Integrated treatment of obesity and the role of Acupuncture Headset

Our study group has defined over time DIMANAT method, which involves the use of auricular stimulation in the integrated treatment of obesity; the first results were communicated as early as World Congress of Auriculotherapy of Lyon in 2000. (Bazzoni G, 2000). The operational guidelines of this method include that the Acupuncture Headset can become an integral part of an "eclectic or integrated model" applicable both in the initial phase of weight loss in the no less important to the maintenance of the lost weight. Despite their limitations of each schematisation this method may be presented using a few essential points, each of which will be discussed based on the data available in the literature, integrated with personal clinical experience and research.

The 1st Stimulation Headset (Headset Acupuncture - Auricular therapy) is able to facilitate, subject overweight and / or obese, weight loss is that the maintenance of achieved weight (efficacy trials). This is because it acts:

2nd - on eating behavior by improving the "compliance" to caloric restriction.

3rd - metabolism and energy consumption.

Despite their limitations of each schematisation this method may be presented using a few essential points, each of which will be discussed based on the data available in the literature, integrated with personal clinical experience and research.

PACING HEADSET AND EATING BEHAVIOUR

    Satiety
    Adipostato hypothalamic
    emotional hunger
    psychological effects of diet restriction
    (Anxiety, mood, irritability / aggression)
    Binge Eating and Craving
    Modulation of stress response

COMPLIANCE TO DIETARY RESTRICTIONS
Point 1st headset stimulation and obesity: evidence of effectiveness

Between the mid-seventies and early eighties they were published the first work on the applicability of Acupuncture Headset (Auriculotherapy) in the treatment of obesity. It was mostly of "uncontrolled studies", published in the Chinese language, which generally reported significantly positive results with regard to the weight loss. These studies, although burdened with different bias, have provided a useful starting point for further research. The numerous works that have followed over time until today, until the most recent and comprehensive systematic review and metanalitica published by Cho in 2009, seem to indicate good efficacy of therapy in aiding weight loss of obese subject. These authors also underlined the need to proceed with higher quality studies to better validate this particular application auricular acupuncture (SH Cho et al., 2009).
Point 2 Action on eating behavior: improves "compliance" to caloric restriction

a) Modulation of biological sensations of hunger and satiety

b) Speaking on Emotional Eating, of dysfunctional behaviors such as food cravings and binge eating, often present in obese patients. Acting on psychoemotive aspects that accompany the calorie restriction

A) Modulation of biological hunger and satiety signals. Hunger and satiety, real semaphores to food intake, are the result of a complex control system that continuously processes a significant amount of exogenous and endogenous signals, neural, metabolic and endocrine. (Rigamonti AE et al., 2006) The rule satiety the interval between one meal and another, and the frequency of the same. Clinical studies but also the same basic research on the animal, seem to indicate that auricular stimulation is capable of modulating the biological signal of satiety, thus promoting weight loss. This is in its clinical rationale in the fact that most of the obese individuals have a substantial difficulty in proving the feeling of satiety, leading to hyperphagia. The auricular acupuncture can then join in a therapeutic context slimming, aimed education of the patient, and the recognition and subsequent control of hunger and satiety sensations. The DIMANAT study group showed, in subjects undergoing therapy headset, a close correlation between weight loss and proven satiety sensation at different times of the day. (Loi V et al., 2009) The neurobiological mechanisms of hunger and satiety control due to the auricular stimulation have been investigated by several works that have allowed to distinguish two levels of control: central and peripheral.

- Stimulation headset and control "center" of the biological signals of hunger and satiety. In 1992 the Japanese neurophysiologist Asamoto has shown that the stimulation with needles of the valley regions of the rat was able to evoke the potential to level the ventromedial hypothalamus (VMN). At the same time the animal reduced food intake losing weight. This work has provided a first theoretical explanatory model applicability of auricular stimulation in obese patient. Asamoto S et al., 1992) The action of the hypothalamus neuromodulante auricular stimulation has been confirmed by other researchers (T Shiraishi T et al., 1995) (Zhao M et al., 2000). In 2001, the Korean Kim has shown that the stimulation with needles of the ear is capable of reducing the hypothalamic NPY expression in fasted rats, suggesting the existence of another neurobiological mechanism that stimulation headset may in turn modulate clinically hunger and satiety. . (Kim EH, 2001)

- Headset and control Stimulation "peripheral" biological signals of hunger and satiety The feeling of satiety receives a further control by metabolic signals, endocrine and nervous originated at peripheral level. It 'worth remembering that the innervation of the pavilion is basically under the control of the nerves Big headset (cervical plexus C2-C3), auricolo-Temporal (III Trigeminal branch) and Headset (N. Vago). (Rabishong P, 2010) It has been hypothesized that auricular therapy, stimulating just this vagal component (of the basin region), determines interference on peripheral signals from the gastrointestinal tract, leading to an increase in satiety and inhibition of hunger. (D Richards et al., 1998) The American Choy, subject to special clips ear sull'Hunger Point tragal, achieved a significant lengthening of the GPT (Gastric Peristalsis Time). It can be assumed that precisely this phenomenon is one of the mechanisms responsible for the more rapid onset and the maintenance in the time of the feeling of satiety, obtainable with auricular stimulation. (Choy DS et al. 1998) are based on this principle newer forms of self stimulation dell'Hunger point tragal practiced by an original magneto-pressure headset system. (Manca G, 2009)

B) The auricular stimulation acts positively on the mental and emotional aspects that accompany obesity or that arise when you are on a diet. And 'now unanimously it agreed that there is a very close relationship between eating habits, emotional states, stress and dietary restriction. The fundamental role that emotions have in determining and maintaining dysfunctional eating behaviors, led to the spread of a term such as "Emotional Eating" or "emotional hunger" indicating the use of food, not as a response to a biological stimulus, but in relation to emotional and interpersonal problems. (Geliebter A et al., 2003) The emotional hunger gives a special coloring to the eating behavior of obese patients, making it difficult to follow any dietary restrictions. It can take the form of "compulsive hunger" present in eating disorders (DCA): Anorexia and Bulimia), Binge Eating Disorders (BED), Night Eating Syndrome. recurrent episodes of compulsive overeating (binge eating), Craving for food (food craving), Grignottage (nibbling small amounts of food), despite the absence of real DCA, are present in obese subjects.

(E Mannucci et al., 2001)

Several papers have studied the close links between stress, obesity and dietary restriction. Obese people under stress tend to eat more than their habits, while the normal weight are usually the opposite. The follow a diet, especially if it is very restrictive, is interpreted by the body as a stressful situation, is a relevant factor in the genesis of abnormal eating behaviors, capable of determining a return to previous eating habits. (Rosen JC et al., 1993) The action of modulating the stimulation headset on emotional hunger and related dysfunctional behaviors (binge eating, Food Craving, Grignottage), details were psychoemotive that often accompany a diet, was confirmed, not only clinical experience of our study group, but also in the work of other researchers.

(Marucci S, 2009)

This particular application is its clinical rational actions: anti-anxiety, mood-control, optimization of the stress response, the control of the drives, therapeutic action on which there is now a large literature. The neurobiological basis of this therapeutic model are closely linked to the modulation carried on complex brain neurochemical systems of controlling emotions, motivation and gratification of stress mechanisms, acting on feeding behavior. (GABAergic, serotonergic, noradrenergic, dopaminergic, Endogenous Opioid, NPYergico, Neuroendocrine Stress). (Napadow V et al., 2006).
Action point 3 ° of metabolism and energy consumption.

Among other possible mechanisms, invoked to explain the action of the auricular stimulation in promoting weight loss, there are those on thermogenesis and metabolism. A key role is played by NPY. In addition to the action oressigena this neuro-peptide reduces reduces the metabolism and energy expenditure, with the mediation of the NPY receptor 1 (Billington CJ et al., 1991) It 'important to note that the NPY is released, not only in shortages food (not desired or suffered by the individual, as in the case of a famine, or in the case of autoprocurata and voluntary deficiency due to diet), but also in situations of stress. (Kuo LE et al., 2007) The Stimulation Headset has proven effective in reducing the hypothalamic expression of NPY. This mechanism may explain the activation of the energy expenditure and the adjustment to a level below the set point of the weight and energy. (Kim EH et al., 2001) Recently, Shen and colleagues hypothesized that the weight loss achieved on a group of patients using the headset stimulation can be attributed not only to a decrease in appetite, but also to a transient increase in metabolism baseline.

(EY Shen et al., 2009)