Efficacy and Safety of Acupuncture for Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Obesity poses an important public health concern globally, requiring effective and safe interventions. Acupuncture, a traditional Chinese medicine therapy, is increasingly used to address various health conditions, including obesity. Previous systematic reviews have examined acupuncture for obesity, but none have comprehensively synthesized evidence from both English and non-English-language databases with rigorous methodological assessment. This review addresses this gap by providing an updated synthesis of randomized controlled trials (RCTs) evaluating acupuncture's effectiveness and safety for obesity management. Aim and Objectives: The primary goal of this research was to evaluate the effectiveness of various acupuncture treatments; it includes acupressure, auricular acupuncture, auricular acupressure, and more treatments for obesity. Specifically, we aimed to determine whether these acupuncture therapies are as effective as placebos or traditional treatments for weight loss. Additionally, we aimed to systematically assess the safety profile of acupuncture by examining the types and frequency of adverse events reported across trials. Method: We conducted a systematic review following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. We searched PubMed, Google Scholar, ISI Web of Science, China National Knowledge Infrastructure, Wanfang Database, and VIP Database from inception to September 2024 without language restrictions. Two independent reviewers screened titles, abstracts, and full texts. We included RCTs comparing acupuncture interventions (manual acupuncture, electroacupuncture, laser acupuncture, auricular acupuncture, or acupressure) with placebo, sham treatments, lifestyle interventions, or medications in adults with obesity (body mass index >= 30 or >= 25 kg/m(2) for Asian populations). We excluded studies combining acupuncture with other therapies except diet, as diet modification is standard care for obesity. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Meta-analyses were conducted using random-effects models in RevMan 5.4. Heterogeneity was assessed using I-2 statistics. The certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. Results: Of 202 identified records, 20 RCTs (n = 2261 participants) met inclusion criteria. Fifteen RCTs with complete data were included in meta-analyses. Compared with lifestyle interventions, acupuncture resulted in additional weight loss of 1.72 kg (95% confidence interval [CI]: 0.50-2.93, I-2 = 20%, five studies, n = 237). Compared with placebo/sham treatments, acupuncture achieved greater weight reduction of 1.56 kg (95% CI: 0.78-2.34, I-2 = 0%, eight studies, n = 412). When compared with medications, acupuncture showed superior weight loss of 3.0 kg (95% CI: 1.53-5.88, I-2 = 20%, two studies, n = 120). Risk ratios (RRs) for obesity remission favored acupuncture over lifestyle interventions (RR = 2.57, 95% CI: 1.98-3.34, six studies) and medications (RR = 2.84, 95% CI: 1.12-7.20, four studies). Only one trial reported adverse events systematically, documenting mild effects in 16.7% of acupuncture participants versus 42.9% in the medication group. GRADE assessment indicated low to moderate certainty of evidence due to risk of bias and imprecision. Conclusion: Current evidence suggests acupuncture may provide modest benefits for weight loss compared with lifestyle interventions or placebo treatments, with a favorable safety profile compared with medications. However, the low to moderate certainty of evidence due to methodological limitations prevents definitive conclusions. Acupuncture should be considered as a complementary rather than primary intervention for obesity management, pending more rigorous research. Well-designed RCTs with standardized protocols, longer follow-up periods, and systematic adverse event reporting are urgently needed.