Because care providers, public health professionals, and individual

Because of continuously growing prevalence of
obesity; greater attention is required regarding how best to treat obesity
epidemic. Lifestyle modification, diet changes, physical activity and exercise
are important components in the obesity management program. 148, 149 Unfortunately, many obese subjects
are unable to start or continue the life style modification program due to
compromised functional status. Without developing effective strategies
to modify the current “obesogenic” environment, it is likely that the
obesity epidemic will continue. Government agencies, health care
providers, public health professionals, and individual persons all
need to play an active role in the growing national efforts to
combat the obesity epidemic. 150

Lifestyle
modification, including a target weight-loss about of 5–10% of initial weight,
associated with moderate intensity physical activity for 30 minutes per day
should be implemented in the obesity management program. 151, 152 Increasing physical activity is an important
component that can act as gateway behavior and ‘opens the door’ for dietary modifications,
153 it
is useful to think of exercise training as a drug with a specific dose-response
relationship. 154

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Although regular activity is an
important component in the obesity management program 155
since increased the level of physical activity in obese subjects is
inversely correlated with the occurrence of serious comorbidities, 156
but lack of encouragement and obesity associated co-morbidities can
hinder obese subjects’ participation in active exercise therapy program.

Reductions in energy intake
(e.g., diet) alone, or increasing energy expenditure (e.g., exercise) alone
have a positive impact on body weight, 157 although the combination of diet
plus exercise has the greatest impact on weight loss. 158 Further,
national governments can help people to make healthier lifestyle options by
making healthier foods and opportunities for physical activity accessible and
affordable. Educating the public on the long terms health effects of obesity is
critical. Educational efforts should also encompass nutritional information
including recommended daily fat and caloric intake. Also, nations might monitor
advertising to vulnerable population groups, including youth to support the
prevention and elimination of obesity. 159

The
last 30 years have seen great increases in the incidence of obesity all over
the world, but limited progress in the development of new anti?obesity drugs. Obesity treatment by pharmacological
interventions reduces body weight and decreases the health risks factors
associated 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. Drugs
approved for treatment of obesity are only for a short term, whereas a long?term is needed. 160

Lasers have been widely applied in many different fields of
medicine, proving their efficacy in the treatment of a wide range of
pathologies. 161 Therapeutic laser used in medicine
is the poor cousin of lasers in surgery, but despite its low profile; is
considered the medicine of the future. 162 Laser light is non?invasive, free from side?effects, and can
support vital bio?regulating processes, particularly in diabetic and
neuropathic conditions. The use of low level laser therapy (LILT) for treatment
can bring about positive outcomes for patients, families, communities and
governments. 163

Literatures investigating the effects of low laser therapy yielded
variable results mainly due to methodological variations between the studies
(differences in number of cases, doses and wavelength of laser, etc.). Widely
spread use of Low Level Laser Therapy (LLLT) has got some limits, especially
related both to a poor penetration and to a little intensity of the light
radiation. High intensity laser therapy (HILT) may overcome these difficulties,
and clinical studies; although limited; but confirm its efficacy. 25 26, 27

Treatment of abdominal obesity through local fat reduction depends
on two different mechanisms. One is an ablative mechanism in which the fat
cells are destroyed by using certain emulsifiers. The other mechanism of local
fat reduction is non-ablative in which fat cells release their fat in response
to exposure to low energy  laser  light which stimulate the fat cells to open
pores  in 
the cell membrane, allowing the triglyceride to  leak out 
into the  interstitial space. The
non-ablative procedure associated with laser irradiation proved to be effective
in reducing waist girth which is accompanied by a clinically and statistically
significant improvement in appearance. 164

The
biological effects of LLLT in a wide range of treatments have been well
documented, with the focus in recent years as an adjunct treatment to
lipoplasty to facilitate fat retrieval and improve recovery time for the obese patient.
165, 166
The
ability of low-intensity Diode Lasers to reduce the contents of adipocytes and
hence their volumes, without causing damage to the cells of neighboring tissues
has been investigated for several years with a focus on opportunity to provide
non-invasive fat reducing options. LLLT can reduce circumference measurements
of specifically treated anatomical areas and offer a significant increase in
net reduction than diet and exercise alone. 167

The ability of
LLLT to cause photomodulation of individual adipose cells and stimulate it to
release their adipose contents without damage to the cell or surrounding
tissues has been successfully and safely used for several years. LLLT started
being investigated as an adjuvant to liposuction, for noninvasive body
contouring, reduction of cellulite, and improvement of blood lipid profile.
LLLT may also aid autologous fat transfer procedures by enhancing the viability
of adipocytes. First it was used as adjunct treatment to reduce the post
treatment swelling and discomfort of liposuction procedures and more recently
on their own as a non-invasive body reshaping treatment option 168

Despite the continuing effort to educate the public that
excessive weight raises the risk for chronic disease, the prevalence of
overweight and obesity continues to increase, 169
a situation that requires extra effort and implantation of
newly elaborated technologies in the treatment of obesity epidemic.

 

 

Literatures investigating the
effects of low laser therapy yielded variable results mainly due to
methodological variations between the studies (differences in number of cases,
doses and wavelength of laser, etc.). Widely spread use of LLLT has got some
limits, especially related both to a poor penetration and to a little intensity
of the light radiation.  HLLT may
overcome these difficulties, and clinical studies; although limited; but
confirm its efficacy. High Level Laser Therapy (HLLT); a
more recent laser application modality; had been quiet recently investigated
for its efficacy. HLLT can be more effective than LLLT due to its more intense
and deeper effects. 25, 26, 27 HLLT is more
effective than LLLT in alleviating pain and disability associated with some
forms of osteoarthritis, due to its higher intensity and to the depth reached
by the laser ray. HILT may be used also in laser-acupuncture, as it could be a
good proposal for pain control and for improvement of patient’s quality of life.
170, 171,
172, 173

Although HLLT has been used in treatment
of sports lesions, acute osteo-muscular diseases 174 and degenerative diseases as
osteoarthritis, 170
low back pain, 175,
176 low back pain, 177 knee arthritis, 178, 179 carpel tunnel syndrome, 179 lateral
epicondylitis, 180
 and in relieve of post-surgical pain;
181 but there no clinical studies concerning HLLT utilization in the treatment of
abdominal obesity. HLLT seems to be more effective than
LLLT in alleviating pain and disability associated with some forms of
osteoarthritis, due to its higher intensity and to the depth reached by the
laser ray. HLLT may be used also in laser-acupuncture, as it could be a good
proposal for pain control and for improvement of patient’s quality of life. 171,
172, 173

The clinical
literature offers an increasing body of evidence supporting the use of class IV
lasers (high level laser) in a wide range of clinical conditions, demonstrating
successful therapeutic results. 182, 183, 184 Additionally, cosmetic
laser applications such as hair removal, skin resurfacing and tattoo removal
use thousands of times more power than class IV therapy lasers. These cosmetic
lasers are being used safely without any detrimental short term or long-term
complications in millions of procedures per year around the world. Since the
Federal Drug Administration approved class IV lasers therapy in the United
States in 2005, the science of laser therapy has developed rapidly. Acceptance
has been seen on the human side in physical therapy, rehabilitation, wound care
and sports medicine programs. 185

High Level pulsed Nd: YAG laser works with high peak
powers and able to stimulate deep tissues and organs that are difficult to
reach by low level lasers. 186 The application of high power lasers can
result in therapeutic effects without tissue damage through control of
photothermal and photomechanical processes. High level Laser Therapy, using a
pulsed Nd:YAG laser, is characterized by a wavelength of 1064 nm that allows it
to penetrate and spread more easily through the tissue due to not having endogenous
chromophores able to efficiently absorb 1064 nm radiation. Moreover, with
Nd:YAG pulses it is possible to deliver power peaks of up to 1000 Watt for
times of 200µ seconds: extremely elevated peak intensity (W/cm2) in
very 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 greater
propagation of the radiation in the tissues with a very low histolesive risk,
leading to the possibility of treating deep tissues and structures. At the same
time, the photothermal effect can be controlled in terms of patient safety and
comfort by modulating pulse intensity and frequency, 124 stimulation of
several metabolic processes in addition to immunomodulation. 187 Because therapeutic efficacy of the treatment is “stimulus
strength” – dependent, 188 it’s a realistic hypothesis that HLLT can yield more
favorable results than LLLT due to its higher intensity and deeper
tissues penetration depth reached by the HLLT 176, 186, 187

Despite the dearth of published studies on the use of
laser therapy, many problems and limitations exist, including the lack of
standard 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 confusing
process; lack standardization makes it difficult to follow a specified protocol
when applying laser therapy on a specific area. Each approach has its
own parameters; power, energy, energy density, duration and wave length that
are all varied between literatures which discussed laser application on various
cases. Variations in laser parameters and
application procedures including wave length, time of application, distance
between body and laser probe and frequencies yielded different outcomes even in
the same cases. 190 The maintenance of functional mobility should be one of the highest
priorities in the management of an obese individual, with or without comorbid
conditions. High levels of body fat plus increased loads on the major joints
has the potential to lead to pain and discomfort, inefficient body mechanics
and further reductions in mobility. 149 So additional therapeutic procedures
are required to fill the gap in the obesity treatment program.

Studies conducted during the past two decades in Saudi Arabia have shown
that obesity affects all age groups of both genders from both urban and rural
areas. At least one out of three adults, one out of five adolescents and one
out 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 for
Saudi Arabia, and the country now must fight obesity along with the rest of the
world. Something must be done to slow this “age of obesity” in Saudi Arabia.
191 It is
urgent that international policies address rising obesity to prevent avoidable
population deaths. Obesity in Saudi Arabia is
a major and serious health problem, which needs further and new types of
research mainly clinical trials, genetics, in addition to qualitative research,
which deal with attitude of obese patients toward their problem and quality?of?life. 

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