Effectiveness of Electroacupuncture for Simple Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Yanling Gao
Zhihai Hu
Yi Wang
Yin Shi
Jing Zhou
Journal: Evidence-based Complementary and Alternative Medicine (2020)
Discipline: CLINICAL MEDICINE
Keywords: Electroacupuncture; Simple obesity; Meta-analysis; Acupoint clustering; Body fat rate
Affiliations: Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China, Department of Acupuncture and Moxibustion, Shanghai TCM-Integrated Hospital, Shanghai University of TCM, Shanghai 200082, China, Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China, Outpatient Department, Shanghai Institute of Acupuncture-Moxibustion and Meridian, Shanghai 200030, China

Abstract:  Objective: To evaluate the effectiveness of electroacupuncture in the treatment of simple obesity. Methods: Randomized clinical trials concerning electroacupuncture as a treatment of simple obesity published prior to October 31, 2019, were searched in the following Chinese and English databases: Chinese National Knowledge Infrastructure (CNKI), WanFang Database, China Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database (CBM), PubMed, Cochrane Library, Web of Science, and Scopus. After data collection and quality evaluation, meta-analysis was performed using RevMan 5.3 software and Stata 15.0 software. Results: A total of 13 studies involving 937 patients with simple obesity were included in the meta-analysis. Results revealed that the total effective rate (RR = 1.29, 95% CI [1.13, 1.48]; P=0.0002), BMI (MD = -1.82, 95% CI [-2.21, -1.43]; P &lt; 0.000), waist circumference (MD = -2.39, 95% CI [-3.95, -0.84]; P=0.003), hip circumference (MD = 0.31, 95% CI [-2.37, 2.99]; P=0.82), waist-hip ratio (MD = -0.05, 95% CI [-0.07, -0.03]; P &lt; 0.00), and body fat rate (MD = -1.56, 95% CI [-2.35, -0.78]; P=0.0001) in the electroacupuncture group were superior to those in the control group. Analysis of acupoint clustering and correlation using SPSS 24.0 and Clementine 12.0 revealed the highest statistical support for acupoint groups CV12-CV4 and CV12-ST25-CV4, while ST36-CV12-ST25, SP6, and ST40-ST24-SP15-ST37-CV4 were found to be validly clustered acupoints. Conclusion: For treating simple obesity, electroacupuncture is superior to other interventions such as acupuncture, acupoint catgut embedding therapy, and simple lifestyle modification for improvement in body fat rate, waist circumference, and waist-hip ratio, although not hip circumference. Acupoint analysis revealed that ST25, CV12, CV4, SP6, and ST36 can form the basis for electroacupuncture therapy for the treatment of simple obesity. 

Retracted: No

PubPeer comments:
 We appreciated reading the work of Gao et al1, which is a meta-analysis that evaluates the association between electroacupuncture treatment and anthropometric measures. However, we found apparent errors warranting correction. First, the x-axes of Figures 5 and 7 need to be corrected by reversing the positions of the group labels, u201cFavours [experimental]u201d and u201cFavours [control]u201d. The risk ratios for overall effectiveness of the treatments are calculated by the effectiveness rate in the experimental group (i.e., electroacupuncture treatment) divided by effectiveness rate in the control group. So, risk ratios greater than 1 should indicate that the experimental group is favored. As of now, Figures 5 and 7 incorrectly indicate that the control group is favored. Second, the abstract indicates a significant effect on body mass index (BMI) from the first fixed effect analysis in Figure 9. However, the presence of large heterogeneity for BMI (I2=80.1%, p 0.001), indicates that a random effects model should have also been utilized in contrast to sole reliance on a fixed effect model. By using the random effects model (DerSimonian and Laird), the overall effect for BMI would be WMD=-1.05, 95%CI [-2.07, -0.03]; p=0.043 which is not nearly as strong as the reported results (WMD=-1.82, 95% CI [-2.21, -1.43]; p 0.001). The study by Wang et al2 is a highly influential data point in terms of effect and variance in Figure 9 for BMI. After removing Wang et al2 from the meta-analysis (similar to the approach the authors used to remove Chen et al3 from the analysis in Figure 5), there was no significant heterogeneity (I2=0.0%, p=0.994), and the overall effect for BMI is much smaller, although still significant (WMD=-0.62, 95% CI [u22121.16, -0.07]; p=0.026). Results from the fixed effects and random effects models are identical with I2=0.0%. Third, Gao et al1 incorrectly listed a non-significant effect for hip circumference (MD=0.31, 95% CI [u22122.37, 2.99]; p=0.82) as u201csuperioru201d in one place in the abstract, but reported it correctly later in the abstract, text, and conclusions. Finally, we are not able to reproduce the meta-analysis because we are unable to obtain the data from three of the cited references4-6. We emailed the corresponding author for the meta-analysis for their data twice, but they have not replied. Although many of the final conclusions in Gao et al1 remain the same in our re-analysis, the effectiveness of electroacupuncture is overstated and the analyses should be corrected. The original data from the papers and abstracts used in the meta-analyses should also be made publicly available. Data and code for our analyses are readily available at https: doi.org 10.5967 ba52-nt67. Xiwei Chen, Stephanie L. Dickinson, Kevin Naaman, Andrew W. Brown, David B. Allison References [1] Gao, Y., Wang, Y., Zhou, J., Hu, Z., Shi, Y. (2020). Effectiveness of Electroacupuncture for Simple Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine, 2020. doi: https: doi.org 10.1155 2020 2367610. [2] Wang, W., Xiao, Y. (2014). A clinical observation on treating simple obesity by electro-acupuncture,u201d Chinese Journal of Primary Medicine and Pharmacy, vol. 21, no. 12, pp. 1878-1879. [3] Chen, Y., Zhou, J., Tang, B. (2012) Effects of electroacupuncture on therapeutic effect and serum Chemerin in patients with simple obesity, Jiangsu Journal of Traditional Chinese Medicine, vol. 44, no. 4, pp. 50u201352. [4] Liu Y. (2019). Clinical Study on Electro Acupuncture Therapy and Acupoint Embedding Therapy in the Treatment of Patients with Simple Obesity of Gastric Heat and Dampness, Nanjing University of Chinese Medicine, Nanjing, China. [5] Cui J. S. (2007). A Clinical Observation on Treating Simple Obesity by Electro-Acupuncture, Nanjing University of Chinese Medicine, Nanjing, China. [6] Huang X. Y. (2009). Electroacupuncture in Treatment of Simple Obesity Complicated with Excess Heat Syndrome of Stomach and Intestine and FMRI imaging Analysis of Hypothalamus Feeding Center, Nanjing university of Chinese medicine, Nanjing, China. ,