Stimulation of auricular
acupuncture points in weight loss
MBBS, MDMA is in private medical acupuncture
practice, South Australia.
John Marley MD, MBChB is Professor,
Department of General Practice, The University of
Adelaide, South Australia.
Many overweight people are aware that diets can
help with weight loss but have difficulty in
suppressing their appetite. Acupuncture
stimulates the auricular branch of the vagal
nerve and raises serotonin levels, both of which
have been shown to increase tone in the smooth
muscle of the stomach, thus suppressing appetite.
The aim of this
study was to determine the effectiveness of
transcutaneous electrical nerve stimulation of
specific auricular acupuncture points on appetite
Sixty overweight subjects, randomly divided into
an active and a control group, used the AcuSlim
device twice daily for four weeks. The active
group attached the AcuSlim to the acupuncture ear
points shenmen and stomach, whereas the control
group attached the device to their thumb where
there are no acupuncture points. The goal of a 2
kg weight loss was set and changes in appetite
and weight were reported after four weeks.
Of those who responded, 95% of the active group
noticed suppression of appetite, whereas none of
the control group noticed such a change. None of
the control group lost the required 2kg, with
only 4 subjects losing any weight at all. Both
the number of subjects who lost weight and the
mean weight loss were significantly higher in the
active group (p<0.05).
- Frequent stimulation of specific auricular
acupuncture points is an effective method of
appetite suppression which leads to weight loss.
Obesity is a
common condition, associated with many health
problems. Low joule diets may reduce weight but
adherence to such diets requires the ability to
sufficiently suppress the appetite.
suppress appetite by controlling stress and
depression via endorphin and dopamine production1-3, by stimulation of the
auricular branch of the vagal nerve and raising
serotonin levels2-4,11. Both vagal nerve
stimulation and serotonin have been shown to
increase tone in the smooth muscle of the gastric
The main auricular
acupuncture points thought to raise serotonin
levels, stimulate the vagus nerve and produce
endorphins and dopamine are shenmen, stomach and
lung (Figure 1).4
been described as effective for weight loss12-14 although constant
stimulation of acupuncture points seems to lose
effect, making frequent, intermittent stimulation
preferable.4 Acupuncture and
transcutaneous electrical nerve stimulation (TCNS)
have been shown to be equally effective but to
differ in their safety and complexity.15,16
randomised study utilised the AcuSlim, developed
by SHP International Pty Ltd, which delivers non-invasive
TCNS to auricular acupuncture points. The study
aimed to investigate the effect of stimulating
the auricular acupuncture points on appetite
suppression and subsequent weight loss.
|Figure 1. The
acupuncture points used by the treatment
group are illustrated in the book Simple
Health Maintenance. The points are no. 13
Shenmen and no. 20 Stomach.17
People having difficulty losing weight were
recruited for the trial using talkback radio and
press advertisements. Inclusion criteria were:
- being over
the age of 18 years;
- having a
reasonably stable body weight for at
least 3 months.
already participating in any other weight
taking hormone replacement therapy;
- body weight
- the presence
of a serious concomitant disease or
mental illness, such as depression;
- the presence
of an eating disorder, for example,
matching the necessary criteria agreed to
participate in the study.
The nature of the experiment was explained to
subjects and they were informed they could
withdraw from the trial at any time. Demographic
information, medical history and history of
previous attempts at weight loss were recorded.
Subjects were randomly allocated to either an
active or a control group. This was organised via
a system of numbered envelopes and numbered cards.
beginning from number one were given to each
subject as they presented.
The cards in the
envelopes contained the number of the device to
be given to each subject.
The cards were in
a randomised order.
The AcuSlim device,
consisting of a small battery operated power pack
with leads to two conductive electrodes, was used
to non-invasively stimulate acupuncture points (Figure
subjects used this acupuncture device for 15-20
minutes, twice daily. The control group attached
electrodes at either end of the skin crease on
the dorsal surface of the thumb where there are
no acupuncture points (Figure 3). In the active group, one
disposable electrode was attached to the
auricular acupuncture point stomach and the other
electrode, in the form of an ear clip, covered
the ear point shenmen. Subjects in each group
were given standard information about the AcuSlim
including instructions on electrode adhesion and
frequency and duration of stimulation. No
specific diet was given to either group, however,
all subjects received a copy of the 1,2,3,4,5
nutrition booklet, developed by the Anti
Cancer Foundation, but were advised not to follow
any specific weight reduction program, such as
Weight Watchers during the program.
The initial weight
of each individual was recorded before their
allocation to a group and subjects were weighed
again at 2 weeks and 4 weeks, with the final
weighing done by a secretary who had no knowledge
of the specific group involved. Patients were
requested to wear the same clothing at each
weighing session. Since the AcuSlim is designed
for use at home, subjects were not required to
report except to be weighed. At home, subjects
were requested to record their fasting, bare body
weight daily and to try weighing themselves at
the same time under the same conditions each day.
The subjects were blind to the group to which
they belonged. They were asked to note any
alteration in appetite during the trial.
2. The Acuslim device attached to the
3. The control group attached the
Acuslim to their thumb
All subjects were given the opportunity to
continue using the AcuSlim as described above and
report again at the end of 12 weeks.
Measured variables were calculated as mean values
▒ standard deviation (SD). Initial data were
analysed using the two sample t-test to ensure
that no difference existed in subject
characteristics between the active and control
groups. The standard x2 test for 2 x 2
table was conducted to ascertain that no gender
bias existed between the two study groups. This
test was also used to test for the presences of
an association between the use of AcuSlim and
appetite suppression and weight loss. The
significance level was set at 0.05.
trial, five subjects from each group withdrew and
were replaced when it was discovered that they
did not fit the selection criteria for reasons
such as pregnancy and busy lifestyle.
As determined by a x2 test, no
significant difference existed in gender balance
between the active and control groups (p>0.05),
although both groups contained more women than
men. T-tests revealed that there was no
difference between the active and control groups
in the number of diets that had previously been
attempted by subjects (p>0.05). No significant
difference in subjects' age, height, initial
weight or body mass index (BMI) existed between
the two groups (p>0.05). These characteristics
are displayed in Table 1.
Initial characteristics of subject in the
control and active groups. Values are
|Body mass index
Of the 32 subjects in the control group 28
subjects noted no change in appetite (Table
subjects (95%) in the active group commented on
their appetite, with 20 reporting a decrease in
appetite. So a significantly higher number of
subjects in the active group reported a decrease
in appetite (p<0.05). Four of the control
group and seven of the active group failed to
enter a comment as to alteration to appetite.
Number of subjects in the control and
active groups reporting changes in
Average weight loss for all subjects, including
increase for those in the control group who
gained weight was:
- total weight
lost 66 kg
- overall loss
= average per subject 1.1kg (Figure 4).
Weight loss was
significantly greater in the active group than
the control group (p<0.05). In the active
group, 93% of subjects lost weight during the
four week period, with 78.5% losing at least the
required 2kg (Table 3). Of subjects in the
control group 12.5% lost weight, but no subjects
in this group lost the required 2kg. For those
subjects that did lose weight, the mean values
were 0.63kg (SD 0.25kg) and 2.98kg (SD 1.35kg) in
the control and active groups, respectively.
Weight loss of subjects in the control
group compared to the active group
|Subjects who lost weight
|Subjects who achieved 2kg
Figure 4. This scatterplot
represents the weight change of control and
active groups after one month, and for those who
continued to report in the study at three months.
None of the control group wished to continue past
the one month.
No subjects from the control group agreed to
continue for longer than the four week trial. Ten
subjects from the active group participated in
the 12 week trial, but without a control group,
statistical analysis was limited. One subject in
the latter group developed an intercurrent
illness and discontinued. Two other subjects did
not lose or gain any more weight. The remaining
seven subjects continued to lose weight and their
weight loss at 12 weeks ranged from 6kg to 11kg.
Acupuncture has been used extensively in various
dysfunctional states and for pain management.
Problems include the aversion to needles, the
fear of infection by needles and the occasional
reported case of damage to vital organs by needle
penetration. Needling of ear acupuncture points
can become quite painful and may risk infection
of the auricular cartilage. Attendance for
conditions that require frequent treatment can
become costly and inconvenient. However, in the
case of weight control, or in the treatment of
addictions such as nicotine, frequent acupuncture
is essential for treatment to be effective.
Embedded needles run similar risks and have been
shown to lose effect over time.4
Therefore, a more
satisfactory means of treating auricular
acupuncture points with sufficient frequency to
produce an effect in weight loss is by way of non-invasive
treatment administered by the individual.
that many obese people have low serotonin levels,
and that serotonin stimulates the smooth muscle
in the wall of the stomach.6,7 Stomach wall tone is also
controlled by the vagus nerve, the auricular
branch of which is concentrated in the area of
the acupuncture point, ear stomach. It has also
been shown that acupuncture stimulation raises
levels of both serotonin and relaxing
neurotransmitter endorphins in the body.2
It has been
demonstrated that acupuncture exerts its effect
on pain by production of endorphins.
The fact that many
pain sufferers receive long term relief from pain
despite cessation of treatment, indicates that
acupuncture may produce a long term rise in
natural endorphin production by the body.
A similar parallel
would assume that acupuncture may well produce a
long term adjustment to normal production of
serotonin by the body, in those with obesity
associated with low serotonin levels. So it is
feasible to expect that frequent stimulation of
the auricular acupuncture points which bring
about these changes in body chemistry, would
assist in controlling excessive appetite in those
with an obesity problem.
associated medical problems have occupied an
increasingly prominent position in health costs.
The financial cost of the various diets provided
by the slimming industry is beyond many of those
requiring long term weight loss support. Even if
these diets prove to be successful, weight is
often regained when the program ceases. Subjects
in this trial who wished to lose weight commented
that they were aware of the foods they should be
eating but were unable to adhere to previous
dietary restrictions. For many overweight people,
the most difficult part of weight reduction is
the establishment of a satisfactory eating
pattern over the initial 4 week period. After
this time they can often see evidence of weight
reduction and this gives them confidence to
continue. Subjects in the control group
experienced significantly less appetite
suppression and weight loss than the active group.
This may help to explain why they did not
continue with the AcuSlim for longer than the
initial 4 week period.
indicate that regularly administered stimulation
of the two auricular acupuncture points commonly
used in weight control is effective in
suppressing appetite such that an eating pattern
is established in that initial 4 week period,
which leads to weight loss.
In the trial many
commented that once the AcuSlim induced a better
eating pattern they could continue this without
Others stated that,
if they showed signs of any increase in appetite
or weight they simply resumed treatment to
control this increase.
The follow up
results imply that the AcuSlim may be successful
in the maintenance of weight reduction. However,
the long term potential of this device to result
in permanent weight loss, remains to be evaluated.
However this study offers hope for people who
have been unsuccessful in other weight loss
programs because they have not been able to
control their appetite. Use of AcuSlim appears to
be a simple, cost-effective method for losing
weight and may be beneficial as an adjunct to any
other form of weight loss program.
wish to thank Kristyn Willson for her statistical
expertise, and Catherine Chittleborough for her
contribution in preparing this manuscript for
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