Background
Obesity is a common clinical challenge at all ages. It is considered to be a complex, multifactorial disease involving genetics, physiological, psychological, and environmental factors, and is influenced by cultural messages: “Does It Matter What You Weigh?,” and “The New Truth About Fat.” Nevertheless. obesity is linked to many comorbidities such as coronary artery disease, stroke, hypertension, diabetes mellitus, gout, dyslipidemias, cholecystitis, and gallstones.

Obesity may even influence some neoplastic processes. Experts agree that overweight and obesity pose a significant public health problem in the United States as the prevalence of overweight among American adults increased by 5% between 1987 and 1993, and continues to rise.

This paper describes a practical and safe approach to clinical obesity when the etiology is dietary error in the management of caloric intake. The treatment protocol incorporates an almost exclusive animal-protein regimen and the use of auriculomedicine. It is safe and easily prescribed by the busy physician. I have employed this high-protein combination with few failures over many years. The auriculomedicine appears to prevent bingeing, but does not produce a weight loss in itself.

Goal
Each patient decided how much weight to lose on an individual basis.

Method Subjects
I enrolled 21 patients with clinical obesity ranging from mild to severe. Each patient underwent a history and physical examination. All patients had thyroid and lipid panels, EKG, fasting blood glucose, creatinine, BUN, and urine studies. All the studies were normal except several patients had elevated cholesterols. In cases of slightly elevated cholesterol, the risk of a short-term, high-protein meat diet was considered less troublesome than a lifetime of being overweight.

Auriculomedicine
Auriculomedicine suppresses the desire to binge. The therapy starts after the first week of the regimen. The auriculomedicine is very simple, consisting of three or four points: Appetite Control Point, Shenmen, and Point Zero. Tranquilizer Point may be added or substituted for Point Zero or Shenmen. The treatment should have a duration of 15 minutes. I have found in some instances a mild suppression of the appetite with therapy over 15-20 minutes. This should be avoided. One wants the patient to indulge in eating meat to prompt weight loss. Seirin blue-topped needles were employed: No. 3 (0.20) x 30mm J-type with tube.

Statistical Analysis
Both the pre-treatment and post-treatment samples of the five groups (weight, cholesterol level, HDL level, LDL level, and triglyceride level) were tested for normality using the Kolmogorov-Smirnov test with a Lilliefors significance correction. Based upon these results, differences between pre-treatment and post-treatment means of the five groups were compared using a two-tailed paired-differences t-test.

Statistical Results
Based upon the results of the Kolmogorov-Smirnov normality test, both the pre-treatment and post-treatment samples of all five groups were consistent with a normal distribution with p-values greater than 0.050, with the exception of the HDL-before group which was within rounding distance of 0.05.

Hence, the assumption was made that the pre-treatment and post-treatment samples of all five groups were from a normal distribution.

Given this assumption of normality, the differences between pre-treatment and post-treatment means of the five groups were then compared using a two-tailed paired-differences t-test. Based upon these results, the differences of both weight and triglyceride level were statistically significant with p-values less than 0.050. The differences of cholesterol level, HDL level, and LDL level were far from being statistically significant as each difference had a p-value greater than 0.500. In conclusion, both weight and triglyceride level decreased due to treatment.

Results
Twenty-one patients successfully completed a clinical program incorporating a high-protein regimen and auriculomedicine. Each patient reached their desired weight goal. The average weight loss was 2.7 pounds per week. There were no clinical complications and compliance was excellent throughout the course.

Auriculomedicine was voluntary. It was the unanimous opinion of the group that the auriculomedicine greatly decreased an urge to binge. Those patients who initially did not wish auriculomedicine, but later opted to try one session for the experience, requested continuation throughout their program. In fact, all patients eventually received auriculomedicine. There was an unexpected significant decrease in triglycerides.

Discussion
This paper is not a research endeavor nor was it designed as such. Instead, I am reporting on a very efficient clinical treatment for simple obesity that combines a high-protein diet and auriculomedicine. Very rarely is obesity the result of a disease. Overeating is probably the major cause of overweight and obesity in the United States, where over half the adults have 20% excess of body fat over ideal weight. There are many popular “crash” diets that produce a rapid water loss but not a sustained weight loss.

The high-protein versus low-protein diet controversy is more an issue of fear and confusion than fact. From the above data, it appears that the high-protein meat regimen does not produce an acute elevation of lipids; in fact, there is a significant drop in the triglycerides. Unfortunately, out of the 21 patients treated, only 6 subjects were compliant regarding lipid testing.

A high-protein and low-carbohydrate regimen apparently causes the body to burn its stored body fat to meet energy needs throughout the day. Large amounts of meat must be digested and this in turn requires energy. The energy required to digest large amounts of protein in the presence of a minimal amount of simple carbohydrates may lend itself to the rapid metabolism of adipose tissue.

Auriculomedicine and the choice of the Appetite Control Point, Shenmen, Point Zero, and the Tranquility Point attenuate cravings for carbohydrates. It is also well known that a high-protein diet suppresses insulin peaks and false hunger pangs. The role of auriculomedicine, as reported by the patients, allowed them to comfortably avoid the need to return to their previous dietary carbohydrate errors. A few patients tried it both ways and were very emphatic about the usefulness of the ear therapy. It was noticed that sessions over 20 minutes seemed to suppress the appetite for a few days.

Conclusion
In conclusion, this paper demonstrates a practical high-protein diet that is very successful for the treatment of obesity caused by poor carbohydrate management. When coupled with auriculomedicine, patients reported a very subjective but definite increase in the quality of the program. Many “crash” diets produce a rapid weight loss in the first week but gradually fall off. The high-protein regimen and auriculomedicine yielded a sustained weight loss.

A paucity of data does not allow any further extrapolation of the data, except for the significant fall in triglycerides. An effort to obtain more patients and data points would be of significant interest.

Acknowledgement
The author wishes to thank Dr. William Kitto and Mr. Jeffry Corn of the United States Air Force Flight Testing Center, Edwards AFB, California, for assistance in the statistical analysis.

Richard Nietmzow will present a lecture and workshop on treating difficult clinical problems such as obesity at Pacific Symposium 2001. The programs are titled Acupuncture: Clinical Challenges.