Low-level laser therapy and lorcaserin aids weight loss

A randomised, open-label pilot of the combination of low-level laser therapy (LLLT) and lorcaserin has found that the procedure is safe and appears to target central adiposity, which resulted in a reduction in waist circumference. However, the study authors from the Mayo Clinic note that additional, larger studies with a longer duration of treatment and follow-up is required to assess the safety and efficacy of LLLT in the treatment of obesity.

According to the authors, low-level laser therapy (LLLT) is a non-invasive body-contouring procedure designed to remove excess fat without emitting heat, sound, or vibrations. The therapy has been used as an adjunct in lipolysis. Energy from the lasers (1.2 to 3.6 Joules/cm2) is proposed to permeabiliae adipocyte membranes, resulting in extravasation of intra-adipocyte lipids.

Lorcaserin is a selective serotonin 2C (5-HT2C) receptor agonist and activation of the 5-HT2C receptor subtype in the hypothalamus increases pro-opiomelanocortin (POMC) production leading to weight loss through satiety. Lorcaserin is FDA-approved for weight management in individuals with a BMI>2 when accompanied by comorbidities or in people with a BMI>30.

The purpose of this study was to evaluate the safety, feasibility, and preliminary efficacy of LLLT alone or in combination with lorcaserin for reducing anthropomorphic meaures of obesity. Biomarkers and adherence to treatment were also measured to provide guidelines for potential future investigations.

A total of 44 patients (BMI27–39.9) were enrolled in this open-label clinical trial in which participants were randomised to one of three treatments: (1) Lorcaserin 10mg by mouth twice a day for 12 weeks; (2) LLLT administered for one hour once a week for 12 weeks; or (3) combination therapy with lorcaserin and LLLT for 12 weeks.

Erchonia Zeron 2.0 Laser

The laser used in this study was an Erchonia Zeron 2.0 Laser consisting of a multiple-head low-level diode laser with six independent diode laser heads. Each diode emits 532 nm (green) laser light. In the active LLLT [25] each diode generates a 17 milliwatt (mW) output. In this trial, participants engaged in weekly treatments for 12 weeks. Lasers were focused around the stomach and abdomen for 30 minutes and then aimed at the central region of their back for another 30 minutes. This was done once a week for 12 weeks for a total of 12 treatments. All study participants assigned to the laser were given instructions to wear body constricting undergarments during the 12 weeks of treatment and to drink plenty of fluids. Participants were administered 10mg orally twice daily for 12 weeks.

The majority of participants were females (84 %), married or living as married (64 %), with at least some college education (95 %); their average age was 43.9 years (range 22 to 64 years). No significant differences were detected between the groups at baseline.

Outcomes

The majority of the 44 participants accrued to this study were female (84 %) with an average age of 43.9 years (range 22 to 64 years). Most participants (93% LLLT alone, 87% LLLT + lorcaserin) completed at least 80% of the LLLT treatments. From baseline to end of treatment, significant reductions in waist circumference were noted for each treatment group (-2.3 ± 4.1 cm, -6.0 ± 7.3 cm, and -4.0 ± 5.5 cm for LLLT, lorcaserin and combination respectively); however, the reduction in body weight was only significant in those receiving lorcaserin and combination treatment (-0.4 ± 1.5kg, -1.3 ± 1.2kg and -1.3 ± 1.3kg). No significant differences were noted between the groups. Self-reported satisfaction was higher in the lorcaserin versus the LLLT group.

At week 12, a significant decrease in WC from baseline to end-of-treatment (week 12) was observed for all treatment groups (-2.3 ± 4.1cm, -6.0 ± 7.3cm, and -4.0 ± 5.5cm for the LLLT, lorcaserin, and combination groups, respectively; p<0.05). Significant reductions from baseline to week 12 were also observed for weight, BMI, and HC in the lorcaserin and combination groups. No significant differences were observed between treatment groups for any of the body measures assessed.

At six months, the mean change in weight from baseline was negative for all treatment groups, and significantly different from baseline for the combination group (-1.4 ± 3.6 kg, p=0.154; -2.4 ± 5.1kg, p=0.097; and -2.0 ± 3.5kg, p=0.045 for LLLT, lorcaserin, and combination groups, respectively). The change in weight from baseline to six months for the combination group was not significantly different from LLLT (p=0.773) or lorcaserin (p=0.775). The mean change in WC from baseline to six months was also negative for all treatment groups (-2.8 ± 4.3 cm, p=0.023; -5.1 ± 8.8 cm, p=0.051; and -2.8 ± 5.2 cm, p=0.059 for LLLT, lorcaserin, and combination groups, respectively). The change in WC from baseline to six months for the combination group was not significantly different from LLLT (p=0.942) or lorcaserin (p=0.424).

In the LLLT monotherapy, a significant decline between baseline and end of treatment occured in white blood cells and neutrophils. A significant decrease in triglycerides was observed in the lorcaserin monotherapy. In the combination therapy group, significant decreases in neutrophils and total cholesterol were observed. No differences were observed between groups (p>0.05).

In the LLLT group, 93 % (14/15) attended at least 80 % of the treatments. In the lorcaserin group, 86 % (12/14) took at least 80 % of the dispensed doses. In the combination group, 73 % (11/15) took at least 80 % of the dispensed dose and 87 % (13/15) attended at least 80 % of the LLLT treatments. Among participants providing information at end of treatment, 50 % (7/14) in the LLLT group and 50 % (6/12) in the combination group reported complying with the body constricting undergarment recommendation; while 50 % (7/14), 69 % (9/13), and 58 % (7/12) (LLLT, lorcaserin, and combination groups, respectively; P = .605) indicated that they increased their water intake.

Among the 3 treatment groups (LLLT, lorcaserin, and combination therapy), 29 % (4/14), 54 % (7/13), and 75 % (9/12), respectively, indicated that they reduced their caloric intake (P = .063); 64 % (9/14), 85 % (11/13), and 92 % (11/12) indicated that they made dietary modifications (P = .224); and 43 % (6/14), 54 % (7/13), and 58 % (7/12) indicated that they increased their physical activity level (p=0.784).

Overall satisfaction with the program was reported as “satisfied” or “extremely satisfied” by 29 % (4/14) in the LLLT group, 100 % (13/13) in the lorcaserin group, and 92 % (11/12) in the combination group (p<0.001).

The authors also noted that patient satisfaction with LLLT was low and they hypothesised that this may be related to unrealistically high expectations surrounding its utility. They note that less than half of the subjects assigned LLLT adhered with the behavioural intervention instructions related to their behaviour changes (i.e., wearing the restrictive undergarments during the treatment weeks and drinking plenty of water), and the investigators speculate that the “study participants assumed that the LLLT would take care of their weight loss with little or no lifestyle changes on their part.”

“While there has been some concern regarding the safety of LLLT, in this small pilot study we did not find any indication of harmful effects based on the biomarkers or self-reported side effects, which provides some initial support for LLLT being a safe intervention, the authors conclude. “It appears that LLLT targets central adiposity, and our finding of reduction in waist circumference supports this premise.”