Acupuncture and obesity 2023

Stimulated by Fumagalli et al 2023 and Landgraaf et al 2023.[1,2]

VLCD – very low calorie diet
BMI – body mass index
PCOS – polycystic ovarian syndrome

key to acronyms

I have to say that I have never been particularly interested in obesity or its treatments, and certainly not the use of acupuncture to help weight loss. However, right from the start of me using acupuncture in the early 90’s, others have been interested in this topic and many patients and practitioners have asked for my opinion on it.

It really started with the idea that acupuncture might reduce appetite rather in the same way as it might reduce cravings for certain substances. Having a point on the ear named ‘Stomach’ as one of the 4 points the BMAS taught did nothing to reduce the hopeful enquiries of students. I was uncomfortable, to say the least, with the idea of food being equated to addictive substances, and far from convinced that acupuncture could or should have any influence over energy intake. On the contrary, if acupuncture was equivalent in some way to strong exercise,[3] surely it would encourage higher energy intake.

Things have moved on somewhat since the mid-90’s and our understanding of the complex systems controlling energy balance has grown along with the average weight of the population, especially in the developed world. The latter is not a good thing of course, but can acupuncture play a role in the solution to our obesity epidemic?

My good friend Maria from Thessaloniki was not particularly interested in obesity either, but academic opportunities led her to consider research on acupuncture in this field. I was astonished to find that her review paper on the topic published in Acupuncture in Medicine in 2013 topped the charts for citations in 2015.[4]

Next, I met Massimo from Switzerland who came to talk to me after my presentation on WMA at the WFAS World Congress in Turkey in 2019. He told me about his multiple clinics across Switzerland and the potential to collect lots of data. I don’t recall any mention of treating obesity then but subsequently I heard him speak at an online meeting. I was particularly taken by his fancy slideshow, but also the size of the data set from his clinics.

Massimo introduced me to Raymond who had taken on the job of synthesising the data and planning formal research on their approach to obesity treatment with acupuncture and diet (VLCD). Finally, we have the first 2 publications from the team – 19 years of data on treating obesity from the Sinomedica clinics and a review paper considering the possible mechanisms.[1,2]

Over a period of nearly 20 years, the data on over 11k patients has been reported with outcomes tracked over 500 days. This is a huge volume of data, and the results seem impressive with weight loss of 10kg to 20kg in the first 100 days (depending on initial BMI) and mostly maintained throughout follow-up.

This is retrospective data, so it is difficult to know how representative it is likely to be of the population at large because of selection and attrition issues, but over 11k patients with an average weight loss of 15.5kg at 18 months is hard to dismiss.

The acupuncture protocol is standardised, as is the dietary regime. The former involves 16 needles: CV17, CV12, CV9, CV4 on the abdomen; ST40, SP6, SP9 on each leg; just HT7 on each wrist; and topped off with the 4 points that make up Sishencong (mentioned on last week’s blog).

The review paper led by Raymond highlights three areas of interest regarding possible mechanisms:

1. Hormonal dysregulation
2. Inflammation
3. Gut dysbiosis

Massimo is convinced that regular acupuncture is the key to patients being able to maintain the diet, and if this is true, we are probably looking at an effect on hormone dysregulation. Lisa Stener-Victorin’s research in PCOS has demonstrated the potential of acupuncture to reverse insulin resistance,[5] so is it too much of a leap to think that the same could not be true of leptin resistance? Time will no doubt tell… with a little prospective research thrown in of course.

References

1          Fumagalli M, Landgraaf RG, Schiavi-Lods NN, et al. Novel insights into weight loss: acupuncture combined with a very low-carbohydrate diet-a Swiss experience. Acupunct Med. 2023;9645284231202811.

2          Landgraaf RG, Bloem MN, Fumagalli M, et al. Acupuncture as multi-targeted therapy for the multifactorial disease obesity: a complex neuro-endocrine-immune interplay. Front Endocrinol. 2023;14:1236370.

3          Andersson S, Lundeberg T. Acupuncture–from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses. 1995;45:271–81.

4          Belivani M, Dimitroula C, Katsiki N, et al. Acupuncture in the treatment of obesity: a narrative review of the literature. Acupunct Med. 2013;31:88–97.

5          Stener-Victorin E, Baghaei F, Holm G, et al. Effects of acupuncture and exercise on insulin sensitivity, adipose tissue characteristics, and markers of coagulation and fibrinolysis in women with polycystic ovary syndrome: secondary analyses of a randomized controlled trial. Fertil Steril. 2012;97:501–8.

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Declaration of interests MC