary behaviour of a person is determined, 1) apart from genetic factors, by information received by the central nervous system and in particular the hypothalamus, 2) from sensory organs and 3) from the function of the gastrointestinal tract.

The discovery in the hypothalamic nuclei of the brain of a large number of peptides regulating the dietary behaviour, may be the explanation of the action of acupuncture. Over 60 peptides are involved and they regulate the synaptic transmission of large neuronal hypothalamic circuits. Cholecystokine and neuropeptide Y have been detected in the gastrointestinal tract. Amino-acids (GABA, glutaminic, aspartic acid), amines (noradrenalin, serotonin, dopamine etc.) and hormone inhibitors are located in special areas of the C.N.S. From these substances noradrenaline and opioid peptides controls the "hunger" sensation and adrenaline, dopamine and serotonine controls the "saturation" feeling.

We believe that our clinical results justify a further study and investigation of the levels of these substances in the blood and the cerebrospinal fluid before and after auricular acupuncture.

This paper may be considered to indicative of the positive clinical effects of auricular acupuncture when applied at a private acupuncture centre, on "true" cases. Our task was to obtain the maximum possible effect with the maximum support to the patients.

As the correlation between obesity and disease has been documented, many physicians treat it as a separate entity. The inhibition of appetite and the anti-anxiety action of acupuncture, combined with the appropriate dietary treatment, may offer much in the treatment of any form of obesity.

Conclusions

The therapeutic help to the control of bulimia and anxiety by auricular acupuncture on the stomach and sedation point (or area) is valuable. About 2/3 of the subjects who participated in at least one session have an initial % B.W.L. (64.8%) and over 1/3 (35.5%) maintain or continue % B.W.L. after the 6 and 12 months period.

The percentage of recognition of therapeutic assistance to the control of bulimia (81.1%) and the associated anxiety (46.7%) during communication after the first 20 days is high. A considerably lower percentage (40.4%) follows repetition of the sessions every 20 days. Part of the subjects (35.6%) recognise no therapeutic effect after the first session. The remaining subjects are either content with the initial result or soon discontinue the effort to control their weight due to the nature of the problem.

Auricular acupuncture of the stomach and Shenmen point in repeated sessions every 15 - 20 days offers a therapeutic assistance to a considerable percentage of persons and to a satisfactory degree. Its appropriate use in an "integrated" obesity control programme may help considerably and in the long term, probably more than other medical programmes (e.g. drugs, diets, psychological support etc.).

REFERENCES

  • 1. Kropej, H., The Fundamentals of ear Acupuncture, Karl. F. Hang Publishers, Heidelberg, 1987, pp. 70-80
  • 2. Nogier, P.M.F., Handbook to Auriculotherapy, Maisonneuve, France, 1981, pp. 55
  • 3. Bourdiol, J.R., Elements of Auriculotherapy, Maisonneuve, France, pp. 150-156
  • 4. Nogier, F.M., Petitjean, F., Mallard, A., Complements des points reflexes Auriculaires, Maisonneuve, Paris, 1989.
  • 5. Sponzilli, O., Reflessologia Auricolare e Cranica, Ed. Marrapese, Roma, 1996, pp. 104-117.
  • 6. Karavis, M., A synopsis of Neural Theories touching the action of Acupuncture proc.
  • 7. Karavis, M., Neuroscience, neurophysiology and acupuncture, proc. VII world Congress of Acupuncture, Copenhagen, 1996.
  • 8. Karavis, Y., Karavis, M., Obesity, 2nd Ed., Athens, 1995, pp. 24-30


    Announced at ICMART '96, VII 's World Congress. Copenhagen, 9 - 12 . 5 . 1996. Abstract's, page 49.
    Correspondence to : Apostolopoulos Apostolos , 7 Halkidos str. , Anthoupolis , Patra , Greece Tel: +30-61-427379 Fax: +30-61-432309