Because of continuously growing prevalence ofobesity; greater attention is required regarding how best to treat obesityepidemic. Lifestyle modification, diet changes, physical activity and exerciseare important components in the obesity management program. 148, 149 Unfortunately, many obese subjectsare unable to start or continue the life style modification program due tocompromised functional status. Without developing effective strategiesto modify the current “obesogenic” environment, it is likely that theobesity epidemic will continue. Government agencies, health careproviders, public health professionals, and individual persons allneed to play an active role in the growing national efforts tocombat the obesity epidemic. 150Lifestylemodification, including a target weight-loss about of 5–10% of initial weight,associated with moderate intensity physical activity for 30 minutes per dayshould be implemented in the obesity management program.
151, 152 Increasing physical activity is an importantcomponent that can act as gateway behavior and ‘opens the door’ for dietary modifications,153 itis useful to think of exercise training as a drug with a specific dose-responserelationship. 154Although regular activity is animportant component in the obesity management program 155since increased the level of physical activity in obese subjects isinversely correlated with the occurrence of serious comorbidities, 156but lack of encouragement and obesity associated co-morbidities canhinder obese subjects’ participation in active exercise therapy program.Reductions in energy intake(e.g., diet) alone, or increasing energy expenditure (e.
g., exercise) alonehave a positive impact on body weight, 157 although the combination of dietplus exercise has the greatest impact on weight loss. 158 Further,national governments can help people to make healthier lifestyle options bymaking healthier foods and opportunities for physical activity accessible andaffordable. Educating the public on the long terms health effects of obesity iscritical.
Educational efforts should also encompass nutritional informationincluding recommended daily fat and caloric intake. Also, nations might monitoradvertising to vulnerable population groups, including youth to support theprevention and elimination of obesity. 159Thelast 30 years have seen great increases in the incidence of obesity all overthe world, but limited progress in the development of new anti?obesity drugs. Obesity treatment by pharmacologicalinterventions reduces body weight and decreases the health risks factorsassociated with obesity. However, most of the anti?obesity drugs are found to possess major side?effects with such as palpitation, tremors, hyperactive reflexes,hypertensive crisis with adrenergic drugs, monoamine, serotonergic drugs. Drugsapproved for treatment of obesity are only for a short term, whereas a long?term is needed.
160Lasers have been widely applied in many different fields ofmedicine, proving their efficacy in the treatment of a wide range ofpathologies. 161 Therapeutic laser used in medicineis the poor cousin of lasers in surgery, but despite its low profile; isconsidered the medicine of the future. 162 Laser light is non?invasive, free from side?effects, and cansupport vital bio?regulating processes, particularly in diabetic andneuropathic conditions. The use of low level laser therapy (LILT) for treatmentcan bring about positive outcomes for patients, families, communities andgovernments. 163Literatures investigating the effects of low laser therapy yieldedvariable results mainly due to methodological variations between the studies(differences in number of cases, doses and wavelength of laser, etc.). Widelyspread use of Low Level Laser Therapy (LLLT) has got some limits, especiallyrelated both to a poor penetration and to a little intensity of the lightradiation. High intensity laser therapy (HILT) may overcome these difficulties,and clinical studies; although limited; but confirm its efficacy.
25 26, 27Treatment of abdominal obesity through local fat reduction dependson two different mechanisms. One is an ablative mechanism in which the fatcells are destroyed by using certain emulsifiers. The other mechanism of localfat reduction is non-ablative in which fat cells release their fat in responseto exposure to low energy laser light which stimulate the fat cells to openpores in the cell membrane, allowing the triglyceride to leak out into the interstitial space.
Thenon-ablative procedure associated with laser irradiation proved to be effectivein reducing waist girth which is accompanied by a clinically and statisticallysignificant improvement in appearance. 164Thebiological effects of LLLT in a wide range of treatments have been welldocumented, with the focus in recent years as an adjunct treatment tolipoplasty to facilitate fat retrieval and improve recovery time for the obese patient.165, 166Theability of low-intensity Diode Lasers to reduce the contents of adipocytes andhence their volumes, without causing damage to the cells of neighboring tissueshas been investigated for several years with a focus on opportunity to providenon-invasive fat reducing options. LLLT can reduce circumference measurementsof specifically treated anatomical areas and offer a significant increase innet reduction than diet and exercise alone. 167The ability ofLLLT to cause photomodulation of individual adipose cells and stimulate it torelease their adipose contents without damage to the cell or surroundingtissues has been successfully and safely used for several years.
LLLT startedbeing investigated as an adjuvant to liposuction, for noninvasive bodycontouring, reduction of cellulite, and improvement of blood lipid profile.LLLT may also aid autologous fat transfer procedures by enhancing the viabilityof adipocytes. First it was used as adjunct treatment to reduce the posttreatment swelling and discomfort of liposuction procedures and more recentlyon their own as a non-invasive body reshaping treatment option 168Despite the continuing effort to educate the public thatexcessive weight raises the risk for chronic disease, the prevalence ofoverweight and obesity continues to increase, 169a situation that requires extra effort and implantation ofnewly elaborated technologies in the treatment of obesity epidemic. Literatures investigating theeffects of low laser therapy yielded variable results mainly due tomethodological variations between the studies (differences in number of cases,doses and wavelength of laser, etc.).
Widely spread use of LLLT has got somelimits, especially related both to a poor penetration and to a little intensityof the light radiation. HLLT mayovercome these difficulties, and clinical studies; although limited; butconfirm its efficacy. High Level Laser Therapy (HLLT); amore recent laser application modality; had been quiet recently investigatedfor its efficacy. HLLT can be more effective than LLLT due to its more intenseand deeper effects. 25, 26, 27 HLLT is moreeffective than LLLT in alleviating pain and disability associated with someforms of osteoarthritis, due to its higher intensity and to the depth reachedby the laser ray. HILT may be used also in laser-acupuncture, as it could be agood proposal for pain control and for improvement of patient’s quality of life.
170, 171,172, 173Although HLLT has been used in treatmentof sports lesions, acute osteo-muscular diseases 174 and degenerative diseases asosteoarthritis, 170low back pain, 175,176 low back pain, 177 knee arthritis, 178, 179 carpel tunnel syndrome, 179 lateralepicondylitis, 180 and in relieve of post-surgical pain;181 but there no clinical studies concerning HLLT utilization in the treatment ofabdominal obesity. HLLT seems to be more effective thanLLLT in alleviating pain and disability associated with some forms ofosteoarthritis, due to its higher intensity and to the depth reached by thelaser ray. HLLT may be used also in laser-acupuncture, as it could be a goodproposal for pain control and for improvement of patient’s quality of life. 171,172, 173The clinicalliterature offers an increasing body of evidence supporting the use of class IVlasers (high level laser) in a wide range of clinical conditions, demonstratingsuccessful therapeutic results. 182, 183, 184 Additionally, cosmeticlaser applications such as hair removal, skin resurfacing and tattoo removaluse thousands of times more power than class IV therapy lasers. These cosmeticlasers are being used safely without any detrimental short term or long-termcomplications in millions of procedures per year around the world. Since theFederal Drug Administration approved class IV lasers therapy in the UnitedStates in 2005, the science of laser therapy has developed rapidly.
Acceptancehas been seen on the human side in physical therapy, rehabilitation, wound careand sports medicine programs. 185High Level pulsed Nd: YAG laser works with high peakpowers and able to stimulate deep tissues and organs that are difficult toreach by low level lasers. 186 The application of high power lasers canresult in therapeutic effects without tissue damage through control ofphotothermal and photomechanical processes.
High level Laser Therapy, using apulsed Nd:YAG laser, is characterized by a wavelength of 1064 nm that allows itto penetrate and spread more easily through the tissue due to not having endogenouschromophores able to efficiently absorb 1064 nm radiation. Moreover, withNd:YAG pulses it is possible to deliver power peaks of up to 1000 Watt fortimes of 200µ seconds: extremely elevated peak intensity (W/cm2) invery brief times. Such a high intensity in such a short time (pulsed mode)prevents the heat accumulation by the tissues as happens with the use of Nd:YAG laser with continuous emission. These features result in a greaterpropagation of the radiation in the tissues with a very low histolesive risk,leading to the possibility of treating deep tissues and structures. At the sametime, the photothermal effect can be controlled in terms of patient safety andcomfort by modulating pulse intensity and frequency, 124 stimulation ofseveral metabolic processes in addition to immunomodulation. 187 Because therapeutic efficacy of the treatment is “stimulusstrength” – dependent, 188 it’s a realistic hypothesis that HLLT can yield morefavorable results than LLLT due to its higher intensity and deepertissues penetration depth reached by the HLLT 176, 186, 187 Despite the dearth of published studies on the use oflaser therapy, many problems and limitations exist, including the lack ofstandard protocols, there are no standard therapy programme regarding dose,period, type of laser and detailed therapy steps application. 189 Studying literatures on laser therapy is a confusingprocess; lack standardization makes it difficult to follow a specified protocolwhen applying laser therapy on a specific area. Each approach has itsown parameters; power, energy, energy density, duration and wave length thatare all varied between literatures which discussed laser application on variouscases.
Variations in laser parameters andapplication procedures including wave length, time of application, distancebetween body and laser probe and frequencies yielded different outcomes even inthe same cases. 190 The maintenance of functional mobility should be one of the highestpriorities in the management of an obese individual, with or without comorbidconditions. High levels of body fat plus increased loads on the major jointshas the potential to lead to pain and discomfort, inefficient body mechanicsand further reductions in mobility. 149 So additional therapeutic proceduresare required to fill the gap in the obesity treatment program. Studies conducted during the past two decades in Saudi Arabia have shownthat obesity affects all age groups of both genders from both urban and ruralareas. At least one out of three adults, one out of five adolescents and oneout of ten children are suffering from obesity in KSA.
77, 78, 79,80, 81, 82 Globalization and economic prosperity has been a double-edged sword forSaudi Arabia, and the country now must fight obesity along with the rest of theworld. Something must be done to slow this “age of obesity” in Saudi Arabia.191 It isurgent that international policies address rising obesity to prevent avoidablepopulation deaths.
Obesity in Saudi Arabia isa major and serious health problem, which needs further and new types ofresearch mainly clinical trials, genetics, in addition to qualitative research,which deal with attitude of obese patients toward their problem and quality?of?life.