Do Alternative Slimming Therapies Work?
Everyday we hear about a new slimming therapy. We are bombarded with countless slimming aids and quick fixes, from slimming pills to slimming belts and even weight loss slippers. Do they work? If they did, would there be a need for so many alternatives?
Creative marketing and imaginative reasoning make it difficult for one to judge if the remedies are genuine. The best way to answer the question is to ask a very basic question:
Does the therapy or slimming tablets create an energy deficit? Apart from physically removing the fat, as in liposuction or through surgical means, the only way to lose fat is by creating an energy deficit, where the individual’s energy expenditure exceeds the intake. To make up for the deficit, the body burns the stored fat.
Let’s look at some of the more popular quick-fix offerings and quickly determine if they are responsible slimming tips:.
Are Creams and Belts Effective Slimming Aids?
Manufacturers have made various claims regarding the mechanism of action for slimming creams, from dissolving fat to burning excess fat to reducing food intake. Even if these claims were true, remember that it is infra-abdominal fat (the fat surrounding your organs) that is strongly linked to health risks, and the creams are unable to penetrate that far.
If you were to apply a tight bandage around a part of your body and later remove it, you would notice that the area that had been bandaged is “indented”. This is because prolonged compression squeezes interstitial fluid (the fluid surrounding our cells) away from the area. With a slimming belt or wraps, the whole body is “bandaged” with cellophane. But if the whole body is bandaged, where is the interstitial fluid going to be squeezed to? The fluid is removed by the kidneys and ends up in the urine. Hence, you end up lighter, except that you have lost water rather than fat, and when you take your next drink, your weight goes back to where it started. Slimming wraps do not create an energy deficit, so fat is not removed from the body.
Ultrasound Treatments
These claim to work by breaking down fat cells, thereby releasing the fat into the bloodstream. If the machines were capable of breaking down fat cells, wouldn’t they do the same to skin cells, since the ultrasound waves have to travel through the skin before reaching the fat layer? Why is it that the skin and other tissues beyond the layer of fat cells remain intact while the fat cells conveniently disintegrate?
If the machine were capable of breaking down fat cells, wouldn’t its use be licensed to qualified medical practitioners only? The ultrasound machines used by and licensed to physiotherapists for treatment have higher energy levels, but nobody claims that they damage cells or that they are effective for weight loss. And even if we assume that the ultrasound treatments do break down fat cells, is it fair to assume that the body would then “excrete” the released fat rather than store it somewhere else in the body, especially if there is no energy deficit?
Acupuncture
Acupuncture points for weight loss vary, the ear being the most commonly used site. It may work by suppressing appetite and improving mood, thereby reducing caloric intake, but high-quality, controlled trials on the efficacy of acupuncture on weight loss are limited.
There is a well-known “fat camp” in China that uses acupuncture, a slimming diet aimed at creating dietary restriction, and exercise to lose weight. Some participants have cut short their stay because they could not tolerate the rigorous diet and exercise regimen. If participants undergoing the acupuncture-diet-exercise regimen lose weight, is it because of the acupuncture or the diet and exercise? We know that diet and exercise create an energy deficit and are thus a proven weight-loss strategy. Acupuncture may be useful as an adjunct, whether due to a real effect on suppressing the appetite or due to a placebo effect. Many will say that the placebo effect is still an effect and that its use should not be totally ignored.
Slimming Slippers/Shoes
One of the purported mechanisms of weight loss is based on foot reflexology, where various organs and other parts of the body are represented as points and areas on the feet.
Would pressure on a certain point on the feet create an energy deficit?
There is a certain shoe that claims to be effective for weight loss and, interestingly, a study that measured a person’s energy expenditure when wearing the shoe did show an increase in energy expenditure. How? All because the shoe was really heavy!
Mesotherapy
Mesotherapy is performed by doctors and has its origins in France. A cocktail of drugs is injected into the subcutaneous tissue of the targeted area, be it the face, abdomen or hips. The cocktails used are proprietary and users are not keen to share their formulations. Hence, there is little published research and little convincing proof that it works.
The concoctions usually contain theophylline, an anti-asthma drug known to cause weight loss. Although it has a weight-loss effect, there is a reason why theophylline is not used for weight loss – it has substantial side effects, such as palpitations, agitation, tremors, vomiting and even respiratory arrest and seizures. Phosphatidylcholine is another possible active ingredient. Hence, efficacy aside, the safety profile of mesotherapy has also not been ascertained and this is especially difficult to do when doctors have their own formulations.
Over-the-Counter Slimming Pills
This comprises a big category of “supplements”. Over-the-counter (OTC) slimming pills are not the same as prescription weight-loss drugs. Prescription drugs are approved for use (e.g. by the U.S. Food and Drug Administration and other national authorities) only after a stringent approval process that includes pre-clinical trials (experiments on animals), phase-one trials (small-scale human trials), phase-two trials (medium-scale human trials), and phase-three trials (human trials usually involving hundreds or thousands of subjects).
Only after that is the drug released to the public. This is a costly process and the average R&D expenditure for each drug that survives the process and reaches the market is EUR 550 million. Only 1 in 5,000 new substances end up in the market and a period of 12 to 16 years of R&D is needed before the health authorities approve a medicine. This tedious process is designed to ensure public safety, and the measures do not end there – the safety of the drug is monitored even after its launch (post-marketing surveillance) and it may be withdrawn from the market at this stage if the adverse effects are deemed unacceptable.
Why are OTC slimming pills not subjected to the same rigors? It is impossible to police all consumables to such an extent, so for practical reasons, a separate category – food and supplements – has been created, where the controls are much less stringent. These non-prescription medications are not FDA-approved and are not always free of adverse effects, so it is a case of “buyers beware”.
There are a myriad of non-prescription slimming pills, from chitosan to HMB, chromium picolinate, garcinia cambogia, green tea catechins, starch blockers, caffeine and ephedrine. Each purports a different, often novel, mechanism of action. Their advantage is that no doctor’s supervision is required.
Ever wondered why this is? Logically, any drug with a proven harmful side effect requires a doctor’s supervision so that its benefits can be weighed against its risks and the dosage titrated to achieve the optimal risk-benefit ratio. For example, a highly effective antihypertensive would not be made available to the public as a non-prescription drug because the lowering of one’s blood pressure is potentially dangerous.
Imagine a person who, not knowing how to interpret blood-pressure readings, mistakenly thinks he has high blood pressure and gets a sample of this antihypertensive – his blood pressure would drop below normal, causing fainting spells which may lead to accidents.
Now, back to slimming pills. If a slimming pill were highly effective in eliciting weight loss, would it be made available as a non-prescription drug? What if someone with anorexia nervosa (a condition where a person thinks he or she is fat, when it is certainly not the case, and takes drastic measures to lose weight) buys this drug off the shelf? Hence, it is not surprising that OTC medications are not the highly effective ones, because, if they were, their use would need to be supervised by a doctor and they would hence be regulated as prescription drugs.