Intern. J.

Neuroscience, 116:165C175, 2006

Copyright 2006 Taylor !rancis ""C
I##N: 0020$7%5% & 15%'$52%5 online
()I: 10.10*0&00207%50500'%1522
THE TREATMENT OF OBESITY
BY ACUPUNCTURE
MEHMET TUGRUL CABYOGLU
NEYHAN ERGENE
(epart+ent o, -hysiology
#el.u/ 0ni1ersity !aculty
o, 2era+ 2e3ical 4onya,
Tur/ey
UNER TAN (epart+ent o,
-hysiology
Cu/uro1a 0ni1ersity
!aculty o, 2e3ical
53ana, Tur/ey
The present study is an investigation of the results of the studies on the effects of
acupuncture application therapy on obesity. It has been reported that acupuncture
application in obesity treatment is effective in procuring weight loss. It can affect
appetite, intestinal motility, and metabolism, as well as emotional factors such as stress.
Increases in neural activity in the ventromedial nuclei of the hypothalamus, in tone in the
smooth muscle of the stomach and in levels of enkephalin, beta endorphin, and serotonin
in plasma and brain tissue have also been observed with the application of acupuncture.
It has been observed that acupuncture application to obese people increases excitability
of the satiety center in the ventromedial nuclei of the hypothalamus. Acupuncture
stimulates the auricular branch of the vagal nerve and raises serotonin levels. Both of
these activities have been shown to increase tone in the smooth muscle of the stomach,
thus suppressing appetite. Among other things, serotonin enhances intestinal motility. It
also controls stress and depression via endorphin and
Received ! "anuary ##$. Address correspondence to %r. &ehmet Tugrul 'abyoglu (amidiye &ah., Ince
&inare )ok., *.
+i,am Apt., +o- ./*# )el0uklu 1#1#, 2onya, Turkey. 34mail- tugcab5yahoo.com
16
5
166 2. T. C567)8"0 9T 5".
dopamine production. In addition to these effects, it is thought that the increase in plasma levels of beta endorphin after
acupuncture application can contribute to the body weight loss in obese people by mobili,ing the body energy depots
through lipolithic effect.
Keywords acupuncture, appetite, beta endorphin, enkephalin, obesity, )erotonin
INTRODUCTION 6besity could well become the most common health problem of the *st
century 78alou et al., ###9. 6besity is a disease resulting from the over storage of fat in the body. It is a
problem concerning the balance of energy. An imbalance between energy input and energy consumption causes
an increase in the body fat rate 78alou et al., ###9. It is known that the prevalence of obesity in adults and
children has been increasing significantly around the world 7:einstock et al., *..!9. In this century, obesity has
been seen especially in industrial countries 7;eonhardt et al., *...9. The over4consumption of delicious, high4
calorie food and decrease in physical activity play ma<or roles in increasing the prevalence of obesity in
industrial countries 7'ampfield et al., *..=> (ill ? 8eters, *..!9. The cost of treatment of obesity and obesity4
related diseases is significant in general health expenditures in the @nited )tates 7Bray, *..!9.
The general principles of obesity treatment are to obtain weight loss, to maintain the reduced body weight
after this loss, and to control the risk factors of disease. At the onset of obesity treatment, a *#A body weight
reduction is targeted. After a one to two kg per week weight loss is observed over = months, new goals can be
determined 7;y,nicki et al., ##*9.
Treatments for obesity include- diet restriction, regulation of physical activity, behavior treatment,
pharmacotherapy, operation, or acupuncture application or the use of any of these methods in combination
7'abyoglu ? 3rgene, ##$> 3rnst, *..B> Richards ? &arley, *..!9.
'omplementary medicine is more popular than ever before. About one third to one half of the general
population uses some type of complementary treatment. Acupuncture is among the most popular
complementary treatments.
TREATMENT OF OBESITY BY ACUPUNCTURE APPLICATIONS 'abyoglu and 3rgene 7##$9
applied body and ear acupuncture for # days
to women who had a body mass index 7B&I9 between C# and 1# while
a
T:95T29NT )! )69#IT7 67 5C0-0NCT0:9 167
*1$ 2cal diet program was prepared for * women under the same circumstances. Besides, there was a
control group including * women. In this study, associated with body weight, levels of the serum total
cholesterol, triglyceride, (%; cholesterol and ;%; cholesterol in obese women were examined. In acupuncture
treatment, the (ungry and )hen &en ear points, and the (egu 7;I 19, Duchi 7;I **9, Tianshu 7)t $9, Eusanli
7)t C=9, +eiting 7)t 119 and Taichong 7;iv C9 body points were used. There was a 1.!A weight reduction in
obese women with electroacupuncture application, whereas obese women in diet restriction had a .$A weight
reduction. There were significant decreases in total cholesterol and triglycerides levels in 3A and diet groups
compared with the control group. Furthermore, there was a decrease in ;%; levels in the 3A group compared
with those in the control group.
(uang et al. 7*..=9 applied auricular acupuncture and diet and aerobics exercise programs for ! weeks to !
men who had a body mass index 7B&I9 over C# and body fat rate over $A and to CB women who had a B&I
over C# and body fat rate over C#A. In the auricular acupuncture application, the points )hen &en, )tomach,
)an<iao, and (ungry were chosen. :eekly application was made to a single ear each session, using one ear in
one session and the other ear in the next session. The diet program was prepared by a dietician to meet the daily
needs of the people participating in the study by calculating their anticipated daily activities, as well as other
factors. The exercise program was arranged to be C to $ times per week and to burn C## to $## kcal of energy
in each session. As a result of this triple application, an average 1.1 kg body weight loss and a $.=A reduction
in body fat rate were observed.
)un and Gu 7*..C9 applied auricular and body acupuncture therapy to **# obese patients. In this study, a
small, spherical seed, a method employed in traditional 'hinese acupuncture, was applied to the auricular
acupuncture points, &outh, 3sophagus )tomach, )hen &en, ;ung, and 3ndocrine in sessions three to five days
apart. This application was made first on one ear and then on the other ear in the following session. Additional
application was made to the body acupuncture points Tianshu 7)t $9, Eusanli 7)t C=9, )anyin<iao 7)p =9,
+eiguan 78 =9, and Fenglong 7)t 1#9. This application was performed once every C to $ days, in *$ min sessions
over C months. As a result of these applications, a $.# kg loss in body weight was observed.
)hafshak 7*..$9 performed a study with C# obese females, dividing them into three groups each including
*# females. (e applied electroacupuncture to the )tomach points on both ears of the sub<ects in the first
group, to th
e
16* 2. T. C567)8"0 9T 5".
(ungry points on both ears of the sub<ects in the second group, and to placebo points on both ears of the
sub<ects in the third group. These applications continued once a day, five days a week, for three weeks. Also a
diet of *### kcal/day was advised to patients. In the first group, !#A of the patients managed to apply the diet.
The rate of diet application for the second group was B#A, whereas that of the third group was #A. In all
patients applying the diet, the observed body weight loss was * to 1 kg in the first group, *.$ to C.$ kg in the
second group and * to C kg in the third group. According to the results of this study, it was observed that the
auricular acupuncture points )tomach and (ungry were effective in weight loss when compared with placebo
points.
Through electroacupuncture to obese people, increases in the serum triglyceride and ;%; cholesterol
levels and a decrease in the serum (%; cholesterol levels were reported by ;y,nicki and his colleagues 7##*9.
These two levels are thought to have particular ties to cardiovascular disease. ;iu et al. 7*..9, using the ear
and body acupuncture points of traditional 'hinese acupuncture, applied acupuncture to *# obese people and
studied the changes in body weight and plasma levels of total cholesterol, triglycerides, (%; cholesterol, and
;%; cholesterol. 3ar acupuncture was applied once every $ days and body acupuncture was performed once
every C days in #4min sessions over a * month period. In ;iuHIs study, a weight loss with a mean value of C.C
kg was noted. Also, decreases in plasma levels of total cholesterol, triglyceride, and ;%; cholesterol levels and
an increase in the (%; cholesterol level were observed. )un and Gu 7*..C9 performed ear and body
acupuncture to obese people and analy,ed the changes in body weight and levels of total cholesterol,
triglyceride, and (%; cholesterol. They applied acupuncture to the &outh, 3sophagus, )tomach, )hen &en,
3ndocrine, and ;ung acupuncture points on one ear once every three or five days, and on the other ear in the
next session by using small seeds that are used in some traditional 'hinese acupuncture methods. They also
applied acupuncture to the )t $, )t C=, )p =, 8 =, and )t 1# body points once every three or five days using
acupuncture needles. In their study, it was observed that decreases in plasma levels of total cholesterol and
triglyceride corresponded with weight loss. Therefore, they concluded that 3A therapy may be a useful
approach to treatment of obesity and potentially decrease the risk factors associated with obesity.
)timulation of the (ungry point creates an increase of the fullness feeling and a repression of the hunger
feeling 7Asomoto ? Takeshige, *..9. )timulation of the )hen &en point regulates cerebral cortex function
and ha
s
T:95T29NT )! )69#IT7 67 5C0-0NCT0:9 16;
a sedative effect 7:ang ? 2ain, ##*9. )timulation of the )tomach point stimulates the auricular branch of the
vagal nerve, which has been shown to increase tone in the smooth muscle of the stomach, thus suppressing
appetite 7Richards ? &arley, *..!9. )timulation of the ;I 1, ;I **, and )t $ body acupuncture points has a
regulatory effect on intestinal motility 7&aciocia, *.!.9, whereas stimulation of )t C= and )t 11 increases
excitability of the satiety center in the ventral medial nucleus of the hypothalamus 7Ehao et al., ###9. In
traditional 'hinese medicine, the )t C= body acupuncture point has been used for the treatment of both diarrhea
and constipation. This point has been reported to regulate gastrointestinal motility by increasing motility in
people with hypoactive intestinal motility and conversely by decreasing motility in people with hyperactive
intestinal motility 7;i et al., *..9. )timulation of this point also increases the amplitude and freJuency of
gastric peristalsis that shortens gastric emptying time and delays the contraction time in regular people 7;i et
al., *..9.
ACUPUNCTURE APPLICATION AND SUPPRESSING APPETITE In the treatment of obesity,
acupuncture applications, especially auricular
acupuncture, are very effective for losing weight in obese people 7)un ? Gu, *..C> ;ei, *.!!> &ulhisen ?
Rogers, *...9. Although diet application causes weight loss in obesity treatment, it has no effect on
suppression of appetite 7Richards ? &arley, *..!9. &any overweight people are aware that diets can help with
weight loss but have difficulty in suppressing their appetite. (owever, it has been determined that acupuncture
application is effective both in weight loss 7Ehan, *..C> )un ? Gu, *..C9 and in suppression of appetite
7)hiraishi et al., *..$> Ehao et al., ###9.
)hiraishi et al. 7*..$9 reported the changes in neural activity of the ventromedial 7K&(9 and lateral
hypothalamus 7;(9 through auricular acupuncture application on normal and experimentally obese rats. 6ne
experimental group of obese rats was obtained by destroying the ventromedial hypothalamus and another
through a high4calorie diet. Auricular acupuncture application was performed to the region that was innerved
by the nervous vagus on a single ear. This region is called the cavum conchae on human beings. Although
the neural activity of the ;( is diminished in normal rats by auricular acupuncture application, the neural
activity of the K&( is increased. ;ikewise, neural activity of the ;( was reduced in both of the two
experimental groups of obese rats, and neural activity of the K&( was increased in the group of high4calorie
diet, obese rats. As a result, it wa
s
170 2. T. C567)8"0 9T 5".
determined that auricular acupuncture application is effective in the formation and protection of the satiety
sense in both normal and obese rats.
Ehao et al. 7###9 in their study on rats, applied electroacupuncture on one side of the body on * day and
on the other side the following day, for * days in $4min daily sessions. For this test, they chose the Eusanli 7)t
C=9 and +eiting 7)t 119 points. It was observed that electroacupuncture application on rats increased
excitability of the satiety center in the ventromedial nucleus of the hypothalamus.
:enhe and Lucan 7*.!*9 observed that the level of serotonin 7$4(T9 in the central nervous system
increased with acupuncture application 7Figure *9. )erotonin has been implicated in the control of eating
behavior and body weight. )timulants of this monoamine reduce food intake and body weight, increase energy
expenditure 7'ur,on, *..#> )imansky, *..=9, and enhance intestinal motility 7Muyton ? (all, ##*9. This
effect of $4(T that reduces food intake can be observed on $4(T receptors of the satiety center in the
ventromedial nuclei of the hypothalamus 7)arah et al., *..!9. Besides that, it was noted that serotonin gave
happiness, helped a person to feel good, controlled the sexual motivation, and had a role in obtaining the
psychomotor balance 7Muyton ? (all, ##*9. Acupuncture stimulates the auricular branch of the vagal nerve
and raises serotonin levels. Both of these activities have been shown to increase tone in the smooth muscle of
the stomach, thus suppressing appetite 7Richards ? &arley, *..!9. It is thought that an increase in the level of
serotonin in the central nervous system with acupuncture application can provide weight loss, as it has a role in
both reducing food intake and arranging the psychomotor balance 7Figure 9.


Acupuncture Stimulation
Serotonin level (Central Nervous
System and Plasma)
Beta Endorphin level (Central
Nervous
System and Plasma)
Enkephalin level (Central
Nervous
System and Plasma)
Figure 1. 3ffects of acupuncture stimulation on the levels of neurotransmitter levels in the central nervous system and
plasma.
T:95T29NT )! )69#IT7 67 5C0-0NCT0:9 171




Acupuncture

Serotonin (Central Nervous System and Plasma)
Effect of 5-! receptors of the satiety center in the ventromedial nuclei of the

Enhances intestinal motility "ncrease tone in the smooth
muscle of the stomach

Suppressin# appetite

$ei#ht loss
Figure 2. Acupuncture application and suppressing of appetite.
ACUPUNCTURE, BETA ENDORPHIN, AND LIPOLITIC
ACTIVITY
In many studies it has been observed that electroacupuncture application caused an increase in the levels of
beta endorphin both in serum and in the central nervous system 7"in et al., *..=> Takeshige et al., *.., *..C>
Fu, ###> 8etti et al., *..!9 7Figure *9. It has been determined that electroacupuncture application with
different current freJuencies causes the secretion of different endo<en opioids. It also has been observed that
low current freJuency 7 (,9 electroacupuncture application increases the concentration of endomorphins,
enkephalins, and beta endorphin but high current freJuency 7*## (,9 electroacupuncture application increased
the concentration of dynorphin in the central nervous system 7(an et al., *...9 7Figure *9.
The studies that showed the lipolitic activity of pro4opiomelanocortin products were performed as in vivo and
in vitro studies on animals 7)chwandt, *.!$> Richter et al., *.!C> Richter ? )chwandt, *.!$9. Richter et al.
7*.!C9 investigated the lipolitic activity of beta endorphin in the isolated fat cells of rabbits in vivo. It was
determined that as a result of the effect of beta endorphi
n
172 2. T. C567)8"0 9T 5".
Acupuncture
Stimulation
eta
Endo
rphin
level
(Cent
ral Nervous System and Plasma)

%ipolitic activity
$ei#ht loss
Figure 3. Acupuncture application and lipolitic activity
.on fat cells, the levels of free fatty acid and glycerol increased in the rabbit plasma. This effect was blocked by
naloxone. Kettor et al. 7*..C9 studied the lipolitic activity of beta endorphin in isolated human fat tissue. In
their study, it was observed that whereas B3 application caused the increase of glycerol secretion from isolated
fat cells, naloxone inhibited this effect.
According to the results obtained from these studies, it is thought that electroacupuncture, which increases
the plasma beta endorphin levels, can contribute to the weight loss by increasing the lipolithic activity 7Figure
C9.
CONCLUSION It has been observed that acupuncture application depresses the appetite by
activating the satiety center in the hypothalamus and increasing sympathetic activity through an increase in
the concentration of serotonin in the central nervous system of obese people. Acupuncture stimulates the
auricular branch of the vagal nerve, which has been shown to increase tone in the smooth muscle of the
stomach, thus suppressing appetite. It also controls stress and depression via endorphin and dopamine
production. In addition to these effects it is thought that the increases of plasma levels of beta endorphin
naturally occurring after acupuncture application can contribute to body weigh
t
T:95T29NT )! )69#IT7 67 5C0-0NCT0:9 17'
loss in obese people. This is accomplished by mobili,ing the body energy depots by lipolithic effect. Through
these mechanisms, acupuncture application can be seen as an effective therapy in the treatment of obesity.
REFERENCES
Asomoto, )., ? Takeshige, '. 7*..9. Activation of the satiety center by auricular acupuncture point stimulation. Brain
Research Bulletin, 2979, *$BN'*=1.
Bray, M. A. 7*..!9. 6besity- A time bomb to be defused. Lancet, 3527.*C9, *=#N'*=*. 'abyoglu, &. T., ? 3rgene, +.
7##$9. 3lectroacupuncture therapy for weight loss
reduces serum total cholesterol, triglycerides, and ;%; cholesterol levels in obese women. The American Journal of
Chinese Medicine, 33719, $$N'$CC.
'ampfield, ;. A., )mith, F. "., ? Burn, 8. 7*..=9. The 6B protein 7;eptin9 8athwaya link between adipose tissue mass and
central neural networks. Hormone and Metabolic Research, 27*9, =*.N'=C.
'ur,on, M. 7*..#9. )erotonin and appetite. Annals of the !e" #or$ Academ% of &ciences, '((, $*N'$C#.
3rnst, 3. 7*..B9. Acupuncture/acupressure for weight reductionO A systematic review. )iener *linische )ochenschrift,
+(979, =#N'=.
Fu, (. 7###9. :hat is the material base of acupunctureO The nervesP Medical H%,otheses, 5-7C9, C$!N'C$..
Muyton, A. '., ? (all, ". 3. 7##*9. Te.tboo$ of Medical /h%siolo0%. 8hiladelphia- :B )aunders.
(an, E., "iang, L. (., :an, L., :ang, L., 'hang, ". 2., ? (an, ". ). 7*...9. 3ndomorphin* mediates (, but not *## (,
electroacupuncture analgesia in the rat1 !euroscience Letters, 22-79, B$N'B!.
(ill, ". D., ? 8eters, ". '. 7*..!9. 3nvironmental contribution to the obesity epidemic. &cience, 2(7$C=!9, *CB*N'*CB1.
(uang, &. (., Lang, R. '., ? (u, ). (. 7*..=9. 8reliminary results of triple therapy for obesity. 3nternational Journal of
4besit% and Related Metabolic 5isorders, 2(7.9, !C#N'!C=.
"in, (. 6., Ehou, ;., ;ee, 2. L., 'hang, T. &., ? 'hey, :. L. 7*..=9. Inhibition of acid secretion by electrical acupuncture is
mediated via beta4endorphin and somatostatin. American Journal of /h%siolo0%, 22+, $1N'$C#.
;ei, E. 8. 7*.!!9. Treatment of 1 cases of obesity with acupuncture. Journal of Traditional Chinese Medicine, 79,
*$N'*=.
;eonhardt, &., (rupka, B., ? ;anghans, :. 7*...9. +ew approaches in the pharmacological treatment of obesity.
6uro,ean Journal of !utrition, 37*9, *N'*C.
;i, L., Tougas, M., 'hiverton, ). M., ? (unt, R. (. 7*..9. The effect of acupuncture on gastrointestinal function and
disorder. American Journal of 7astroenterolo0%, 27*#9, *CBN'*C!*
.
17% 2. T. C567)8"0 9T 5".
;iu, E., )un, F., ;i, "., )hi, G., (u, ;., :ang, L., ? Dian, E. 7*..9. 8rophylactic and therapeutic effects of acupuncture on
simple obesity complicated by cardiovascular diseases. Journal of Traditional Chinese Medicine, +27*9, *N'..
;y,nicki, ". &., Loung, %. '., Riggs, ". A., ? %avis, R. &. 7##*9. 6besity- Assessment and management in primary care.
American 8amil% /h%sician, '37**9, *C.N' *1$.
&aciocia, M. 7*.!.9. The 8oundations of Chinese Medicine. +ew Lork- 'hurchill ;ivingstone.
&ulhisen, 2., ? Rogers, ". E. 7*...9. 'omplementary and alternative modes of therapy for the treatment of the obese
patient. Journal of the American 4steo,athic Association, 99, !N'*.
8alou, A., )erra, F., Bonet, &. ;., ? 8ico, '. 7###9. 6besity- molecular bases of a multifactorial problem. 6uro,ean
Journal of !utrition, 39719, *BN'*11.
8etti, F., Bangra,i, A., ;iguori, A., Reale, M., ? Ippoliti, F. 7*..!9. 3ffects of acupuncture on immune response related to
opioid4like peptides. Journal of Traditional Chinese Medicine, +7*9, $$N'=C.
Richards, %., ? &arley, ". 7*..!9. )timulation of auricular acupuncture points in weight loss. Australian 8amil% /h%sician,
2279, BCN'BB.
Richter, :. 6., 2erscher, 8., ? )chwandt, 8. 7*.!C9. Beta4endorphin stimulates in vivo lipolysis in the rabbit. Life &ciences,
337*9, B1CN'B1=.
Richter, :. 6., ? )chwandt, 8. 7*.!$9. 8eptide hormones and lipolysis in rabbits adipocytes. Hormone and Metabolic
Research, +27C9, *B.
)chwandt, 8. 7*.!$9. (ypothalamic control of lipid metabolism1 Acta !eurochirur0ica, 257*N'19, *N'*1.
)hafshak, T. ). 7*..$9. 3lectro4acupuncture and exercise in body weight reduction and their application in rehabilitating
patients with knee osteoarthritis. American Journal of Chinese Medicine, 237*9, *$N'$.
)hiraishi, T., 6noe, &., 2o<ima, T., )ameshima L., ? 2ageyama, T. 7*..$9. 3ffects of auricular stimulation on feeding4
related hypothalamic neuronal activity in normal and obese rats. Brain Research Bulletin, 3'79, *1*N'*1!.
)imansky, 2. ". 7*..=9. )erotonergic control of the organi,ation of feeding and satiety. Beha9ioural Brain Research,
237*N'9, CBN'1.
)un, D., ? Gu, L. 7*..C9. )imple obesity and obesity hyperlipemia treated with otoacupoint pellet pressure and body
acupuncture. Journal of Traditional Chinese Medicine, +37*9, N'=.
Takeshige, '., +akamura, A., Asamoto, )., ? Arai, T. 7*..9. 8ositive feed4back action of pituitary beta endorphin on
acupuncture analgesia afferent pathway. Brain Research Bulletin, 227*9, CBN'11.
Takeshige, '., 6ka, 2., &i,uno, T., (isamitsu, T., ;uo, '. 8., 2obori, &., et al. 7*..C9. The acupuncture point and its
connecting central pathway for producing acupuncture analgesia. Brain Research Bulletin, 3(7*N'9, $CN'=B
.
T:95T29NT )! )69#IT7 67 5C0-0NCT0:9 175
Kettor, R., 8agano, '., Fabris, R., ;ombardi, A. &., &acor, '., ? Federspil, M. 7*..C9. ;ipolytic effect of beta4endorphin in
human fat cells. Life &ciences, 527B9, =$BN'==*.
:ang, ). &., ? 2ain, E. +. 7##*9. Auricular acupuncture- A potential treatment for anxiety. Anesthesia and Anal0esia,
9279, $1!N'$$C.
:einstock, R. )., %ai, (., ? :adden, T. A. 7*..!9. %iet and exercise in the treatment of obesity. Archi9es of 3nternal
Medicine, +579, 1BBN'1!C.
:enhe, E., ? Lucun, ). 7*.!*9. 'hange in levels of monoamine neurotransmitters and their main metabolites of rat brain
after electric acupuncture treatment. 3nternational Journal of !euroscience, +57C9, *1BN'*1..
Ehan, ". 7*..C9. 6bservations on the treatment of C.C cases of obesity by semen pressure on auricular points. Journal of
Traditional Chinese Medicine, +37*9, BN'C#.
Ehao, &., ;iu, E., ? )u, ". 7###9. The time4effect relationship of central action in acupuncture treatment for weight
reduction. Journal of Traditional Chinese Medicine, 2(7*9, =N'..