Effects of electroacupuncture in reducing weight and waist circumference in obese women: a randomized crossover trial

Abstract

OBJECTIVE:

To compare the effects of weight control on simple obese women between electroacupuncture and sit-up exercise.

DESIGN:

Randomized and crossover trial conducted from 1 January 2002 to 31 December 2002. The subjects were randomly divided into groups A and B. Group A received electroacupuncture treatment first while group B received sit-up exercise treatment first. After 6 weeks of treatment and 7 days of washout, group A switched to sit-up exercise treatment and group B received electroacupuncture treatment for another 6 weeks.

PATIENTS:

In total, 54 simple obese women, with waist circumference (WC)>90 cm and body mass index (BMI)>30 kg/m2, and who had not received any other weight control maneuver within the last 3 months.

MEASUREMENT:

The measurements of body weight (BW), BMI and WC were performed at the beginning, 6, 8 and 13 weeks. The data at different time periods were compared and expressed as % reductions.

RESULTS:

Electroacupuncture (n=46) showed significant differences in the % reductions in BW (P=0.001), BMI (P=0.003) and WC (P=0.005) compared with sit-up exercise. At the end of 13 weeks, there were no significant difference between groups A (n=24) and B (n=22) in all the measurements. At the end of the study, groups A and B showed significant differences in the % reductions in BW (P=0.004; 0.001), BMI (P=0.003; 0.021) and WC (P≤0.001; 0.001) compared with the initial values.

CONCLUSIONS:

Electroacupuncture treatment is more effective than sit-up exercise in reducing weight and WC, making it an alternative treatment option for weight and WC control on obese women.

Introduction

More than 50% of Americans are overweight,1 with 20% classified as obese (body mass index (BMI)>30 kg/m2).2 In the UK, the overweight and obese populations increased by almost 15% from 1990 to 1992.3 Furthermore, the incidence and prevalence of obesity are increasing worldwide, especially in the developing and newly industrialized nations. Obesity is related to diabetes mellitus, hyperlipidemia and cardiovascular disease, which are major diseases in Taiwan and other developing countries.4, 5, 6, 7, 8 Obesity is becoming a global epidemic and common health problem.

Obesity is defined as BMI>30 kg/m2, which necessitates weight control treatment. Guideline of the management of obesity recommended modest weight loss and weight maintenance, rather than a target of ideal weight.9, 10 Acupuncture is being utilized to treat a variety of health problems, one of which is obesity management.11 However, the majority of reports lack a well-controlled design.11, 12 Thus, we conducted this randomized crossover clinical trial to examine its effectiveness.

Methods

Study design

This was a randomized crossover study (Figure 1). Each patient was randomly allocated to receive either the electroacupuncture treatment (group A) for 6 weeks and then, after a 1-week washout period, a sit-up exercise treatment for 6 weeks, or the same treatments in the reverse order (group B). To examine the effects of electroacupuncture, we used the sit-up exercise for comparison.

Figure 1
figure1

Trial profile and design.

Patients and setting

The trial was conducted from January 2002 through December 2002 in the Taipei Hospital, Taiwan. A total of 54 simple obese women were enrolled. Enrolled subjects were between 16 and 65 y old, with waist circumference (WC)>90 cm and BMI>30 kg/m2. Table 1 also lists the exclusion criteria. The protocol was approved by the Human Ethics Committee of our hospital. Informed consent was obtained from all the enrolled patients. After a lead-in period of 2 weeks during which the patients should maintain weight and WC within 0.2% and were given details of study intervention, the patients were then randomly assigned to one of the two groups by computer, which generated a random number from 0.0 to 0.99. If the random number is between 0.0 and 0.49, the subjects would be assigned to group A, otherwise to group B. The patients were not allowed to receive other obesity management and were asked to keep their previous diet habit during the study period. All the patients were free to withdraw at any time during the course of the study.

Table 1 Inclusion criteria and exclusion criteria

Acupuncture

The standardized acupuncture points were chosen by several consultants and Chinese-medicine doctors of our study, according to the theory of Chinese medicine and clinical experience. Six acupuncture points on the abdomen including Qihai (REN-6), Shuifen (REN-9), right Shuidao (ST-28), left Suidao (ST-28), right Siman (K-14) and left Siman (K-14), and six acupuncture points including Zusanli (ST-26), Fenglong (ST-40) and Sanginjao (SP-6) on both lower legs were selected. The stainless-steel acupuncture needles (3.8 cm long) were inserted to a depth of approximately 2.5 cm after using skin sterilization procedures. The needles in acupuncture points of lower legs were manipulated by rotating back and forth. The subjects should have the sensation of ‘De-Xi’, a term used in acupuncture to describe a feeling of ‘heaviness’ in the area surrounding the insertion locus.

Electrical stimulation was applied to the abdominal acupuncture points only. Six 34 gauge stainless-steel acupuncture needles were inserted at the six abdominal acupuncture points, three needles serving as the positive pole, and the others as the negative pole to allow three electrical stimulation sets as Qihai (REN-6) to Shuifen (REN-9), right Shuidao (ST-28) to right Siman (K-14), left Suidao (ST-28) to left Siman (K-14). The needles were connected to an electrical stimulator (GWO-JIH, MODEL-05, Taiwan). Electricity was generated as an output of programmed pulse voltage, 42 Hz, dense-disperse wave, 390 μs square pulse, and at a maximal tolerable intensity, 500 Ω (12–23 V) (a strong, but not painful sensation to the patient). Each acupuncture treatment lasted 40 min. All subjects should receive two treatments per week, for a total of 6 weeks during electroacupuncture treatment course. All Chinese-medicine doctors participating in this study have received a training course beforehand to ensure same-quality procedures given.

Sit-up exercise

The subjects were instructed to do the standard sit-up exercise during the lead-in period. All subjects should do 10 times per day for 6 weeks during the sit-up exercise treatment course.

Assessment

The main outcome evaluated is the % reductions in BMI and WC after electroacupuncture and sit-up exercise treatment. All measurements were carried out after an overnight fast using standardized methods and were performed in the beginning, 6, 8 and 13 weeks later. Height was measured with a wall-mounted stadiometer to the nearest 0.1 cm, weight was measured on a calibrated balance beam scale to the nearest 0.1 kg, and BMI was calculated (BMI=body weight (BW)/height (kg/m2)). WC was measured mid-way between the lateral lower rib margin and the iliac crest, hip circumference (HC) was measured at the levels of the major trochanters through the pubic symphysis, with the scale to the nearest 0.1 cm, and WC/HC ratio (WHR) was calculated (WHR=WC/HC). All subjects were measured in the undergarments with a hospital gown on. We simultaneously collected the demographic data and fasting serum laboratory data of the subjects such as blood glucose and triglyceride.

Statistical analysis

The data were analyzed with SPSS software (version 11.5). Student's t-test was used to examine the main outcome, demographic data, and other measurements between group means. Paired t-tests were used to examine differences within group at 0–13 weeks. All P-values were two-tailed and the α level of significance was set at 0.05. We estimated in power 0.8 that each group needed 25 subjects.

Results

Demographics and measurements

Among the 70 obese women screened at the outpatient ward of Taipei Hospital in Taiwan, 54 fulfilled the inclusion and exclusion criteria (Table 1). We allocated randomly the subjects into two groups by computer. Three subjects of group A and five subjects of group B withdrew due to personal reason. In the end, 46 patients completed the study (Figure 1). The demographic and clinical profiles of the groups at the time of entry were indistinguishable (Table 2). Table 3 shows the BW, BMI and WC measurements before and after crossover. As can be seen, there were no significant differences between groups A and B in all the measurements.

Table 2 Characteristics of participants at baseline
Table 3 Measurements at different stages and the days after intervention (stage A: before crossover; stage B: after crossover)

Comparison at 6 weeks

Table 4 showed the % reductions in BW, BMI and WC. After the first 6 weeks of treatment, the % reductions in BW (P=0.02), BMI (P=0.01) and WC (P=0.01) were significantly higher in group A (n=24) treated with electroacupuncture (2.0 (2.3), 2.0(2.2) and 2.3(2.0)) than in the sit-up exercise group B (n=22) (0.5(1.4), 0.6(1.4) and 0.6(2.2)).

Table 4 % Reductions in outcomes between groups A and B after 6 weeks and 13 weeks of treatment

Comparison at 13 weeks

Comparing the % reductions in BW (P=0.02), BMI (P=0.04) and WC (P=0.21) between 8 and 13 weeks showed that group B (1.6(1.6), 2.7(4.9) and 1.8(1.5)) achieved better result than group A (0.3(1.9), 0.3(2.0) and 1.2(1.7)).

At the end of 13 weeks, there were no significant differences between groups A and B in all the measurements. Within group comparison, groups A and B were significantly different in the % reductions in BW (P=0.004 and 0.001), BMI (P=0.003 and 0.021) and WC (P<0.001 and P=0.001) compared with the initial values.

Comparison between electroacupuncture and sit-up exercise (n=46)

Table 5 showed the % reductions in outcomes of electroacupuncture and sit-up exercise after crossover treatment. Electroacupuncture showed more significant difference in BW (P=0.001), BMI (P=0.003) and WC (P=0.005) than sit-up exercise.

Table 5 % Reductions in outcomes of electroacupuncture and sit-up exercise after 13 weeks of treatment

Adverse effects

No subjects withdrew from the study because of discomfort or adverse effects associated with the treatment. Two subjects developed mild ecchymosis and one patient had abdominal discomfort after electroacupuncture treatment. No major adverse effects were noticed.

Discussion

According to a recent survey, over 40% of US adults use alternative medicine.13 For the increasing prevalence of obesity, it is not surprising that safe and effective alternative treatments for weight control are very desirable.13 There are many alternative treatments for obesity management, one of which is acupuncture. Many studies have reported on the beneficial effects of acupuncture for obesity control.14, 15, 16, 17, 18 However, most studies have methodological limitations, including small sample sizes and inadequate or lack of control groups.17, 18

The double-blind placebo-controlled clinical trial is recognized as the gold standard for showing whether an intervention has a specific effect over placebo or control.19 However, double-blind design is impossible in acupuncture study because the acupuncturist has to be aware of the method applied. Although many placebo methods in acupuncture research have been proposed, they are still inadequate to be applied in clinical use.20 To compare the effect of electrical stimulation on abdominal acupuncture points, we designed the abdominal sit-up exercise for comparison. In order to avoid the bias due to the diverse sensation of subjects and different skill of acupuncturists, we chose the standard acupuncture regimens and same sets of electricity. Thus, we conducted this randomized and crossover clinical study to demonstrate the effects of electroacupuncture on obesity.

Our crossover design has helped make the sample more representative. It can compare both the individual effect of each mode and the combined effect of different intervention modes in alternating order. Our study assumes the absence of carry-over effect and that the baseline for each half of the crossover starts from the same place. However, in clinical setting, no subjects wanted to return to the baseline BW and WC. After the 1-week washout period, even though neither group returned to the initial baseline, the BW, BMI and WC of both groups at the beginning of the second period showed no significant differences.

Results shown in Tables 4 and 5 reveal that electroacupuncture is more effective than sit-up exercise in reducing BW and BMI during the first 6 weeks of the study and the last 6 weeks of the study after crossover. At the end of 13 weeks, there was no significant difference between groups A and B in all the measurements, meaning that different treatment order will not influence the outcomes of the 13-week treatment. Studies of a longer follow-up period should be considered in the future.

In WC comparison, only the results in the early period (0–6 weeks) show significant difference (P=0.01), indicating better effect achieved by electroacupuncture. Although the late electroacupuncture treatment (group B, 1.8(1.5)) had better reducing effect than sit-up exercise (group A, 1.2(1.7)), it did not reach statistical difference (P=0.21). WC is related to the superficial abdominal fat tissue. At 6 weeks of abdominal electroacupuncture might help to redistribute or lysis superficial abdominal fat tissue. Such lasting effect can enable the following six weeks of sit-up exercise to have greater effect in reducing WC. The results obtained can also be attributed to the carry- over effects of electroacupuncture, which explain why the second stage of sit-up intervention (group A) had a larger effect on reducing WC than the first stage of sit- up exercise (group B). Both treatments during the late period have similar effect on reducing WC, so they show no statistical difference. Longer washout period to eliminate the carry-over effect of electroacupuncture could be considered in future related studies.

The literature shows that traditional acupuncture, auricular acupuncture, electroacupuncture and related acupuncture treatment can reduce BW in obese patients.17, 18, 21, 22 However its role in obesity control remains largely controversial.11, 12, 13 Animal experiments suggest that acupuncture may reduce the appetite with the regulation of feed-related lateral hypothalamic (feeding center) and ventromedial hypothalamic (satiety center) neuronal activity.23 Despite the minimal side effects, we found some interesting phenomena in our study groups, including the improvement of constipation (two patients) and dysmenorrhea (three patients). These might be associated with balance flow of bodily ‘energy’ or ‘Xi’ according to the Chinese-medicine theory after the acupuncture stimulation, which has been verified by neurophysiological interaction.24, 25, 26

Finally, it could be argued that the minimal beneficial effects of electroacupuncture, only around 2% reduction during 6 weeks of treatment, can be easily obtained by other management methods such as diet control or drug therapy. However, because of its lack of adverse reactions and the lasting effect on reducing WC, electroacupuncture might be a preferred or synergistic treatment option for obesity control.

Despite the encouraging results, our study still had limitations, such as the difficulties of selecting suitable control or placebo group, the carry-over effect in the second stage and the short duration. Studies of a longer follow-up period and longer washout period, different sets of electricity, with other acupuncture points selected and other well-designed protocols should be performed in the future.

In conclusion, this study demonstrated that electroacupuncture is more effective than sit-up exercise in reducing BW, BMI and WC, making it an alternative treatment option for weight and WC control on obese women.

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Acknowledgements

We thank Shier-Chieg Huang, Chien-Chung Chen, Yen-Yi Ho, Shu-Ling Hsie, Chi-Jung Wang and Ying-Li Liao for conducting this trial. We also thank all colleagues in Taipei Hospital, Taiwan for helping with this study. This study was supported by grants from the Taipei Hospital.

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Correspondence to P Chou.

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Hsu, CH., Hwang, KC., Chao, CL. et al. Effects of electroacupuncture in reducing weight and waist circumference in obese women: a randomized crossover trial. Int J Obes 29, 1379–1384 (2005). https://doi.org/10.1038/sj.ijo.0802997

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Keywords

  • acupuncture
  • electroacupuncture

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