Skip to main content

A randomised cross-over pilot study investigating the use of acupuncture to promote weight loss and mental health in overweight and obese individuals participating in a weight loss program

Abstract

Background

Acupuncture is widely used as an alternative modality for weight loss. Despite its increasing use, few acupuncture studies have evaluated the effect of a weight loss program on the mental health of obese/overweight participants and none have looked at the effect on those with eating, weight and shape concerns.

Objectives

To investigate the feasibility of conducting an acupuncture study involving overweight or obese individuals undertaking a weight loss program with particular reference to those with eating concerns.

Methods

Thirty-five overweight/obese males and females participated in a single-blinded randomised cross-over study. The two intervention phases were: (1) nutritional counselling plus Traditional Chinese Medicine (TCM) acupuncture and (2) nutritional counselling plus sham acupuncture.

Outcome measures

This study evaluates the feasibility and practicalities of the study including recruitment, retention, adverse events, effectiveness for defining eating and weight concerns, study design and statistics for power calculations.

Conclusion

The outcome measures, the recruitment of those with eating and weight concerns and the acceptability of the intervention demonstrate a larger trial investigating the use of acupuncture for weight loss in those who have elevated eating and weight concerns is feasible.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Cabroglu M, Ergene N (2007) Electroacupuncture treatment of obesity with psychological symptoms. Int J Neurosci 117:579–590

    Article  Google Scholar 

  2. Abraham S, Llewellyn-Jones D (2001) Eating disorders: the facts, 5th edn. Oxford University Press, Oxford

    Google Scholar 

  3. Grilo CM (2006) Eating and weight disorders. Psychology Press, London

    Google Scholar 

  4. Australian Institute of Health and Welfare (2013) Risk factors to health. http://www.aihw.gov.au/risk-factors/. Accessed 9 Jan 2015

  5. Briggs M (2006) Overweight and obesity in Australia. http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Publications_Archive/archive/obesity. Accessed 9 Jan 2015

  6. Belivani M, Dimitroula C, Kasiki N, Apostolopoulou M, Cummiings M, Hatzitolios A (2013) Acupuncture in the treatment of obesity: a narrative review of the literature. Acupunct Med 31(1):88–97. doi:10.1136/acupmed-2012-010247

    Article  PubMed  Google Scholar 

  7. Sui Y, Zhao HL, Wong VC, Brown N, Li XL, Kwan AKL et al (2012) A systematic review on use of Chinese medicine and acupuncture for the treatment of obesity. Obes Rev 13(May):409–430. doi:10.1111/j.1467-789X.2011.00979

    CAS  Article  PubMed  Google Scholar 

  8. Cho S-H, Lee J-S, Thabane L, Lee J (2009) Acupuncture for obesity; a systematic review and meta analysis. Int J Obes (Lond) 33:183–196. doi:10.1038/ijo.2008.269

    CAS  Article  Google Scholar 

  9. Rerksuppaphol L, Rerksuppaphol S (2011) Efficacy of transcutaneous electrical acu-point stimulation compared to electroacupucnture at the main acupoints for weight reduction in obese Thai women. Int J Collab Res Intern Med Public Health 3(11):811–820

    Google Scholar 

  10. Darbandi S, Darbandi M, Mokarram P, Qwji A, Zhao B, Ghayor-Mobarhan M et al (2013) Effects of body electroacupuncture on plasma leptin concentrations in obese and overweight people in Iran: a randomized controlled trial. Altern Ther Health Med. 19(2):24–31

    PubMed  Google Scholar 

  11. Wang Q, Li W-H, Zhou Q-H, Tang X-D, Zhang X-X, Shu S (2012) Weight reduction effects of acupuncture for obese women with or without perimenopausal syndrome: a pilot observational study. Am J Chin Med 40(6):1157–1166. doi:10.1142/S0192415X12500851

    Article  PubMed  Google Scholar 

  12. Elder CR, Gullion CM, DeBar LL, Funk KL, Lindberg NM, Ritenbaugh C et al (2012) Randomized trial of tapas acupressure technique for weight loss maintenance. BMC Complement Altern Med 12:19. doi:10.1186/1472-6882-12-19

    PubMed Central  Article  PubMed  Google Scholar 

  13. Mazzoni R, Mannucci E, Rizzello SM, Ricca V, Rotella CM (1999) Failure of acupuncture in the treatment of obesity: a pilot study. Eat Weight Disord 4:198–202

    CAS  Article  PubMed  Google Scholar 

  14. Bosmans G, Goossens L, Braet C (2009) Attachment and weight and shape concerns in inpatient overweight youngsters. Appetite 53:454–456. doi:10.1016/j.appet.2009.08.011

    Article  PubMed  Google Scholar 

  15. Celio CI, Luce KH, Bryson SW, Winzelberg AJ, Cunning D, Rockwell R et al (2006) Use of diet pills and other dieting aids in a college population with high weight and shape concerns. Int J Eat Disord 39:492–497

    Article  PubMed  Google Scholar 

  16. Mond JM, Hay PJ, Rodgers B, Owen C (2006) Recurrent binge eating with and without the ‘‘undue influence of weight or shape on self-evaluation’’: implications for the diagnosis of binge eating disorder. Behav Res Ther 45:929–938

    Article  PubMed  Google Scholar 

  17. Ramacciotti CE, Coli E, Bondi E, Burgalassi A, Massimetti G, Dell’Osso L (2008) Shared psychopathology in obese subjects with and without binge-eating disorder. Int J Eat Disord 41:643–649. doi:10.1002/eat.20544

    Article  PubMed  Google Scholar 

  18. Roehrig M, Masheb RM, White MA, Grilo CM (2009) Dieting frequency in obese patients with binge eating disorder: behavioral and metabolic correlates. Obesity (Silver Spring) 17:689–697. doi:10.1038/oby.2008.600

    Article  Google Scholar 

  19. Werrija MQ, Jansena A, Mulkensa S, Elgersmab HJ, Amenta AJHA, Hospersa HJ (2009) Adding cognitive therapy to dietetic treatment is associated with less relapse in obesity. J Psychosom Res 67:315–324. doi:10.1016/j.jpsychores.2008.12.011

    Article  Google Scholar 

  20. Burrows A, Cooper M (2002) Possible risk factors in the development of eating disorders in overweight pre-adolescent girls. Int J Obes Relat Metab Disord 26:1268–1273

    CAS  Article  PubMed  Google Scholar 

  21. Chugh R, Puri S (2001) Affluent adolescent girls of Delhi: eating and weight concerns. Br J Nutr 86:535–542

    CAS  Article  PubMed  Google Scholar 

  22. Polivy J, Herman P (2002) Causes of eating disorders. Annu Rev Psychol 53:187–213

    Article  PubMed  Google Scholar 

  23. Stice E (2001) A prospective test of the dual pathway model of bulimic pathology: mediating effects of dieting and negative effect. J Abnorm Psychol 110:1–12

    Article  Google Scholar 

  24. Garner DM (2004) EDI-3 eating disorder inventory-3-professional manual. PAR Psychological Assessment Resources Inc, Florida

    Google Scholar 

  25. Senn S (2002) Cross-over trials in clinical research. Wiley, West Sussex

    Book  Google Scholar 

  26. A.D.A.M. (2015) Appetite Decreased. http://www.healthcentral.com/ency/408/003121.html. Accessed 9 Jan 2015

  27. National Health and Medical Council. Dietary Guidelines for all Australians. Australian Government; 2003 (cited 13 July 2010). Reference No: N29–N34 Further information: nhmrc.publications@nhmrc.gov.au]. Available from: http://www.nhmrc.gov.au/publications/synopses/dietsyn.htm

  28. Deng T (2000) Practical diagnosis in traditional Chinese medicine. Churchill Livingstone, Edinburgh

    Google Scholar 

  29. Cabroglu M, Ergene N (2005) Electroacupunctre therapy for weight loss reduces serum total cholesterol, triglycerides, and LDL cholesterol levels in obese women. Am J Chin Med 33(4):525–533

    Article  Google Scholar 

  30. Cabroglu M, Ergene N (2006) Changes in levels of serum insulin, C-peptide and glucose after electroacupuncture and diet therapy in obese women. Am J Chin Med 34(3):367–376

    Article  Google Scholar 

  31. Shafshak T (1995) Electroacupuncture and exercise in body weight reduction and their application in rehabilitating patients with knee osteoarthritis. Am J Chin Med 23(1):15–25

    CAS  Article  PubMed  Google Scholar 

  32. Hsu C, Hwang K, Chao C, Lin J, Kao S, Chou P (2005) Effects of electroacupunctre in reducing weight and waist circumference in obese women: a randomized crossover trial. Int J Obes (Lond) 29:1379–1384

    Article  Google Scholar 

  33. Myeong L, Jeong K, Hyun-Ja L, Byung-Chenul S (2006) Effects of abdominal electroacuncture on parameters related to obesity in obese women: A pilot study. Complement Ther Clin Pract 12:97–100

    Article  Google Scholar 

  34. Hsu C, Hwang K, Chao C, Chang H, Chou P (2005) Electroacupuncture in obese women: a randomized, controlled pilot study. J Womens Health (Larchmt) 14(5):434–440

    Article  Google Scholar 

  35. Deadman P, Al-Khafaji M, Baker K (1998) A Manual of Acupuncture. Journal of Chinese Medicine Publications, East Sussex

  36. O'Connor J, Bensky D (1981) Acupuncture: A Comprehensive Text. Shanghai college of traditional medicine. Eastland Press, Chicago

  37. Kraft N (2003) Anorexia nervosa. Orient Med J 11(1):19–23

    Google Scholar 

  38. Beck A, Brown G, Steer R (1996) Manual for the beck depression inventory-II. San Antonio. Psychological Corporation, TX

  39. Spielberger C (1983) State-Trait anxiety inventory for adults, sampler set. Manual, test booklet and scoring key. Consulting Psychologists Press, Inc, Mind Garden

  40. QualityMetric. SF-36v2 Health Survey. 2010 (cited 13 May 2010). Available from: http://www.qualitymetric.com/WhatWeDo/GenericHealthSurveys/SF36v2HealthSurvey/tabid/185/Default.aspx

  41. Quantitative Micro Software (2007) E-Views Statistical Software. Version 6.1

  42. Jones B, Kenward MG (1989) Design and analysis of cross-over trials. Chapman and Hall Ltd, London

    Google Scholar 

  43. G*Power: Statistical Power Analyses for Windows and Mac. 2014 (cited 5 Dec 2014]; 3.1.9.2: Available from: http://www.gpower.hhu.de/en.html

  44. Greenway FL, Fujioka K, Plodkowski RA, Mudaliar S, Guttadauria M, Erickson J et al (2010) Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 376(9741):595–605. doi:10.1016/S0140-6736(10)60888-4

    CAS  Article  PubMed  Google Scholar 

  45. Pi-Sunyer F, Aronne L, Heshmati H, Devin J, Rosenstock J (2006) Effect of rimonabant, a cannabinoid-1 receptor blocker, on weight and cardiometabolic risk factors in overweight or obese patients: RIO-North America: a randomized controlled trial. JAMA 295(7):761–775

    CAS  Article  PubMed  Google Scholar 

  46. Cabroglu M, Ergene N, Tan U (2006) The treatment of obesity by acupuncture. Int J Neurosci 116:165–175

    Article  Google Scholar 

  47. Yeo S, Kim KS, Lim S (2014) Randomised clinical trial of five ear acupuncture points for the treatment of overweight people. Acupunct Med 32(2):132–138. doi:10.1136/acupmed-2013-010435

    Article  PubMed  Google Scholar 

  48. Lacey J, Tershakovec A, Foster G (2003) Acupuncture for the treatment of obesity: a review of the evidence. Int J Obes Relat Metab Disord 27:419–427

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgments

Thanks to Tony at Helio Supply Co for supplying the acupuncture needles. AJM is supported by the Australian Government’s Collaborative Research Networks (CRN) program.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew J. McAinch.

Appendix 1: Understanding the analysis of a cross-over trial

Appendix 1: Understanding the analysis of a cross-over trial

Cross-over studies have a couple of issues that need to be addressed in the analysis. They are carry-over [“Carry-over is the persistence (whether physically or in terms of effect) of a treatment applied in one period in a subsequent period of treatment” [25].] and a period effect (“Period effect is where a trend affecting the experiment as a whole” [25]) which looks at the effect of the order with which the participant received the treatment.

The approach detailed in “Study design” of Jones and Kenward was followed [42] to address these issues. This approach consists of first performing a t test for the presence of a carry-over effect in those who received acupuncture in the first phase of the trial. The presence of carry-over is tested using a two sample t test for equality of means of \( Y_{1} + Y_{0} \) between those that received acupuncture first and second (page 24, [42]). This approach caters for random effects.

If significant carry-over effects are found, then following the approach of Jones and Kenward (page 28, [42]) the effect of the treatment is measured using a two sample t test on period 0 (both groups first phase only) results only. This tests for equality of means of those who received acupuncture first and those who received sham first.

If no significant carry-over is found, then, another t test is performed for period effect. The presence of a period effect is tested using a two sample t test for equality of means (crossover difference) of \( Y_{1} - Y_{0} \) for those that received acupuncture first and \( Y_{0} - Y_{1} \) for those that received acupuncture second (page 27 [42]).

If significant period effects are found, then following the approach of Jones and Kenward (page 25, [42]), the effect of the treatment is measured using a two sample t test for the equality of the two means: \( Y_{1} - Y_{0} \) for those that received acupuncture first and \( Y_{1} - Y_{0} \) for those that received acupuncture second.

If no significant period effect is found then following the approach of Senn (page 42, [25]) the effectiveness of the acupuncture can be measured using a paired t test. \( \left( {\begin{array}{*{20}c} {Y_{1} - Y_{0} } \\ {Y_{0} - Y_{1} } \\ \end{array} } \right) \), where \( Y_{1} - Y_{0} \) is for acupuncture second and \( Y_{0} - Y_{1} \) for acupuncture first. This pools the groups together and a t test is done for zero means.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fogarty, S., Stojanovska, L., Harris, D. et al. A randomised cross-over pilot study investigating the use of acupuncture to promote weight loss and mental health in overweight and obese individuals participating in a weight loss program. Eat Weight Disord 20, 379–387 (2015). https://doi.org/10.1007/s40519-014-0175-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-014-0175-7

Keywords

  • Obesity
  • Overweight
  • Binge eating disorder
  • EDNOS