Lam et al.

BMC Complementary
BMC Complementary Medicine and Therapies (2024) 24:62
https://doi.org/10.1186/s12906-024-04340-5 Medicine and Therapies

RESEARCH Open Access

Electro‑acupuncture for central obesity:

a patient‑assessor blinded, randomized
sham‑controlled clinical trial
Tsz Fung Lam1†, Zipan Lyu5†, Xingyao Wu1, Yi Ping Wong1, Peihua Cao2, Emily Yen Wong3, Hung Bun Hung4,
Shiping Zhang1, Zhaoxiang Bian1 and Linda L. D. Zhong1,5*

Abstract
Background Central obesity is considered as a significant health threat to individuals. Scientific research has dem-
onstrated that intra-abdominal fat accumulation is associated with higher metabolic and cardiovascular disease risks
independent of Body Mass Index (BMI). This study aimed to evaluate the efficacy and safety of electro-acupuncture
in treating central obesity compared with sham acupuncture.
Method This was a patient-assessor blinded, randomized, sham-controlled clinical trial. One hundred sixty eight
participants aged between 18 and 65 years old with BMI ≥ 25 kg/m2 and waist circumference (WC) of men ≥ 90 cm
/ women ≥ 80 cm were enrolled and allocated to the acupuncture or sham acupuncture group equally. For the acu-
puncture group, disposable acupuncture needles were inserted into eight body acupoints, including Tianshu (ST-25),
Daheng (SP-15), Daimai (GB-26), Qihai (CV-6), Zhongwan (CV-12), Zusanli (ST-36), Fenglong (ST-40), and Sanyinjiao
(SP-6) with electrical stimulation. For the control group, Streitberger’s non-invasive acupuncture needles were utilized
at the same acupoints with identical stimulation modalities. The treatment duration was 8 weeks with 2 sessions
per week and the follow-up period was 8 weeks. The primary outcome was the change in WC before and after
the treatment. The secondary outcomes were the changes in hip circumference, waist-to-hip circumference ratio, BMI,
and body fat percentage during the treatment and follow-up period.
Results The acupuncture group displayed a significant change in WC compared to the sham group both treatment
and follow-up period (MD = -1.1 cm, 95% CI = -2.8 to 4.1). Significant change in body fat percentage was recorded
for both groups after treatment but no significance was observed during the follow-up period (MD = -0.1%, 95%
CI = -1.9 to 2.2). The changes in hip circumference were also significant both treatment and follow-up period
for the acupuncture group (MD = -2.0 cm, 95% CI = -3.7 to -1.7). Compared with sham acupuncture, the body weight
(MD = -1 kg, 95% CI = -3.3 to 5.3), BMI (MD = -0.5, 95% CI = -0.7 to 1.9) also decreased significantly within and between
groups. The incidence of adverse events was similar in the two groups.
Conclusion This study provided evidence that electro-acupuncture could be effective in treating central obesity
by reducing WC, hip circumference, body weight, BMI, and waist-to-hip circumference ratio.
Trial registration ClinicalTrials.gov Identifier: NCT03815253, Registered 24 Jan 2019.

†
Tsz Fung Lam and Zipan Lyu are co-first authors.
*Correspondence:
Linda L. D. Zhong
[email protected]
Full list of author information is available at the end of the article

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
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Lam et al. BMC Complementary Medicine and Therapies (2024) 24:62 Page 2 of 10

Keywords Central obesity, Acupuncture, Electro-acupuncture, Randomized controlled trial

Introduction evidence to support the effectiveness of electro-acu-

In 2020, over 2.6 billion people are considered as over- puncture in treating central obesity.
weight or obese (BMI ≥ 25 kg/m2) globally, represent-
ing 38% of the world’s population. Among them, 14% Method
are with BMI ≥ 30 kg/m2 [1]. In Hong Kong, accord- Study design
ing to the Department of Health Population Health It was a patient-assessor blinded, randomized, sham-con-
Survey (PHS) 2020–22, 32.6% of the adult population trolled clinical trial on electro-acupuncture for central
were overweight or obese (BMI ≥ 25.0 kg/m2) [2]. In obesity. Registered TCM practitioners with at least three
China, the number of people considered overweight years of clinical experience were trained to treat partici-
and obesity have reached 100 million and 15 million pants following the study protocols. The TCM practition-
respectively [3]. Among well-developed regions, sur- ers were aware of the grouping of each participant, but
vey reported that up to 29.9% of the people aged 15–84 the participants and assessor were blinded to the group
were obese. As obesity is a chronic condition that can allocation.
cause multiple metabolic diseases, obesity problem will
cause both economic and medical burdens in the long
run [4–6]. Sample size
Obesity can be categorized into generalized and The results of our pilot study with 72 participants showed
abdominal obesity (also known as central obesity). Cen- that electro-acupuncture combined with auricular acu-
tral obesity is defined as the accumulation of excessive pressure could reduce WC by 1.57% (SD = 0.025) from
fat in the abdomen compared with the lower extremi- the baseline at week 8, compared with 0.14% (SD = 0.041)
ties and hips [7–9]. Apart from the commonly known in the sham group [24]. Considering 80% efficacy and
correlation with type 2 diabetes, dyslipidaemia, hyper- 5% alpha (two tails), at least 70 subjects were required
tension, and abnormalities in blood coagulation and in each group to test its effectiveness. Considering a 20%
fibrinolysis, central obesity also significantly correlates dropout rate, we planned to recruit 84 subjects for each
with cardiovascular and cancer mortality [10–13]. In group, i.e. a total of 168 subjects. Calculations were per-
primary healthcare settings, health providers always formed using PASS 11 software in Caseville, Utah, USA.
need to handle obese patients with related chronic One hundred sixty-eight participants with central
symptoms and diseases [14]. Moreover, patients might obesity were recruited from the public through adver-
raise inquiries regarding various weight loss interven- tisement. Eligible participants were randomly assigned
tions including the potential risks and benefits of phar- into the two groups with 1:1 ratio. The treatment group
maceutical medications [15–17]. (n = 84) received electro-acupuncture. The control group
Changes of lifestyle through diet control and physi- received sham acupuncture (n = 84). Appropriate acu-
cal exercise are well-known and effective solution for puncture frequency was the premise of effective acu-
weight loss. However, it requires strong self-discipline puncture [25]. The frequency of acupuncture in western
for months to years [18, 19]. Meanwhile, although vari- countries was once a week, while that in China was 2–3
ous types of slimming pharmaceutical products claim times a week [26]. However, frequent clinic visits might
their effectiveness, there may be adverse effects or even lead to commuting concerns and compliance may be
rebound after the patient stop using the products [20]. compromised, which may in turn lead to high dropout
Traditional Chinese medicine (TCM) provides alter- rate. Therefore, in this trial, participants were treated
native approaches towards weight control. Based on twice a week for a total of eight weeks, with a follow-up
previous clinical studies and experience, acupunc- session scheduled eight weeks after completion of treat-
ture is the most acceptable TCM therapy in treating ment. Every participant was administered 16 sessions of
overweight and obesity [21, 22]. The effectiveness of acupuncture in total (Fig. 1).
acupuncture can be seen in improvement in fat decom- The primary outcome was the change in WC at the
position as well as reduction of blood triglycerides beginning and at the end of the study. Secondary out-
levels and WC [20, 21]. Through meta-analysis and comes included the changes in hip circumference (HC),
clinical studies, the related evidence of the effective- waist-to-hip circumference ratio, BMI, body fat percent-
ness of weight control by acupuncture keeps on grow- age, and body weight. All outcomes were evaluated at the
ing [23]. In this study, our objective is to provide solid 1st, 4th, 8th, 16th sessions of treatment and at the follow-
up session.
Lam et al. BMC Complementary Medicine and Therapies (2024) 24:62 Page 3 of 10

Fig. 1 Participant Flow Diagram. A total of 580 participants underwent initial screening for eligibility. Among them, 412 participants were excluded
based on predefined criteria. The remaining 168 eligible participants were randomly assigned to either the treatment group (n = 84), receiving
electro-acupuncture, or the control group (n = 84), receiving sham acupuncture. Both groups underwent twice-weekly treatments over eight
weeks, followed by a post-treatment follow-up session at eight weeks. Seven participants discontinued intervention or were lost to follow-up
in the treatment group, and eight participants in the control group faced similar circumstances. The final analysis included 168 participants,
adhering to the intention-to-treat (ITT) principle, for efficacy and safety assessments

Recruitment Inclusion criteria

We recruited participants through advertisements and Respondents were included in the trial if they met the
TV programs. Eligible participants signed the consent following criteria:
form before randomization.
1. In the past three months, they have not received
weight-loss treatment by Chinese medicine, conven-
Participants tional medicine, or nutritionist;
A total of 168 participants were screened from 580 2. Aged between 18 and 65 years old;
respondents by applying the following criterion.
Lam et al. BMC Complementary Medicine and Therapies (2024) 24:62 Page 4 of 10

3. Central obesity, i.e. WC of men ≥ 90 cm or Interventions

women ≥ 80 cm; Electro‑acupuncture treatment
4. BMI ≥ 25 kg/m2. The acupuncture prescription
According to a systematic review [19], Zusanli(ST-36),
Sanyinjiao(SP-6), Tianshu(ST-25), Fenglong(ST-40),
Zhongwan(CV-12), Qihai(CV-6) were frequently used
Exclusion criteria acupuncture points in body weight control trials. In
Respondents were excluded from the trial if they met addition to these six acupuncture points, we added
the following criteria: two acupoints on the abdomen, i.e. Daheng(SP-15) and
Daimai(GB-26), that are effective for treating central
1. Endocrine system diseases, e.g. thyroid disorder, obesity based on our clinical experience. There were 8
pituitary disorder, and sex gland disorder, etc.; acupoints and 14 needling points in total (Table 1).
2. Impaired hepatic or renal function; The course of treatment of this clinical experiment
3. Heart disease, e.g. arrhythmia, heart failure, myocar- was 8 weeks, with 2 acupuncture treatment sessions per
dial infarction, and persons implanted with a pace- week, making a total of 16 sessions. The needle reten-
maker, etc.; tion time was 30 min in each session. At the beginning
4. Pregnant or lactating women; of the session, the TCM physician instructed the par-
5. Bleeding tendency; ticipant to lie supine on the treatment bed, exposing
6. Allergy and immunology disease; the abdomen and legs for disinfection before acupunc-
7. Bleeding coagulation disorders; ture was administered.
8. Stroke or otherwise unable to exercise.

Electro‑acupuncture (for the experimental group)

The TCM physician used acupuncture needles (verum
Setting acupuncture needles Asia-med Special No. 16 with
The trial was conducted in four Chinese Medicine Clin- 0.30 × 0.30 mm matching the Streitberger sham-nee-
ics under the School of Chinese Medicine, Hong Kong dles) to puncture 8 acupoints with a total of 14 needling
Baptist University listed as below: points. The needles were inserted through a rubber ring
base to the body, which matched the sham needling
Hong Kong Baptist University Mr. & Mrs. Chan procedure of Streitberger sham-needles. The insertion
Hon Yin Chinese Medicine Specialty Clinic and depth of each acupoint was about 10–25 mm to achieve
Good Clinical Practice Center; Deqi sensation, a feeling of soreness, numbness, heavi-
Hong Kong Baptist University Chinese Medicine ness, and pressure soreness by the participant or a

Hong Kong Baptist University ‒ Jockey Club Chi-

Specialty Center; feeling of heavy, tightness, astringency and stagna-
tion by the TCM physician [27]. Electrical stimulation
nese Medicine Disease Prevention and Health was then applied to the abdominal points with 50 Hz
Management Center; and densely dispersed waves at 50 V through an electric
Haven of Hope – Hong Kong Baptist University needle stimulator (ES-160 6-Channel Programmable
Chinese Medicine Specialty Clinic. Electro-acupuncture). The handle of the needles would
start to tremble slightly after the electrical stimulation
The study was approved by the Committee on the was applied. The needles would then remain for 30 min.
Use of Human and Animal Subjects in Teaching and
Research, Hong Kong Baptist University (HASC/
HASC/17–18/C03). Informed consent was obtained Sham acupuncture (for the control group)
from all participants and the study was carried out Streitberger’s non-invasive acupuncture needles (speci-
in accordance with the Declaration of Helsinki. The fication 8 × 1.2 inches / 0.30 × 30 mm) were used at the
recruitment started in February 2019 and the study same 8 acupuncture points in the same stimulation
completed in December 2020. manner, but the needles were only adhered to the skin
We designed a diet diary for participants to record with a rubber ring base and not inserted. The validity
their food intake and exercise patterns daily. The diary and credibility of the model have been fully proven.
was reviewed by researchers in every treatment session The needles were also connected to an electric needle
and at the follow-up session. stimulator for 30 min, but no electrical stimulation was
Lam et al. BMC Complementary Medicine and Therapies (2024) 24:62 Page 5 of 10

Table 1 Acupoints and its locations, symptoms, and indications

Acupoint Locations Symptoms and indications

Tianshu(ST-25) 2-inch lateral to the level with the umbilicus (CV-8) Gastrointestinal disorders:
e.g. nausea, vomiting, diarrhea
Fluid metabolism disorders:
e.g. excessive intake of drinks, polyuria, tumescence
Daheng(SP-15) 4-inch lateral to the center of the umbilicus (CV-8) lateral to rectus abdomi- Gastrointestinal disorders:
nus e.g. diarrhea, constipation
Daimai(GB-26) Directly below LV-13 at the crossing point of a vertical line through the free Gastrointestinal disorders:
end of the 11th rib and a horizontal line through the umbilicus e.g. bloating, constipation, diarrhea
(level with CV-8) Gynecological disorders:
e.g. dysmenorrhea, abnormal vaginal discharge
Qihai(CV-6) Midway between CV-5 and CV-7, 1.5-inch below CV-8 (umbilicus) Gastrointestinal disorders:
e.g. abdominal pain, constipation
Reproductive system disorders:
e.g. irregular menstruation, infertility
General weakness of the body
Zhongwan(CV-12) Midway between CV-8 and CV-16, Gastrointestinal disorders:
4-inch above CV-8 (umbilicus) e.g. gastric pain, vomiting, indigestion, loss of appetite
Zusanli(ST-36) 3-inch below ST-35, one finger width lateral from the anterior border Gastrointestinal disorders:
of the tibia e.g. indigestion, abdominal pain
Local symptoms:
e.g. lower limb pain, paralysis
Fenglong(ST-40) 8-inch below ST-35, one finger width lateral to ST-38, two finger widths Fluid metabolism disorders:
lateral to the anterior border of the tibia e.g. tumescent limbs and abdomen, sparing urine
Local symptoms of the lower limbs
Sanyinjiao(SP-6) 3-inch directly above the tip of the medial malleolus on the posterior Gastrointestinal disorders:
border of the tibia e.g. nausea, diarrhea, colic
Renal/reproductive system disorders:
e.g. menstrual disorder, impotence, edema

applied. The stimulator only emits the same beeping randomization, simple, complete, non-sequential ran-
sound and flashing light continuously. dom numbers were generated in advance by a computer
program in a block of four, and kept by the Principal
Lifestyle intervention Investigator (PI, LDZ). After confirming that the partici-
All participants were advised to follow the guidelines of pant met all the selection criterion, the PI provided the
Balanced Diet Food Pyramid Designed by Hong Kong acupuncturist with a random number corresponding to
Dietitian’s Association in their daily diets. Subjects were the group assignment. This design was to ensure that
not required to do exercises, but they can continue with clinical assessors and participants were not informed of
their prevailing exercise routine, if any. the distribution.

Outcome measures Blinding process

We measured participants’ WC (i.e. the primary outcome), This was a patient-assessor blinded sham-controlled
hip circumference, waist-to-hip circumference ratio, BMI clinical trial. The participants were not informed of
and body fat percentage (i.e. secondary outcomes) at the their group assignment. Participants in the sham-
1st, 4th, 8th and 16th treatment sessions and at the follow- controlled group received treatment with Streitberg-
up session. Bodyweight, BMI, and body fat percentage er’s non-invasive acupuncture needles (specification
were measured by body Omron Karada Scan HBF-701. 8 × 1.2 inches / 0.30 × 30 mm) at the same 8 acupunc-
Adverse events of acupuncture treatment were recorded ture points in the same stimulation manner as the
using the Treatment Emergent Symptom Scale (TESS) and experimental group. After the treatment, the partici-
reported based on the participants’ reports. pants were asked about perceived treatment alloca-
tion to evaluate the success rate of blinding. Only the
Randomization assignment acupuncturists knew the group allocation of each par-
Participants were randomly assigned to receive acupunc- ticipant. The clinical assessors and the statistician per-
ture (body electro-acupuncture) or control (sham). For forming the data analyses were blinded to the group
Lam et al. BMC Complementary Medicine and Therapies (2024) 24:62 Page 6 of 10

allocation throughout the study. Only when the lead Table 2 Baseline characteristics
investigator (PI, LDZ) considered if any parameters of Characteristic All Participants Group A Group B
a case was critical to patient safety, such as in medical (Acupuncture) (Sham)
emergencies will blindness be eliminated on a case-by- [N = 168] [N = 84] [N = 84]
case basis.
Female, n (%) 109 (64.9%) 59 (35.1%) 50 (29.8%)
Male, n (%) 59 (35.1%) 25 (14.9%) 34 (20.2%)
Mean Age (SD) 47.5 (11.0) 46.8 (11.1) 48.2 (10.9)
Data processing and analysis
Mean Weight (SD), kg 78.7 (13.3) 79.2 (13.3) 78.2 (13.3)
Statistical analysis was performed using the Social Sci-
Mean BMI (SD), kg/m2 29.7 (4.0) 29.9 (4.2) 29.5 (3.9)
ence Statistics Package (SPSS) for Windows version
Mean DBP (SD), mmHg 83.8 (10.2) 83.8 (10.0) 83.9 (10.6)
23.0. Statistical significance was defined as a two-sided
Mean SBP (SD), mmHg 127.1 (12.7) 129.5(14.0) 124.7(11.0)
P value of < 0.05. Efficacy and safety analyses were per-
Mean HR (SD) per min 76.6 (11.7) 75.6 (11.1) 77.5 (12.3)
formed by the intention-to-treat (ITT) principle. Impu-
Mean WC (SD) cm 99.1 (9.9) 98.9 (10.2) 99.2 (9.6)
tation methods for dropout participants data were
estimated using the last observation carried-forward Mean HC (SD) cm 108.0 (8.1) 108.3 (8.6) 107.7 (7.5)
method. Baseline characteristics were reported as mean Mean BF (SD) % 36.5 (6.3) 36.2 (6.0) 36.8 (6.7)
(SD). Normally distributed continuous variables were BMI Body mass index, DBP Diastolic blood pressure, SBP Systolic blood pressure,
WC Waist circumference, HC Hip circumference, BF Body fat percentage
evaluated using the Student’s t-test, and non-normal
There was no significant difference on the baseline data between the two
distribution was evaluated using the non-parametric groups (P > 0.05)
Mann–Whitney U test to assess baseline differences
between the two groups. For categorical variables, chi-
square tests or Fisher’s precise tests were used. The decrease of 0.4 cm (95% CI = -2.2 to -0.5) in WC at week
analysis of covariance based on ANCOVA was used. 4 and decrease of 0.6 cm (95% CI = -2.5 to -1.7) at week 8.
ANCOVA was used to compare the treatment groups The mean difference of the two groups was -1.0 cm (95%
and subscales, with the treatment group as the model CI = -2.5 to 3.9) at week 4 and -1.2 cm (95% CI = -2.4 to
factor and the baseline as the covariate. Changes in 4.3) at week 8 (Table 3).
covariate scores from baseline to the end of treat-
ment were examined by repeated analysis of variance Secondary outcomes
(ANOVA). Paired t-test was used to evaluate normally Changes in weight (kg)
distributed data, and the Wilcoxon positive and nega- Both groups recorded a decrease in body weight dur-
tive rank test was used to evaluate the normal distribu- ing treatment (MD = -0.9 kg, 95% CI = -3.0 to 5.3). The
tion data. sham group had no difference during the follow-up
(MD = -1.3 kg, 95%CI = -1.9 to -0.7).
Electro-acupuncture is found to be more effective in
Results reducing body weight than sham acupuncture both in
Of 580 respondents, 168 eligible patients were rand- treatment and during follow up (Table 4). The changes
omized to the electro-acupuncture group (n = 84) and of body weight in the follow up period were -2.3 kg (95%
sham group (n = 84). 91.7% (77/84) of participants in CI = -1.9 to -0.7) and -1.3 kg (95% CI = -1.9 to -0.7) for the
the electro-acupuncture group and 90.5% (76/84) in experimental and sham group respectively.
the sham group finished all the treatment and follow–
up sessions.
The baseline characteristics of the two groups were BMI
balanced (P > 0.05). The figures were summarized in The changes in BMI at week 4, week 8, and week 16
Table 2. (i.e. at follow-up) compared with the baseline (week 0)
were: -0.4 (95% CI = -0.6 to -0.2), -0.4 (95% CI = -0.6 to
-0.1), -0.6 (95% CI = -0.9 to -0.3) for the electro-acu-
Primary outcome puncture group; and -0.2 (95% CI = -0.8 to -0.2), -0.2
After 8 weeks of treatment, the WC of participants in (95% CI = -0.9 to -0.3), -0.1 (95% CI = -1.0 to -0.3) for
the electro-acupuncture group showed a significant the sham acupuncture group. Electro-acupuncture was
decrease compared with the baseline, with decrease of more effective than sham acupuncture both in treat-
1.4 cm (95% CI = -1.3 to -0.5) at week 4 and 1.8 cm (95% ment and during follow up concerning the decrease in
CI = -2.3 to -0.4) at week 8. The control group showed a BMI (Table 4).
Lam et al. BMC Complementary Medicine and Therapies (2024) 24:62 Page 7 of 10

Table 3 Primary outcome within and between different groups

Group A (electro-acupuncture) Group B (sham acupuncture) Group A vs Group B
Mean Changes from P Value Mean Changes from P Value Differences (95% CI) P Value
Baseline (95% CI) Baseline (95% CI)

Waist Circumference (cm)

Before treatment NA NA NA NA -0.3 0.858
0 wk (-3.4 to 2.8)
During treatment -1.4 0.002 -0.4 0.406 -1.0 0.063
4 wk (-1.3 to 0.5) (-2.2 to -0.5) (-2.5 to 3.9)
After treatment -1.8 0.008 -0.6 0.267 -1.2 0.003
8 wk (-2.3 to -0.4) (-2.5 to -1.7) (-2.4 to 4.3)
Follow up -1.5 0.021 -0.4 0.328 -1.1 0.029
16 wk (-2.7 to -0.2) (-2.4 to -1.5) (-2.8 to 4.1)

Changes in hip circumference (cm) of depression (n = 3). All adverse events were reported
The hip circumference of the electro-acupuncture to be mild. One patient withdrew from the study due to
group showed a significant decrease compared with the headache.
baseline. There was a significant statistical difference
between the two groups. The drop in hip circumference Discussion
in the electro-acupuncture group sustained to week 16 In this study, electro-acupuncture was found to be effec-
(MD = -2.7 cm, 95% CI = -3.6 to -1.9). There was also a tive in reducing WC, hip circumference, body fat per-
significant statistical difference between the two groups centage, body weight and BMI when compared with
at week 16 (MD = -2.0 cm, 95% CI = -3.7 to -1.7) (Table 4). sham acupuncture during the treatment period(P < 0.05).
It was observed that during the follow up period at week
Changes of waist‑to‑hip circumference ratio 16, the electro-acupuncture group still shown significant
The change in waist-to-hip circumference ratio was sum- improvement in body weight, BMI, waist-to-hip circum-
marized in Table 4. Compared with the sham group, the ference ratio. This might indicate the persistent effects of
electro-acupuncture group showed better improvement the therapy and its sustainable benefits on central obesity.
in the waist-to-hip circumference ratio after treatment The study replicated the conclusion of the effectiveness
(MD = 1.2, 95% CI = -1.3 to 3.8)and follow-up (MD = 0.7, of acupuncture in weight control from our pilot study,
95% CI = -1.9 to 3.3). The sham acupuncture group did showing consistent effects on Hong Kong people.
not show any significant changes for this index. Acupuncture was a well-accepted therapy in China
and East Asia especially for chronic disorders like obe-
sity, pain and idiopathic constipation [21, 24, 25]. In our
Changes of body fat percentage trial, we selected five abdominal points (Tianshu ST-25,
The change of body fat percentage of both the electro- Daheng SP-15, Daimai GB-26, Qihai CV-6, Zhong-
acupuncture group and sham group was listed in Table 4. wan CV-12) and three points from stomach meridian
The acupuncture group showed significant improvement and spleen meridian (Zusanli ST-36, Fenglong ST-40,
in the body fat percentage after the treatment (MD = -0.3, Sanyinjiao SP-6) at the lower limbs based on evidence
95% CI = -0.9 to 0.3) but there was no further improve- from a systematic review and local experts’ consensus.
ment at week 16. The sham acupuncture group did not Among the utilized acupoints, the classical functions of
show any significant changes for this index. the abdominal points were harmonizing gastrointesti-
nal functions and treating localized issues, which cor-
responded to excessive adipose tissue deposition in the
Safety and adverse events abdomen. Besides, the selected acupoints at the lower
Both groups were well tolerated. There were no serious limbs were considered to be effective in stabilizing gas-
adverse events (e.g. requiring hospital admission). In trointestinal functions and enhancing fluid drainage [28].
the electro-acupuncture group, adverse events reported We did not analyze our data separately based on the
were headaches (n = 4), dizziness (n = 2) and insomnia gender of participants. But it was observed that female
(n = 5). In the sham group, adverse events reported were subjects in the electro-acupuncture group showed
stomachache (n = 1), headache (n = 2) and worsening larger reduction in WC than male participants. Some
Lam et al. BMC Complementary Medicine and Therapies (2024) 24:62 Page 8 of 10

Table 4 Secondary outcomes within and between different groups

Items Group A Group B Group A vs Group B
(electro-acupuncture) (sham acupuncture)
Mean Changes from P Value Mean Changes from P Value Differences (95% CI) P Value
Baseline (95% CI) Baseline (95% CI)

Weight (kg)
Before treatment NA NA NA NA 1.0 0.617
0 wk (-3.1 to 5.2)
During treatment -1.6 0.001 -0.7 0.597 -0.9 < 0.001
4 wk (-1.0 to -0.3) (-1.0 to -0.4) (-3.0 to 5.3)
After treatment -3.0 < 0.001 -1.0 0.034 -2.0 < 0.001
8 wk (-1.4 to -0.5) (-1.4 to -0.6) (-3.1 to 5.3)
Follow up -2.3 < 0.001 -1.3 0.643 -1.0 < 0.001
16 wk (-2.0 to -0.7) (-1.9 to -0.7) (-3.3 to 5.3)
Body Mass Index (kg/m2)
Before treatment NA NA NA NA 0.5 0.456
0 wk (-0.8 to 1.7)
During treatment -0.4 < 0.001 -0.2 0.103 -0.2 0.037
4 wk (-0.6 to -0.2) (-0.8 to -0.2) (-0.7 to 1.8)
After treatment -0.4 0.009 -0.2 0.257 -0.2 0.021
8 wk (-0.6 to -0.1) (-0.9 to -0.3) (-0.6 to 2.0)
Follow up -0.6 < 0.001 -0.1 0.074 -0.5 0.005
16 wk (-0.9 to -0.3) (-1.0 to -0.3) (-0.7 to 1.9)
Hip Circumference (cm)
Before treatment NA NA NA NA 0.6 0.626
0 wk (-1.9 to 3.1)
During treatment -1.8 < 0.001 -0.4 < 0.001 -1.5 0.723
4 wk (-2.5 to -1.0) (-2.0 to 2.9) (-2.2 to -0.8)
After treatment -2.4 < 0.001 -1.2 < 0.001 -1.2 0.041
8 wk (-2.5 to -1.2) (-1.3 to 3.8) (-3.3 to -1.5)
Follow up -2.7 < 0.001 -0.7 0.601 -2.0 < 0.001
16 wk (-3.6 to -1.9) (-1.9 to 3.3) (-3.7 to -1.7)
Waist-to-hip Circumference Ratio
Before treatment NA NA NA NA 0.06 0.549
0 wk (-0.01 to 0.15)
During treatment -0.02 0.020 -0.00 0.861 0.03 0.032
4 wk (-0.04 to 0.12) (-0.01 to 0.07) (-0.02 to 0.89)
After treatment -0.03 0.007 -0.01 0.254 1.2 0.001
8 wk (-0.01 to 0.15) (-0.02 to 0.15) (-1.3 to 3.8)
Follow up -0.01 0.549 -0.00 0.714 0.7 0.046
16 wk (-0.01 to 0.08) (-0.02 to 0.08) (-1.9 to 3.3)
Body Fat Percentage, %
Before treatment NA NA NA NA -0.7 0.535
0 wk (-2.7 to 1.4)
During treatment 0.0 0.919 -0.1 0.435 0.1 0.973
4 wk (-0.6 to 0.6) (-0.8 to 0.4) (-2.0 to 2.0)
After treatment -0.3 0.001 -0.2 0.058 -0.1 0.049
8 wk (-0.9 to 0.3) (-1.8 to 0.1) (-2.0 to 2.1)
Follow up -0.3 0.433 -0.2 0.072 -0.1 0.892
16 wk (-0.9 to 0.4) (-1.8 to 0.1) (-1.9 to 2.2)

female subjects reported improvement on their men- obesity in Polycystic ovary syndrome or Perimenopause
struation. The findings correlated to the gynecological could be developed to further investigate these results.
effects of the acupoints Daimai GB-26, Qihai CV-6 and Increased satiation and satiety were reported by
Sanyinjiao SP-6. Studies on female endocrinal-caused some of the subjects in the treatment group. Studies on
Lam et al. BMC Complementary Medicine and Therapies (2024) 24:62 Page 9 of 10

psychological conditions such as mood-influenced sati- WC Waist circumference

HP Hip circumference
ety and the treatment of binge eating could be developed BF Body fat percentage
with the data from this clinical trial. Scalp points could be
selected as part of the core points of such treatment. The Acknowledgements
We acknowledge all the participants in this study and the Health and
chief effect of these points was to regulate brain functions Medicine
resulting in ease of mental stress and easing symptoms Research Fund (Ref. No.:15163331) for financially supporting this study.
of psychological disorders. Therefore, integrating scalp-
Authors’ contributions
abdomen-lower limb points could be suggested for a bet- Linda LD Zhong, Zhaoxiang Bian: designing the protocols, acquiring research
ter and holistic approach to treating obesity. funding. Linda LD Zhong, Tsz Fung Lam , Xingyao Wu, Yi Ping Wong: screening
Patients’ diet could influence the effectiveness of the participants, providing treatments, administrating resources. Linda LD Zhong,
Zipan Lyu , Tsz Fung Lam : writing and reviewing the manuscript. Emily Yen
treatment. The fat metabolized by the body after electro- Wong, Peihua Cao, Shiping Zhang, Hung Hung Bun: interpreting results,
acupuncture could be offset by their daily calorie intake, extracting and analysing data, validating and supervising.
if excessive. In such cases, the effect of the treatment
Funding
might be overtaken. We suggested that obese patients to This research was financially supported by Health and Medical Research Fund
adhere to the normal daily calorie intake suitable for their (HMRF) under Food and Health Bureau Research Project (Ref. No.:15163331).
gender, age, and activity level. Diets resulting in daily cal- The funding organization has no role in designing and analyzing the study.
orie deficit might not be necessary for better compliance Availability of data and materials
by the subjects. Details of this study are available from the corresponding author upon
Central obesity was a major risk factor of diabetes, car- request.
diovascular disease, and colorectal cancer worldwide.
On the other hand, inflammation was a well-known risk Declarations
factor for the initiation and perpetuation of obesity [29]. Ethics approval and consent to participate
Our study provided an option without pharmaceuti- The study was approved by the Committee on the Use of Human and Animal
cal treatment and severe side effects for obese patients. Subjects in Teaching and Research, Hong Kong Baptist University (HASC/
HASC/17–18/C03). Informed consent was obtained from all study participants
Moreover, the mechanism of the efficacy also needed to and the study was carried out in accordance with the Declaration of Helsinki.
be further investigated. For example, acupuncture may
play a role in the regulation of glucolipid metabolism. It Consent for publication
Not applicable.
was illustrated that electro-acupuncture could reduce the
serum levels of total cholesterol, triglycerides, low-den- Competing interests
sity lipoprotein, lipoprotein A and apolipoprotein B, but The authors declare no competing interests.
enhance the level of insulin and C peptide [22, 30, 31]. Author details
This could be further evaluated in our next stage research 1
School of Chinese Medicine, Hong Kong Baptist University, 7 Baptist
moving from clinical trial evidence to exploring the University Road, Kowloon Tong, Hong Kong S.A.R, China. 2 Clinical Research
Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
mechanism behind the findings. 3
Department of Family Medicine and Primary Care, LKS Faculty of Medicine,
The study had some limitations. It did not involve any the University of Hong Kong, Hong Kong S.A.R, China. 4 Promed Chinese Medi-
blood tests to verify the metabolic changes, which could cine Specialist Clinic, Hong Kong S.A.R, China. 5 School of Biological Sciences,
Nanyang Technological University, 60 Nanyang Drive, Singapore 637551,
be essential for future exploration. We also could not Singapore.
analyse the age-related changes due to the small sample
size and we need a more evenly distributed age of partici- Received: 29 November 2022 Accepted: 6 January 2024
pants. Furthermore, multi-arm studies could be designed
to evaluate and explore the cost-effectiveness of acupunc-
ture therapy precisely.
In conclusion, this single-blinded, randomized con- References
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