Acupuncture for the treatment of obesity: a review of the t he evidence J M Lacey1, A M Tershakovec 2 and G D Foster 2 1
1.
West Chester University, West Universit y, Str!e"ecker #ea$th Sciences Center, West West Chester, %A, %A, USA
2.
2
University o& %ennsy$vania, '('( Market Street Site '1)*, %hi$ade$+hia, %A, USA
Corres+ondence Dr JM Lacey, '1- Str!e"ecker #ea$th Sciences Center, West West Chester University, West Chester, %A 1-'*', USA. eceived 22 A+ri$ 2))2/ evised 1 0cto"er 2))2/ Acce+ted 1 ove3"er 2))2. To+ o& +a4e
Abstract A$tho4h ac+nctre is "ein4 ti$i!ed to treat a variety o& i3+ortant hea$th +ro"$e3s, its se&$ness in o"esity 3ana4e3ent has not yet "een &$$y eva$ated. The ai3 o& this revie5 +a+er 5as to srvey and critica$$y eva$ate the descri+tive and contro$$ed tria$s o& ac+nctre &or enhancin4 5ei4ht $oss. The nder$yin4 +rinci+$es o& ac+oint sti3$ation are descri"ed, 5ith an e3+hasis on aric$ar 6ear7 ac+nctre, the 3ethod 3ost o&ten chosen &or o"esity stdies. The di&&ic$ties o& se$ectin4 sita"$e +$ace"o contro$s are hi4h$i4hted. To To date, 3ost tria$s tria$s have "een descri+tive descri+tive in natre, natre, o& short dration dration 6 12 5eeks7, 5eeks7, and desi4ned desi4ned sin4 nonstandard treat3ent +rotoco$s. Des+ite the ni8e cha$$en4es invo$ved, &rther care&$ stdy o& ac+nctre9s +otentia$ se&$ness as an ad:nct in 5ei4ht 3ana4e3ent is reco33ended. An a4enda &or &tre research in this area is +rovided. Keywords:
ac+nctre, 5ei4ht 3ana4e3ent, a$ternative, co3+$e3entary To+ o& +a4e
Introduction and overview The problem of obesity
0"esity is a serios, +reva$ent, and re&ractory +ro"$e3. 1 ;ndivida$s 5ho are over5ei4ht 6
327 or o"ese 63 27 are at 4reater risk &or a variety o& 3edica$ conditions inc$din4 dia"etes, hy+ertension, dys$i+ide3ia, cardiovasc$ar disease, and s$ee+ a+nea.2 The +sycho$o4ica$ conse8ences are a$so severe and inc$de "ody i3a4e dis+ara4e3ent, i3+aired 8a$ity o& $i&e and, a3on4 the severe$y o"ese, de+ression. ',?,( The CDC recent$y re+orted that '?@ o& A3ericans are over5ei4ht and 2@ are o"ese. Wor$d5ide, it is esti3ated that @ o& ad$ts are o"ese, "t t5o to three ti3es as 3any are
considered over5ei4ht. The +reva$ence o& o"esity in esta"$ished 3arket econo3ies 6Bro+e, Canada, Astra$ia, etc7 is esti3ated to "e 1(2)@.* ;n deve$o+in4 contries, the +ro+ortion o& over5ei4ht in +reschoo$ chi$dren 5as &ond to "e increasin4 in 1 o& '* contries. - A consistent &indin4 o& "ehaviora$ treat3ents is that onethird o& the 5ei4ht $ost is re4ained 1 y a&ter treat3ent, t5othird a&ter 2' y and &$$ 5ei4ht is re4ained at ( y. 1),11 A 3yriad o& &actors 3ay 3ake e&&orts to contro$ 5ei4ht di&&ic$t, inc$din4 nrea$istic eE+ectations, 12 4enetic +redis+osition,1' an environ3ent that +ro3otes increased ener4y intake, and decreased +hysica$ activity.1? Complementary and alternative approaches
The serios, 5ides+read and re&ractory natre o& o"esity 3akes it ri+e &or investi4ations o& co3+$e3entary and a$ternative a++roaches.1(,1 T5o "road ty+es o& a++roaches have "een s44ested. 0ne is a co3+$ete a"andon3ent o& the dietin4 +aradi43, o&ten re&erred to as 9ndietin49 or 9nondietin4.91 This 3ove3ent contends that dietin4 is not on$y ine&&ective, it is har3&$.1*,1-,2) This a++roach has not "een 5e$$ stdied, "t see3s to +rodce &avora"$e +sycho$o4ica$ chan4es 6"ody i3a4e, de+ression, and se$&estee37 5ithot +rodcin4 5ei4ht $oss.21 Another "road c$ass o& co3+$e3entary and>or a$ternative a++roaches has not a"andoned the "asic &nda3enta$s o& dietin4 6ie, decreasin4 intake7 "t has either decreased the intake o& tar4eted &oods 6ie, redcin4 car"ohydrates rather than tota$ ca$ories7 or has co3"ined traditiona$ dietin4 3ethods 5ith her"s, s++$e3ents or nontraditiona$ 3ethods sch as ac+nctre. Freed3an et al 22 have s33ari!ed the &indin4s &or $o5&at and $o5 car"ohydrate diets, and A$$ison et al 2' have revie5ed the se o& her"s and s++$e3ents in the treat3ent o& o"esity. #o5ever, $itt$e co3+rehensive in&or3ation has "een +"$ished re$atin4 to ac+nctre in the treat3ent o& o"esity. The &ocs o& this revie5 5i$$ "e on ac+nctre as a treat3ent &or o"esity. This +a+er 5i$$ +rovide 617 a "rie& overvie5 o& the 3ethods and 3echanis3s o& ac+nctre/ 627 a s33ary o& descri+tive and contro$$ed stdies o& ac+nctre in the treat3ent o& o"esity/ and 6'7 an a4enda &or &tre research. To+ o& +a4e
Mechanisms and methods of acupuncture Ac+nctre, +racticed &or severa$ thosand years in China,2? is increasin4$y sed 5or$d5ide in the treat3ent o& 3any disorders. An acc3$atin4 "ody o& evidence s33ari!ed in a ;# Consenss State3ent on Ac+nctre 2( con&ir3s that ac+nctre treat3ent has "ene&icia$ e&&ects &or conditions ran4in4 &ro3 +osto+erative denta$ +ain to che3othera+yassociated e3esis. ;t is a$so e&&ective as an ad:nctive 3oda$ity &or :oint and 3sc$e +ain, addictions, and asth3a. Meridians and acupoints
;n Traditiona$ Chinese Medicine 6TCM7, $i&e &orce or 9i9 69chee97 is tho4ht to circ$ate 5ithin ener4y +ath5ays or 93eridians9 $on4itdina$$y thro4hot the "ody. There are 1? 3a:or 3eridians, corres+ondin4 6$oose$y7 to the Western de&inition o& 9or4ans.9 Ac+nctre +oints are s+eci&ic $ocations on the "ody considered to "e connected to these ener4y 3eridians. 2(,2,2
Drin4 i$$ness i is tho4ht to "e ot o& "a$ance, and sti3$ation o& ac+nctre +oints corrects this i3"a$ance. Theoretica$$y, an 9eEcess9 or 9de&iciency9 o& i can "e 9nor3a$i!ed9 "y the s+eci&ic 3anner o& +oint sti3$ation. Usin4 this +aradi43, o"esity and>or eEcess a++etite has "een conce+ta$i!ed in a variety o& 5ays, sch as 9heat9 in the sto3ach and intestine, 2* a de&iciency o& i in the s+$een and sto3ach,2*,2- or a de&iciency o& +ri3ary i. 2*
Si3+$i&ied theoretica$ +ath5ay o& need$e sti3$ation sendin4 nerve i3+$ses to "rain and interna$ or4an.'2 F$$ &i4re and $e4end 6'27
Acupoint stimulation
A $ar4e n3"er o& ac+nctre +oints 6'( +oints have "een identi&ied in Chinese ac+nctre 3a+s7 sho5 concentrations o& +eri+hera$ nerve :nctions, re&erred to as 9tri44er +oints9.2 A variety o& 3ethods are sed to sti3$ate ac+oints.2(,'1,'' These inc$de 1. eed$in4 or 9traditiona$ ac+nctre9, in 5hich &ine stain$essstee$ need$es are inserted thro4h the skin to varios de+ths, ke+t in +$ace &or varyin4 $en4ths o& ti3e and>or &rther sti3$ated 3ana$$y or e$ectrica$$y 69e$ectroac+nctre97. 2. %ress need$es or 9sta+$e+nctre9 in 5hich short ac+nctre need$es are ta+ed into +$ace &or eEtended +eriods 5ith +ressre "ein4 a++$ied on a re4$ar "asis. '. 9Ac+ressre9 in 5hich "eads are 3assa4ed or +ressed at s+eci&ic $ocations. ?. 9MoEi"stion9 invo$vin4 the a++$ication o& heat, "y "rnin4 s3a$$ 4rainsi!ed +e$$ets o& co3"sti"$e 3ateria$ on or near the ac+oints.
(. 9C++in49 or sin4 c+s o& varios 3ateria$s to create 9ne4ative +ressre9 or a vac3 on the skin sr&ace &or increased "$ood circ$ation and +oint sti3$ation. . Transctaneos e$ectrica$ nerve sti3$ation 69TBS97 5hich invo$ves a++$yin4 e$ectrode +ads to the skin sr&ace 5hich trans3it a 3i$d crrent into the ac+oint. Auricular acupuncture
Aric$ar 6ear7 ac+nctre is the 3ethod 3ost o&ten sed &or the treat3ent o& o"esity. 2Co33on aric$ar +oints sed in the treat3ent o& o"esity inc$de 9#n4er9 and 9Sto3ach9 +oints 6&or satiety and &$$ness7 and 9Shen3en9 6&or sedation and ana$4esia7'?,'(,',','* 6Fi4re 27. The eEterna$ ear 6aric$e7 is innervated "y severa$ nerves, inc$din4 va4s, 4$osso+haryn4es, tri4e3ins, &acia$is, and "ranches 6the second and third7 o& the cervica$ s+ina$ nerves.2- The va4s nerve is tho4ht to interact 5ith crania$ nerves and those o& the di4estive tract, as these nerves share a co33on +ath to the "rain .'- ;t is hy+othesi!ed that sti3$ation o& the aric$ar nerve cases inter&erence to a++etite si4na$s &ro3 the 4astrointestina$ tract?) 6see Fi4re '7. Figure !
Ac+ointor4an re$ationshi+s in the ear '* 1Hteeth ++er :a5, 2H3oth, 'H:a5 and tonsi$, ?Hteeth $o5er :a5, (Heye, Hinner ear, Hteeth $o5er :a5, *Htonsi$, -Hinner ear, 1)H &oot, 11Hank$e, 12Hknee, 1'HShen3enre$aE, 1?H5rist, 1(Hhi+, 1He$"o5, 1H +rostate, 1*H4a$$ "$adder, 1-H!erore$aE, 2)Hsto3ach, 21H$iver 22Hsho$der, 2'H$n4 and "ronchi, 2?Hheart, 2(Hinterna$ nose, 2Htoothache, 2Hneck, 2*Hadrena$, 2-H %in4chanasth3a, ')Hendocrine, '1Hhn4er, '2H$3"ar verte"rae, ''Hdia+hra43, '? Hs"corteE, '(Htri+$e 5ar3er, 'H$ar4e intestine, 'Hsy3+athetic, '*HeEterna$ 4enita$ia '-Hters, ?)Hkidney. F$$ &i4re and $e4end 6-7
Figure "
Sche3e o& distri"tion o& the va4s nerve.?) F$$ &i4re and $e4end 6)7
#atiety$ hunger$ and appetite
at stdies s44est that sti3$ation o& the aric$ar re4ionsHassociated 5ith the ventro3edia$ hy+otha$a3sHa&&ects the satiety center and $eads to i3+roved 5ei4ht $oss 6or redced 4ain7 in "oth o"ese and nono"ese rats.?1,?2,?' Like5ise, there have "een anecdota$ re+orts o& redced a++etite and cravin4s &ro3 +atients 5earin4 aric$ar ac+nctre devices 6+ress need$es, sta+$es, or "eads7.?) Mood
%esults of clinical trials with acupuncture &ncontrolled trials
Most stdies o& ac+nctre in the treat3ent o& o"esity have "een descri+tive in natre 5ith $itt$e syste3atic re+ortin4 or ana$ysis o& data.(2,(',(? ;n 4enera$, the re+orts &ro3 China a++ear to "e +ositive 5ith re4ard to the se o& ac+nctre &or 5ei4ht $oss ,((,( redction o& cardiovasc$ar risk &actors( and +ara3eters o& car"ohydrate 3eta"o$is3 6$o5er ins$in and i3+roved 4$cose contro$7. (*
3onth, ()@ 4ood sccess 6contro$ o& the eatin4 ha"its and ha$& o& their individa$$y set 4oa$ reached7, 5hi$e 2)@ 5ere 9not in&$enced at a$$9. Soon4(- stdied 21 o"ese +atients sin4 varios aric$ar +oints &or treat3ent +eriods ran4in4 &ro3 2 5eeks and re+orted a 3ean 5ei4ht $oss ran4e o& '.' 1.- k4 5ith a ran4e o& 1 .' k4. A$$ +atients re+orted anecdota$ decreases in a++etite, "t the data 5ere not s33ari!ed or ana$y!ed. Dn4 (' treated ' over5ei4ht individa$s 62 &e3a$es, nine 3a$es7 sin4 ac+nctre 9+ress9 need$es 6t5o need$es in "oth ears7 &or 2 5eeks at a ti3e, 5ith a 1) day rest +eriod +rior to the neEt cyc$e. A$tho4h &e5 +eo+$e retrned &or a second series o& need$e +$ace3ents, '-@ 61? o& ' +atients7 had $ost ? $" 6ran4e ? to 12 $"7 in a '5eek +eriod. The athor conc$ded that the stdy res$ts 5here 9not very +ro3isin49, a$tho4h the 5ei4ht $oss &or the 4ro+ as a 5ho$e 6re+orted as a $ist "t not ana$y!ed7 5as indeed statistica$$y si4ni&icant 6 P I).))17. More recent$y, #an4 et al '? eva$ated 5eek$y aric$ar ac+nctre in co3"ination 5ith individa$i!ed dietary and aero"ic eEercise reco33endations 6soca$$ed 9tri+$e thera+y97 a3on4 ?( ad$t o"ese +atients 6* 3a$es, ' &e3a$es7. A&ter * 5eeks, e&&ectiveness 5as rated at *@ 6ie, "ody 5ei4ht and "ody &at redced "y at $east 2 k4 and 1@, res+ective$y7. The $ack o& a contro$ 4ro+ 3akes it di&&ic$t to se+arate the e&&ects o& diet and eEercise &ro3 those o& ac+nctre. Controlled trials
There are seven co3+arison stdies o& ac+nctre in the treat3ent o& o"esity 6 Ta"$e 17. A3on4 these seven, one has on$y "een re+orted in a"stract &or3, ) another as a con&erence +roceedin4,' and another did not se rando3 assi4n3ent. 1 Table 1 ' Controlled trials of acupuncture for enhancing weight loss
F$$ ta"$e
;n a nonrando3i!ed stdy o& 12) +artici+ants 6initia$ 5ei4ht not s+eci&ied7, Gi$$er 1 re+orted that ear ac+nctre +ress need$es a++$ied &or 5eeks res$ted in 9hn4er redction9 and 5ei4ht $oss 6over 2 $">5eek &or at $east ? 5eeks7 in )@ o& +atients 5ho had "een treated at the 9hn4er +oint9. A3on4 +artici+ants treated at 9sto3ach,9 9$n49, or a 9+$ace"o9 ear +oint, on$y 2)@ re+orted$y $ost 5ei4ht. #o5ever, no 8antitative data 5ere +resented in this re+ort and the treat3ent 5as not consistent &or a$$ +artici+ants 6e4, +$ace3ent o& need$es 5as chan4ed every 2 5eeks i& there had "een no e&&ect7.
Sn and 2 sed a standardi!ed treat3ent o& aric$ar ac+ressre K "ody ac+nctre over a -)day +eriod in 11) s":ects co3+ared to (1 contro$s 6rando3i!ed 2 to 17. Those in the contro$ 4ro+ received on$y an her"a$ s++$e3ent, Oenothera erythrosepala, evenin4 +ri3rose oi$ 61()) 34 t5ice a day7, 5hich is hi4h in $ino$enic acid. The treated 4ro+ had si4ni&icant$y 4reater redctions in 5ei4ht 6(.) 2.' vs 2.1 1. k4/ P I).)17 and "ody &at +ercenta4e 6'.) 1. vs 1.( 1.)@/ P I).)17. Si3i$ar$y, in an *5eek c$inica$ tria$ o& 1? o"ese 5o3en in Astria, individa$s receivin4 dietKac+nctre 6+oint +$ace3ent not descri"ed7 $ost 3ore than t5ice as 3ch 5ei4ht than dieton$y contro$s 6. ?.? vs '. 2.2 k4/ P I).))(7.) Sha&shak ' &ond that aric$ar e$ectroac+nctre, ad3inistered &ive ti3es a 5eek &or ' 5eeks co3"ined 5ith a 1)))kca$>day diet, 5as associated 5ith 4reater 5ei4ht $oss sccess 6 P I).)(7 &or the o"ese 5o3en treated at the 9hn4er9 6 n1)7 and 9sto3ach9 6n1)7 ear +oints, co3+ared to those treated at a +$ace"o 6n1)7 +oint. S+eci&ica$$y, a3on4 +atients treated at the 9hn4er9 and 9sto3ach9 +oints, o& 1) individa$s $ost 1? k4 co3+ared to 2 o& 1) individa$s in the +$ace"o 4ro+. ;n this stdy, treatin4 the sto3ach +oint a++eared to "e e&&ective, in contrast to the res$ts o& Gi$$er 1 descri"ed a"ove. Steiner et al ' rando3i!ed * s":ects into &or 4ro+s rea$ ac+nctre 6"ody and ear +oints7, sha3 ac+nctre 6+oints near those sed in rea$ ac+nctre 4ro+, "t e$ectrica$$y inactive7, "ehavior 3odi&ication on$y 65eek$y c$asses on ntrition and "ehavior 3ana4e3ent7, and 5ait$ist contro$s. Data &ro3 ( s":ects a&ter * 5eeks sho5ed that a"so$te and +ercent 5ei4ht $osses in the rea$ ac+nctre 4ro+ 62. k4/ '.'@7 5ere co3+ara"$e to those achieved 5ith "ehavior 3odi&ication 6?.2 k4/ '.@7 and 4reater than "oth the 9+$ace"oac+nctre9 61.2 k4/ 1.2@7 and 5ait$ist contro$ 4ro+s 6K).( k4/ ).'@ 5ei4ht 4ain7. The 5ei4ht $oss o& "oth the rea$ ac+nctre and "ehavior 3odi&ication 4ro+s di&&ered si4ni&icant$y &ro3 the 5ait$isted contro$s 6 P I).)(7. T5o stdies have &ond no e&&ect &or ac+nctre. Fo$$o5in4 ' 3onths o& 5eek$y aric$ar ac+nctre +$s 3oEi"stion or +$ace"o 93ini3a$ ac+nctre9 6s+er&icia$ need$in4 and $atera$ to the treat3ent +oints7, Ma!!oni et al '( re+orted no di&&erences in 5ei4ht chan4e in ?) s":ects and no si4ni&icant "et5een4ro+ chan4es in
Severa$ stdies have eEa3ined $ess invasive ac+nctrere$ated 3ethods &or 5ei4ht contro$. A$$ison et al ? eva$ated the e&&icacy o& an aric$ar ac+ressre device 69AcSto+ 2)))97 sin4 a rando3i!ed, contro$$ed desi4n in - s":ects, a$$ o& 5ho3 received ntrition edcation. Treat3ent s":ects 5ere instrcted to 3assa4e the ear 5ith the device &or a &e5 3intes at s+eci&ic ti3es thro4hot the day/ contro$s a++$ied the device to their 5rists. A&ter 12 5eeks o& treat3ent, 5ei4ht $oss did not di&&er "et5een 4ro+s. ichards and Mar$ey'* assessed the e&&icacy o& a +orta"$e, noninvasive TBS device 6AcS$i37 in a ?5eek rando3i!ed c$inica$ tria$ o& ) s":ects. ;n tota$, -(@ o& res+ondents
in the treat3ent 4ro+, 5ho a++$ied the TBS to t5o ear +oints, re+orted a++etite s++ression 6se$&re+orts7, co3+ared to none o& the contro$s, 5ho ad3inistered the device to their th3". one in the contro$ 4ro+ $ost 2 k4, co3+ared to -@ in the treat3ent 4ro+. A3on4 individa$s 5ho $ost 5ei4ht 6&or contro$s and 2 treated s":ects7, the avera4e 5ei4ht $oss 5as ). ).' k4 in the contro$ 4ro+ vs ?.) 1.? k4 6 P I).)(7 in the treat3ent 4ro+.
