Cellulite: The Battle of the Bulge

by

Jill Rapuzzi

 
In society today it seems the goal of many Americans is to be thin. In their hope of achieving this so-called perfection, it means taking extreme measures to get there. A common complaint of most women in their quest for thinness is trying to combat cellulite, a word that makes them cringe. It seems to plague women (rarely ever effecting men) of all shapes and sizes and usually resides in the hips, thighs and buttocks regions, and sometimes even the triceps and lower abdomen areas. By common definition, "cellulite is lumpy unevenly distributed bulges of fatty tissue which often have a cottage cheese consistency. It is composed of gel-like lumps of water, fat and residues of toxic substances that should have been eliminated from the body." (http://www.beautiful-body.com/) So in other words, cellulite is the way in which fat is arranged underneath the skin. Its lumpy appearance is due to fatty tissue trapped in spaces between connective tissues called septa. The amount of cellulite an individual has is mostly due to genetic composition. Cellulite is extremely difficult to get rid of because it is caused by excess fat whose surrounding net-like fibers are very weak. This causes the fat to bulge in between the fibers and under the skins surface, making it a multi-faceted problem.

During the 90's new revolutionary treatments for cellulite are invented every day. Because cellulite is so difficult to lose, women are willing to try almost any solution even if it sounds ridiculous. Today the methods are endless, beginning with unbelievable thigh creams that claim to reduce the size of your thighs. Next, salons are performing cellulite massages and using body wraps to change the appearance of cellulite. Liposuction and Endermologie are another quick but expensive fix. Finally ,there is the dreaded and most rigorous method which most females hope to avoid due to the time and willpower commitment, diet and exercise. So amongst all of these treatments, many women would like to know, which one works? What is worth the time and money at this point? Instead of wasting money or dreaming up another drastic worthless measure, read on to find the facts and end the battle to find a crazy solution.

When thigh cream first hit the market, women went crazy. It sounded amazing to be able to apply a cream twice daily and watch your thighs shrink without dieting or exercising, a true miracle. Most thigh creams main ingredient is aminophylline, a vasodilator used in asthma medications. It is said that beta-adrenergic stimulation increases the cyclic adenosine monophosphate (cAMP) concentrations of fat cells, which stimulates lipolysis. Aminophylline is said to increase cAMP concentrations by blocking an enzyme phosphodiesterase, which usually degrades cAMP. By using cream with aminophylline it will block phosphodiesterase which will increase cAMP which in turn with increase regional lipolysis or fat reduction in that area. (Dickinson, pg.292) This is the basis of how thigh creams claim to shrink the girth of thighs.

Among the many thigh creams on the market, I found one called Forever Young Body Perfecting Lotion. They claim, "this lotion reduces cellulite and fatty tissues while strengthening connective tissues in the skin. The softening and moisturizing aspects of this lotion are wonderful. It has the amazing ability to actually shape and contour parts of the body returning them to their youthful shape and appearance." (http://carlosdhea.simplenet.com/p3.html) The website continues to explain how the cream actually breaks down the fat with a specific form of aminophylline called theophylline. The scientific explanation they use is very difficult for individuals uneducated about medicine to follow. Also, they make no references to medical research on their product and provide us with no evidence of the products effectiveness. They claim that a topical cream can actually burn fat and cause weight loss, and that the addition of exercise makes the results incredible. The website attempts to sound scientific and they even add some herbal ingredients to make their product sound natural. Overall, they give the reader no facts about actual results from test trials, leaving this miracle cream totally unsubstantiated.

In my internet search for information on cellulite, I did find some medical and substantiated information. I came across a short page refuting thigh creams that actually sited a research study. It did not mention the particular cream used but it did contain aminophylline, the supposed miracle asthma medication. It said, "in this research study of thigh cream, 12 women used it over a 6 week period. Their thigh circumference was reduced by about half an inch. A summary of this study appeared a year ago in Obesity Research, but the full study has never been released, according to the University of California at Berkeley Wellness Letter." (www.delicious-online.com/D_backs/Jan_95/thigh_creams.bs.html) This seems slightly suspicious that the real results were never released, and the Wellness Letter also reported that most thigh creams sold on the market actually contain less aminophylline than the amount used in the cream in this particular study. So thigh creams sold to the public may not even result in this much reduction in thigh size if they contain less aminophylline. Also according to this site, when using thigh cream the fat does not necessarily disappear but it relocates to another part of your body. So if you apply the cream to your buttocks, the fat would be displaced elsewhere. This may sound great but the real problem with thigh creams is that the results are temporary. The minute the application process is ended the fat is returned to its original location. This same website also mentions liposuction and massage techniques saying that even though these methods may break down the connective tissue reducing the appearance of cellulite for a while, they will eventually reconnect so its not a permanent solution.

Further, I decided to investigate thigh creams from a more medical standpoint. I actually had a difficult time finding any sited studies on thigh creams. One I did find was in the medical journal, The Annals of Pharmacotherapy. There I located a review of 2 specific studies of thigh cream effectiveness and safety. Both studies were randomized, double-blind, placebo-controlled studies done to evaluate the efficacy and safety of the revolutionary aminophylline miracle thigh creams. The first study involved 6 women whom weighed 20% more than their desired weight. All six women were put onto a strict liquid diet and exercise program for a 4 week period. The aminophylline cream was applied to one thigh and a placebo cream applied to the other thigh. After the 4 week trial period reductions in thigh girth had a mean +/- SD 1.5+/-0.77 cm greater decrease in the thigh with the aminophylline cream. (Dickinson, pg.292) Therefore, the cream did produce statistically significant results. However, the review states that although this study was well-designed, its methods for interpreting results were not so good. It was not reported how or with what methods the thighs were measured, or whether the participants were clothed or not. Where on the thigh measurements were taken was also not mentioned. With centimeter amounts of girth change, these could be due to incorrect measurements or perhaps discrepancies in before and after methods of measurement. No adverse side effects were reported by any participant. The second study had very similar results and it did not incorporate any diet or exercise program.

Another issue raised in the review of these studies is that they do not follow the participants after the study to determine long-term results and long-term safety. It is unknown the effects of using this product for a long period of time. Also these studies fail to determine if the reduction in thigh girth continued after the use of the cream was ceased. The conclusions made by both of these studies are as follows, "The data supporting the safety and efficacy of aminophylline thigh cream are limited by small patient populations and incomplete disclosure of methods. Until such data are available, an aminophylline thigh cream to be safe and effective remains, as coined by the Washington Post a "dream cream."" (The Annals of Pharmacotherapy)

Thigh creams are not the only solution these days, contact www.beautiful-body.com and you will find an entire website devoted to massage. A large part of the site focuses on cellulite massage. Their claim, "cellulite massage is a massage technique designed to help you be your most beautiful. This is the manual manipulation of the subcutaneous layers of the skin (2 layers of fat below the skin) to breakdown fat, and move waste and toxins out of the affected areas." (http://www.beautiful-body.com/) They give no credit to genetic disposition as a cause of cellulite, but in fact point the finger to poor circulation, poor elimination, poor diet combined with pollution, stress and medication as the main contributors. For a reader of this website, believing these reasons would probably have you at a salon within hours to have them massage the dimples out of your thighs. They claim it takes the hands of a masseuse to massage the fat out of their trapped bulges, then detoxify the skin with body wraps, then strengthen and tighten the skin, and finally exercise is mentioned to maintain these results at home. Like the first website mentioned, they claim no medical research or results to prove that massage even effects cellulite. The massage may feel great, but in reality you are ridding yourself of cash and not dimples.

Similar to massage as a cellulite treatment, is a method I had never heard of before called Endermologie. "It is a new technique that proponents claim will mobilize subcutaneous fat, reduce cellulite, and release fat that collects under the skin, so that the body can carry it away naturally." (Kinney, pg.1903) Apparently it involves a massage machine, no hands are involved, that massages the affected areas with a suction motion. It is a combination of positive or rolling like motions with negative or suction type motions and this force can rupture the fat cells. Initially this procedure was discovered in France for treatment of burn victims and patients with scar tissue, when it was noticed it also reduced the appearance of cellulite. Since then, several thousand machines have been in use for cellulite reduction all over Europe. This sounds awfully painful and outright frightening. The process, in order to be effective, requires 15 to 20 sessions, each 35 minutes, at $100 a pop. Finally, to have permanent results you really need to have a maintenance session once a month forever.

(http://data.detnews.com/1997/metlife/9703/17/03170068.htm)

In discovering this website on Endermologie, I was not very convinced about its claims because the article lacked any medical testimony or evidence of results. It honestly sounded terribly painful and not worth the money or time. In conducting outside research on this cellulite treatment, I was surprised to find more information on this method. A study was conducted at Texas State University in Austin, Texas, that included 22 women between the ages of 24 and 48. A typical session of Endermologie is about 14 sessions, and in this particular study every participant completed at least 7 sessions. A session was 45 minutes in duration and occurred one or twice a week. The participants were encouraged to drink a lot of water and follow a low-fat diet, although this was not monitored by experimenters. Before beginning the treatments specific measurements were taken of the patient's waist, hip, thighs, knees, and calves, and their weight was recorded. (Ersek,Mann,Salisbury, pg.61) These weight and circumference measurements were taken before the first session, and on the day of the 7th and 14th sessions. Regardless if one component of measurement went up or down, it was averaged together to give an overall figure. The experimenters tracked circumference and weight fluctuations over groups that participated in treatments for 7 sessions or 14 sessions. The 22 patients in the study showed a mean body circumference index loss of 1.3815cm (.5439 in) after 7 sessions. Nineteen of these patients showed an average weight loss of .612kg (1.35 lbs.) over the 7 sessions. Six patients that completed 14 sessions showed a mean body circumference index loss of 2.8484cm (1.121 in) and an average weight loss of .321kg (.708 lbs.) (Ersek,Mann,Salisbury, pg.66) Some participants even reported some small weight gain, but their mean body circumference always decreased. Obviously this study shows that Endermologie does mildly effect the size and appearance of cellulite on the body, and is even more effective when a patient has 14 or more treatments. "The conclusion on this study suggests that colleagues develop a double-blind protocol in a controlled setting to better understand the effects and mechanism of action of this method." (Ersek,Mann,Salisbury, pg.67) This study is definitely preliminary in making a strong statement about the effectiveness of Endermologie. The long-term effects and long-term safety are still unknown. Also one must be skeptical of their methods of measurement, as they were not clearly described in the report. It is very possible for human error when recording and measuring small changes in body parts. Also the study did not remark on patient tolerance with the treatment, as other articles have mentioned pain and possible bruising. As Brian Kinney of the Plastic Surgery Educational Foundation DATA Committee said, "Until such investigations are completed, this technique and the device should be presented as an emerging allied health modality and a nonmedical device." (Kinney, pg.1904)

So far the best and most logical evidence in battling the bulge was found in an article posted on the web from Health & Law magazine, entitled "Conquering Cellulite." (http://victorvalley.com/health&law/97mar/fitness.shtml) It blames cellulite almost solely on genetic disposition, and sites molecular biologists speculation that there may even be a cellulite gene on the X chromosome. Whatever the case for the cause is irrelevant for most, you either have it or you don't. In this Health & Law article they are the most realistic and honest with the public by saying that cellulite reduction requires a reduction in overall body fat. Also, the weakness of the underlying skin fiber in the cellulite regions must be targeted. This is not going to be permanently or effectively achieved by any cream or massage therapy. As most would expect at this time the real and only solution is through a diet and exercise regimen, that includes the combination of an aerobic, anaerobic, and nutritional combination. Many of these other miracle treatments are still in their preliminary stages of testing, and it is not proven whether any of them are really safe or effective. Even though the public is desperate to be cellulite-free, the quest to battle the dimple is not considered to be a medical problem; therefore, there is little research done to assist the public in finding the most accurate information.

In reality I think the public already knows that a dream cream or a leg massage sounds too good to be true, and it is. After all the websites I found with miracle cures for cellulite, hopefully someone will read this and not waste their time or money finding a silly solution. Diet, exercise, and drink water regularly, and do the best you can with your inherited genes!
 

 

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