IâM lying on a bed in a cosy room. Soothing music plays in the background. Four palm-sized paddles rest silent and cool across my midriff. In the time it takes to do a typical gym workout, I could be up to 7 inches thinner than I was before I lay down. No, Iâm not in the middle of a daydream, Iâm in a private clinic in London, and Iâm about to have my fat zapped.
Half an hour ago, I walked into a plush reception lobby on Harley Street â a thoroughfare famed for its exclusive private medical practices. Business is good. Two beauty therapists sit in the reception area chatting to a customer. âYou lost just 3 inches this time? Never mind, weâll see if we can get a few more next week. How does Tuesday suit?â
I am visiting , one of a string of new companies that promise to transform your waistline in your lunch break. My visit is the culmination of a journey that began when a press release landed on my desk boasting a treatment that could make me â7 inches thinner in 20 minutesâ.
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It sounded too good to be true. Yet thousands of people have attended one of the hundreds of clinics around the world that offer the treatment, and scores of reviews in lifestyle magazines speak of results that are ânothing short of amazingâ. At around ÂŁ250 per treatment it doesnât come cheap, but with the diet industry estimated to turn over tens of billions of dollars every year in the US alone, the appetite for a quick fix is clearly there.
Praise from customers is one thing, but independent scientific evidence corroborating the claims is harder to find. So while the promise of being able to lose inches in minutes is undeniably amazing, does the technique really work, or are people parting with their cash for a snake-oil treatment? And more importantly, is it safe?
After months of research, which involved reading several studies of the technology and questioning experts in the field, I am satisfied that I am not putting my life at risk, so Iâve come to the clinic to try the procedure for myself. To be honest, now that Iâm here Iâm having second thoughts. To complement , the inch-loss treatment that Iâm receiving, Harley Fit also offers âWowSlimChocâ, a chocolate bar that promises to help you lose weight in one week, and the rather daunting âWowWillyâ, a âmedically proven permanent expansion deviceâ which promises: âonce stretched, is everlastingly expandedâ. It feels like Iâve walked into the real-world equivalent of a spam email.
Despite all this, curiosity has got the better of me. If nothing else, my research revealed that getting rid of fat by zapping it with lasers is based on a scientifically plausible idea. The treatment is a form of non-invasive, laser-assisted fat-removal, or lipolysis. In 2001 Rodrigo Neira, a plastic surgeon at Red Deer Regional Hospital in Alberta, Canada, shone a laser at cultured fat cells, and found that this emulsified the targeted tissue. He presented his results later that year at the second South American Congress on Plastic and Reconstructive Surgery in Lima, Peru.
âGetting rid of fat by zapping it with lasers is based on a scientifically plausible ideaâ
In later studies, he showed that shining a low-level laser for 6 minutes onto the outside of the body where liposuction was about to take place made it much (Aesthetic Surgery Journal, vol 22, p 451). The technique was approved by the US Food and Drug Administration in 2004.
Neira then suggested that it might be possible to dispense with the invasive, hazardous and costly surgical procedure and just use lasers on their own. He reasoned that the laser was damaging the fat cells, allowing their contents to move from inside to outside the cell. Could the body then dispose of the fat without the need for liposuction?
His idea was sound. Lasers have been used in medicine for decades, and depending on the wavelength, energy level and treatment time, can be used to cut, cauterise, destroy tissue and control pain by altering cellular function.
Using lasers to âzapâ fat, however, is a relatively new concept. Paddles containing a low-level, 635-nanometre laser are placed over regions of unwanted fat. While a small amount of the light is absorbed by the skin, the majority of the energy penetrates through to adipose tissue beneath. Here, bunches of grape-like fat cells attached to the skin absorb light energy from the laser, triggering a cascade of biochemical reactions that ends up with the cells rupturing.
According to Ryan Maloney, medical director at , one of the main distributors of this technology, the energy emitted by the lasers causes holes to form in the fat cell membranes, releasing the fat into spaces between the cells. The enzyme cytochrome c oxidase, present in the fat cell membrane, may play a key role in forming these holes. Energy from the laser causes changes in the activity of this enzyme, which affect the chemical state of the cell. This in turn affects genes that control the formation and maintenance of the fat cell membrane, causing pores to appear ().
The proof is in the pictures. In 2002, Neira watched the process under an electron microscope to identify the formation of a pore within the membrane of a fat cell after exposure to a 635-nanometre laser. He showed that the contents of the fat cell flowed across the membrane and into the extracellular space (Plastic and Reconstructive Surgery, vol 110, p 912). Erchonia claims that the excess fat is then âpassed through the body during its normal course of detoxificationâ. Though how the body does this, Erchonia does not say.
In 2008, Erchonia sponsored a double-blind clinical trial of the technique to zap fat in 67 volunteers aged between 18 and 65, who were all candidates for conventional liposuction. Each volunteer received low-level laser therapy (LLLT) on their waist, hip and thighs, three times a week for two weeks. Half the participants were assigned the real treatment; the other half received a placebo from a device that looked similar to the laser but was in fact a low-power LED. No change in exercise or dietary routine was allowed during the trial, and patients were asked to keep a diary of their exercise and food regimes to ensure that these habits were kept constant.
Overall, participants in the treatment group demonstrated a total girth reduction across all four sites of 89 millimetres (3.51 inches) compared with control subjects who showed a 17-millimetre reduction. Maloney says the reduction in the placebo group is a reflection of the typical placebo response. The results were published last month in (vol 41, p 799).
So far this is the only trial of the treatment. In Europe it does not require any further testing to comply with government regulations as the European Union has already approved the laser for surgical use. The US Food and Drug Administration has recently received experimental data demonstrating that the procedure works, but as New ĐÓ°ÉÔ´´ went to press the FDA had yet to announce that it has approved it. Its use in the US is therefore still âoff-labelâ.
Scientific evidence doesnât seem to be necessary for some people who have used the treatment. âCuriosity got the better of me,â says Jane Lewis, a sales consultant from London, who heard about the treatment when she bumped into the owner of Harley Fit at a business conference. âForty minutes after my treatment my therapist showed me Iâd lost 6 inches in total from three separate areas of my body. I wasnât that overwhelmed, until I got back into a close-fitting dress that Iâd been wearing and I was in awe at the difference.â
For Nigel Potter, a finance director from London, the results were even more dramatic. âI lost a total of 19.5 inches from around various areas of my body after six weeks of treatments,â he says.
Generally, this slimming down does not translate into a statistically significant reduction in weight. âCustomers only lose 0.5 to 1 kilogram after lipolysis,â says Maloney.
So what happens to the fat once it has leaked out of the cell? âThe body canât excrete fat: it doesnât come out through the urine or the stool. We need to find out where itâs going before we know whether these treatments will be truly safe and effective,â says , a dermatologist from Massachusetts General Hospital in Boston, who uses lasers for other medical procedures.
âThe body canât excrete fat: it doesnât come out through urine or stool. So we need to find out where itâs goingâ
Wanner is not the only person to have raised this question. , director of research in the department of plastic surgery at the University of Texas Southwestern Medical Center, is equally perplexed. âIt doesnât seem logical, thatâs the puzzling part. But the clinical results show that patients are certainly losing inches, so there has to be a redistribution of fat or fluids somewhere.â
Both Brown and Maloney suspect that the fat is broken down through the bodyâs natural metabolic pathways. âThe body cannot excrete triglycerides, but fat can be broken down,â says Maloney. The body transports fatty acids to the liver to be broken down into products which then undergo oxidative phosphorylation â a process which produces energy. Harley Fitâs customers are advised to do 60 minutes of exercise within 24 hours of each treatment to burn off the released fat. So far, no trials have been done to test whether this aids the fat loss process.
Brown suspects that some of the released fat is used to repair the fat cellâs membrane. âIt takes a lot of energy to repair cells so I would suspect that some of the free fatty acids would participate in this process and be transferred into that energy cycle,â he says.
Zapping fat with lasers isnât the only way to target your love handles. Treatments that destroy fat cells by freezing (see âFreezing fatâ) or create mechanical disruption by using ultrasound are being marketed outside the US.
Brown acts as a medical adviser for UltraShape, a company which provides body contouring through the use of ultrasound. Ultrasound treatments are non-invasive: they apply high-energy ultrasound to target the fat cells. But unlike the laser treatments, which exploit biochemical pathways to create pores in the fat cell, they generate mechanical forces that rupture these cells.
Longer-lasting effect
While Brown says that destroying fat cells in this way causes more internal damage, he reckons it could also provide a longer-lasting effect. âWith LLLT the fat cells recover very quickly, but with ultrasound the cell is destroyed. Although adults can create new fat cells, this process takes much longer than fixing damaged ones,â he says.
While LLLT is approved as a safe mechanism for assisting with liposuction, there are questions to be answered over what happens when it is used by itself. Fat leaking from the damaged fat cells is not removed from the body straight away, so what happens if the patient doesnât exercise to burn it up? Can the body cope with a sudden increase in cholesterol and triglycerides floating around?
In one , Maloney looked at the cholesterol and triglyceride levels in 19 patients undergoing LLLT. The patients received laser treatment three times a week for two weeks. Cholesterol levels were taken pre-procedure and at the end of the two-week treatment where you would expect any rise in cholesterol to be at its peak. Yet there was an overall reduction in cholesterol levels in 84 per cent of participants, with 74 per cent experiencing a reduction in low-density-lipoprotein or âbadâ cholesterol (which is responsible for increasing the risk of heart disease), while 58 per cent of participants either maintained or increased their levels of high-density-lipoprotein â the âgoodâ cholesterol (which can have a protective effect). Over half of the participants showed a reduction in triglyceride levels, suggesting that the body is more than capable of coping with the increase.
While the results look promising, the test group was very small, and independent experts in the field have yet to be convinced. âI would have expected the levels to go up, and would need more data to be convinced they donât,â says , an obesity expert from the University of Birmingham, UK.
He also highlights other potential hazards such as pancreatitis and fat emboli, in which multiple blood vessels are plugged with fat globules that are too large to pass through the capillaries â with potentially life-threatening results. âThese diseases could have significant health impacts if levels did increase as would have been expected, though this may not be an issue if the data is confirmed,â says Thomas.
Michael Hamblin, a researcher at Harvard Medical School in Boston who studies LLLT treatments, says that in his opinion these hazards are extremely unlikely. âWhile there is some evidence that high blood triglycerides are associated with acute pancreatitis, this is only after chronically high levels for a considerable time.â
Maloney says further investigation is warranted, and is conducting a placebo-controlled, randomised, double-blind, multi-centred clinical investigation to evaluate the efficacy of LLLT in lowering serum lipid levels.
âAt this stage it is really not possible to judge what will happen with the technology,â Thomas adds. âIts effects appear to be relatively short-lived and the big problem in obesity is fat regain, so this would likely still be an issue for anyone using it as a means to reduce weight.â
According to Harley Fit I lost two-and-a-half inches (more than 60 millimetres) from around my hips and stomach after one 20-minute session. Would I go again? There are still unanswered questions over how the body deals with the released fat, and how much extra it can cope with. I would want these questions answered before returning for the treatment week after week.
âIt may well be a decent alternative to liposuction which is perfectly acceptable as a cosmetic procedure, but does nothing to improve health,â says , an obesity specialist at the Centre for Obesity Research at Luton and Dunstable Hospital, and chair of the UK National Obesity Forum. âIndividuals who undergo treatment should be aware that diet and physical activity are the cornerstones, and the best way to make a long-lasting improvement in health and appearance.â
âIt may be a decent alternative to liposuction, but it does nothing to improve healthâ
And while questions still remain, itâs certainly not a long-term option, nor, as Haslam says, is it a replacement for a gym membership and eating fewer doughnuts.
Freezing fat
Forget about a vigorous workout, or lasers to zap your fat. Could you freeze it off instead? There are hints that adipose tissue is susceptible to damage by the cold. The phenomenon has been well documented in a few rare cases of cold-induced fat necrosis in children whose fatty tissue in their cheeks became damaged by sucking for too long on frozen lollies.
Fat appears to be selectively damaged when exposed to low temperatures. If so, this might provide another way of sculpting away fatty areas of the body.
To test the theory, Dieter Manstein and colleagues from Harvard Medical School in Boston exposed anaesthetised pigs to cooling plates at temperatures between +20 °C and -7 °C for 10 minutes. Using photographs, ultrasound and histological evaluation, the researchers then examined the tissue to assess the level of fat damage, as well as any potential damage to the skin. The team found that the cooling plates caused a biological response in the adipose tissue which resulted in a decrease in the level of fat at sites exposed to cold ().
Happily, there was no apparent discomfort to any of the animals, although there were some changes in pigmentation and superficial damage to the skin. Histological examination showed 40 per cent of the thickness of the fat layer had been removed under the exposure site. It appeared that most of the fat disappeared from the surface layer, while the deeper fat remained relatively unchanged.
Clinical trials are in progress to test whether freezing off fat is safe and effective on humans. The results are likely to be published within the next few months.
