Fung-Kei Cheng

Hong Kong

Introduction

Increasingly becoming epidemics in not only high-income countries,obesity and being overweight cause mortality,reaching 2.8 million people each year:it is now the fifth highest health risk[1-3].According to the World Health Organisation,more than 1.9 billion people aged 18 or older(39%of the worldwide adult population)are overweight and 600 million(13%)are obese,along with an estimated 41 million children under five years old who are either overweight or obese. This has escalated into a situation that has been coined“globesity”[4,5].

Obesity and over-weight are largely nutrition-related disorders,resulting in abnormal or excessive fat accumulation[6].They are measured by a ratio of body weight over square of height;namely,body mass index(BMI):over-weight refers to a BMI of over 25,and obesity over 30[7,8].In addition, a correlation between BMI and age is applied to children [9]. However, BMIs vary in different ethnic groups; for instance, overweight Asians have a BMI over 23 and those with obesity over 25[10-12].

A positive connection between obesity and chronic non-communicable illnesses exists in a wide range of conditions such as cardiovascular diseases,diabetes mellitus, musculoskeletal disorders, cancers,pulmonary embolism, and liver diseases [13-18].Worse still,complications of maternal obesity often occur among pregnant women, which adversely affects respiratory, cardiovascular and gastrointestinal systems and produces increased preterm births and the mortality rate among term births[19,20].Such consequences harm the infants and their childhood health [21, 22]. Therefore,health-related costs have become a fiscal burden as well[23].

In addition to regular inventions for body weight management [24], including pharmacy, bariatric surgery, food intake, behavioural modifications,lifestyle adjustment, and physical exercise,complementary and alternative therapy is also being used;such as meditation,yoga, dietary seaweed,aromatherapy, Chinese herbal medicine, and acupuncture[25-36].

Acupuncture is a traditional Chinese medical practice, used for more than 2500 years. It is documented in ancient Chinese texts,among which the A-B Classic of Zhenjiujiayijiang(215-282,A.D.Jin Dynasty),is rich in describing the efficacy of acupuncture in treating various diseases[37,38].This method began to be disseminated to adjacent countries starting in the 6th century[39].It consists of the insertion of needles into a single or group of specific acupoints (trigger points for neurologic connectivity)on 14 meridians along the body for a few seconds or minutes in order to activate qi(energy) and balance yin-yang (dualistic forces),resulting in healing or preventing illnesses[40-42].Tingling,distension and soreness are the common feelings experienced,indicating get Qi(acquisition of energy) which stimulates nerve signals and activates neurotransmitters[43-45].

Having the support of clinical evidence,acupuncture is effective on a spectrum of diseases;for instance, pain management, autism, stroke rehabilitation,hypertension,Parkinson’s disease,and dementia [46-51]. When operated by trained practitioners it is safe,with trivial adverse effects for a wide range of treatment recipients,with sterile techniques,including preterm infants,children,the elderly,and pregnant women[52-65].This practice is cost effective[66,67].These benefits have boosted its popularity, which has then been followed by worldwide scholarly and practical attention as well as scientific investigation [68-70].Also, acupuncture has gained a place in medical care in the USA as adjunctive therapy[71].

Developed from conventional manual acupuncture,modern acupuncture technology is conducive to this approach, including electro-acupuncture and laser acupuncture.Acupuncture often accompanies the use of other Chinese traditional methods such as moxibustion(dredging qi flow by the heat of burning moxa wool applied on meridians),cupping therapy(regulating qi by the suction of thin air in a glass which can remove stagnation), and acupressure(acupoint massage)[72-74].

Research has reported on the efficacy of acupuncture on adiposity,particularly for weight loss and also in obese women[75-79].Reductions in body weight,and improvements in BMI result from controlling the appetite and decreasing food consumption,due to activating the satiety center of the hypothalamus and the central nervous system,regulating the endocrine system and the metabolism,and strengthening gastrointestinal motility[80-84].Acupuncture plausibly affects glucose and lipid metabolism, insulin resistance, and obesity-associated peptides [85, 86]. It likely facilitates the enhancement of anti-inflammatory functions through increased haemorphins in the plasma, activates the signals of β-3 adrenergic receptors, increases heat, and affects adipokines which are significantly related to weight management[87-89].Furthermore,the effect of ear acupuncture on weight control is noticeable[90].Coupled with moxibustion, namely, warming acupuncture, this combination regulates the hypothalamic function, diverse brain areas,neurotransmitters,nuclei,hormones,and receptors,consequently inhibiting calorie intake and increasing energy consumption[90-91].Despite abundant experiments upholding the usefulness of acupuncture in managing obesity,there lacks a fuller investigation into Anglophone and Chinese studies. This narrative review analyses English and Chinese research and then offers an overview of how acupuncture can contribute to body weight reduction and obesity-incurred diseases.Its recommendations may inspire practical enhancements and future research directions.

Research Method

This review employed 27 major electronic databases in ProQuest(Biological Sciences,British Nursing Index,MEDLINE,PsycARTICLES,PsycINFO,and so on),by inputting the keywords“acupuncture”and“obesity OR weight control OR weight loss”,from the results of which listed 106 works.Additionally,the China National Knowledge Infrastructure(CNKI)and Taiwan Electronic Periodical Services(TEPS) were searched with the keywords“针灸”and“肥胖OR 痴肥OR 减肥”,retrieving 625 Chinese works.The inclusion criteria comprised full texts(including Online First publications)published prior to May 2017 in peer-reviewed and scholarly journals or books about clinical human-based studies on using acupuncture in adiposity,except for non-result trials,duplications, literature reviews, book reviews,dissertations,editorials,and commentaries.

Findings and discussion

Resulting from the eligibility criteria,this review analysed 101 projects(n=25 in English,n=76 in Chinese)(refer to Figure 1 and Table 1),involving 15941 participants from 9-80 years old in mainland China(n=80),Taiwan(n=6),Turkey(n=4),Brazil(n=2),Egypt(n=2),Iran(n=2),Greece(n=1),Korea(n=1),Sudan(n=1),Thailand(n=1),and the USA(n=1).Its analyses illuminate positive results from using acupuncture in weight loss and obesity-induced illnesses; for example,cardiovascular diseases, metabolic disorders,degenerative knee arthritis, emotional disorders,gynaecological illnesses,and childhood obesity.

Figure 1 Selection process

Table 1 Analysis of the reviewed 101 projects

Chinese30-minute daily session, total 15 medicinesessions.and Chinese medicine alone on simple obesity.Hung,To examine62 postpartum women.Randomly assigned to laserReductions in body weight,BMI,body fatTaiwan Hungthe effectsUnspecified age range.acupuncture(n=32),and control(n=percentage..[101]of laser30)groups.acupunctur5-second session,total 12 sessions.e on postpartum weight control.LiTo compare529 participants(n=322Randomly assigned to the acupunctureEffect rate: 82.2% in acupuncture withChina.[102]the effectsmales,n=207 females),with rehabilitation exercise(n=264;nrehabilitation exercise group, 70.2% in ofaged 60-78.=160 males,n=104 females;agedrehabilitation exercise alone group.acupunctur60-78),and rehabilitation exercise aloneReductions in BMI, waist-hip ratio,e with(n=265;n=162 males,n=103abdominal circumference, and hip rehabilitatiofemales;aged 60-78)groups.circumference; more significant in n exerciseAcupuncture:20-minute session,totalacupuncture with rehabilitation exercise and40 sessions.group.rehabilitatioExercise:1-1.5 hours session,total 40Improvements in cardiac function indices,n exercisesessions.and quality of life.alone on obesity.Liu,To50 participants (n = 8Acupuncture:30-minute daily session,Effect rate:88%. China.Wanginvestigatemales,n=42 females),total 45 sessions.[103]the effect ofaged 14-46.Moxibustion: 30-minute session, total acupunctur45 sessions.e and moxibustio n on obesity.Pang,To assess160 participants(n=29Randomly divided into the warmingEffect rate:94.4%in warming acupunctureChina.Liuthe effectsmales,n=131 females),acupuncture and ear acupuncture(n=and ear acupuncture group, 83.3% in[104]of warmingaged 18-72.54;n=9 males,n=45 females;agedwarming acupuncture group.acupunctur19-45),and warming acupuncture(n=Reductions in weight, BMI, body fat e and ear54;n=9 males,n=45 females;agedpercentage,and degree of obesity.acupunctur18-72)groups,together with a standardDecreases in lipid levels including total e onweight group(n=52;n=11 males,n=cholesterol(TC),triglycerides(TG),low obesity.41 females;aged 23-55).density lipoprotein cholesterol (LDL-C),30-minute session,total 45 sessions.high density lipoprotein(HDL-C),fat-islet axis relevant indexes including fasting plasma glucose (FBS), fasting leptin(FLP), fasting insulin (FINS), insulin sensitive index (ISI), insulin resistance index(Homa-IR),insulin secretion index(Homa-β),and autonomic nerve function index(Y value).Song,To compare48 participants(n=21Randomly allocated to the acupunctureEffect rate: 91.7% in acupuncture withChina.Duanthe effectsmales,n=27 females),(n=24;n=10 males,n=14 females;Chinese medicine group,and 70.8% in[105]ofaged 24-61.aged 24-61), and acupuncture withacupuncture group.acupuncturChinese medicine (n = 24; n = 11 e andmales, n=13 females; aged 25-60)acupuncturgroups.e with30-minute daily session, total 56 Chinesesessions within 8 weeks.medicine on obesity.Tseng,To assess53 participants (n=11Randomly allocated to the laserSignificant reductions in BMI,body fatTaiwan Tsengthe effectsmales,n=42 females).acupuncture(n=26)and sham laserpercentage, waist circumference, hip.[106]of laserUnspecified age range.acupuncture(n=26)groups.circumference,and waist-hip ratio in the acupunctur10-second session, total 24 sessionslaser acupuncture group.e onwithin 8 weeks.Evident improved scores on the fullness,appetitehunger,satiety,desire to eat,and overall sensations.well-being.Wang,To compare136 participants(n=26Randomly allocated to the abdominalEffect rate:83.6%in abdominal vibrationChina.Wangthe effectsmales,n=110 females),vibration therapy at acupoints(9n=68;therapy at acupoints group,and 81.5%in[107]ofaged 30-55.n=12 males,n=56 females;agedacupuncture group.acupunctur30-55),and acupuncture(n=68;n=14Reductions in BMI, waist-hip ratio,e andmales, n=54 females; aged 30-55)abdominal fat,and thickness in 2 groups.

abdominalgroups.vibration30-minute session,total 24 sessions.therapy at acupoints on obesity.Wang,To compare38 post-natal women,Distributed to the acupuncture withEffect rate:89.5%in acupuncture with dietChina.Liuthe effectsaged 25-40.massage,cupping,diet and exercise(nand exercise group, 52.6% in diet and[108]of=19),and diet and exercise(n=19)exercise group.acupuncturgroups.More significant reductions in body e on30-minute session, unspecified totalweight,and BMI in acupuncture with diet post-natalsessions.and exercise group than that in diet and obesity.exercise group.Yan,To1527 patients (n=20630-minute session,total 45 sessions. Effect rate:88.6%.China.Liuinvestigatemales,n=1321 females),The younger,the more effective:93.4%in[109]the effectsaged 16-77.the group of aged 16-30,89.5%in aged of31-40,80.9%in aged 41-77.acupunctur e on obese people with hyperlipide mia.Ye,To examine88 participants(n=47Divided into the acupuncture withEffect rate: 86.4% in acupuncture withChina.Zhongthe effectsmales,n=41 females),Chinese medicine (n = 44; n = 23Chinese medicine group, 65.9% in[110]ofaged 15-64.males,n=21 females;aged 16-64),andChinese medicine.acupuncturChinese medicine (n = 44; n = 24Recurrence rate after 6 months:11.4%in e withmales, n=20 females; aged 15-62)acupuncture with Chinese medicine group,Chinesegroups.31.8%in Chinese medicine.medicine15-20 minute session,total 10 sessions.on obesity.Yuan,To examine125 participants(n=2530-minute session,total 45 sessions. Effect rate:93.6%.China.Liuthe effectsmales,n=100 females),Reductions in body weight,BMI,degree[111]of warmingaged 18-66.of obesity,body fat percentage.acupuncturReductions in total cholesterol (TC),e on obesitytriglycerides(TG),low density lipoprotein with(LDL-C).hyperlipideAn increase in high density lipoprotein mia.(HDL-C)Yuan,To1528 patients (n=20730-minute session,total 45 sessions. Effect rate:88.5%.China.Liuinvestigatemales,n=1321 females),Weight loss:96.5%.[112]the effectsaged 16-72.Reduction in hyperlipidemia:88.7%of acupunctur e on obese people with hyperlipide mia.ZengTo assess50 participants(n=2230-minute daily session, total 90Reductions in body weight, BMI, andChina.[113]the effectsmales,n=28 females),sessions.body fat percentage.of warmingaged 20-68.Decreases in systolic bold pressure,and acupuncturdiastolic blood pressure.e and ear acupunctur e on obesity with primary hypertensio n.ZhangTo compare100 obese women,agedRandomly allocated to the acupunctureReductions in body weight, BMI,China.[114]the effects22-38.with metformin(n=50;aged 22-38,waist-hip ratio,and size of cystic ovary.ofand metformin alone (n = 50; agedA decrease in hormones.acupunctur23-37)groups.More significant indicators in acupuncture e with30-minute session, 6 months;with metformin group.metforminunspecified total sessions.andMetformin:3 times a day,6 months.metformin alone on obese patients with infertility caused by polycystic ovary syndrome.

ZhuTo compare60 participants(n=35Randomly allocated to the earReductions in BMI (93.3%), waistChina.[115]the effectsmales,n=25 females)acupuncture(n=30;n=17 males,n=circumference (96.7%), waist-hip ratio of earaged 23-64.13 females; aged 25-62), and(90%)in ear acupuncture group.acupuncturacupuncture on abdomen(n=30;n=Reductions in BMI (80%), waist e and18 males,n=12 females;aged 23-64)circumference (83.3%), waist-hip ratio acupuncturgroups.(67.7%) in acupuncture on abdomen e on30-minute session,total 20 sessions.group.abdomen on simple obesity.Zhu,To compare320 participants(n=117Randomly assigned to the acupunctureReverting to normal glucose toleranceChina.Huangthe effectsmales,n=203 females).with diet(n=160;n=56 males,n=(NGT):46.9%in acupuncture with diet,[116]ofUnspecified age range.104 females),and exercise and diet(n=and 15.6%in exercise and diet groups.acupunctur160;n=61 males,n=99 females)More significant reductions in fasting e with dietgroups.blood glucose(FBG),2-hour postprandial andUnspecified session duration,and totalblood glucose(PBG),triglycerides(TG),exercisesessions.BMI, waist circumference, total with diet oncholesterol(CHO),low density lipoprotein thecholesterol(LDL-C)in acupuncture with impaireddiet group than that in exercise and diet glucosegroup.tolerance(IGT).ChenTo compare80 participants(n=35Randomly distributed to acupunctureEffect rate: 97.5% in acupuncture withChina.[117]the effectsmales,n=45 females),with lifestyle adjustment(n=40;n=18lifestyle adjustment group, 60% in ofaged 28-69.males,n=22 females;aged 29-67),andlifestyle adjustment alone group.acupuncturlifestyle adjustment only(n=40;n=17 e andmales, n=23 females; aged 28-69)lifestylegroups.adjustmentUnspecified session duration,and total on obesitysessions.with type 2 diabetes.He,To assess56 women.Randomly distributed to theReductions in body weight. China.Zhangthe effectsUnspecified age range.acupuncture(n=20)and acupuncture[118]ofwith massage(n=20)groups.acupunctur30-minute session,total 21 sessions.e and acupunctur e with massage on body weight loss.Hou,To look50 participants (n = 9Randomly assigned to the acupunctureEffect rate: 72% in acupuncture group,China.Yanginto themales,n=41 females),(n = 25), and acupuncture, music92%in acupuncture,music therapy,and[119]effects ofaged 16-59.therapy, and aromatherapy (n = 25)aromatherapy group.acupuncturgroups.e, music30-40 minute session,total 48 sessions.therapy,and aromathera py on simple obesity.Ismail,To examine80 participants (n = 630-minute session,total 48 sessions. Reductions in hs-CRP and body weight. Egypt.Ibrahithe effectsmales,n=73 females).mofUnspecified age range.[120]acupunctur e and ear acupunctur e with low-calorie diet on weight loss.Lu,To assess126 women,aged 17-62. Randomly assigned to the warmingEffect rate of weight loss: 95.2% inChina.Liuthe effectsacupuncture and ear acupuncture(n=warming acupuncture and ear acupuncture[121]of warming63; aged 17-62), and warminggroup, 82.5% in warming acupuncture acupuncturacupuncture (n = 63; aged 18-56)group.e and eargroups.Reduction in lipid: 93.7% in warming acupunctur30-minute session, unspecified totalacupuncture and ear acupuncture group,e on obesitysessions.81%in warming acupuncture group.withReductions in BMI, degree of obesity,hyperlipidebody fat percentage, and waist mia.circumference.

Decreases in serum total cholesteroal(TC), triglycerides (TG), low density lipoprotein(LDL-C).An increase in high density lipoprotein(HDL-C).Pang,To examine130 women,aged 18-54. Randomly distributed to the warmingEffect rate:95.4%in the acupuncture andChina.Liuthe effectsacupuncture and ear acupuncture(n=ear acupuncture group, 84.6% in[122]of warming65; aged 19-54), and warmingacupuncture group.acupuncturacupuncture (n = 65; aged 18-54)Reductions in body weight,BMI,degree e and eargroups.of obesity,body fat percentage.acupunctur30-minute session,total 45 sessions.Decreases in serum total cholesteroal e on obesity(TC), triglycerides (TG), low density withlipoprotein(LDL-C).hyperlipideAn increase in high density lipoprotein mia.(HDL-C).Tür,To look19 participants.30-minute session, total 20 sessionsReductions in HbA1c levels,weight andTurkey.Aksayinto theUnspecified age rangewithin 10 weeks.BMI.[123]effects ofand sex ratio.acupunctur e and ear acupunctur e on reducing H lebvAel1 sc,weight and BMI.WangTo67 participants(n=3845-minute session,total 30 sessions. Effect rate:78.1%.China.andinvestigatemales,n=29 females),Reductions in body weight,and BMI.Wangthe effectsaged 16-58.[124]of acupunctur e on weight loss.Wang,To compare164 participants(n=30Randomly allocated to theReductions in body weight,BMI,degreeChina.Liuthe effectsmales,n=134 females),electro-acupuncture and catgutof obesity, body fat percentage in[125]ofaged 16-58.embedding(n=56;n=10 males,n=treatment groups.electro-acu46 females; aged 18-55),Decreases in total cholesterol (TC),punctureelectro-acupuncture(n=56;n=10triglycerides(TG),low density lipoprotein and catgutmales,n=46 females;aged 16-58),and(LDL-C).embeddingcontrol(n=52;n=10 males,n=42An increase in high density lipoprotein on simplefemales;aged 23-55)groups.(HDL-C).obesity30-minute session,total 36 sessions.Positive changes in fasting plasma glucose(FPG), fasting insulin (FINS), fasting leptin (FLP), insulin sensitivity index(ISI),insulin resistance index(Homa-IR)，β-cell function index (Homa-β) and vegetative nerve system equilibrium index(Y value)in treatment groups.Wang,To200 participants(n=3030-minute session,total 45 sessions. Effect rate:94.2%. China.Liuinvestigatemales,n=170 females),[126]the effectsaged 18-66.of warming acupunctur e on obesity.Wei,To compare86 participants(n=41Randomly distributed to theEffect rate:84.6%in acupuncture group,China.Chenthe effectsmales,n=45 females),acupuncture(n=44;n=21 males,n=64.3%in diet control group.[127]ofaged 18-57.23 females; aged 18-57), and dietReductions in body weight,BMI,basal acupuncturcontrol(n=42;n=20 males,n=22metabolic rate,body fat percentage,waist e and dietfemales;aged 20-56)groups.circumference,hip circumference.control on30-minute session,total 30 sessions.Decreases in total cholesterol (TC),simpletriglycerides(TG),low density lipoprotein obesity.(LDL-C).An increase in high density lipoprotein(HDL-C).Better positive indicators in acupuncture group.Wei,To compare200 participants(n=50Allocated to acupuncture with cuppingEffect rate: 94% in acupuncture withChina.Xuthe effectsmales,n=150 females),(n = 100), and cupping (n = 100)cupping,57%in cupping group.[128]ofaged 18-57.groups.acupuncturTotal 20 sessions;unspecified session e withduration.

cupping,Cupping:2-3 sessions per week,total and10 sessions.cupping alone on obesity.ZhangTo compare100 participants.Randomly divided into the diet controlEffect rate: 30% in diet control withChina.[129]the effectsUnspecified age rangewith exercise(n=40),and acupunctureexercise group,and 76.7%in acupuncture of standardand sex ratio.with diet control and exercise(n=60)with diet control and exercise group.treatmentgroups.and30-minute session, unspecified total acupunctursessions.e on obesity.Zhang,To67 women,aged 16-58. 30-minute session,total 45 sessions. Effect rate:95.5%.China.DuaninvestigateReductions in body weight,BMI,chest[130]the effect ofcircumference, waist circumference, hip electro-acucircumference, thigh circumference,puncture onwaist-hip ratio.obesity with breast hyperplasia.Zhou,To compare84 participants(n=15Randomly distributed to the He’s threeEffect rate: 81.8% in He’s three passChina.Xiethe effectsmales,n=69 females),pass acupuncture(n=44;n=6 males,acupuncture group,65%in acupuncture[131]of He’saged 13-71.n = 38 females; aged 18-58), andgroup.three passacupuncture(n=40;n=9 males,n=Reductions in body weight,BMI,waist acupunctur31 females;aged 13-71)groups.circumference, hip circumference, and e andTotal 30 sessions,unspecified sessionbody fat percentage.acupuncturduration.e on obesity.DarbaTo compare80 obese men, agedRandomly assigned to Group AReductions in BMI,trunk fat mass,waistIran.ndi,the effects18-50.(electro-acupuncture)(n=20),Group Bcircumference, hip circumference in all Darbaof(sham acupuncture) (n = 20), eargroup.ndielectro-acuacupuncture(n=20),and sham earBetter improvements in genuine practices[132]punctureacupuncture(n=20).than in sham groups.and ear20-minute session,total 12 sessions.Higher decreases in BMI,trunk fat mass,acupuncturand waist circumference in e and shamelectro-acupuncture group than in sham practices onelectro-acupuncture group, except hip obesity.circumference.LiuTo91 women,aged 43-54. 30-minute session,total 36 sessions. Effect rate of obesity:88.4%.China.andinvestigateReductions in body weight,BMI,body fat,Liuthe effectsand degree of obesity.[133]of warmingEffect rate of menopause:99.1%.acupuncturSignificant reductions in Kupperman e on obesitymenopausal index, follicle-stimulating amonghormone.menopausal women.Set,To examine24 women.15-20 minutes per session, total 6No reduction in BMI and depression. Turkey.Cayirthe effectsUnspecified age range.sessions.[134]of ear acupunctur e on the obese women with depression.XueTo compare60 participants (n = 9Randomly distributed to theReductions in BMI(56.7%in acupunctureChina.andthe effectsmales,n=51 females),acupuncture on the back-shu points(n=on the back-shu points group and 16.7%in Zhangofaged 25-45.30;n=4 males,n=26 females,agedacupuncture on different acupoints group),[135]acupunctur28-45), and acupuncture on otherwaist circumference (83.3% in e on theacupoints(n=30;n=5 males,n=25acupuncture on the back-shu points group back-shufemales;aged 25-40)groups.and 43.3% in acupuncture on different points and30-minute daily session, total 30acupoints group),waist-hip ratio(56.7%in acupunctursessions.acupuncture on the back-shu points group e onand 30% in acupuncture on different differentacupoints group), weight (60% in acupointsacupuncture on the back-shu points group on obesity.and 26.7% in acupuncture on different acupoints group).Yang,To46 women,aged 21-54. Randomly distributed to theReductions in body weight,BMI,waistKorea.Kiminvestigateacupuncture (n = 23), and shamcircumference.

[136] the effectsacupuncture(n=23)groups.Deactivation of parasympathetic function of30-minute session, unspecified totaland an increase in sympathetic activity.acupunctursessions.e on heart rate variability in obese premenopa usal women.ZhangTo test the80 participants(n=10Randomly divided into theEffect rate:100%in electro-acupunctureChina.[137]effects ofmales,n=70 females),electro-acupuncture with acupuncturewith acupuncture group, 95% in electro-acuaged 45-78.(n=40;n=3 males,n=37 females),electro-acupuncture group.punctureand acupuncture(n=40;n=7 males,nRelapse rate at 12-month follow-up:7.5%and=33 females)groups.in electro-acupuncture with acupuncture acupunctur73-minute daily session, total 50group,37.5%in acupuncture group.e on simplesessions.obesity with degenerativ e knee arthritis.Feng,To examine36 participants, aged30-minute session,total 45 sessions. Effect rate:91.7%.China.Liuthe effects16-62.Reductions in body weight,BMI,body fat[138]of warmingUnspecified sex ratio.percentage,and degree of obesity.acupuncturDecreases in systolic blood pressure,and e and eardiastolic blood pressure.acupunctur e on obesity with primary hypertensio n.HuTo look60 participants(n=2515-minute daily session, total 30Reductions in body weight,BMI,body fatChina.[139]into themales,n=35 females),sessions.percentage,basal metabolism,waist,hip effects ofaged 24-52.circumference, upper arm, and thigh acupuncturcircumference.e on obesity.Li,CuiTo compare66 participants(n=29Randomly assigned to the acupunctureGreater reductions in weight loss,BMI,China.[140]the effectsmales,n=37 females).with medication (n = 33), andwaist circumference,and level of fasting ofUnspecified age rangemedication(n=33)groups.insulin in acupuncture with medication acupunctur30-minute daily sessions, total 60group than that in medication only group.e andsessions.medicationMedication: Metformin hydrochloride on obesitytablet,0.5mg,2 tablets per day.with diabetes.Lv,To compare50 participants who wereRandomly distributed to theEffect rate: 87.5% in acupuncture withChina.Liuthe effectsoverweight with kneeacupuncture with moxibustion(n=32;moxibustion group,72.2%in moxibustion[141]ofosteoarthritis (n = 22n=15 males,n=17 females;agedgroup.acupuncturmales,n=28 females),42-72),and moxibustion(n=18;n=7 e andaged 42-73.males, n=11 females; aged 44-73)moxibustiogroups.n on30-minute daily session, total 90 obesitysessions.with knee osteoarthriti s.RenTo examine87 women with primaryDivided into the dysmenorrhea(n=44;Effect rate (10 sessions): 97.7% inChina.[142]the effectsdysmenorrhea, agedaged 18-45), and dysmenorrhea withdysmenorrhea group,72.7%dysmenorrhea of warming17-45.obesity(n=43;aged 17-44).with obesity group.acupunctur30-minute session,total 90 sessions.Effect rate (20 sessions): 100% in e and eardysmenorrhea group,86%dysmenorrhea acupuncturwith obesity group.e onEffect rate (30 sessions): 100% in dysmenorrhdysmenorrhea group,88.4%dysmenorrhea ea withwith obesity group.obesity.XiaTo compare68 participants(n=10Randomly allocated to the acupunctureEffect rate:64.7%in acupuncture group,China.andthe effectsmales,n=58 females),(n=34;n=4 males,n=30 females;and 82.4%in acupotomology group.Zhuofaged 18-50.aged 18-47),and acupotomology(n=[143]acupotomol34;n=6 males,n=28 females;aged ogy and18-50)groups.

acupunctur30-minute daily session, total 10 e onsessions.obesity.YuanTo examine500 participants(n=7930-minute session,total 20-30 sessions. Effect rate:96.4%. China.[144]the effectsmales,n=421 females),ofaged 11-71.acupunctur e and ear acupunctur e on obesity.ZhangTo test the61 participants(n=29Allocated to the simple obesity(n=Effect rate:96.8%in simple obesity group,China.andeffects ofmales,n=32 females),32),and obesity with sub-health(n=96.6%in obesity with sub-health.Zhouacupuncturaged 21-59.29)groups.Reductions in body weight, BMI,[145]e, cupping,Acupuncture:30-minute daily session,waist-hip ratio,body fat percentage.andtotal 10 sessions.massage onCupping:5-minute daily session,total simple10 sessions.obesity andMassage:8-minute session.obesity with sub-health.Abdi,To161 participants, agedRandomly assigned to the acupunctureA significant reduction in measures ofIran.Zhaoinvestigate18-55.(n=79),and sham acupuncture(n=82)adiposity.[146]the effectsUnspecified sex ratio.groups.Reductions in anti-HSP antibodies and of20-minute session, total 12 sessionshs-CRP.acupuncturwithin 6 weeks.Improvement in lipid profile.e and electro-acu puncture with low-calorie diet on obesity.Cao,To look131 women,aged 16-50. 30-minute session,total 45 sessions. Effect rate:87.8%.China.Liuinto theReductions in body weight,BMI,body fat[147]effects ofpercentage,and obesity index.acupuncturThe younger,the more effective.e and ear acupunctur e with moxibustio n on obesity with pre-menstru al tension syndrome.Güçel,To examine40 women.20-minute session,total 10 sessions. Reduction in body weight. Turkey.Baharthe effectsUnspecified age range.[148]of acupunctur e on weight loss.Guo,To compare46 participants(n=20Randomly distributed to theEffect rate: 92% in acupuncture withChina.Chenthe effectsmales,n=26 females),acupuncture with music therapy(n=music therapy group, and 61% in[149]ofaged 17-68.23),and acupuncture(n=23)groups.acupuncture group.acupunctur30-minute session,total 20 sessions.e with music and acupunctur e alone on obesity.HaddaTo inquire37 obese workers in a30-minute weekly session, total 837.8%improved sleep quality. Brazil.d,into theteaching hospital(n=11sessions.Medeieffects ofmales,n=26 females),roselectro-acuaged 32-67.[150]puncture and ear acupunctur e on sleep disorder caused by obesity.

LengTo compare60 participants.Randomly divided into the earWeight loss:90%in ear acupuncture andChina.andthe effectsUnspecified age rangeacupuncture and catgut embedding(n=catgut embedding group, and 60% in Liuof earand sex ratio.30),and acupuncture(n=30)groups.acupuncture group.[151]acupuncturAcupuncture: 30-minute session,e and catgutunspecified total sessions.embedding on obesity.LiuTo compare50 participants.Randomly allocated to the acupunctureEffect rate:76.7%in acupuncture with dietChina.[152]the effectsUnspecified age rangewith diet control(n=30),and dietcontrol group, 30% diet control alone ofand sex ratio.control(n=20)groups.group.acupunctur30-minute session, unspecified total e with dietsessions.control and diet control alone on obesity.Liu,To28 female students,agedDivided into 1 placebo group,and 3The laser groups receiving 358 and 597China.Zhanginvestigate19-25.groups with different levels of laserJ/cm2 showed significant reductions in[153]the effects(358,478,and 597 J/cm2;powers:150,body weight,BMI,body fat mass,waist of laser200, and 250 mW; intensity: 1194,girth,hip girth,and waist-hip ratio after acupunctur1592,and 1990 mW/cm2;irradiationtreatment compared with the placebo e ontime:5 min/point,25 min in total).group.The percent reductions of body fat obesity.Total 24 sessions.mass in the laser groups receiving 358 and 597 J/cm2 were 4.29% and 3.94%,respectively,and the corresponding values of body weight were 1.99%and 1.63%,respectively.Qin,To compare76 participants, agedRandomly assigned to the medicine(nEffect rate:a greater reduction in BMI andChina.Lithe effect of18-25.=39),and acupuncture with medicinetriglycerides,and better improvement in[154]acupuncturUnspecified sex ratio.(n=37)groups.high density lipoprotein cholesterol in e and4-hour session,total 30 sessions.acupuncture with medicine group.acupuncturNo change in BMI in medicine group.e with medicine on lipid metabolism.Ren,To look151 obese women,aged30-minute session,total 45 sessions. Reductions in weight, BMI, body fatChina.Liuinto the45-55.percentage,and obesity index.[155]effects ofReduction in climacteric syndrome:acupunctur98.7%.e andReduction in obesity:85.5%.moxibustio n on obese women with climacteric syndrome.RerksuTo compare29 women,aged 21-60. Randomly distributed toHigher reductions in body weight,BMI,Thailan ppaphthe effectselectro-acupuncture and earwaist circumference, hip circumference,d.olofacupuncture (n = 16), and earwaist-hip ratio,triceps skinfold thickness,[156]electro-acuacupuncture(n=13)groups.subscapular thickness, mid arm puncture30-minute session, unspecified totalcircumference in electro-acupuncture and and earsessions.ear acupuncture group than in ear acupuncturacupuncture group.e and acupunctur e alone on obesity.TanTo compare120 participants(n=22Randomly distributed to the warmingEffect rate:96.7%in warming acupunctureChina.[157]the effectsmales,n=98 females).acupuncture(n=60;n=10 males,n=with moxibustion group, 83.3% in of warmingUnspecified age range.50 females),and acupuncture(n=60;nelectro-acupuncture group.acupunctur=12 males,n=48 females)groups.Reductions in body weight,BMI,body fat e withWarming acupuncture: 30-minutepercentage, waist circumference, hip moxibustiosession,total 30 sessions.circumference,and waist-hip ratio.n andElectro-acupuncture:40-minute session,Decreases in serum total cholesteroal electro-acutotal 30 sessions.(TC), triglycerides (TG), low density puncture onMoxibustion, 30-minute session, totallipoprotein(LDL-C).simple30 sessions.Limited improvement in high density obesity.lipoprotein (HDL-C) only in electro-acupuncture group.Yi,CaiTo assess122 participants(n=48Total 30 sessions,unspecified sessionEffect rate:92.6%. China.[158]the effectsmales,n=74 females),duration.ofaged 12-68.

acupunctur e on obesity.Zhang,To examine58 women,aged 35-65. Randomly assigned to the acupuncture92.9% in acupuncture with medicinalChina.Tangthe effectswith medicinal moxibustion(n=28;moxibustion group, and 70% in[159]ofaged 35-62),and electro-acupuncture(nelectro-acupuncture group.electro-acu=30;aged 37-65)groups.puncture40-minute acupuncture with andmoxibustion per daily session,total 15 medicinalsessions.moxibustio n on obesity due to spleen and kidney yang deficiency.ZhengTo test the112 participants(n=86Randomly divided into the acupunctureEffect rate:82.4%in acupuncture based onChina.[160]effects ofmales,n=26 females),based on theory of warming yang andtheory of warming yang and benefiting qi acupuncturaged 18-56.benefiting qi(n=57;n=42 males,n=group,61.8%in acupuncture group.e based on15 females; aged 18-55), andReductions in BMI,waist circumference.theory ofacupuncture (n =40 males, n = 15More positive indicators of total warmingfemales;aged 18-55)groups.cholesterol, triglyceridess, low density yang and20-minute daily session, total 21lipoprotein,and high density lipoprotein in benefitingsessions.acupuncture based on theory of warming qi onyang and benefiting qi group.simple obesity.Cao,To look731 participants(n=15330-minute session,total 45 sessions. Effect rate:93.8%.China.Liuinto themales,n=578 females),The younger,the more effective.[161]effects ofaged 16-80.acupunctur e and ear acupunctur e on obesity with hypertensio n.ChenTo test the115 participants.Randomly distributed to the warmingEffect rate:94.7%in warming acupunctureTaiwan[162]effects ofUnspecified sex ratio andacupuncture and electro-acupuncture(nand electro-acupuncture group,87.9%in.warmingage range.=57),and acupuncture(n=58)groups.acupuncture group.acupunctur30-minute session,total 36 sessions.Reductions in body weight,BMI,waist e andcircumference,body fat percentage.electro-acu puncture on simple obesity.HaddaTo evaluate37 obese workers(n=11Random selection sample.Reduced waist-hip ratio.Brazil.d andthe effectsmales,n=26 females),30-minute weekly session, total 8No decreases in body weight,BMI,and Marcoofaged 32-67.sessions.waist-hip ratio.nelectro-acu[163]puncture and ear acupunctur e on appetite sensation behaviour.HouTo compare46 participants (n = 2Randomly distributed to theEffect rate:95.8%in acupuncture group,China.[164]the effectsmales,n=44 females),acupuncture(n=24;n=1 male,n=2372.7%in ear acupuncture group.ofaged 14-53.females; aged 14-53), and ear acupuncturacupuncture(n=22;n=1 male,n=21 e and earfemales;aged 16-50)groups.acupunctur40-minute session,total 30 sessions.e on simple obesity.HuTo test the95 participants(n=22Total 12 sessions,unspecified sessionReductions in body weight,BMI. China.[165]effects ofmales,n=73 females),duration.laseraged 14-76.acupunctur e on simple obesity.HuangTo compare61 participants(n=10Randomly distributed to the Bo’sEffect rate: 86.2% in Bo’s acupunctureChina.,Yangthe effect ofmales,n=51 females),acupuncture(n=29;n=5 males,n=group,84.4%in acupuncture group.

[166] Bo’saged 16-55. 24 females; aged 18-55), andReductions in body weight,BMI,waist acupuncturacupuncture(n=32;n=5 males,n=circumference,waist-hip ratio.e and27 females;aged 16-54)groups.Improvements in emotion.acupunctur30-minute session,total 16 sessions.e on obesity.Pu,JinTo compare140 participants(n=22Randomly allocated to the acupunctureEffect rate (15 sessions): 44.8% inChina.[167]the effectsmales,n=118 females),(n=67;n=12 males,n=55 females),acupuncture group,67.2%in acupuncture ofaged 18-55.and acupuncture with fumigation(n=with fumigation group.acupunctur73;n=10 males,n=63 females)Effect rate (30 sessions): 83.6% in e andgroups.acupuncture group,94.5%in acupuncture acupunctur20-minute session,total 30 sessions.with fumigation group.e with fumigation on obesity.Shi,To102 obese women with30-minute daily session, total 30Effect rate:95.1%on weight loss,100%China.Liuinvestigatedysmenorrhea, agedsessions.on menstrual pain.[168]the effects18-49.Reductions in weight,BMI,obesity index,ofbody fat percentage,and menstrual pain.acupuncturThe younger,the more effective on weight e and earloss.acupuncturEffect rate after 10 sessions:81.4%on e on obeseweight loss,92.2%on menstrual pain.womenEffect rate after 20 sessions:92.2%on withweight loss,100%on menstrual pain.dysmenorrhEffect rate after 30 sessions:97.1%on ea.weight loss,100%on menstrual pain.WuTo test the60 participants (n = 4Divided into the electro-acupuncture(nEffect rate: 100% in both groups forChina.[169]effects ofmales,n=56 females).=1 male,n=29 females),and shamweight loss and pain.electro-acuUnspecified age range.acupuncture (n = 3 males, n = 27Relapse rate at 12-month follow-up:10%puncture onfemales)groups.in electro-acupuncture group, 40% in degenerativ70-minute daily session, total 50sham acupuncture group.e kneesessions.Xie,aTrot hritis.400 participants, agedRandomly assigned to the shamEffect rate at the 4th week:16%shamChina.Fuinvestigate18-65.acupuncture(n=100),acupuncture(n=acupuncture group, 57% acupuncture[170]the effectsUnspecified sex ratio.100),acupuncture and ear acupuncturegroup, 60% acupuncture and ear of(n=100),and ear acupuncture(n=acupuncture group,32%ear acupuncture ae c u punctu o rn 130-m0)i ngurtoeu spess.sion,total 36 sessions.gErfof eucpt. rate at the 8th week:19%sham obesity.acupuncture group, 66% acupuncture group, 71% acupuncture and ear acupuncture group,36%ear acupuncture gErfof eucpt. rate at the 12th week:24%sham acupuncture group, 73% acupuncture group, 82% acupuncture and ear acupuncture group,39%ear acupuncture group.Reductions in serum total cholesterol,triglycerides,body weight,BMI,and body fat percentage.YangTo test the38 women,aged 16-51. 45-60 minutes session, total 15Effect rate:94.7%. China.andeffects ofsessions.Zhangacupunctur[171]e and Chinese medicine on obesity.Zhang,To examine10 obese children(n=715-minute session,total 8 sessions. Decreases in BMI,body weight,waist andChina.Pengthe effectsboys,n=3 girls),agedhip circumferences, waist-hip ratio, and[172]of9-14.abdominal fat.acupunctur e on hepatic and abdominal lipids.ZhouTo look180 participants(n=5930-minute session,total 30 sessions. Reductions in BMI,and waist-hip ratio. China.andinto themales,n=121 females),Zhangeffects ofaged 18-45.[173]acupunctur e on obesity.Zhou, To 36 participants(n=12 30-minute session,total 30 sessions. Effect rate:72.2%. China.

Huinvestigatemales,n=24 females),Reductions in body weight,and BMI.[174]the changesaged 20-60.Reductions in aerobic bacteria,escherichia of intestinalcoli,and bacteroides.microfloraAn increase in enterococcus.duringNo changes in bifidobacterium, and acupuncturlactobacillin.e treatment.Abd-ETo20 obese postmenopausal30-minute session,total 24 sessions. Reductions in BMI,waist-hip ratio,andEgypt.laziz,investigatewomen,aged 50-60.body fat percentage.El-the effects Koserof yelectro-acu[175]puncture on body fact compositio n.Cai,LiTo compare95 participants(n=18Randomly assigned to the acupunctureEffect rate: 98% in acupuncture andChina.[176]the effectsmales,n=77 females),and cupping(n=50;n=10 males,n=cupping group, 97.8% in sibutramine ofaged 15-64.40 females; aged 15-64), andgroup.acupunctursibutramine(n=45;n=8 males,n=37More significant reductions in body e withfemales;aged 18-60)groups.weight, BMI, body fat percentage,cuppingAcupuncture:30-minute session,totalwaist-hip ratio in acupuncture and cupping and20 sessions.group.sibutramineCupping: 10-miute session, total 12(medicationsessions.) onSibutramine:10mg daily,8 weeks.Duan,oTboe sciot ym.pare106 participants(n=30Randomly distributed to theEffect rate:after the 1st course:75.8%inChina.Z[1u 7o7]tohfe effectsm agae lde s2,1 n-67=.76 females),a=c u p4o8t o m feo m lo aglye s(;n =a g6e6d; n=211-86 7m),a le a s,n nd aa cc uuppou tnocmt uor leo ggyr o ugp r;o uapf t,e r atnhde 26n2d .5c%o u r s ien:acupotomolacupuncture(n=40;n=12 males,n=95.5%of participants in acupotomology ogy and28 females;aged 22-66)groups.group,and 80%in acupuncture group.acupunctur30-minute daily session,30 sessions perReductions in body weight, BMI, and e oncourse,2 courses,total 60 sessions.waist circumference.obesity.GaoTo compare108 obese women,agedDivided into the acupuncture(n=54),Effect rate of obesity: 96.1% inChina.[178]the effects40-55.and Chinese medicine(n=54)groups.acupuncture,69.4%in Chinese medicine.of30-minute session,total 30 sessions.Effect rate of menopausal syndrome:acupunctur82.4%in acupuncture,84.7%in Chinese e andmedicine.Chinese medicine on perimenopa usal obesity.Hu,To assess95 participants(n=2210-second session,4 weeks,unspecifiedReductions in body weight(-3.8%)andTaiwan Changthe effectsmales,n=73 females),total sessions.BMI(-3.8%)..[179]of laseraged 14-76.acupunctur e with low-calorie diet on visceral postmenopa usal obesity.JiangTo compare808 participants(n=114Divided into the simple obesity(n=Effect rate:95.8%in simple obesity group,China.andthe effectsmales,n=694 females),408;n=55 males,n=353 females;and 92.5% obesity with hypertension Liuofaged 16-73.aged 16-67), and obesity withgroup.[180]acupuncturhypertension(n=400;n=59 males,n e and ear=341 females;aged 16-73).acupunctur30-minute session, total 45 sessions e on simplewithin 3 months.obesity and obesity with hypertensio n.Jiang,To229 patients (n = 16Divided into the simple obesity(n=Effect rate:96.5%in simple obesity group,China.Liuinvestigatemales,n=113 females),113;n=9 males,n=104 females;agedand 94.8% obesity with hypertension[181]the effectsaged 17-66.17-66),and obesity with hypertensiongroup.of(n=116;n=7 males,n=109 females;acupuncturaged 21-64)groups.

e and ear30-minute session,total 45 sessions.acupunctur e on obese people with hypertensio n.Li,CaiTo compare95 participants(n=18Randomly assigned to the acupunctureWeight loss: 98% in acupuncture withChina.[182]the effectsmales,n=77 females),with cupping therapy(n=50;n=10cupping therapy group, and 97.8% in ofaged 15-64.males,n=40 females;aged 15-64),andsibutramine group.acupuncturmedication(sibutramine)(n=45;n=8No significant differences of BMI e withmales, n=37 females; aged 18-60)improvement between 2 groups.cuppinggroups.More favourable improvements in therapy,Acupuncture:30-minute session,totalwaist-hip ratio and body fat percentage in and20 sessions within 4 weeks.acupuncture with cupping therapy group.medicationCupping: 10-minute session, total 12 on obesity.within 4 weeks.Sibutramine:10mg daily,4 weeks.Tu,To examine42 participants(n=12Divided into groups A(VA/SA<6;n=Reduced SA and VA.China.Xiongthe effectsmales,n=30 females),34;n=10 males,n=24 females)and BImproved distribution of SA and VA.[183]ofaged 18-68.(VA/SA>6;n=8;n=2 males,n=6 electro-acufemales).puncture30-minute session,total 90 sessions.and ear acupunctur e on abdominal fat.XuTo808 obese women withDivided into the obesity(n=407;agedEffect rate:96.3%in obesity group,89%China.[184]investigatedysmenorrhea, aged16-44),and obesity with dysmenorrheain obesity with dysmenorrhea.the effects13-50.(n=401;aged 13-50)groups.Reduction in dysmenorrhea:89%.of30-minute session,total 45 sessions.acupunctur e and ear acupunctur e on obesity with dysmenorrh ea.Yuan,To compare108 participants(n=39Randomly allocated into theReductions in BMI,triacylglycerol,andChina.Luthe effectsmales,n=69 females),acupuncture(n=56;n=20 males,n=total cholesterol.[185]ofaged 40-64.36 females;aged 40-64),and diet(n=The acupuncture group gained greater acupunctur52;n=19 males,n=33 females;agedreductions.e and diet40-63)groups.on obesity30-minute session,total 24 sessions.with hyperlipide mia.ZhouTo121 participants(n=3130-minute session,total 90 sessions. Reductions in body weight,and BMI. China.[186]investigatemales,n=90 females),the effectsaged 18-52.of acupunctur e, ear acupunctur e, and diet on obesity.ZhouTo compare150 participants(n=18Randomly distributed to the earReduction in weight loss over 5kg:10%China.[187]the effectsmales,n=132 females),embedding(n=20),acupuncture(n=ear embedding group,30%acupuncture of earaged 13-48.40), and acupuncture with eargroup, 67.8% acupuncture with ear embedding,embedding(n=90).embedding group.acupunctur30-minute daily session, total 20 e, andsessions.acupunctur e with ear embedding on weight loss.Hsu,To examine45 obese women, agedRandomly distributed to earNo significant reductions in body weight,Taiwan Wangthe effects16-65.acupuncture(n=23),and sham earBMI,waist circumference in both groups.[188]of earacupuncture(n=22)groups.A significant increase in ghrelin level and acupuncturTotal 12 sessions.decrease in leptin level in ear acupuncture e ongroup but not in sham ear acupuncture obesity,andgroup.obesity-rela

ted hormone peptides.WuTo examine20 participants, aged30-minute session,total 20 sessions. Decreases in body weight, waistChina.[189]the effects16-65.circumference,fasting triglycerides(TG),ofUnspecified sex ratio.serum total cholesterol (TC), and acupuncturlow-density lipoprotein(LDL).e on waist and hip circumferen ces, and lipid metabolism.Sheu,To5 participants (n = 230-minute session,total 16 sessions. Effect rate:80% Taiwan Cheninvestigatemales, n = 3 females),.[190]the effectsaged 22-56.of acupunctur e with Chinese medicine on weight loss.CabioTo compare55 women,aged 35-50. Allocated to the no treatment(n=12),4.8% of weight loss inTurkey.gluthe effectselectro-acupuncture(n=22),and dietelectro-acupuncture, and 2.5% in diet andofcontrol(n=21)groups.groups.Ergeneelectro-acu30-minute session,total 20 sessions.Significant decreases in total cholesterol[191]punctureand triglycerides levels in and dietelectro-acupuncture and diet groups.control onLow-density lipoprotein(LDL)cholesterol weight lossin the electro-acupuncture group.andNo significant changes could be found in anthropomehigh-density lipoprotein(HDL)cholesterol triclevels among the three groups.indicators.ApostTo examine800 participants(n=117Distributed to groups A(1 session)(n=Reductions in food consumption:81.1%.Greece.olopouthe effect ofmales,n=683 females),468),B(2-4 sessions)(n=278),and CDecreased anxiety level.los andearaged 15-76.(>4 sessions)(n=54).Weight loss: 64.8% during the first 3 K s[a 1 r9a v2i]ael o c sousnp. uwnec ti u gh r t Unspecified total sessions.mWmWm ooo ee nnn ii gg ttt hhh hh s,,tt ,aa ll ann oo ndd ss dss 37 3i9i7 nn 5..18 .5 gg%%%rr ooaa uu att pp ttt hh 6BCee-1 ::11 26282 m1t8thh. .2m9m o%%noo tnn haatt shh.tt ..tt hh ee 66 tthh Liu,To718 participants(n=8320-30 minute session,total 15 sessions. Reduction in fat percentage:20%amongChina.Wanginvestigatemales,n=635 females),males participants, and 30% among[193]the effectsaged 17-67.females participants.ofWeight loss:5%>5 kg.acupuncturOverall effect rate:90.1%.e and ear acupunctur e on simple obesity.Mok,To look24 participants (n = 1Unspecified session duration and totalNo weight changes. USA.Parkerinto themale,n=23 females).session.[194]effect of earUnspecified age range.acupunctur e on weight loss.

Weight Reduction

This review elicited the effectiveness of acupuncture on treating over-weight conditions and adiposity;one of the possibilities is connected with appetite sensation, improving eating desire [106, 163].Despite unfavourable results from an earlier study with 24 participants,recent projects have elucidated that this method can decrease body weight,BMI,and various indicators: waist and hip circumferences,waist-hip ratio,circumferences of upper arm and thigh,body fat percentages,body moisture rates and visceral fat across sectional area,total cholesterol,triglycerides, low density lipoprotein cholesterol,fasting low glucose, HbA1c levels, anti-HSP antibodies,and basal metabolic rates[97,103,104,115,116,123,124,126,127,131,135,139,145,146,157,158,160,162,165,166,170,173,174,177,179,186,187,193,194].Improvements are also attributable in high density lipoproteins,hs-C-reactive proteins,blood lipids,muscle mass,bone mass,water quality,distribution of abdominal subcutaneous adipose area,and visceral adipose area[94,98,120,125,183].

Gender disparity inclines towards the severe,with overweight being more common among men and obesity among women;therefore,higher health risks are present among obese women, such as albuminuria and asthma [195-197]. Apart from weight loss,obese women who received acupuncture alleviated BMIs,body fat percentages,abdominal subcutaneous fat thickness,prehepathic fat thickness,trunk fat mass,circumferences of waist and hip,waist-hip ratios, triceps skinfold thickness, and subscapular thickness[95,118,132,148,153,156,159,171,175,188,191].

Also, combined treatments gained additional effects:examples of combined treatments include acupuncture with Chinese medicine, cupping,acupotomology, ear acupuncture, fumigation,physical exercise, diet management, abdominal vibration therapy,aromatherapy,and music therapy[100,102,105,107,110,119,128,129,143,144,149,151,152,164,167,176,182,190].

Obesity and cardiovascular diseases

Obesity exacerbates cardiovascular diseases,which also increases morbidity and mortality[198].Yan and colleagues recruited 113 participants,aged 18-77,to assess how warming acupuncture and ear acupuncture could cope with adiposity with hyperlipidemia[96].The effect rate reached 94.7%after 45 30-minute sessions,reporting reductions in BMIs,body fat percentages,degrees of obesity,total cholesterol levels, triglycerides, and low density lipoprotein cholesterol levels,and an increase in high density lipoprotein cholesterol.These positive signs were echoed by other projects,including Yan’s team,Yan’s projects,and Yuan and colleagues[109,111,112,185].Better effectiveness was achieved when combining warming acupuncture with ear acupuncture [121, 122]. Another study with 98 patients compared the effects of warming acupuncture with simvastatin (medication) on obesity-related hyperlipidemia[99].The participants were randomly,equally assigned to the warming acupuncture and medication groups. The former underwent 90 sessions of 30 minutes each;the latter took 10-20mg simvastatin daily for 225 days.Significant variations presented themselves: the incidence of hypoventilation in the acupuncture group was 2%versus 10.2%in the medication group,of cardiovascular disease was 4.1%in the former and 16.3%in the latter,of endocrine disorders 2%in the former and 12.2%in the latter,and of digestive disorders nil in the former and 8.2%in the latter.

Hypertension raises alarms for obese individuals[199]. Fifty patients with adiposity and primary hypertension, after 90 sessions of warming acupuncture and ear acupuncture 30 minutes daily,reduced not only body weight,BMIs,and body fat percentages,but also systolic and diastolic blood pressure[113].This outcome was also supported by other studies[138,161,180,181].

Obesity and metabolic disorders

Obesity-linked diabetes largely comprises the majority of diagnosed diabetes cases[200].Research compared the efficacy of acupuncture and metformin(medication)on adiposity with diabetes through the random allocation of acupuncture and medication(n=33),and medication only(n=33)groups[140].Greater decreases in the former were reported in body weight, BMIs, waist circumferences, and greater significance in the levels of fasting insulin.Chen remarked an effect rate of 97.5% when adopting acupuncture together with lifestyle adjustment,compared to 60%in lifestyle adjustment only[117].

Lipid metabolism affects adiposity,both of which are also connected to cardiovascular health[201,202]. A randomised study with 76 participants delineated the effects of acupuncture on reducing BMI and triglycerides and improving high density lipoprotein cholesterol levels[154].Wu added that this method lessened body weight, waist circumferences, fasting triglycerides, serum total cholesterol levels, and low-density lipoproteins[189].

Obesity and degenerative knee arthritis

Heavy body weight and weak muscle mass and strength yield compressive pressure onto weight-bearing joints, producing arthritis [203].Eighty obese patients with degenerative knee arthritis were randomly, equally divided into electro-acupuncture and manual acupuncture groups for 50 treatment sessions[137].The former attained a 100%effect rate and 7.5%relapse rate after 12 months;whereas the latter achieved 95%and 37.5%respectively.A similar study also resonated with these results[169].Another randomized controlled research project distributed patients between the acupuncture with moxibustion (n = 32) and moxibustion only(n=18)groups[141].After 90 sessions,the effect rates were reported to be 87.5%and 72.2%correspondingly.

Obesity and emotional disorders

Clinical evidence presents an interactive relationship between obesity and sleep deprivation [204].Following psychometric assessment,37.8%of 37 obese employees who suffered from sleep disorders reported enhancements in sleep quality after 8 30-minute sessions for electro-acupuncture and ear acupuncture[150].Another team of 800 participants not only reduced their food consumption and therefore body weight,but also their anxiety levels[192].In contrast,24 obese women with depression showed no improvements in body weight and depressive symptoms, notwithstanding the prevalence of co-occurrence for these two problems[134,205].

Obesity and gynaecological Illnesses

Warnings have also been posted on the impact of obesity on gynaecological problems across different life stages for women [206].This review covers pre-menstrual tension syndrome, dysmenorrhea,menopausal symptoms, breast hyperplasia,polycystic ovary syndrome,and postpartum obesity.

Experimental data show a strong association between body weight and pre-menstrual tension syndrome [207]. One examination depicted how 87.8% of 161 women suffering from obesity concurrently took 45 30-minute sessions for acupuncture, ear acupuncture and moxibustion,diminishing body weight, BMIs, body fat percentages,and obesity indices[147].Among these women,the younger their age,the stronger the effect was.

Dysmenorrhea frequently occurs among both underweight and overweight females [208]. Ren listed the effect rates of a combined treatment(ear acupuncture and warming acupuncture)on primary dysmenorrhea (n = 43) and obesity with dysmenorrhea(n=43)groups who completed 90 sessions: 97.7% and 72.7% respectively after 10 sessions,100%and 86%after 20 sessions,and 100%and 88.4%after 30 sessions[142].Another inquiry also presented escalating results from 10 to 30 sessions of acupuncture and ear acupuncture,with overall effect rates of 95.1%on weight loss and 100% on reduced menstrual pain [168]. Other research has shown agreement with these outcomes[184].

The impact of adiposity on menopausal symptoms ranges through varied phases [209]. Forty-six premenopausal women,21-54 years old,received acupuncture;and benefited from improvements in body weight,BMI,and waist circumference[136].This investigation also presented a deactivation of parasympathetic function and an increase in sympathetic activity.

Gao invited 54 obese perimenopausal women to join an acupuncture group and another 54 to join a Chinese medicine group[178].The results showed that 96.1%and 69.4%saw improvements in their obesity correspondingly,and 82.4%and 84.7%noted decreases in menopausal syndrome.

Liu, et al. offered 36 30-minute warming acupuncture sessions to 91 women with menopausal syndrome,aged 43-54[133].Among them,88.4%reported decreases in body weight,BMI,body fat,and degree of obesity;and 99.1%showed reductions in follicle-stimulating hormone. Another similar project agreed with such outcomes,within which 98.7%of 151 women,45-55 years old,observed reductions in climacteric syndrome, and 85.5%experienced lower body weights[155].

In response to the high potential for the development of adipose-induced breast cancer,one team of researchers looked into how electro-acupuncture could tackle obesity with breast hyperplasia among 67 women who underwent 45 sessions [130, 210]. 95.5% of the participants significantly reduced body weight, BMIs,circumferences of chest,waist,hip and thigh,and waist-hip ratios.

Physicians have observed a feasible link between obesity and polycystic ovary syndrome phenotypes[211].Zhang studied the efficacy of acupuncture with metformin(medication)over a 6 month period on 50 young women with polycystic ovary syndrome[114]. The encouraging outcomes included reductions in BMI,body weight,waist-hip ratio,and the size of cystic ovaries.

Postpartum weight retention interferes with many women’s lives after giving birth[212].Two groups of overweight post-natal women were distributed between a combined treatment group(n=19)which included acupuncture,cupping,massage,diet control and exercise,and a group(n=19)for diet and exercise only[108].The effect rate for the former was 89.5%, compared with 52.6% in the latter.Furthermore,more significant drops were indicated in the former,regarding body weight and BMI.Laser acupuncture was able to achieve these effects[101].

Childhood obesity

Childhood obesity has been a public health risk,related to genetic,environmental,and peri-natal and post-natal factors [213-215]. Ten obese children,9-14 years old,completed 8 15-minute acupuncture sessions[172].They saw decreased body weights,BMIs,waist and hip circumferences,waist-hip ratios,and abdominal fat.

Recommendations

This review supports the usefulness of acupuncture in dealing with obesity and relevant health concerns.Nevertheless, common shortcomings have been detected which call for recommendations.

In spite of there being 49 randomised controlled projects out of the 101 reviewed studies(48.5%),nearly one-third of them were conducted using a small sample size, which probably lessens the credibility of the results.Additionally, a lack of research details weakens the evaluation of the randomised controlled trials.This review suggests a greater elaboration of research design and indicators,including randomisation procedures and p-values,in order to improve research reliability and validity.

Moreover, 31.6% (n = 32) of the reviewed researches were projects with less than 60 participants each,which is considered to be a small sample size[216].Such small sizes provide low statistical power and result duplicability[217].In order to strengthen statistical confidence,research projects with larger samples are strongly proposed in order to ameliorate data quality[218,219].

There are also only four studies (4%) with follow-up measurements,from 3-12 months.More longitudinal studies for this issue are necessary,and follow-up assessment provides a more comprehensive understanding of the effectiveness and changes over a period of time, through cumulative data[220,221].

Although traditional Chinese medicine is conducted on an individual basis (for instance,diverse acupoints will be applied to different patients in accordance with the diagnosis of obesity type as classified by Chinese medicinal theory),this review proposes protocols,which need more well-designed randomised controlled studies to stipulate standard treatments together with individual accommodations[222].

This review unequivocally suggests integrative approaches. For example, acupuncture can be combined with yoga for weight loss,where yoga can boost energy expenditure and improve mood;or with dance therapy which can enhance self-body image and the quality of life of obese people[223-225].This makes treatment more interesting and effective.

Conclusion

As one of the world’s major health hazards,obesity has become an epidemic and has received substantial attention,particularly in its association with chronic diseases.This narrative review examines 101 clinical studies with 15941 participants from 9-80 years old in Africa,Asia,Europe,the Middle East,and North and South America.The outcomes corroborate the usefulness of either acupuncture alone or with other methods for body weight management,cardiovascular diseases, metabolic disorders,degenerative knee arthritis, emotional disorders,gynaecological illnesses, and childhood obesity.Despite these,this research suggests enhancements in both practical and research methodological development to fortify the effectiveness of this traditional Chinese medical practice.It reveals its potential contribution to patients and medical care professionals.

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