Obesity and overweight have become serious global health issues, affecting a significant portion of the population, including young people. The World Health Organization (WHO) highlights the rapidly growing rates of overweight individuals in many European countries. Obesity is defined as abnormal or excessive fat accumulation that may impair health. Adipose tissue, also known as body fat, consists mainly of adipocytes, which are cells formed from fibroblast-like, progenitor, undifferentiated cells, known as preadipocytes.
For individuals seeking to manage their weight and improve their health, non-invasive weight loss treatments offer a range of options, avoiding the need for surgery. At UPMC, it's understood that weight loss is a highly personal journey, and what works for one individual may not be suitable for another. Medical weight loss considers the big picture, taking into consideration individual needs, overall health, medical conditions, and weight loss goals.
This article explores various non-invasive weight loss treatment options, their mechanisms, benefits, and potential risks.
Understanding Adipose Tissue and Weight Gain
Adipose tissue accounts for about 15-20% of body weight in men and slightly more in women. It plays a crucial role in energy homeostasis and thermogenesis. Brown adipose tissue (BAT) prevents obesity caused by diet and hypothermia through uncoupling protein 1 (UCP1). This mechanism is particularly important in young children due to their undeveloped capacity for thermoregulation.
Weight gain occurs when adipocytes accumulate triacylglycerols as an energy store, increasing the adipose tissue volume. Weight gain can be prevented through damage to the adipocyte structure or an increase in the body’s metabolic rate.
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Non-Invasive Fat Reduction Techniques
Non-surgical fat reduction includes minimally invasive treatments that selectively break down fat cells in specific areas to reduce the size of subcutaneous fat pockets (fat deposits that sit beneath the skin, but above the muscle). A number of FDA-cleared treatments are available, each achieving gradual, modest fat loss without surgery or downtime.
Several non-invasive or micro-invasive techniques are available to reduce fat cells. These methods offer a less invasive approach to body contouring, with the goal of reducing fat deposits without the risks and downtime associated with surgery.
1. Cryolipolysis (Fat Freezing)
Cryolipolysis, commonly known as fat freezing, is a noninvasive technology that uses extreme cold to dismantle fat cells and help reduce a fat pocket. This method involves using cold to freeze the fat cells sucked by the device in the targeted areas, causing the apoptosis of adipocytes, which are then naturally absorbed and eliminated. A paneled or cupped device is placed on top of the skin in the treatment area, where it transmits temperatures that are just low enough to freeze fat cells, essentially destroying them.
The principle of cryolipolysis is based on the assumption that adipocytes are more susceptible to cooling than other skin cells. Their death is initiated when they are cooled to −1 °C. An inflammatory response is induced, and inflammatory cells flow in. Within 2 weeks, the adipocytes are surrounded by histiocytes, neutrophils, lymphocytes, and other mononuclear cells. Then, the macrophages surrounding the adipose tissue reduce the inflammatory focus by metabolizing the lipid cells. About a month after the procedure, the inflammation and the volume of the adipocytes decrease.
Just one session can lead to a reduction in the thickness of body fat by up to 20%, and the effects are visible after 3-4 months. Cryolipolysis is known for its good efficacy and safety profile; the side effects reported so far are insignificant.
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Common side effects include temporary, mild swelling, numbness, redness, and tingling. Adjadj L, SidAhmed-Mezi M, Mondoloni M, Meningaud JP, Hersant B. Assessment of the Efficacy of Cryolipolysis on Saddlebags: A Prospective Study of 53 Patients. Plastic and Reconstructive Surgery. 2017. Krueger N, Mai SV, Luebberding S, Sadick NS. Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction. Clinical, Cosmetic and Investigational Dermatology. 2014.
2. Laser Lipolysis
Laser lipolysis has been a commonly used method to reduce body fat since 2006. The generated laser beam, with possible wavelengths of 924, 968, and 980 nm for the diode laser, and 1064, 1319, 1320, and 1440 nm for the Nd:YAG laser (neodymium-YAG laser) penetrates the tissue, and is scattered, reflected, and absorbed. Laser fat reduction depends on the laser wavelength and energy.
This non-invasive method raises the temperature of adipocytes to the threshold of cell death, i.e., 42~47 °C; their complete decomposition occurs at 50~65 °C. With the accumulation of heat, the adipocytes are irreversibly damaged by the formation of transient micropores in their membranes, followed by the release of intracellular lipids. As with cryolipolysis, the inflammation leads to the removal of dead cells.
Innovative devices for laser lipolysis are equipped with a cooling system or supported by a cryogenic spray to protect against the side effects of laser photothermolysis and improve the general therapeutic effect. Laser therapy has been proven to be effective in reducing the waist, hip, and thigh circumference, closing small vessels, removing skin imperfections (e.g., rosacea and erythema) and signs of skin aging such as a loss of firmness and tissue flabbiness (e.g., wrinkles and folds), but also in lowering cholesterol and leptin levels, while remaining a non-invasive and safe method.
Laser fat reduction works by dismantling subcutaneous fat using controlled heat. A specific laser wavelength is delivered through the skin, heating fatty tissues to the point where fat cells begin to break down. A constant cooling mechanism ensures that skin is not damaged in the process. It's FDA cleared for the abdomen and flanks.
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3. Injection Lipolysis
Injection lipolysis is often confused with mesotherapy; however, injection lipolysis is a much broader concept. Lipolysis describes the hydrolysis or degradation of lipids into their constituent fatty acids and glycerol esters. This process, regulated by lipases, takes place in the adipocytes and vascular space of the muscle or adipose tissue.
In treatment aimed at reducing body fat, mesotherapy is used, which constitutes multiple intradermal injections of small doses of the appropriate drug into selected parts of the body. However, injection lipolysis is most often associated with the technique of 1-2 punctures, such as intralipotherapy, repeated in cycles of 2-5 series at intervals of 4-6 weeks. The active substances applied for the subcutaneous fat are most commonly phosphatidylcholine (PPC) or sodium deoxycholate (DC).
PPC is the basal phospholipid component of cell membranes and a precursor to acetylcholine. As a result of the subcutaneous injection of PPC into the adipose tissue, adipocytes burst, and the phosphatidylcholine increases the secretion of triglyceride-rich lipoproteins. DC is a component of human bile acid, which helps in the emulsification and digestion of fats in the intestines. However, when administered externally, it damages the cell membrane of adipocytes, causing their death.
The best-known combinations of these two drugs in injection lipolysis are Lipostabil PPC (50 mg/mL), along with DC, sodium hydroxide, sodium chloride, α-tocopherol, benzyl alcohol and ethanol, and formulations differing in the value of DC, i.e., Kybella, which contains DC (10 mg/mL), and GeoLysis, which contains DC (10 mg/mL). The cascade of inflammatory response triggered by the adipocyte destruction causes the migration and stimulation of fibroblasts and, eventually, the accumulation of more collagen.
Deoxycholic acid is a naturally occurring substance in the body that helps break down fat for digestion. In injectable form, deoxycholic acid can break down fat cells on contact for isolated reduction of a fat pocket. Common side effects include temporary, mild swelling, numbness, redness, and bruising at the treatment side. Liu M, Chesnut C, Lask G. Overview of Kybella (Deoxycholic Acid Injection) as a Fat Resorption Product for Submental Fat. Facial Plastic Surgery. 2019.
4. Ultrasonic Lipolysis (HIFU)
Ultrasonic lipolysis and, more specifically, high-intensity focused ultrasound (HIFU) lipolysis, affects the adipose tissue by two mechanisms. It causes negative acoustic pressure that breaks cell membranes by inducing cavitation bubbles, releasing heat energy, and increasing the temperature, which causes protein denaturation and coagulation.
The cavitation phenomenon used here affects the adipose tissue by converting it into a liquid form, which is then naturally excreted in urine. A higher temperature is achieved through ultrasonic vibrations. The effect is the destruction of adipocytes, with the release of lipids, which are transported to the hepatobiliary system through lymphatic drainage. The result of these mechanisms is a reduction in the local volume of adipose tissue. This method is completely non-invasive and painless.
Ultrasound fat reduction uses highly focused sonic waves to break down fat cell walls in the treatment area, thereby releasing the fat inside to be metabolized by the body and reducing the size of a fat deposit. Kiedrowicz M, Duchnik E, Wesołowska J, Bania B, Peregud-Pogorzelska M, Maciejewska-Markiewicz D, Stachowska E, Kruk J, Marchlewicz M. Early and Long-Term Effects of Abdominal Fat Reduction Using Ultrasound and Radiofrequency Treatments. Nutrients. Nutrients. 2022.
5. Radiofrequency Lipolysis
Radiofrequency lipolysis uses radio waves that emit heat, which is selectively directed to a layer of collagen-rich tissue, causing the shrinkage and denaturation of collagen fibers, and the stimulation of fibroblasts. This method is mainly used to firm the skin and gently reduce body fat through the thermal apoptosis of adipocytes. It works best as an additional therapy for other fat-removal procedures.
Radiofrequency treatments and technology, such as Vanquish, use magnetic waves to heat and melt away fat cells without actually touching the skin.
6. Low-Level Laser Therapy (LLLT)
Low-level laser therapy (LLLT), emitting waves between 630-640 nm, can be used as a supplement to lipoplasty. The EML laser, which emits 14 mW of light with a wavelength of 635 nm, is applied to the surface of the skin before the liposuction procedure. This allows the fat to emulsify and softens the body area prior to suction. This therapy shortens the procedure time, increases the volume of fat removed, and accelerates the patient’s recovery. In addition, this therapy presents bio-stimulating properties related to the wavelength used.
One of the newest technologies to be FDA cleared for non-surgical fat reduction uses red light therapy to reduce the volume of subcutaneous fat cells. Instead of removing or destroying fat cells, photonic lypolysis, or “red light therapy,” delivers specific wavelengths of light through the skin using a specialized lamp. This light triggers selected fat cells to create small openings and release some of their contents, thus helping them shrink in size.
7. Carboxytherapy
Carboxytherapy is the transdermal administration of carbon dioxide for therapeutic needs. Depending on the area of the body, the amount of CO2 infused is, respectively, 50-100 mL for the chin and arm, 200-300 mL for the thigh, and 300-600 mL for the abdomen. However, the role of carboxytherapy in lipolysis is still controversial. The local application of CO2 can enhance the peripheral circulation, improve tissue perfusion, increase the oxygen partial pressure through reflex vasodilation, and stimulate neoangiogenesis. An important aspect that proves the effectiveness of therapy in obesity treatment is based on the clear shrinkage of adipocytes and a density decrease in the area exposed to carboxytherapy.
8. High-Intensity Focused Electromagnetic Field (HIFEM)
High-intensity focused electromagnetic field (HIFEM) is a non-invasive method used to reduce body fat, along with aiding in muscle repair. The device generates an electromagnetic field that activates the neuromuscular tissue through an induced electrical current, leading to muscle contractions. The significant energy demand forces the muscles to use the energy stored in adipocytes, i.e., free fatty acids. This consequently reduces the size.
9. Non-Surgical Lipo (Laser Lipo)
Non-surgical lipo, much like traditional liposuction, removes small fat deposits from your body. However, SmartLipo® uses laser heat combined with small fiber optic cables under the skin to the target area to break down the fat cells for your body to reabsorb. Laser lipo is not entirely non-invasive but requires minimal incisions and suction or massage to help remove the fat. Laser lipo takes about 25 minutes on each targeted area.
10. ThermaLipo
ThermaLipo combines laser liposuction and radiofrequency to help reduce cellulite and create a smooth, contoured appearance. One session that takes about an hour to an hour and a half will get you closer to the smooth and contoured body you want.
11. Emsculpt Neo
Emsculpt Neo combines muscle stimulation and radiofrequency to melt away fat while also toning muscle and tightening skin.
Endoscopic Weight Loss Procedures
Endoscopic weight loss procedures are minimally invasive options for people who want help losing weight but don't want -- or may not qualify for -- bariatric surgery. Endoscopic weight loss procedures can achieve better weight loss than medication but not as much as bariatric surgery. Because they are newer procedures, more data is needed on how they perform over the long term.
Endoscopy is a thin, flexible tube with a light and camera at its tip that allows your doctor to view your internal organs. The endoscope is inserted through a small opening in your body, such as your mouth, to reach your stomach and small bowel. These procedures require specialists with advanced training in GI endoscopy.
Like other weight loss procedures, nonsurgical weight loss options require lifestyle changes for you to achieve success.
1. Gastric Balloon
The gastric balloon may be an option for adults whose BMI is between 30 and 40. First, the doctor gives you a mild sedative. Then, using an endoscope passed through your mouth, the doctor will insert a soft, durable balloon in your stomach and fill the balloon with a saline solution.
Gastric balloon is a temporary procedure; the balloon is removed after six months. Rapid weight loss is typically experienced during the first four months following placement of the balloon. In the first few days after it is placed, the gastric balloon can cause abdominal pain, nausea, and vomiting. The intragastric balloon procedure can help you shed pounds without the need for surgery. This minimally invasive outpatient procedure typically takes about 30 minutes. It can help jump-start weight loss by taking up space in your stomach - limiting how much you can eat and keeping you feeling full longer after meals.
2. Endoscopic Sleeve Gastroplasty
People with a BMI greater than 30 may be candidates for endoscopic sleeve gastroplasty. Folds are stitched into your stomach to reduce its size by about 70%. This restricts how much food and drink you can consume and makes you feel fuller faster. No part of your stomach is cut or removed. Only stitches hold the folds in place. The procedure can be undone, but scar tissue may remain.
Studies report that 60% of people lost about 20% of their total body weight during the first year after surgery. Sleeve gastroplasty is an alternative to gastric sleeve surgery, in which the surgeon places sutures along the inside of your stomach to decrease the size of your stomach. A similar procedure, called gastric plication, also involves a similar approach in which your stomach is folded in on itself and stitched together to decrease your stomach size. Both procedures can be performed endoscopically and don’t involve any actual cutting of your stomach like in traditional bariatric procedures.
3. Endoscopic Gastric Bypass Revision
There are times when people have trouble reaching their weight loss goals -- or even gain weight -- after gastric bypass, because of stretching that may occur at the connection between the stomach and small intestine, also known as gastrojejunostomy. In this case, we may recommend an endoscopic gastric bypass revision, which is performed by inserting a tube into your mouth to reach your stomach.
Additional Non-Surgical Weight Loss Approaches
Besides the techniques mentioned above, other non-surgical approaches can aid in weight loss.
1. Intragastric Balloons
Intragastric balloons are balloon-like devices that are inserted into your stomach and expanded with liquid or air to reduce the available space inside your stomach. There are two primary types of intragastric balloons on the market:
- Liquid-filled: Once liquid-filled intragastric balloons are inserted into your stomach, they can be expanded with liquid. Orbera, which was first approved by the Food and Drug Administration (FDA) in 2015, is the most commonly used liquid-filled intragastric balloon.
- Air-filled: Air-filled intragastric balloons are inserted into your stomach and then expanded with air instead of liquid. Obalon, which was approved by the FDA in 2016, a year after Orbera, is the most common air-filled intragastric balloon.
Intragastric balloons are typically inserted through your esophagus in a noninvasive, nonsurgical procedure called an endoscopy.
2. AspireAssist
AspireAssist is another nonsurgical weight loss device that was first approved by the FDA in 2016 to help assist with weight loss in people with obesity. With this device, a tube running from the inside of your stomach to the outside of your stomach allows you to drain a portion of your stomach’s contents after a meal. This reduces your calorie intake by roughly 30%. Like many other nonsurgical weight loss procedures, AspireAssist is inserted directly into your stomach with the help of an endoscope.
Lifestyle Changes and Medical Supervision
Long-term weight loss requires a commitment to major lifestyle changes, such as eating healthy and being active. They’ll help you to recognize unhealthy eating habits, emotional eating, and other personal barriers to weight loss. Low-calorie meal replacements are available at some UPMC bariatric locations. Many people who struggle with their weight find that lifestyle changes - such as following a healthy eating plan and getting regular exercise - can help them lose weight and keep it off.
Medically supervised weight-loss medicines work in different ways. Some help curb your appetite or make you feel fuller sooner. Others are designed to make it harder for your body to absorb fat from the foods you eat. UPMC’s weight loss experts will work with you to create an effective plan for healthy, non-surgical weight loss. After being medically evaluated, you’ll work with a registered dietitian/nutritionist to create and follow an effective diet plan. You’ll also receive counseling to help you change your behavior and lifestyle.
Risks and Considerations
As with any medical procedure, there are risks and complications associated with using body contouring devices. Each technology has its own set of risks and may have certain limitations on who can be treated safely. Minor complications may occur shortly after a procedure and last only a short time. However, some complications may last a long time, become permanent, or require surgery to correct.
Complications reported for all body contouring devices may include:
- Pain or discomfort
- Redness
- Swelling
- Bruising
- Nodules (lumpiness you can feel but not see)
Before undergoing any non-invasive weight loss treatment, it is essential to consult with a qualified healthcare professional to determine the most suitable option based on individual health status and weight loss goals.