Effect of Electroacupuncture on Central Obesity and Fatty Liver in Postmenopausal Women: A Randomized Controlled Trial
Phase: NA
Conditions: Postmenopausal Women
Sponsor: Cairo University

Ethical comitee number approval: 012/005973 Document 
Date: July 5 , 2025
 
 
 
EFFECT OF ELECTROACUPUNCTURE ON 
CENTRAL OBESITY AND FATTY LIVER IN 
POSTMENOPAUSAL WOMEN
 
 
 
 
 
 
 
By 
Mohamed Abdel Hamid El Maghwary ElGaedy 
 
 
 
 
 
 
 
 
 
 
 
Submitted in Partial Fulfilment for The Requirements of Doctoral Degree in 
Physical Therapy Department for Women’s Health 

Faculty of Physical Therapy 
Cairo University 
2025 
 
 
Supervisors 
 
 
 
Prof. Dr. Mohamed Ahmed Mohamed Awad 
Professor of Physical Therapy for Women’s Health 
Faculty of Physical Therapy 
Cairo University 
 
 
 
Prof. Dr. Amir Araby Gabr  
  Professor of Gynecology and Obstetrics 
Faculty of medicine 
Cairo University 
 
 
 
Prof. Dr. Doaa Ahmed Mohamed Osman  
 Assistant Professor of Physical Therapy for Women’s Health 
Faculty of Physical Therapy 

Cairo University 
 
 
 
Chapter I 
Introduction            
            Menopause is defined as 
a permanent interruption of 
menstruation, because of limited endometrial stimulation by estrogens 
and the end of the ovarian follicles. The estrogen reduction happened 
especially during the first year of amenorrhea (Rannevik et al., 2004). 
Estradiol levels being reduced to near 75% in postmenopausal period than 
menstrual women (Barret and Stuenkel., 2009).  
           Obesity is a chronic condition that can cause multiple 
metabolic diseases, obesity problems will cause both economic and 
medical burdens in the long run. Obesity can be categorized into 
generalized and abdominal obesity (also known as central obesity). 
Central obesity is deﬁned as the accumulation of excessive fat in the 
abdomen compared with the lower extremities and hips (Adiels et al., 
2010). 
           Fatty liver disease encompasses a spectrum of liver conditions, 
ranging from simple fatty liver to steatohepatitis. It is associated with 
visceral adiposity and metabolic syndrome, and its prevalence is as high 
as that of type 2 diabetes (Diehl and Day, 2017).        
         The pathogenesis of fatty liver disease is primarily attributed to the 
accumulation of fat in the liver, which is typically associated with various 
metabolic abnormalities. Insulin resistance (IR), a critical factor in the 
pathogenesis of fatty liver disease, leads to an increase in de novo lipid 

synthesis, promotes the transport of fatty acids to the liver, inhibits the β-
oxidation of free fatty acids (FFA), thereby further contributing to the 
accumulation of hepatic lipids. So, central obesity and fatty liver 
increases body mass index (BMI), Waist circumference, Waist-hip ratio, 
Cholesterol, Triglyceride, low-density lipoproteins (LDL) and high-
density lipoproteins (HDL) (Li and Xu, 1999).  
In China in the 1960‟s, electro-acupuncture (EA) was introduced 
into clinical practice, especially for the treatment of chronic pain and 
neurological diseases (Stux and Pomeranz, 1998). 
  
Acupuncture is a treatment method used in Traditional Chinese 
Medicine (TCM). Acupuncture has been used for the treatment of 
neurological and musculoskeletal diseases such as intervertebral disk 
disease and spinal cord (Stener-Victorin et al., 2013). 
According to traditional Chinese medicine there are more than 
2,000 acupuncture points on the human body, and these connect with the 
twelve main and two of eight extra pathways called meridians (channels). 
In practice, however, a typical acupuncturist may only use 150 points. 
Traditionally each acupuncture point has defined healing (therapeutic) 
actions. Western acupuncture uses the same needling technique but is 
based on affecting nerve impulses and the central nervous system (Ahsin 
et al., 2009). 
Statement of the problem: 
Does electroacupuncture has an effect on central obesity and fatty 
liver in postmenopausal women? 
Purpose of the study: 

The aim of this study is to determine the effect of 
electroacupuncture on central obesity and fatty liver in postmenopausal 
women. 
 
 
Significance of the study: 
           Post menopause is the time after you’ve been without a menstrual 
period for 12 months. It lasts for the rest of your life. During this stage, 
menopausal symptoms, such as hot flashes, get milder or go away 
(Chang and Lewis, 2023).  
Electro-acupuncture has a major advantage that it’s the margin of 
error in needle placement for electro-acupuncture is greater than for 
manual therapy and therefore a less accurate placement is required, as the 
current spreads and may reach a nerve several millimeters away (Stux 
and Pomranz, 1998). 
In electro-acupuncture, the therapist inserts the acupuncture 
needles in acupuncture points and electric current is connected to the 
body through the acupuncture needles (Ahsin et al., 2009). 
Electro-acupuncture treatment helps in decreasing blood lipids in 
patients with fatty liver disease and plays a significant role in improving 
the immunity system in patients with hepatitis in addition to improving 
their clinical symptoms. Previous clinical studies in China indicated that 
electro-acupuncture able to decrease total cholesterol (TC), triglycerides 
(TG), LDL, and elevate HDL in patients suffering from dyslipidemia 
(Steven and William, 2007). 
Delimitations: 

This present study will be delimited by the following aspects: 
1- Subjects: 
Sixty obese postmenopausal women will be recruited from the 
outpatient clinic of gynecology department in Kasre El Ainy University 
Hospital in Cairo, Egypt. 
2- Instruments: 
A- Standard weight height scale. 
B- Tape measurement. 
C- Red kites blood. 
D- Brahminy kites blood. 
E- Electro acupuncture. 
3- Outcome measures: 
A- Measurement of weight, height and BMI. 
B- Measurement of waist circumferences, hip circumferences and 
waist/hip ratio. 
C- Assessment of liver function test serum glutamic oxaloacetic 
transaminase (SGOT) and serum glutamic pyruvic transaminase 
(SGPT). 
D- Assessment of lipid profile (TC, TG, LDL, and HDL). 
4- Interventions:  
   Group A (Control group) will be treated by medical treatment in 
addition to hypocaloric diet (1200 kcal/day) for 12 weeks.   
   Group B  (Intervention group) will receive the same medical treatment 
and hypocaloric diet (1200 kcal/day) as Group A, in addition to 
electroacupuncture sessions administered three times per week for 12 
weeks.   
Limitations: 

This study will be limited to the following criteria: 
1- Psychological status. 
2- Cooperation of the patients may affect the result of the study. 
3- Environmental factors that may have affected the patient's 
response. 
4- The daily effort may affect the result of the study. 
Basic assumptions: 
It will be assumed that: 
1- All potential participants will show adequate cooperation with 
study procedure. 
2- All patients will follow the instructions that will be given to them. 
3- The results obtained from this study would be of value in physical 
therapy. 
Null Hypothesis: 
There will be no effect of electroacupuncture on central obesity and fatty 
liver in postmenopausal women. 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
Chapter II 
Literature review 
             Post menopause is defined retrospectively after 12 consecutive 
months of amenorrhea. It represents the end of the reproductive period 
and ovarian failure. A decrease in estrogen leads to several changes in the 
short and long term. Among the early changes, vasomotor symptoms (hot 
flashes) are particularly common, occurring in about 70% of women 
(Helena et al., 2023). 
       Menopause is a cycle that happens spontaneously or is medically 
induced in women to mark the end of their ability to reproduce (Nikpour 
and Haghani, 2014).  
           In comparison to medically induced menopause, natural 
menopause is a progressive cycle with permanent cessation of 
menstruation which is determined 12 months after the last menstrual 
period, which occurs in most women between 47 and 55 years of age 
(Lee et al., 2011). 
Symptoms and causes: 
          Many people in post menopause feel lingering symptoms from 
menopause, although the symptoms are usually less intense. Lingering 
symptoms occur due to low levels of reproductive hormones. Some 
people have no symptoms in post menopause (Chang et al., 2023). 
Common postmenopausal symptoms include: 

• Hot flashes and night sweats. 
• 
Vaginal dryness and pain during sex. 
• 
Depression. 
• Changes in sex drive (low libido). 
• 
Insomnia. 
• Dry skin. 
• Weight changes. 
• 
Hair loss. 
• 
Urinary incontinence (Koothirezhi and Ranganathan, 2023). 
              The risks of excess body weight and related comorbidities are 
influenced by diet, physical inactivity, perceptions of health, and cultural 
beliefs. The World Health Organization15 claims that lack of physical 
activity, for example, has been recognized as the fourth major cause of 
global death, accounting for 27% of diabetes cases, and about 30% of 
ischemic heart disease cases (Li et al., 2023). 
            Menopause is associated with increased cardiovascular disease 
and once women develop acute coronary symptoms, they have worse 
short‐ and long‐term outcomes than men (Ng, 2007). 
       Many different factors contribute, including marked hormonal 
changes changes in metabolic profile associated with increased risk of the 
metabolic syndrome and relative increase in intra‐abdominal fat with age 
( Pasquali et al., 1997). 
           Accumulation of intra‐abdominal fat is associated with increased 
waist circumference and liver fat overproduction of very low‐density 
lipoprotein (VLDL), and decreased catabolism of apolipoprotein (apo)B‐
containing particles in men (Pou et al., 2009). 

         Although abdominal obesity tends to be associated with obesity in 
men, data from the United States have been used to estimate that 40% of 
women have an abdominal fat distribution pattern as defined by waist:hip 
ratio (Chan et al., 2002). 
        Hypertriglyceridemia is associated with atherogenic dyslipidemia 
including the production of small dense LDL, lower HDL cholesterol, 
and accumulation of postprandial TG‐rich lipoproteins. In men with type 
2 diabetes, the secretion of VLDL1 is associated with liver fat, 
hypertriglyceridemia, and increased atherogenic risk (Meigs et al., 2003). 
Obesity in postmenopausal women: 
        Women have an increased tendency to gain weight after menopause. 
The increase of body fat and central obesity may be due to hormonal 
changes occurring during or after the menopausal transition. The decline 
of endogenous estrogen and decreased physical activity are the major 
causes of these phenomena. The insufficiency of estrogen? leads to 
decreased basal metabolic rate and energy expenditure (Nieves et al., 
2003). 
           Postmenopausal overweight and obesity increases the risk of 
hypertension, coronary artery disease, diabetes, and mortality.The 
incidence of excess body weight among women is increasing worldwide 
to epidemic proportions (Abate and Garg, 2005). 
          The arrival of the menopause in middle age is associated with a 
tendency to gain weight. It is estimated that the prevalence of obesity 
among women aged 40–59 years in the United States is approximately 
38.2%, while the prevalence of overweight and obesity is 66.3% (Lakka 
et al., 2002). 

         Obesity is the most prevalent nutrition-related disorder in Western 
countries, and the prevalence of overweight and obesity is increasing 
worldwide at an alarming rate affecting both developed and developing 
countries (Hall, 2004). 
          Although increasing BMI is a powerful predictor of metabolic 
disease risk, individuals with the same BMI may have greatly different 
amounts of visceral (central or abdominal) fat, the adipose tissue depot 
known to be associated with the greatest metabolic risk (Abate and 
Garg, 2005). 
    Abdominal obesity, when accompanied by metabolic derangements, 
including insulin resistance, low HDL, elevated TG, and raised blood 
pressure, significantly increases the predicted cardiovascular disease risk 
and constitutes the well-known metabolic syndrome. Insulin resistance 
and inflammation are the two more common abnormalities that link 
obesity with adverse metabolic changes (Festa et al., 2000). 
        The rapid increases in overweight and obesity are multifactorial and 
only partly attributable to changes in lifestyle practices. The prevalence 
of obesity is typically higher in females than males globally. Moreover, 
weight gain, with an increase in body fat percentage and a concomitant 
redistribution of fat accumulation from peripheral locations toward 
increased intra-abdominal depots, is common after the menopause. This 
timing suggests that the female sex steroid pattern is important in adipose 
tissue metabolism and highlights the role of sex hormones on fat 
distribution, a fact that has been extensively reported (McKinlay et al., 
2002). 
Causes obesity with postmenopausal women: 

        Postmenopausal women have an increased tendencyfor gaining 
weight. It is as yet unclear whether themenopausal transition itself leads 
to weight gain, but is known that the physiological withdrawal of 
estrogen bringsabout changes in fat distribution, together with physical 
inactivity, are probably the major causes of this phenomenon. Other 
contributing factors include ethnicity, reduced lean mass, resting 
metabolic rate and treatment with certain drugs, e.g. steroids, insulin, 
glitazones (Hodson et al., 2014). 
        Moreover, estrogen withdrawal during menopause has a detrimental 
effect on metabolism and bring changes in body fat distribution from a 
gynoid to an android pattern, reduced glucose tolerance, abnormal plasma 
lipids, increased blood pressure, increased sympathetic tone, endothelial 
dysfunction and vascular inflammation (Berry et al., 2003). 
        As a result postmenopausal obesity compounds the situation  leading 
to increased rates of hypertension, diabetes mellitus, coronary artery 
disease and mortality. Additional consequences of obesity may include 
hormone-dependent cancer, gallstones, nephrolithiasis, and osteoarthritis 
withincreased mortality (Basurto et al., 2003). 
Lipid profile of postmenopausal women with central obesity: 
       Following menopause, adverse changes in lipid profile occur and the 
levels of several coagulation factors increase. The lipid profile is a group 
of tests that are often done together to determine risk of CHD. It includes 
TC, HDL cholesterol, LDL- cholesterol and triacylglycerol (TAG). It is 
used to guide health care providers in decision making as to how a person 
at risk should be treated. The scenario of the lipid profile is considered 
along with other known risk factors of CHD to develop a plan of  
treatment and follow-up (Ruppelli,  2002). 

           Obesity is a term commonly used to describe  individual with 
increased body fat. It is associated with an increased risk of 
atherosclerosis, diabetes mellitus and gall bladder disease. Normal fat 
content of body is considered to be 12-18% of body weight in men and 
18–25% of body weight in women (Loverove et al, 2002). 
          Abdominal obesity has been linked to signi-ficant metabolic 
abnormalities including  insulin resistance, hyperinsulinaemia, and 
elevated TAG levels as well as increased incidence of hypertension, 
glucose intole-rance and diabetes mellitus. Abdominal adiposity as 
measured by waist-hip ratio (WHR), is an independent risk factor for 
CHD in men and perhaps also in women (Rexrode et al., 2008). 
         Waist circumference and WHR are important indicators of 
cardiovascular risk even after adjustment for BMI. The increased visceral 
fat mass associated with increased waist circumference is largely the 
result of overall obesity, whereas in case of an increased WHR, the 
increase in visceral fat is due to other factors as well. The prevalence of 
obesity is increasing worldwide. Cardiovascular disease (CVD) remains 
the major cause of death in postmenopausal women. Before menopause, 
women are relatively protected from ischaemic heart disease and 
thromboembolism by their circulating oestrogen, but this protection is 
lost after menopause(Chang et al., 2000). 
         Therefore it is important to study lipid profile in postmenopausal 
women with central (abdominal) obesity. So this study was designed to 
observe the pattern of lipid profile parameters in the postmenopausal 
central obese wome (Loverove et al., 2002). 
Fattyliver in postmenopausal women: 

           Nonalcoholic fatty liver disease (NAFLD) is a chronic disease that 
develops as a result of excessive accumulation of triglycerides in the 
liver. Nonalcoholic fatty liver disease is also a common disease, affecting 
~24% of the global population (Younossi et al., 2018). 
 
  
Development and progression of NAFLD: 
       Nonalcoholic fatty liver disease is defined by the presence of hepatic 
steatosis in the absence of excessive alcohol consumption, certain 
hereditary disorders, and use of medications that may contribute to 
secondary hepatic fat accumulation (Ipsen et al., 2018). 
       Hepatic steatosis arises from an imbalance of fat accumulation and 
disposal, which result from increased de novo lipogenesis and/or hepatic 
fatty acid uptake, and decreased lipid disposal, respectively. Hepatic 
steatosis is defined as liver fat fraction exceeding 5% to 10% by weight 
and is also estimated as the percentage of hepatocytes containing visible 
triglycerides (Kleiner et al., 2005). 
            Estrogen deficiency Levels of 17β estradiol (E2), an endocrine 
hormone produced by the ovaries and circulated in plasma, decline 
significantly following menopause. The impact of estrogen deficiency on 
liver lipid metabolism has been investigated extensively in animal 
models. Aromatase-deficient (ArKO) mice, which lack endogenous 
estrogen production, accumulated abdominal fat and developed abundant 
fat droplets in liver cells of the centrilobular and intermediate zones, 
indicative of hepatic steatosis (Zhong and Tang, 2024). 
Management of obesity in patients with NAFLD: 
Medical treatment: 

Anti-obesity medications: 
        Anti-obesity medications (AOMs) approved by the Food and Drug 
Administration (FDA) for weight loss might be considered as the next 
line of treatment for obesity or obesity-related liver diseases. The FDA 
adopts a figure of at least 5% difference in mean weight loss of 
medication, compared with placebo, to be approved for the long-term use 
in patients with a body mass index (BMI) > 30 kg/m 2 , or those with a 
BMI > 27 kg/m 2 and have one or more obesity-related comorbidities such 
as T2DM, hypertension, and dyslipidemia (Daneschvar et al.,  2016). 
         The current AOMs approved for long-term use include 
phentermine/ topiramate, orlistat, liraglutide and bupropion/naltrexone 
reviewed in detail elsewhere (Acosta et al., 2017).  
         These medications achieved 6 to 11% TBWL over 12 months in 
conjunction with lifestyle modifications (Daneschvar et al., 2016). 
          GLP-1 is an endogenously produced, gut-derived incretin hormone. 
It augments insulin secretion by β-cells and reduces glucagon release. It 
also reduces gastric emptying and food intake. GLP-1 analogs 
demonstrated potency in enhancing insulin sensitivity and reducing body 
weight; thus, improving the overall outcome in patients with NAFLD and 
NASH (Sunyer et al., 2015). 
Physical treatment for central obesity and fatty liver: 
1- Lifestyle modifications through: 
A-Diet: 
           The cornerstone of NAFLD management is weight loss. This 
requires adopting an energy restrictive lifestyle that includes a decrease in 
oral caloric intake and an increase in the body's energy expenditure. 
According to multiple randomized-controlled trials (RCTs), weight loss 

in NAFLD patients led to an improvement in hepatic triglyceride contents 
(determined using an MR) and in NAS (determined by liver biopsy) with 
an accompanied reduction in cardiovascular risk factors such as insulin 
resistance and the level of serum lipid (George et al., 2009). 
 
B-Exercises: 
           Along with the prescription for a reduced-calorie diet, a 
comprehensive lifestyle intervention program should advocate increasing 
aerobic physical activity for ≥ 150 min per week (such as brisk walking 
for ≥ 30 min/d most days of the week), and a goal of > 10,000 steps per 
day. Higher levels of physical activity, approximately 200 to 300 minutes 
per week, are recommended to maintain weight loss or minimize weight 
regain for long term (> 1 year) (Hannah and Harrison, 2016). 
2- Electroacupuncture: 
          Acupuncture has been the subject of active scientific research since 
the late 20th century, but it remains controversial among medical 
researchers and clinicians (Ernst et al., 2007). 
Point selection, location and application: 
         There are tender areas at certain points of the body surface with all 
diseases, regardless of whether they are physical or mental, which 
disappear when the illness is cured. There are acupuncture points. 
Jayasuria (1993) stated that the use of acupuncture points to treat 
diseases of local and adjacent areas is one of the key principles in the 
practice of acupuncture therapy. It is the first consideration that should 
govern the selection of the acupuncture points for any regional disease. 
The local points are the most effective points in treating a majority of 

disorders. Every acupuncture point has a local effect on the surrounding 
tissues (Stux and Pomeranz, 1998). 
Location methods for body acupuncture : 
There are various methods for locating acupuncture points : 
Anatomical approach: many acupuncture points are situated at clearly 
defined anatomical locations, for example in depressions, at muscle and 
tendon insertions, in grooves, at joint clefts, at bony prominences, etc. 
Proportional measurements: when trying to locate points not situated at 
any prominent structures, Chinese medicine applies the proportional cun 
measurement. 
Electric tools: these measure the electric resistance of the skin in order to 
find the correct location of the points. Generally, electric resistance is 
lower in the immediate area around the point (Steven and William, 
2007). 
 
 
 
 
 
 
 
 
 

 
 
 
Chapter III
 
Subjects, Materials and Methods  
Design of the study: 
The study is designed as a prospective, randomized, pre-post test, 
controlled trial. 
I- 
Subjects: 
Sixty obese postmenopausal women will participate in this study to 
determine the effect of electroacupuncture on central obesity and fatty 
liver. They will be selected randomly from the Outpatient Clinic of 
gynecology department of Kasre El Ainy University Hospital, in Cairo, 
Egypt on the following criteria: 
Inclusion criteria:  
1- Their ages will be ranged between 50 and 60 years old. 
2- Their body mass index will be ranged from 30-40 kg/m2. 
3- SGOT more 40 U/L. 
4- SGPT more 40 U/L. 
5- Waist/Hip Ratio more 1 cm. 
6- Triglyceride more 150 mg/dl. 
7- Cholesterol more 200 mg/dl. 
8- LDL more 100 mg/dl. 
9- HDL less 40 mg/dl. 
Exclusion criteria: 

Women will be excluded if they have one of the following criteria: 
1- Cancer. 
2- Concomitant cardiovascular disorders. 
3- Respiratory, renal and liver dysfunction. 
They will be randomly distributed into two equal groups: 
Group (A) (Control group): 
It will be consisted of thirty obese postmenopausal women. They will be 
treated by medical treatment in addition to hypocaloric diet (1200 
kcal/day) for 12 weeks.   
Group (B) (Study group): 
It will be consisted of thirty obese postmenopausal women who will 
receive the same medical treatment and hypocaloric diet (1200 kcal/day) 
as Group A, in addition to electroacupuncture sessions administered three 
times per week for 12 weeks.   
II- 
Instrumentations: 
A- Evaluation instrumentations: 
1- Informed consent form: (Appendix I). 
2- Recording data sheet: 
It will be used to record all data of each woman before starting this study 
(Appendix II). 
3- Standard weight height scale: 
It will be used to measure weight and height to calculate the body mass 
index (BMI) for each woman in both groups (A&B) before and after 
treatment through this equation: 
BMI= body weight (Kg) / square of body height (m2) = Kg/m2. 
4- Tape measurement:  

It will be used to measure waist and hip circumferences to calculate the 
waist/hip ratio for each patient in both groups (A&B) before and after 
treatment, Fig (1). 
 
Fig. (1): Tape measurement. 
5- Red kites blood: 
It will be used to assess the level of liver function test (SGOT and SGPT) 
for each woman in both groups (A&B) before and after treatment. 
6- Brahminy kites blood: 
It will be used to assess the level of lipid profile (TC, TG, LDL, and 
HDL) for each woman in both groups (A&B) before and after treatment. 
B- Treatment instrumentation: 
1- Electro acupuncture (SDZ- Chinese): 
       Electro acupuncture device (No 18 Huatuo Rd., Suzhou New 
District, china) power supply: 6 * 1.5 V (AA UM3) battery or (AC 
Adaptor (output DC9V, 200Ma), input power: 10.0 VA, output power: 
0.3 VA, output frequency: 1- 100HZ. It will be used for treatment of all 
women in study group B, 3 sessions/week for 12 weeks, Fig. (2). 

 
Fig. (2): Electro acupuncture. 
III- Procedures: 
All women will be given a full explanation of the protocol of the study 
and consent form will be signed for each woman before participating in 
the study, the purpose and nature of the study will be explained to all 
women. 
A- Evaluation procedures: 
1. BMI: 
Weight and height measurements will be measured while the patient is 
wearing a thin layer of clothes to calculate the BMI according to the 
following equation before and after treatment for both groups: 
BMI = weight/height2 (kg/m2) (Hamilton et al., 2015). 
2. Waist/Hip Ratio: 
Waist circumference will be measured at the narrowest point between 
xipho-sternum and the iliac crest at the end of a gentle expiration; hip 
circumference will be measured at the maximum circumference at the 
level of the femoral trochanter. Then, the waist /hip ratio will be 
calculated by dividing waist circumference by hip circumference (Ross et 

al., 2008). This will be taken for all patients in both groups (A&B), while 
she is in the standing position, before and after treatment (12 weeks). 
3. Blood analysis: 
Blood samples will be collected from the antecubital vein of each woman 
both before and after the treatment period. Samples will be centrifuged 
within 8 hours of collection. The obtained serum will be stored at −20°C 
and later analyzed for liver function tests (SGOT and SGPT) as well as 
lipid profile parameters (Tilburt and Kaptchuk, 2008). 
B- Treatment procedures: 
1- Medical treatment: 
It will be given for all women in both groups in the form of orlistat (120 
mg capsule, 3 times before the meal and phentermine (15 mg capsule, one 
time before the meal). (Guerciolini, 1997 and Greydanus et al., 2011). 
2- Hypocaloric diet: 
All women in both groups (A and B) will be instructed to follow the same 
hypocaloric diet, as prescribed by a certified nutrition specialist, with a 
daily caloric intake of 1,200 kcal for a duration of 12 weeks (Evert et al., 
2014) (Appendix III). 
• Carbohydrates: Approximately 55% of total caloric intake will be 
derived from complex carbohydrates rich in dietary fiber and low in 
glycemic index. Each participant will consume 170–240 grams of 
carbohydrates per day, emphasizing whole grains, legumes, and 
vegetables. 
• Fats: Fat will comprise 15% of the total caloric intake, and each 
patient will be advised to consume between 60 and 100 grams of fat 
per day. 

• Proteins: Approximately 30% of the total caloric intake will come 
from protein. Each patient will be instructed to consume between 30 
grams of protein per day, sourced from low-fat meat, fish, or other 
high-protein foods. 
• Fiber: Each patient will be advised to consume about 20 to 35 
grams of fiber per day. 
• Dietary restrictions: Patients will be advised to avoid increased 
amounts of salt (to prevent effects on blood pressure), as well as tea 
and caffeine. 
3- Electroacupuncture: 
All women in group B will be treated by electroacupuncture, 3 times per 
week for a total duration of 12 weeks. Each session will begin with the 
woman lying in a supine position on the treatment bed, with the abdomen 
and lower limbs exposed for proper skin disinfection. Sterile verum 
acupuncture needles (asia-med Special No. 16, 0.30 × 0.30 mm) will be 
inserted into a total of eight standardized acupoints, selected for their 
efficacy in central obesity and weight management. The insertion depth at 
each point will range between 10–25 mm, depending on anatomical 
location. 
Following needle insertion, electrical stimulation will be applied 
using a low-frequency current (2 Hz) with a pulse width of 0.5 ms, 
targeting the abdominal area for 30 minutes per session. 
The selected acupoints will include: 
• Central obesity-related points: Daheng (SP-15), Daimai (GB-26) 
• Body weight regulation points: Zusanli (ST-36), Sanyinjiao (SP-6), 
Tianshu (ST-25), Fenlong (ST-40), Zhongwan (CV-12), Qihai (CV-6) 
 

Table (1): The acupuncture points and its locations: 
Acupuncture 
points 
Locations 
Tianshu (ST-
25) 
2-in. lateral to the AML level with the umbilicus (CV 8) 
Daheng (SP-
15) 
4-in. lateral to the center of the umbilicus (CV 8) lateral to rectus 
abdominus 
Daimai (GB-
26) 
Directly below LV 13 at the crossing point of a vertical line through 
the free end of the 11th rib and a horizontal line through the 
umbilicus (level with CV 8) 
Qihai (CV-6) Midway between CV 5 and CV 7, 1.5-in. below CV 8 (umbilicus) 
Zhongwan 
(CV-12) 
Midway between CV 8 and CV 16, 4 -in. above CV 8 (umbilicus) 
Zusanli (ST-
36) 
3-in. below ST 35, one finger width lateral from the anterior border 
of the tibia 
Fenlong (ST-
40) 
8-in. below ST 35, one finger width lateral to ST 38, two finger 
widths lateral to the anterior border of the tibia 
Sanyinjiao 
(SP-6) 
3-in. directly above the tip of the medial malleoulus on the posterior 
border of the tibia 
Statistical analysis: 
• The data will be collected and statistically analyzed by using the 
following: 
• Descriptive statistics and unpaired t-test will be conducted for 
comparison of the demographic data between both groups. 
• Unpaired t-test will be conducted for comparison of mean values of 
pre and post-treatment between groups. 
• Paired t-test will be conducted for comparison between pre and post-
treatment mean values in each group. 
• The level of significance for all statistical tests will be set at p < 0.05. 
 

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Appendix I 
Informed consent form 
             I am Misses /                                                  freely and 
voluntarily consent to participate in research study under the direction of 
the researcher /Mohamed Abdel Hamid Elgaedy. A thorough description 
of the procedures has been explained and I understand that I may 
withdraw my consent and discontinue participation in this research at any 
time without prejudice to me. 
Participant:                                                                                    Date: 
……………………….                                                   …………………..                           
 
 اﻗــــــــــــﺮار
 

 /أﻗﺮ اﻧѧﺎ اﻟﺴѧﯿﺪة
..……………………………
  
اﻟﻤﻮﻗﻌѧﺔ أدﻧѧﺎه ﺑѧﺈرادﺗﻲ ﺑѧﺄﻧﻨﻲ ﻣﻮاﻓﻘѧﮫ 
ﺑﺤﺮﯾﺔ وﺗﻄﻮع ﻋﻠﻲ اﻟﻤﺸﺎرﻛﺔ ﻓﻲ اﻟﺒﺮﻧﺎﻣﺞ اﻟﺒﺤﺜﻲ ﺗﺤﺖ إﺷﺮاف وﺗﻮﺟﯿѧﮫ ﻣѧﻦ اﻟﺒﺎﺣѧﺚ/ 
ﻣﺤﻤѧﺪ ﻋﺒѧﺪ 
اﻟﺤﻤﯿﺪ اﻟﺠﻌﯿﺪي 
 
وذﻟﻚ ﻣﻦ ﺧﻼل وﺻﻒ وﺷﺮح اﻻﺧﺘﺒﺎرات وﻣﻌﺮﻓﺘﻲ ﺑﺄﻧﻨﻲ ﯾﻤﻜﻦ أن أﻧﺴѧﺤﺐ ﻣѧﻦ 
اﻟﻤﺸﺎرﻛﺔ ﻓﻲ أي وﻗﺖ ﺑﺪون أي ﺿﺮر ﻟﻲ.
 
 
             اﻟﺘﻮﻗﯿѧѧѧѧѧѧѧѧѧѧѧѧѧѧﻊ                                                                                       اﻟﺘѧѧѧѧѧѧѧѧѧѧѧѧѧѧﺎرﯾﺦ
    
.............
........................                                                                    ............
 
Appendix II 
Recording data sheet 
 
Number: 
Name: 
Group: 
Age: 
Address: 
Occupation: 
 
 
 
 
Group  
 
Control treatment 
 
Intervention treatment 
Weight 
 
 

Height 
 
 
BMI 
 
 
TC 
 
 
TG 
 
 
LDL 
 
 
HDL 
 
 
SGOT 
 
 
SGPT 
 
 
 
Appendix III 
Hypocaloric Diet (Evert et al., 2014)
   
 
   
          

   
 
  Calories:1200 
Total fat: 15% 
 
 Total Carb: 55% 
 Avoid salt, tea, caffeine 
Protein: 30% 
Fibers:20-25gm/day