Traditional Chinese Medicine Appears Useful for Obesity

Joe Barber Jr, PhD

April 19, 2012

April 19, 2012 — Traditional Chinese medicine (TCM), including acupuncture and Chinese herbal medicine, has better efficacy than placebo and lifestyle interventions and similar efficacy to antiobesity drugs, with fewer side effects, according to the findings of a systemic review.

Yi Sui, from the Chinese University of Hong Kong, in Shatin, Hong Kong, China, and colleagues published their findings in the May 2012 issue of Obesity Reviews.

Although TCM is used frequently in clinical practice, the authors noted that its efficacy has not been thoroughly researched by using international standards. "Many systematic reviews in this area do not include clinical trials conducted in China, especially those using traditional Chinese herbal recipes," the authors write. "Most authors also do not evaluate the rationale, safety and relapse of weight gain in these reviews."

The authors identified 96 randomized trials conducted within and outside China that compared TCM with a control group: 49 evaluating Chinese herbal medicine, 44 on acupuncture, and 3 evaluating a combination of these treatments. Through use of a randomized effect model, the efficacy of Chinese herbal medicine against obesity was found to be similar to that of the antiobesity agents fenfluramine and metformin among 9 clinical trials (pooled risk ratio [RR], 1.11; 95% confidence interval [CI], 0.96 - 1.28), although heterogeneity was observed (I2 = 82%) because of the small number of studies and small sample sizes and effects.

The authors included participants in the accepted studies irrespective of age, sex, and obesity status and excluded pregnant and lactating women, patients with serious medical conditions, and those with secondary obesity. Additionally, the authors excluded preclinical studies, case reports, and self-control and nonrandomized trials. The primary outcomes measured were changes in body weight, body mass index (BMI), waist and hip circumference, and body fat percentage.

Among 15 trials of acupuncture, acupuncture treatment resulted in greater weight loss than did no-treatment sham operation, co-interventions, and lifestyle modification, as indicated by a pooled RR of 2.14 (95% CI, 1.58 - 2.90) in favor of acupuncture; heterogeneity (I2 = 88%) was noted because of the small number of studies and small sample sizes and effects. Among 11 trials that compared acupuncture with western drugs, including sibutramine, fenfluramine, and orlistat, acupuncture exhibited greater efficacy (pooled RR, 1.14; 95% CI, 1.03 - 1.25), with heterogeneity (I2 = 76%) due, again, to the small number of studies and small sample sizes and effects.

When analyzed according to the mean difference in body weight reduction, both Chinese herbal medicine (body weight reduction, 2.93 kg; 95% CI, 1.81 - 4.05 kg; BMI reduction, 1.36 kg/m2; 95% CI, 0.89 - 1.82 kg/m2) and acupuncture (body weight reduction, 1.85 kg; 95% CI, 1.03 - 2.67 kg; BMI reduction, 1.42 kg/m2; 95% CI, 0.63 - 2.20 kg/m2) were associated with greater efficacy compared with controls. In addition, relapse of weight gain was more common in the control groups than in the Chinese herbal medicine or acupuncture treatment groups.

The adverse effects of Chinese herbal medicine and acupuncture were generally mild. The most common were gastrointestinal symptoms for both Chinese herbal medicine and acupuncture, and local skin reactions for those receiving acupuncture treatments.

The limitations of the review included the use of different herbal formulations within and outside China, the lower methodologic quality of studies conducted within China, and the incomplete citation tracking of some studies.

Overall, the findings indicate the efficacy and tolerability of TCM, including Chinese herbal medicine and acupuncture. "Given the large unmet needs of obesity, these findings may form the basis for selection of intervention strategies in future randomized clinical trials," the authors write. "The combined use of Western principles of scientific inquiry and the holistic approach of Chinese medicine may provide a vital new dimension in our pursuit of control and prevention of chronic diseases, such as obesity and diabetes."

This work was supported by Hong Kong Hospital Authority and Hong Kong Foundation for Research and Development under the Chinese University of Hong Kong. The authors have disclosed no relevant financial relationships.

Obes Rev. 2012;13:409-430. Abstract

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